Health-related quality of life anticipated with different management strategies for febrile neutropenia in adult cancer patients

PURPOSE: To describe anticipated health-related quality of life (HRQL) for different hypothetical strategies of febrile neutropenia (FN) management in adult cancer patients. METHODS: Seventy-eight adult cancer patients were enrolled. Our study considered four different hypothetical treatment strategies for FN: (1) entire inpatient management with intravenous (IV) antibiotics; (2) oral treatment at home after an initial observation in hospital with IV antibiotics; (3) entire outpatient management with IV antibiotics; and (4) entire outpatient management with oral antibiotics. Initially, patients were asked to rank the different treatment strategies for FN based on their personal preference. Subsequently, HRQL was rated using visual analog scale (VAS), time trade-off (TTO), and willingness-to-pay (WTP). RESULTS: Seventy-five percent of all respondents preferred an outpatient strategy for FN (36% oral, 21% intravenous, 18% early discharge). Further, outpatient strategies were associated with higher mean VAS scores (possible range 0-10) (oral: 6.1 (standard deviation (SD) 3.1); intravenous: 6.2 (SD 2.2); early discharge: 5.7 (SD 2.1)) as compared to inpatient care (5.3 (SD 2.9)). On the aggregate level, patients were willing to give up between 9 and 10 weeks of their life (TTO; corresponding to <1% of remaining life expectancy) and to pay between $255 and $327 Canadian dollars (WTP) to avoid treatment in hospital. CONCLUSIONS: Our study indicates that the majority of adult cancer patients would prefer an outpatient strategy for FN. However, patients' preferences vary substantially at the individual level. Implementation of outpatient strategies into routine clinical practice should consider this variability.

A Communication Platform for Tele-monitoring and Tele-management of Type 1 Diabetes

Type 1 diabetes mellitus is a chronic disease characterized by blood glucose levels out of normal range due to inability of insulin production. This dysfunction leads to many short- and long-term complications. In this paper, a system for tele-monitoring and tele-management of Type 1 diabetes patients is proposed, aiming at reducing the risk of diabetes complications and improving quality of life. The system integrates Wireless Personal Area Networks (WPAN), mobile infrastructure, and Internet technology along with commercially available and novel glucose measurement devices, advanced modeling techniques, and tools for the intelligent processing of the available diabetes patients information. The integration of the above technologies enables intensive monitoring of blood glucose levels, treatment optimisation, continuous medical care, and improvement of quality of life for Type 1 diabetes patients, without restrictions in everyday life activities.

[Second victim : Critical incident stress management in clinical medicine]

BACKGROUND Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. METHODS A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. RESULTS In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. CONCLUSIONS The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.

The FORA Framework - A Fuzzy Grassroots Ontology for Online Reputation Management

Online reputation management deals with monitoring and influencing the online record of a person, an organization or a product. The Social Web offers increasingly simple ways to publish and disseminate personal or opinionated information, which can rapidly have a disastrous influence on the online reputation of some of the entities. The author focuses on the Social Web and possibilities of its integration with the Semantic Web as resource for a semi-automated tracking of online reputations using imprecise natural language terms. The inherent structure of natural language supports humans not only in communication but also in the perception of the world. Thereby fuzziness is a promising tool for transforming those human perceptions into computer artifacts. Through fuzzy grassroots ontologies, the Social Semantic Web becomes more naturally and thus can streamline online reputation management. For readers interested in the cross-over field of computer science, information systems, and social sciences, this book is an ideal source for becoming acquainted with the evolving field of fuzzy online reputation management in the Social Semantic Web area. ​

The FORA Framework - A Fuzzy Grassroots Ontology for Online Reputation Management

Online reputation management deals with monitoring and influencing the online record of a person, an organization or a product. The Social Web offers increasingly simple ways to publish and disseminate personal or opinionated information, which can rapidly have a disastrous influence on the online reputation of some of the entities. This dissertation can be split into three parts: In the first part, possible fuzzy clustering applications for the Social Semantic Web are investigated. The second part explores promising Social Semantic Web elements for organizational applications,while in the third part the former two parts are brought together and a fuzzy online reputation analysis framework is introduced and evaluated. Theentire PhD thesis is based on literature reviews as well as on argumentative-deductive analyses.The possible applications of Social Semantic Web elements within organizations have been researched using a scenario and an additional case study together with two ancillary case studies—based on qualitative interviews. For the conception and implementation of the online reputation analysis application, a conceptual framework was developed. Employing test installations and prototyping, the essential parts of the framework have been implemented.By following a design sciences research approach, this PhD has created two artifacts: a frameworkand a prototype as proof of concept. Bothartifactshinge on twocoreelements: a (cluster analysis-based) translation of tags used in the Social Web to a computer-understandable fuzzy grassroots ontology for the Semantic Web, and a (Topic Maps-based) knowledge representation system, which facilitates a natural interaction with the fuzzy grassroots ontology. This is beneficial to the identification of unknown but essential Web data that could not be realized through conventional online reputation analysis. Theinherent structure of natural language supports humans not only in communication but also in the perception of the world. Fuzziness is a promising tool for transforming those human perceptions intocomputer artifacts. Through fuzzy grassroots ontologies, the Social Semantic Web becomes more naturally and thus can streamline online reputation management.

Management of postpartum hemorrhage (PPH): algorithm of the interdisciplinary D-A-CH consensus group PPH (Germany – Austria – Switzerland)

Postpartum hemorrhage (PPH) is one of the main causes of maternal deaths even in industrialized countries. It represents an emergency situation which necessitates a rapid decision and in particular an exact diagnosis and root cause analysis in order to initiate the correct therapeutic measures in an interdisciplinary cooperation. In addition to established guidelines, the benefits of standardized therapy algorithms have been demonstrated. A therapy algorithm for the obstetric emergency of postpartum hemorrhage in the German language is not yet available. The establishment of an international (Germany, Austria and Switzerland D-A-CH) "treatment algorithm for postpartum hemorrhage" was an interdisciplinary project based on the guidelines of the corresponding specialist societies (anesthesia and intensive care medicine and obstetrics) in the three countries as well as comparable international algorithms for therapy of PPH.The obstetrics and anesthesiology personnel must possess sufficient expertise for emergency situations despite lower case numbers. The rarity of occurrence for individual patients and the life-threatening situation necessitate a structured approach according to predetermined treatment algorithms. This can then be carried out according to the established algorithm. Furthermore, this algorithm presents the opportunity to train for emergency situations in an interdisciplinary team.

FORA - A Fuzzy Set Based Framework for Online Reputation Management

The Social Web offers increasingly simple ways to publish and disseminate personal or opinionated information, which can rapidly exhibit a disastrous influence on the online reputation of organizations. Based on social Web data, this study describes the building of an ontology based on fuzzy sets. At the end of a recurring harvesting of folksonomies by Web agents, the aggregated tags are purified, linked, and transformed to a so-called fuzzy grassroots ontology by means of a fuzzy clustering algorithm. This self-updating ontology is used for online reputation analysis, a crucial task of reputation management, with the goal to follow the online conversation going on around an organization to discover and monitor its reputation. In addition, an application of the Fuzzy Online Reputation Analysis (FORA) framework, lesson learned, and potential extensions are discussed in this article.

Digital Personal Assistant for Cognitive Cities: A Paper Prototype

This chapter presents an evaluation and initial testing of a meta-application (meta-app) for enhanced communication and improved interaction (e.g., appointment scheduling) between stakeholders (e.g., citizens) in cognitive cities. The underlying theoretical models as well as the paper prototype are presented to ensure the comprehensibility of the user interface. This paper prototype of the meta-app was evaluated through interviews with various experts in different fields (e.g., a strategic consultant, a small and medium-sized enterprises cofounder in the field of online marketing, an IT project leader, and an innovation manager). The results and implications of the evaluation show that the idea behind this meta-app has the potential to improve the living standards of citizens and to lead to a next step in the realization and maturity of the meta-app. The meta-app helps citizens more effectively manage their time and organize their personal schedules and thus allows them to have more leisure time and take full advantage of it to ensure a good work-life balance to enable them to be the most efficient and productive during their working time.

Prevalence and management of familial hypercholesterolaemia in patients with acute coronary syndromes.

AIMS We aimed to assess the prevalence and management of clinical familial hypercholesterolaemia (FH) among patients with acute coronary syndrome (ACS). METHODS AND RESULTS We studied 4778 patients with ACS from a multi-centre cohort study in Switzerland. Based on personal and familial history of premature cardiovascular disease and LDL-cholesterol levels, two validated algorithms for diagnosis of clinical FH were used: the Dutch Lipid Clinic Network algorithm to assess possible (score 3-5 points) or probable/definite FH (>5 points), and the Simon Broome Register algorithm to assess possible FH. At the time of hospitalization for ACS, 1.6% had probable/definite FH [95% confidence interval (CI) 1.3-2.0%, n = 78] and 17.8% possible FH (95% CI 16.8-18.9%, n = 852), respectively, according to the Dutch Lipid Clinic algorithm. The Simon Broome algorithm identified 5.4% (95% CI 4.8-6.1%, n = 259) patients with possible FH. Among 1451 young patients with premature ACS, the Dutch Lipid Clinic algorithm identified 70 (4.8%, 95% CI 3.8-6.1%) patients with probable/definite FH, and 684 (47.1%, 95% CI 44.6-49.7%) patients had possible FH. Excluding patients with secondary causes of dyslipidaemia such as alcohol consumption, acute renal failure, or hyperglycaemia did not change prevalence. One year after ACS, among 69 survivors with probable/definite FH and available follow-up information, 64.7% were using high-dose statins, 69.0% had decreased LDL-cholesterol from at least 50, and 4.6% had LDL-cholesterol ≤1.8 mmol/L. CONCLUSION A phenotypic diagnosis of possible FH is common in patients hospitalized with ACS, particularly among those with premature ACS. Optimizing long-term lipid treatment of patients with FH after ACS is required.

Personal Digital Assistant 2.0 - A Software Prototype for Cognitive Cities

This paper presents a software prototype of a personal digital assistant 2.0. Based on soft computing methods and cognitive computing this mobile application prototype improves calendar and mobility management in cognitive cities. Applying fuzzy cognitive maps and evolutionary algorithms, the prototype represents a next step towards the realization of cognitive cities (i.e., smart cities enhanced with cognition). A user scenario and a test version of the prototype are included for didactical reasons.