scholarly journals Therapeutic decision making in autoimmune and inflammatory disorders of the central nervous system in children

2016 ◽  
Author(s):  
Russell Clive Dale
Keyword(s):  
Decision Making ◽  
Central Nervous System ◽  
Nervous System ◽  
Fatal Outcome ◽  
Decision Making Process ◽  
Therapeutic Decision ◽  
Inflammatory Disorders ◽  
Sydenham Chorea ◽  
The Central Nervous System ◽  
Therapeutic Decision Making

Autoimmune and inflammatory disorders of the central nervous system can result in significant morbidity and mortality. Through the recognition of syndromes using diagnostic biomarkers, the clinician is now able to use immune suppressive therapies to improve outcomes. However, the therapeutic decision-making process is complex. The clinician has to balance the risk of disease, with the risk of treatment side effects. To achieve this balance, it is important to understand the natural history of disease, the risk of residual disability, the risk of relapse, and risk of a fatal outcome. It is also important to have some understanding of the pathological processes, as some of the entities have more reversible processes, whereas others have destructive processes. This review will assess the dynamic nature of this decision-making process, and compare some of the more severe diseases such as neuromyelitis optica, anti-N-methyl-D-aspartate receptor encephalitis and opsoclonus myoclonus ataxia syndrome, with disorders with more favourable outcomes such as Sydenham chorea and post-infectious cerebellar ataxia. 

scholarly journals Extensive systemic metastases from primary central nervous system haemangiopericytoma

2020 ◽  
Vol 6 (2) ◽  
pp. 20190081
Author(s):  
Chi Long Ho ◽  
Jeremy JH Lam ◽  
Robert Chun Chen
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Fatal Outcome ◽  
Imaging Features ◽  
Tumour Control ◽  
Local Tumour Control ◽  
Meningeal Tumour ◽  
Local Tumour ◽  
The Central Nervous System ◽  
Extracranial Metastases

Primary intracranial tumours rarely metastasise outside of the central nervous system (CNS). This report describes a rare case of recurrent meningeal haemangiopericytoma with extensive systemic metastases, which eventually resulted in a fatal outcome. We discuss some prevailing theories as to the rarity of extracranial metastases from primary CNS haemangiopericytoma, and elucidate the epidemiology, imaging features, differential diagnosis, treatment, and prognosis of this unusual but surprisingly aggressive meningeal tumour. Besides aggressive treatment for local tumour control, patients with primary CNS haemangiopericytoma require long-term post-treatment surveillance to detect systemic metastases.

Safe control of SEMS in group interaction

2019 ◽  
pp. 23-31 ◽  
Author(s):  
A. E. Gorodetskiy ◽  
V. G. Kurbanov ◽  
I. L. Tarasova
Keyword(s):  
Decision Making ◽  
Central Nervous System ◽  
Nervous System ◽  
Internal State ◽  
Optimal Solution ◽  
Quality Criteria ◽  
Phase Constraints ◽  
Decision Making System ◽  
The Central Nervous System ◽  
Safe Control

Introduction:In control over a group of interacting smart electromechanical systems (SEMS), situations may arise when the operator’s instructions and/or the automatic control system at a higher level contradict the internal state of the controlled SEMS and/or the environment of choice. Such situations can be prevented by algorithms which check the fulfillment of conditions for the admissibility of movements. These algorithms can be based on modeling the SEMS behavior using logical-probabilistic or logicallinguistic descriptions of situations, and on non-scalar quality criteria when making decisions.Purpose:The development of algorithms for safe control over robots based on SEMS modules with phase constraints, under incomplete certainty of the environment.Results:Algorithms have been developed for safe control over three robots, using a mathematical description of situational control over a group of SEMS and the methodology of organizing the situational control over a group of mobile SEMS. The algorithms move the robots from certain current positions to specified terminal positions, avoiding their collisions with each other. In order to avoid collisions, the decision-making system in a robot’s central nervous system uses robot’s priorities based on the distance between the robots. An approach has been proposed to overcome uncertainty on the way (trajectory) of the robots. Uncertainties in the form of logical-probabilistic and logical-linguistic type constraints are considered. It is shown that these restrictions can be translated into a logical-interval form. This allows you to use standard mathematical programming procedures when searching for the optimal solution.Practical relevance:The obtained algorithms can be used for decision-making in the central nervous system and when controlling robots.

Therapeutic decision-making process in the intensive care unit: role of biological point-of-care testing

2017 ◽  
Vol 55 (2) ◽  
Author(s):  
Adrien Auvet ◽  
Mai-Anh Nay ◽  
Leslie Grammatico-Guillon ◽  
Fabien Espitalier ◽  
Pierre-François Dequin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Point Of Care ◽  
Decision Making Process ◽  
Therapeutic Decision ◽  
Point Of Care Testing ◽  
Therapeutic Decision Making

scholarly journals Empowering Patients in the Therapeutic Decision-Making Process: A Glance Into Behçet's Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Diana Marinello ◽  
Federica Di Cianni ◽  
Alessandra Del Bianco ◽  
Irene Mattioli ◽  
Jurgen Sota ◽  
...  
Keyword(s):  
Decision Making ◽  
Psychological Status ◽  
Care Process ◽  
Decision Making Process ◽  
Behçet’S Syndrome ◽  
Therapeutic Decision ◽  
Behçet's Syndrome ◽  
Behcet’S Syndrome ◽  
Therapeutic Decision Making ◽  
Behcet's Syndrome

Behçet's syndrome (BS) represents a challenging condition, characterized by a variable spectrum of disease profile and associated with a significant limitation of the daily activities as well as a potential negative impact on relationships and psychological status. Considering also the complexity of the therapeutic management of BS, that often includes biological off-label treatments, the participation in the therapeutic decision-making process of the BS patients is essential to ensure the integration of the care process into the life of the patient. For this reason, the empowerment of BS patients represents a crucial need and the present work is aimed at fully exploring all the potential variables implicated in the BS patient empowerment, also highlighting major points to consider and concrete actions to be planned in the immediate future in order to implement a pragmatic facilitation of the patients' empowerment.

scholarly journals Health emergencies and interoceptive sensibility modulate the perception of non-evidence-based drug use: Findings from the COVID-19 outbreak

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256806
Author(s):  
Gerardo Salvato ◽  
Daniela Ovadia ◽  
Alessandro Messina ◽  
Gabriella Bottini
Keyword(s):  
Decision Making ◽  
Individual Characteristics ◽  
Decision Making Process ◽  
Evidence Based ◽  
Care Providers ◽  
Therapeutic Decision ◽  
Therapeutic Approaches ◽  
Experimental Drugs ◽  
Therapeutic Decisions ◽  
Therapeutic Decision Making

Scientific evidence plays an important role in the therapeutic decision-making process. What happens when physicians are forced to make therapeutic decisions under uncertainty? The absence of scientific guidelines at the beginning of a pandemic due to an unknown virus, such as COVID-19, could influence the perceived legitimacy of the application of non-evidence-based therapeutic approaches. This paper reports on a test of this hypothesis, in which we administered an ad hoc questionnaire to a sample of 64 Italian physicians during the first wave of the COVID-19 pandemic in Italy (April 2020). The questionnaire statements regarding the legitimacy of off-label or experimental drugs were framed according to three different scenarios (Normality, Emergency and COVID-19). Furthermore, as the perception of internal bodily sensations (i.e., interoception) modulates the decision-making process, we tested participants’ interoceptive sensibility using the Multidimensional Assessment of Interoceptive Awareness (MAIA). The results showed that participants were more inclined to legitimate non-evidence-based therapeutic approaches in the COVID-19 and Emergency scenarios than the Normality scenario. We also found that scores on the MAIA Trusting subscale positively predicted this difference. Our findings demonstrate that uncertain medical scenarios, involving a dramatic increase in patient volume and acuity, can increase risk-taking in therapeutic decision-making. Furthermore, individual characteristics of health care providers, such as interoceptive ability, should be taken into account when constructing models to prevent the breakdown of healthcare systems in cases of severe emergency.

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