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Intensive Care Medicine Feb 2019The massive consumption of antibiotics in the ICU is responsible for substantial ecological side effects that promote the dissemination of multidrug-resistant bacteria... (Review)
Review
The massive consumption of antibiotics in the ICU is responsible for substantial ecological side effects that promote the dissemination of multidrug-resistant bacteria (MDRB) in this environment. Strikingly, up to half of ICU patients receiving empirical antibiotic therapy have no definitively confirmed infection, while de-escalation and shortened treatment duration are insufficiently considered in those with documented sepsis, highlighting the potential benefit of implementing antibiotic stewardship programs (ASP) and other quality improvement initiatives. The objective of this narrative review is to summarize the available evidence, emerging options, and unsolved controversies for the optimization of antibiotic therapy in the ICU. Published data notably support the need for better identification of patients at risk of MDRB infection, more accurate diagnostic tools enabling a rule-in/rule-out approach for bacterial sepsis, an individualized reasoning for the selection of single-drug or combination empirical regimen, the use of adequate dosing and administration schemes to ensure the attainment of pharmacokinetics/pharmacodynamics targets, concomitant source control when appropriate, and a systematic reappraisal of initial therapy in an attempt to minimize collateral damage on commensal ecosystems through de-escalation and treatment-shortening whenever conceivable. This narrative review also aims at compiling arguments for the elaboration of actionable ASP in the ICU, including improved patient outcomes and a reduction in antibiotic-related selection pressure that may help to control the dissemination of MDRB in this healthcare setting.
Topics: Anti-Infective Agents; Antimicrobial Stewardship; Humans; Intensive Care Units; Medical Overuse; Rationalization; Risk Factors
PubMed: 30659311
DOI: 10.1007/s00134-019-05520-5 -
Journal of Advanced Nursing Jul 2018To identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing. (Review)
Review
AIMS
To identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing.
BACKGROUND
Research has established associations between nurse staffing levels and adverse patient outcomes including in-hospital mortality. However, the causal nature of this relationship is uncertain and omissions of nursing care (referred as missed care, care left undone or rationed care) have been proposed as a factor which may provide a more direct indicator of nurse staffing adequacy.
DESIGN
Systematic review.
DATA SOURCES
We searched the Cochrane Library, CINAHL, Embase and Medline for quantitative studies of associations between staffing and missed care. We searched key journals, personal libraries and reference lists of articles.
REVIEW METHODS
Two reviewers independently selected studies. Quality appraisal was based on the National Institute for Health and Care Excellence quality appraisal checklist for studies reporting correlations and associations. Data were abstracted on study design, missed care prevalence and measures of association. Synthesis was narrative.
RESULTS
Eighteen studies gave subjective reports of missed care. Seventy-five per cent or more nurses reported omitting some care. Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care.
CONCLUSIONS
Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy. The extent to which the relationships observed represent actual failures, is yet to be investigated.
Topics: Health Care Rationing; Hospital Mortality; Humans; Nurses; Nursing Care; Nursing Staff, Hospital; Patient Care Team; Personnel Staffing and Scheduling
PubMed: 29517813
DOI: 10.1111/jan.13564 -
Topics in Cognitive Science Jul 2022We seek to understand rational decision making and if it exists whether finite (bounded) agents may be able to achieve its principles. This aim has been a singular...
We seek to understand rational decision making and if it exists whether finite (bounded) agents may be able to achieve its principles. This aim has been a singular objective throughout much of human science and philosophy, with early discussions identified since antiquity. More recently, there has been a thriving debate based on differing perspectives on rationality, including adaptive heuristics, Bayesian theory, quantum theory, resource rationality, and probabilistic language of thought. Are these perspectives on rationality mutually exclusive? Are they all needed? Do they undermine an aim to have rational standards in decision situations like politics, medicine, legal proceedings, and others, where there is an expectation and need for decision making as close to "optimal" as possible? This special issue brings together representative contributions from the currently predominant views on rationality, with a view to evaluate progress on these and related questions.
Topics: Bayes Theorem; Decision Making; Heuristics; Humans
PubMed: 35261177
DOI: 10.1111/tops.12585 -
Frontiers in Artificial Intelligence 2023Recent advances in deep learning have improved the performance of many Natural Language Processing (NLP) tasks such as translation, question-answering, and text... (Review)
Review
Recent advances in deep learning have improved the performance of many Natural Language Processing (NLP) tasks such as translation, question-answering, and text classification. However, this improvement comes at the expense of model explainability. Black-box models make it difficult to understand the internals of a system and the process it takes to arrive at an output. Numerical (LIME, Shapley) and visualization (saliency heatmap) explainability techniques are helpful; however, they are insufficient because they require specialized knowledge. These factors led rationalization to emerge as a more accessible explainable technique in NLP. Rationalization justifies a model's output by providing a natural language explanation (rationale). Recent improvements in natural language generation have made rationalization an attractive technique because it is intuitive, human-comprehensible, and accessible to non-technical users. Since rationalization is a relatively new field, it is disorganized. As the first survey, rationalization literature in NLP from 2007 to 2022 is analyzed. This survey presents available methods, explainable evaluations, code, and datasets used across various NLP tasks that use rationalization. Further, a new subfield in Explainable AI (XAI), namely, Rational AI (RAI), is introduced to advance the current state of rationalization. A discussion on observed insights, challenges, and future directions is provided to point to promising research opportunities.
PubMed: 37818431
DOI: 10.3389/frai.2023.1225093 -
Journal of Medical Economics 2022
Topics: Hospital Administration; Hospitals; Humans; Rationalization
PubMed: 35678267
DOI: 10.1080/13696998.2022.2088008 -
Fertility and Sterility Jun 2018
Topics: Ascorbic Acid; Diet; Embryo Culture Techniques; Evidence-Based Medicine; Female; Humans; Pregnancy; Randomized Controlled Trials as Topic; Rationalization; Research Design; Scurvy
PubMed: 29935658
DOI: 10.1016/j.fertnstert.2018.04.015 -
Frontiers in Public Health 2023Healthcare rationing has been the subject of numerous debates and concerns in the field of health economics in recent years. It is a concept which refers to the... (Review)
Review
Healthcare rationing has been the subject of numerous debates and concerns in the field of health economics in recent years. It is a concept which refers to the allocation of scarce healthcare resources and involves the use of different approaches to the delivery of health services and patient care. Regardless of the approach used, healthcare rationing fundamentally involves withholding potentially beneficial programs and/or treatments from certain people. As the demands placed on health services continue to rise and with that significant increases to the cost, healthcare rationing has become increasingly popular and is deemed necessary for the delivery of affordable, patient-care services. However, public discourse on this issue has largely been centered on ethical considerations with less focus on economic rationality. Establishing the economic rationality of healthcare rationing is essential in healthcare decision-making and consideration of its adoption by healthcare authorities and organizations. This scoping review of seven articles demonstrates that the economic rationality of healthcare rationing is the scarcity of healthcare resources amidst increased demand and costs. Therefore, supply, demand, and benefits are at the core of healthcare rationing practices and influence decisions on its suitability. Given the increased costs of care and resource scarcity, healthcare rationing is a suitable practice towards ensuring healthcare resources are allocated to people in a rational, equitable, and cost-effective manner. The rising costs and demands for care place significant pressure on healthcare authorities to identify suitable strategies for the allocation of healthcare resources. Healthcare rationing as a priority-setting strategy would support healthcare authorities identify mechanisms to allocate scarce resources in a cost-effective manner. When used in the context of a priority-setting approach, healthcare rationing helps healthcare organizations and practitioners to ensure that patient populations achieve maximum benefits at reasonable costs. It represents a fair allocation of healthcare resources to all populations, especially in low-income settings.
Topics: Humans; Delivery of Health Care; Health Care Rationing
PubMed: 37415702
DOI: 10.3389/fpubh.2023.1160691 -
The Journal of the American College of... 2009It is human nature to overestimate how rational we are, both in general and even when we are trying to be. Such irrationality is not random, and the search for and...
It is human nature to overestimate how rational we are, both in general and even when we are trying to be. Such irrationality is not random, and the search for and explanation of patterns of fuzzy thinking is the basis for a new academic discipline known as behavioral economics. Examples are given of some of the best understood of our foibles, including prospect theory, framing, anchoring, salience, confirmation bias, superstition, and ownership. Humans have two cognitive systems: one conscious, deliberate, slow, and rational; the other fast, pattern-based, emotionally tinged, and intuitive. Each is subject to its own kind of error. In the case of rational thought, we tend to exaggerate our capacity; for intuition, we fail to train it or recognize contexts where it is inappropriate. Humans are especially poor at estimating probabilities, or even understanding what they are. It is a common human failing to reason backwards from random outcomes that are favorable to beliefs about our power to predict the future. Five suggestions are offered for thinking within our means.
Topics: Attitude; Choice Behavior; Cognition; Community Participation; Emotions; Forecasting; Humans; Intuition; Judgment; Ownership; Pattern Recognition, Physiological; Prejudice; Probability; Rationalization; Risk-Taking; Superstitions; Thinking
PubMed: 20415136
DOI: No ID Found -
Circulating and circular RNAs and the need for rationalization and synthesis of the research spiral.Advances in Clinical and Experimental... Jun 2019In this essay, we aim to draw a short comparison between 2 important research topics - circular and circulating RNAs - and show how they are connected. The findings... (Review)
Review
In this essay, we aim to draw a short comparison between 2 important research topics - circular and circulating RNAs - and show how they are connected. The findings described here in the field of circular RNAs, which are still quite obscured by the rapidly expanding body of knowledge in biology, have added another dimension to our view of the process of gene expression, which is formed by a more complex network of molecule interactions than we previously thought. The term "circulating RNAs" refers to a broad spectrum of RNA fragments originating from different sources, such as physiologically dying cells, sites of inflammation or cancer cells, and fragments floating in human liquid tissues together with other elements. Fragments of nucleic acids circulating in blood are emerging as promising biomarkers in different medical conditions. Interestingly, circular RNAs have been found to be present in human blood and form a fraction of circulating RNAs. In addition to updating readers on these fast-developing areas of biology, we also stress the need for the study of complex networks of molecule interactions as whole structures (in unison with the thoughts of systems biology), as opposed to the trend toward searching for individual key player molecules. Fundamentally, we want to add to the rationalization and synthesis of new research findings in the scientific literature, because this direction is important not only for students, teachers and researchers, but also for the general population.
Topics: Biomarkers; Humans; RNA; RNA, Circular; Rationalization; Systems Biology
PubMed: 30843678
DOI: 10.17219/acem/94148 -
Frontiers in Psychology 2022This article seeks to analyze the conditions in which group-based pride is rationally appropriate. We first distinguish between the and of an emotion. For the... (Review)
Review
This article seeks to analyze the conditions in which group-based pride is rationally appropriate. We first distinguish between the and of an emotion. For the appropriate shape of group-based pride, we suggest two criteria: the distinction between and , and between and sociality. While group-based hubris is inappropriate irrespective of its mode due to the arrogant, contemptuous, and other-derogating character of this emotion, group-based pride in the is appropriate in terms of shape if it is felt over an achievement to which the group members collectively committed themselves. For the same reason, members of groups can feel appropriately proud of the achievement of their group if they have collectively contributed to it. Instead, group-based pride by mere private identification with a successful group can be rationally appropriate if it manifests the person's reduced-agency ideal and is also part of a coherent pattern of rationally interconnected emotions focused on the same ideal. Moreover, we suggest that pride in the success of one's family member or a close friend is typically felt over the that one group member's success grants to the group. However, social status cannot be valued for its own sake as this undermines the values upon which social status is founded. Instead, direct or indirect causal contribution to the success of one's child, friend, or student can warrant group-based pride, which may be justified on the basis of shared values without causal contribution as well. Finally, regarding the size of group-based pride, members of groups are warranted to experience and express more intense pride than members of groups. Moreover, the proper intensity of this emotion depends on the particular other(s) to whom the expression is directed. Finally, criteria of appropriate size don't apply to shared group-based pride as sharing increases the intensity of emotion by default.
PubMed: 35615180
DOI: 10.3389/fpsyg.2022.848644