Implementation of complex adaptive chronic care: the Patient Journey Record system (PaJR).

Background: The Patient Journey Record system (PaJR) is an application of a complex adaptive chronic care model in which early detection of adverse changes in patient biopsychosocial trajectories prompts tailored care, constitute the cornerstone of the model.

Aims: To evaluate the PaJR system's impact on care and the experiences of older people with chronic illness, who were at risk of repeat admissions over 12 months.

Design: Community-based cohort study - random assignment into intervention and usual care group, with process and outcome evaluation.

Complex adaptive chronic care - typologies of patient journey: a case study.

Rationale: Complex adaptive chronic care (CACC) is a framework based upon complex adaptive systems' theory developed to address different stages in the patient journey in chronic illness. Simple, complicated, complex and chaotic phases are proposed as diagnostic types.

Aims: To categorize phases of the patient journey and evaluate their utility as diagnostic typologies.

Maternal brain death: medical, ethical and legal issues.

Case Presentation: We present the case of a pregnant woman who experienced a cerebral venous sinus thrombosis resulting in brain death at 13 weeks gestation. We discuss the management of the mother and foetus following this tragic event. We also discuss the complex medical, legal and ethical issues that arose following maternal brain death.