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The Language of Caring: Quantitating Medical Practice Patternsusing Symbolic Dynamics

Published online by Cambridge University Press:  28 April 2010

J. Paladino ,
A. M. Kaynar ,
P. S. Crooke  and
J. R. Hotchkiss
J. Paladino
Affiliation:
Department of Medicine, University of Hawaii
A. M. Kaynar
Affiliation:
Departments of Critical Care Medicine and Anesthesiology, University of Pittsburgh
P. S. Crooke
Affiliation:
Department of Mathematics , Vanderbilt University
J. R. Hotchkiss*
Affiliation:
Departments of Critical Care Medicine and Medicine, University of Pittsburgh and Pittsburgh Veterans Affairs Healthcare System
*
* Corresponding author. E-mail:hotchkissjr@upmc.edu
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Abstract

Real-world medical decisions rarely involve binary Ðsole condition present or absent-patterns of patient pathophysiology. Similarly, provider interventions are rarely unitaryin nature: the clinician often undertakes multiple interventions simultaneously.Conventional approaches towards complex physiologic derangements and their associatedmanagement focus on the frequencies of joint appearances, treating the individualderangements of physiology or elements of intervention as conceptually isolated. Thisframework is ill suited to capture either the integrated patterns of derangement displayedby a particular patient or the integrated patterns of provider intervention. Here weillustrate the application of a different approach-that of symbolic dynamics-in which theintegrated pattern of each patients derangement, and the associated provider response, arecaptured by defining words based on the elements of the pattern offailure. We will use as an example provider practices in the context of mechanicalventilation- a common, potentially harmful, and complex life support technology. We alsodelineate other domains in which symbolic dynamics approaches might aid in quantitatingpractice patterns, assessing quality of care, and identifying best practices.

Keywords

symbol dynamicspatient carelanguage
Type
Research Article
Information
Mathematical Modelling of Natural Phenomena , Volume 5 , Issue 3: Mathematical modeling in the medical sciences , 2010 , pp. 165 - 172
Copyright
© EDP Sciences, 2010

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