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PubMed2002

"The less-than-perfect medication system": a systems approach to improvement.

The 1999 Institute of Medicine (IOM) report increased the focus by health care providers, regulators, and the public on the cause and effect of medical errors. The IOM report recognizes the complexity of the problem of medical errors and advocates a systematic approach to error reduction. Medication delivery systems in health care facilities are an excellent example of the complexity that exists. General Systems Theory (GST) provides a framework to evaluate system design and effectiveness. This article presents an example of the use of GST in the design and evaluation of medication systems with a focus on error reduction.

Humans↗
PubMedDate not supplied

An adaptive strategy for controlling chaotic system.

This paper presents an adaptive strategy for controlling chaotic systems. By employing the phase space reconstruction technique in nonlinear dynamical systems theory, the proposed strategy transforms the nonlinear system into canonical form, and employs a nonlinear observer to estimate the uncertainties and disturbances of the nonlinear system, and then establishes a state-error-like feedback law. The developed control scheme allows chaos control in spite of modeling errors and parametric variations. The effectiveness of the proposed approach has been demonstrated through its applications to two well-known chaotic systems: Duffing oscillator and Rössler chaos.

Computer Simulation↗
PubMed2000

A nursing theory of personal system empathy: interpreting a conceptualization of empathy in King's interacting systems.

This article presents a theory of empathy discovered through rational hermeneutic interpretation within King's personal system. Personal system concepts from King's general systems framework include perception, self, growth and development, body image, space, time, and learning. Propositions for each concept in the personal system were explicated and a theory of nursing empathy was developed. This nursing theory proposes that empathy organizes perceptions; facilitates awareness of self and others; increases sensitivity; promotes shared respect, mutual goals, and social awareness; cultivates understanding of individuals within a historical and social context; and affects learning.

Awareness↗
PubMed1981

Decision making in an interdisciplinary team.

Decision making in an interdisciplinary team occurs at the interface between groups with varied backgrounds, orientations, interests, and goals. Most interdisciplinary teams attempt to identify the complex set of variables influencing their decisions and then utilize this knowledge to maximize efficiency in health care delivery. Models of information and decision analysis developed by general systems theory are suggested as a method for advancing the understanding of where, when, and how decisions are made by the interdisciplinary team. A university-affiliated psychiatric service in a private general hospital is studied. Here the following forces meet, complement, compete, and collide: the community, university, hospital administration, private practitioners, insurance companies, consultation and liaison psychiatrists, university staff psychiatrists and residents, nurses, aides, social workers, activities personnel, patients and their families, the patient group, the ward milieu. Considering these factors, we describe: (1) the flow of information and feedback loops into, within, and out of the psychiatric service; (2) the location of decision nodes; (3) decision-making echelons. The general systems theory concepts utilized in this analysis are proposed as pragmatic tools for improving interdisciplinary team function.

Decision Making↗
PubMed2005

A longitudinal study of the effects of dual-earner couples' utilization of family-friendly workplace supports on work and family outcomes.

Little research exists on the effects of the utilization of workplace supports on work-family conflict and job satisfaction. With family systems theory as a framework, 2 waves of national survey data were collected from 234 couples (N = 468) caring for children and for aging parents. Data were analyzed with structural equation modeling techniques. Longitudinal results indicate that individuals' use of workplace supports was related to work-family conflict in the direction opposite to expectations and was related to job satisfaction in the direction consistent with expectations. Differential effects for wives versus husbands were found. In addition, couples' use of workplace supports was only minimally related to wives' outcomes. Results are discussed in terms of gender differences, family systems theory, and methodological and measurement issues related to the longitudinal study of utilization of workplace supports.

Adolescent↗
PubMed1990

Physicians' role in managing emotionally distressed patients already in psychotherapy.

Much has been written on how physicians should manage patients in emotional distress, including recommendations for making successful referrals to mental health providers. Little has been written, however, on the management of distressed patients who are already in psychotherapy. This article, drawing on three cases, a review of the literature, and systems theory, presents recommendations for managing these patients. Physicians are encouraged to assess these patients for risk of suicide or homicide, substance abuse, and indications for psychotropic medication. They are advised to seek a patient's permission to speak to his or her therapist when the patient may be in immediate danger, when psychotropic medications, hospitalization, or psychiatric consultation is considered, and when the patient fails to respond to ongoing treatment. For patients whose therapists are not psychiatrists, psychiatric consultation is recommended when there are questions about psychotropic medications, when psychiatric and substance abuse disorders coexist, and when hospitalization is considered. Therapists skilled in applying systems theory should be consulted when the patient, psychotherapist, and physician agree that the patient is not making sufficient progress. In most cases, however, physicians should reassure patients about distressing symptoms, avoid expressing opinions about the therapist and psychosocial issues, and encourage patients to renew or to expand their commitment to their psychotherapy.

Adult↗
PubMed1983

Infant crying and stability in the mother-infant relationship: a systems analysis.

Mother-infant interaction was studied using a general systems theory framework. 20 mother-infant pairs were observed in their home for a 7-hour period when the infants were 2, 3, 4, and 5 weeks of age. A measurement procedure was devised to assess, for each pair, the consistency over weeks in their allocation of time to 4 interactional contexts that make up the day: feeding, changing or bathing, social attention, and baby alone. The measure was called an Interactional Stability Score. Construct validity for this measure was investigated based on our hypothesis that high interactional stability would be strongly linked to low levels of crying during social attention. This hypothesis was confirmed. The results are interpreted within a general systems theory perspective--namely, that this measure of interactional stability is an empirical indicator of the degree of equilibrium within the relationship, at the level of patterning of interactional contexts. High stability scores represent consistency in allocation of time to the 4 contexts over weeks and not a rigidity in sequencing of these contexts, and thus appeared to reflect a dynamic process of mutual constraints on the behaviors of both partners.

Child Development↗
PubMed2004

The development of family hierarchies and their relation to children's conduct problems.

Despite the intuitive richness of family systems theory, relatively little research has sought to test the validity of constructs theorized to be critical in the development of children's adjustment. One such cornerstone of structural and strategic family therapy is the family hierarchy. The present study investigated both the development of hierarchical structure in families from infancy to late middle childhood and relations between strong hierarchical structure and children's conduct problems. Using structural equation modeling, direct pathways to low hierarchical structure were evident for early caregiving behavior and parent-child conflict, with indirect associations present for parental adjustment, marital functioning, negative child behavior, and ecological disadvantage. In turn, family hierarchies were associated with youth antisocial behavior, an effect that was moderated by ethnic and neighborhood context. The results are discussed in reference to family systems' theory and implications for prevention and intervention.

Child↗
PubMed1995

Tutorial: chaos theory--a primer for health care.

Chaos theory, also called nonlinear systems theory, provides new insights into processes previously thought to be unpredictable and random. It also provides a new set of tools that can be used to analyze common administrative and clinical data. This tutorial provides an introduction to chaos theory. Subsequent articles will address applications of those principles to the administrative activities of health care organizations, implications of those principles for clinical data, and application of chaos theory concepts to our understanding of organizational dynamics.

Fractals↗
PubMed1976

An exploration of the dynamics of the overlapping worlds of work and family.

The relationship between the working lives and family lives of people in our society is a concern to both families and corporations. This article describes a research project that yielded theoretical statements about the interactions between organization life and family life for members of large corporations; grounded theory methodology and a systems theory approach were used. Data were obtained in a large multinational corporation from managers and their families who were undergoing three different kinds of organizational stress: international transfer, extensive travel, and job change to facilitator of personal and organizational change. The findings give reason for viewing organization and family as interacting systems and for considering the uniqueness of each individual's response to stressful events. They also indicate that an individual's feeling of influence over stressful events at the organization-family boundaries are significant for both organizational and family effectiveness.

Adaptation, Psychological↗
PubMed2004

Dysfunctional assumptions in bipolar disorder.

BACKGROUND: Despite the initial encouraging outcome in developing CBT for bipolar affective disorder [Arch. Gen. Psychiatry 2002 (in press); Psychol. Med. 31 (2001) 459-467], very little is known about whether there are any differences in dysfunctional attitudes between unipolar and bipolar patients. Both the behavioural activation system theory [J. Pers. Soc. Psychol. 67 (1994) 488-498; Major Theories of Personality Disorder, Guilford Press, New York, 1996; Psychol. Bull. 117 (1995) 434-449] and the cognitive model for bipolar affective disorder [Cognitive Therapy for Bipolar Disorder: A Therapist's Guide to Concepts, Methods and Practise, Wiley, New York, 1999] postulate high goal striving as a risk factor for bipolar disorder. However, the existing subscales in the dysfunctional attitude scale (DAS) were derived from patients and relatives of patients suffering from unipolar depression, patients with a mixed psychiatric diagnosis or normal controls. None of the existing subscales reflects high goal striving beliefs. Using a sample of bipolar patients may yield different factors. METHODS: A total of 143 bipolar 1 patients filled in the short version of DAS 24. Principal component analysis was carried out to derive factors. The scores of these factors were compared with those of 109 unipolar patients to investigate if these factors distinguish bipolar patients from unipolar patients. RESULTS: Three factors were derived: factor 1 'Goal-attainment' accounted for 25.0% of the total variance. Factor 2 'Dependency' accounted for 11.0% of the total variance. Factor 3 'Achievement' accounted for 8.2% of the total variance. However, factor 1 appeared to consist of items that made a coherent theoretical construct. No significant differences were found when the validation sample was compared with 109 patients suffering from unipolar depression in any of the three factors. When subjects who were likely to be in a major depressive episode were excluded, the scores of bipolar patients (n=49) were significantly higher than euthymic unipolar patients (n=25) in factor 1 'Goal attainment'. Goal-attainment also correlated with the number of past hospitalisations due to manic episodes and to bipolar episodes as a whole. CONCLUSIONS: The Goal-attainment subscale captures the risky attitudes described by the behavioural activation system theory and the cognitive model for bipolar affective disorder. It is postulated that these beliefs may interact with the illness and predispose bipolar patients to have a more severe course of the illness.

Adult↗
PubMed2002

Theory of system zones in capillary zone electrophoresis.

In the last years, it has been shown that the formation and migration of system zones is an inherent feature of capillary zone electrophoresis (CZE) and that it depends predominantly on the composition of an actual background electrolyte (BGE). In most of the currently used BGEs, the SZs are invisible by the UV absorbance detection system, however, the comigration of SZs with the zones of analytes deteriorates the analytical performance of CZE and may be fatal for its utilization. Therefore, the theoretical predictions of the existence and migration of SZs is of key importance for the expediency of CZE. This is a review of the theoretical treatments of SZs which reveals the origin and the properties of SZs and shows how to cope with them. Also, a table of some typical BGEs is presented where the existence and mobilities of SZs are given.

Electrophoresis, Capillary↗
PubMed1991

Modeling of biological and medical systems: a systemic strategy.

A strategy in the frame of General System Theory is proposed for the study of biological systems for medical purposes. Its definition and use requires in each experiment the collaboration between physician and system scientists and hence the definition of a common language, by which the real system under study is described. The strategy is based on three intermingled steps: first an ingenuous model is proposed, gathering all the medical knowledge about the studied system, organized within an informal frame derived from the state space approach. Next, a functional model is derived, enlightening the organization of the relations in the medical model. Finally, this organization is formalized by the most suitable algebraic tools, which are thereafter translated into APL programs. This last version is used for simulation, which is exploited not only as a tool to describe and make provisions on the dynamics of the models, but also to deepen and improve the knowledge about the observed system.

Computer Simulation↗
PubMed1983

[The drug scene during the past 10 years of experience and inquiries].

Drug dependence has been defined in 1964 as 'a state arriving from repeated administration of a drug on a periodic or continuous basis'. Its characteristics would vary with the agent involved, but partly with individual and social characteristics, too. Multiple interactions between various distal and/or immediate psychosocial antecedents with aversive and/or reinforcing consequences of drug use lead to a state of neuroadaptation. This term needs further explanation in the light of research regarding biological aspects (e.g. peptides, neurotransmitters, tetrahydroisoquinolines) as well as psychosocial theories (e.g. social learning, systems theory). In the field of rehabilitation one is struck by the relatively high rate of prosocial behavioral change looking on different samples surveyed. It seems that change takes place virtually irrespective of the type of treatment. Nevertheless diversification of rehabilitative procedures and study of comparative virtues of different strategies should be promoted.

Adolescent↗
PubMed2005

Nonlinear multivariate analysis of neurophysiological signals.

Multivariate time series analysis is extensively used in neurophysiology with the aim of studying the relationship between simultaneously recorded signals. Recently, advances on information theory and nonlinear dynamical systems theory have allowed the study of various types of synchronization from time series. In this work, we first describe the multivariate linear methods most commonly used in neurophysiology and show that they can be extended to assess the existence of nonlinear interdependence between signals. We then review the concepts of entropy and mutual information followed by a detailed description of nonlinear methods based on the concepts of phase synchronization, generalized synchronization and event synchronization. In all cases, we show how to apply these methods to study different kinds of neurophysiological data. Finally, we illustrate the use of multivariate surrogate data test for the assessment of the strength (strong or weak) and the type (linear or nonlinear) of interdependence between neurophysiological signals.

Action Potentials↗
PubMed2005

Development of a multiple objective planning theory and system for sustainable air quality monitoring networks.

Air quality monitoring data are important bases for air quality management strategies planning and performance assessment. Therefore, the environmental protection authorities need to plan the air quality monitoring network effectively. However, in Taiwan, the national Environmental Protection Administration (EPA) and some county environmental protection bureaus (EPB) separately installed their own monitoring stations. This study developed an integrated methodology and computer system for planning air quality monitoring networks. The environmental, social, and economic objectives and sub-objectives, and their weights were identified using system analysis and multiple objective planning, based on the principles of sustainable development. A multiple objective optimization model and procedure for sustainable air quality monitoring networks planning are developed in this study. According to the procedure, a multiple objective planning system for sustainable air quality monitoring networks (MOPSSAQMN) is developed using computer software based on the modified bounded implicit enumeration algorithm with the constraint arrangement method. The air quality monitoring network of Taoyuan County, in northern Taiwan, was used as a case study to demonstrate the proposed method. Two satisfactory alternatives based on different conditions were generated using MOPSSAQMN. The compared results show that this study generated better alternatives than the current monitoring network. An installation schedule for the alternative was proposed, and its first step is now being implemented by the EPB of Taoyuan County Government. The procedure and computer system developed in this study can be used to assist the competent authorities to devise good and different alternatives for air quality monitoring networks planning.

Air Pollutants↗