ii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

I didn't have time to finish reading Frankel et al. before WCCS26. This book has an index which was very useful, to efficiently check certain points. It is amazing the number of books without an index.

Chapter 1 is 'Guiding Principles' and links really well with the index. At two pages it is brief and yet also constitutes Part 1. 

Part II The Clinical Situation, continues an introductory thread. Chapter 2 The “Clinical Situation”: An Introduction to Its Structure and Complexity is what attracted me to the book. At five pages, there was more in this vein. I looked ahead and found that the chapters all seemed short. Checking the book's web page, 50 chapters in 270 pages, so just over 5 pages and well referenced too.

Initially, you might feel short-changed, of course, I didn't with a review copy. But don't worry. You are in patient- person-centred hands here. Sometimes content matters. The three authors work and are researchers in psychiatry. For me, the guiding principles and part II provide a handshake with the index. The person here then, is given a literary hug. Immediately, there is a link between the variables of care and the structure of a case (or caseness). 

'But importantly that "structure" is dynamic changing over time. We classify variables as "clinical" as they are brought into play for the purpose of treatment, i.e., the goal of healing.

The clinician is not just challenged to unravel this complicated situation but also to represent the patient accurately, including his or her "human" elements as represented by temperament and personal attitudes. What are the patient's essential needs. tolerances, preferences? Yet, there is even more to know about each patient. Does she have children? What is her financial status, her ethnicity? What are her attitudes about medical professionals. Does she believe in medicine, or even in science?

Beware! None of these factors are dispensable when trying to understand a patient. Just try to leave out a few and you are left with a gutted rendering of that person, not a living human being.' p.7. 

(and continued in fragmented form below ...)

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

'The result even when this level of detail, is available may still be an anemic version of the patient.    Traditionally a medical patient is subjected to an extensive workup that includes a mental status examination, in addition to a detailed past and present history, ...	... and an extensive "review of (organ) systems.
Now add the multiplicity of problems, psychiatric and systemic medical, from which the patient suffers. ...	Multiplicity may include systemic medical, psychiatric, social, financial, and lack of access to health providers.' p.7.

'From this description it seems logical that complex patients presenting with mixed medical-psychiatric disorders be managed with an ongoing collaborative approach delivered by a multispecialty team. Included may be a primary care physician, psychiatrist, and/or psychotherapists. One or more of the collaborating professionals may be a nurse practitioner and/or a physician's assistant.' p.7

I will return to the 'logical' in the final quoted paragraph above. The author's declare their intent from the outset, and by the literature-to-date they achieve this (may I please add? 'in spades!').

 

Over the years and as raised on W2tQ, several colleagues and contacts have asked "Where is the book on Hodges' model?" Not to sound weird, but this book asks that same question through some challenges to the usual 'medical' text. There are several lessons to take away here, even if only to keep a dream alive. While the physical size of a textbook, its practical appeal and stance makes it appear as something to pop in your top shirt/jacket pocket. A pocket guide: quite an impression just 10-20 pages in, and in this digital age.

 

As you would expect from mental health practitioners - psychiatrists - psychotherapists, interpersonal, subjective-objective and intersubjective factors are integral to how complexity is defined and measured. In Chapter 2, pp.11-12 there is mention and reference to the Value-Based Integrated Case Management Complexity Assessment Grid:

Specker, S., Andrew, R., Drexler, E., Koithan, E., Thurber, S., & Frankel, S. (2026). Development of the Self-Administered Health Complexity Screening Instrument. Professional case management, 31(2), 81–89. https://doi.org/10.1097/NCM.0000000000000845

I will check this instrument as I complete this review. As noted on April 9th this book was published in 2023, so I remain grateful to Daniela and colleagues at SpringerNature for the review copy (which also enjoyed WCCS!).

Previously: 'complex' : 'holistic bandwidth' : 'mental health' : 'person(-centred)'

More to follow ...

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

Move Over LLMS! AI Legends Yann LeCun and Alex LeBrun Debut AMI Labs' Bold Ambitions for World Models in Healthcare

The math behind world models might just blow your mind 🤯

All public text: ~30T words.

Four years of vision: ≈10¹⁴ bytes.

That’s why text-only AI falls short.

And for us as physicians, this matters.

🎧 Listen to the full conversation with Offcall’s co-founder, Dr.… pic.twitter.com/DRhe52onaC

— Offcall (@OffCallDotCom) February 14, 2026

My source: https://x.com/OffCallDotCom/status/2022708074105242035?s=20

Narketpally syndrome: A different approach to medical education and research

From: Marc Jamoulle
MD (UCL 1974), PhD (ULg 2017)
Family physician, Belgium (INAMI 15324119004)
marc.jamoulle AT uliege.be
Associate researcher at HEC-Liège, BAS-SCM, University of Liège, University of Rouen, D2IM & CAMG-UCL, Brussels

hi friends,

in an unknown syndrome, another way to deal with the patient, to learn from the patient, to develop a partnership with the patient, caring while waiting for the cure,

Jamoulle, M., & Soylu, S. (2025). Phenotyping Long COVID in Children in Primary Care: A Case-Based Study Using the Human Phenotype Ontology. ORBi-University of Liège. https://orbi.uliege.be/handle/2268/334447

From: Rakesh Biswas
rakesh7biswas AT gmail.com

This paper illustrates a global patient-centered learning ecosystem, anchored in Narketpally, that adopts a syndromic approach to medical education and research. Rooted in the etymological origins of 'syndrome' ("together we flow"), this approach reframes medical research as a collective, contextual response to individual patient needs.

https://pubmed.ncbi.nlm.nih.gov/40674544/

Methods: The structure of the paper is intentionally modeled as a team-based learning exercise, grounded in our prior Web 2.0-based cognitive tools: CBBLE (Case-Based Blended Learning Ecosystem) https://pmc.ncbi.nlm.nih.gov/articles/PMC6163835/ and PaJR (Patient Journey Record) https://pajr.in/. These are framed against the conceptual scaffolding provided by three key publications: a framework by Sturmberg et al. and two contrasting commentaries by Greenhalgh and Ioannidis.

Results: Through our ongoing CBBLE-PaJR workflow, thematic learning outcomes emerged in response to these frameworks. Sturmberg's stratified realism helped us recognize how individual patient connections, recorded in our daily practice and online learning portfolios, can drive both contextual learning and meaningful changes in patient outcomes. Greenhalgh's commentary inspired our conceptualization of a 'wildebeest river crossing value model,' contrasting population-based efficiency with individual-centered compassion. Ioannidis's critique of methodological rigor highlighted the potential for expanding low-resource, high-impact research through patient-centered designs, particularly in phases 1 and 4 of the clinical trial hierarchy.

Podder, V., Kulkarni, R., Samitinjay, A., Salam, A., Gade, S., Agrawal, M., Surendran, A. K., & Biswas, R. (2025). Narketpally Syndrome and the Embedding of Contextual Values in Real-Life Patient Pathways. Journal of evaluation in clinical practice, 31(5), e70186. https://doi.org/10.1111/jep.70186
[Citation added PJ].
--

My source:
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Reflective equilibrium and equipoise

I can't believe, or don't want to, that it's nearly 15 years since I posted - 

h2cm and clinical equipoise in 2010. 

The post didn't try to be 'technical', but perhaps demonstrates the journey here.

In a post to follow, in London 4-7th July I came across a book by Edouard Machery and upon return up north, found a paper which refers to reflective equilibrium. This, one again technical or not, is a purpose of Hodges' model.

Machery, Edouard, Philosophy Within Its Proper Bounds (Oxford, 2017; online edn, Oxford Academic, 24 Aug. 2017), https://doi.org/10.1093/oso/9780198807520.001.0001, accessed 24 June 2025.

Reflective equilibrium has an entry in the The Stanford Encyclopedia of Philosophy:

'If you believe that conduct in some case is right or wrong, you have a moral judgment or intuition. Perhaps you have many such judgments about different cases. You might, nevertheless, consider that judgments alone do not justify the moral views they express. You and your moral interlocutors might be concerned that “what we actually accept is fraught with idiosyncrasy and vulnerable to vagaries of history and personality” (Elgin 1996: 108) or displays “irregularities and distortions” (Rawls 1971: 48).

John Rawls proposed to address these concerns through the method of reflective equilibrium.We first ensure that our judgments are considered, being made in circumstances appropriate for moral deliberation. We are then to consider general principles that might accommodate our set of considered judgments—and more than that, explain and extend them. On the standard wide reflective equilibrium, we are to consider

all possible descriptions to which one might plausibly conform one’s judgments together with all relevant philosophical arguments for them. (Rawls 1971: 49)

This requires that we reflect on a wide range of principles, arguments, and theories. Equilibrium is reached where principles and judgments have been revised such that they agree with each other. In short, the method of reflective equilibrium is the mutual adjustment of principles and judgments in the light of relevant argument and theory.'

The encyclopaedia entry is informative for studies here. I will revisit clinical equipoise in the near future; and bring in the idea of 'holistic bandwidth'.

Knight, Carl, "Reflective Equilibrium", The Stanford Encyclopedia of Philosophy (Spring 2025 Edition), Edward N. Zalta & Uri Nodelman (eds.), URL = <https://plato.stanford.edu/archives/spr2025/entries/reflective-equilibrium/>.

Rawls, John, 1971, A Theory of Justice, Cambridge, MA: Belknap Press of Harvard University Press.

SSMJ February 2025 - South Sudan Medical Journal

Dear Reader,

The full issue of our February 2025 issue is online here; the articles are listed below. 

Editorial 

• South Sudan cholera outbreak: A call to improve sanitation Ruot Garjiek Teny 

Research Articles 

• Prevalence and associated risk factors of hepatitis B virus infections among women of reproductive age in Juba, South Sudan Ezbon WApary, Akway M. Cham, Oromo F. Seriano 
• Management and outcome of women requiring massive blood transfusion after childbirth: A cross-sectional study at Muhimbili National Hospital, Tanzania Wangwe Peter Joseph, Sawe Eshi-Fisha Linda, Meda Elineema Robson 
• Addressing barriers in paediatric tuberculosis reporting: A qualitative study of private healthcare providers’ perspectives Suryanti Chan, Idris Adewale Ahmed, Hamzah Hamzah 
• Knowledge, attitudes, and practices of caregivers of malnourished children at the Al Sabbah Children’s Hospital, Juba, South Sudan Francis Beek Akook, Nyok Daniel Ngor 

Case Report 

• Evaluation and surgical repair of retroperitoneal duodenal perforation following blunt trauma: A case report Rashmi Ranjan Sahoo, Abhinav Voona, Nalini Naik, and Jyotirmay Jena 

Main Articles 

• Epidemic keratoconjunctivitis (Pink Eye) in South Sudan: A review Wani Mena The Establishment of the National Public Health Institute (NPHI) in South Sudan Nyinypiu Tong, Anthony Garang, Joseph Lako 
• The third community health workers’ symposium, Liberia, 2023: What are the implications for South Sudan’s Boma Health Initiative? Kon Alier, Solomon Anguei, William Kuon, Christopher Ajumara 

Short Communications 

• South Sudan’s journey to defeat Guinea Worm Disease: The role of President Jimmy Carter and the Carter Center Makoy Samuel Yibi Logora 
• Letter to the Editor: President Jimmy Carter deserves a special recognition for his work to eradicate Guinea worm in South Sudan. Victor Vuni Joseph 
• Letter to the Editor: Simulation-based education amid conflict: The Sudanese American Medical Association experience in Sudan Mohamed Almahal, Mohamed Ahmed, Omer Gomaa, Salaheldin Abusin, Ihab Abdalrahman
• Obituary: Maj. Dr Santino Kuot Maluil 
• Obituary: Dr Benjamin Peter Oduk 

See the back page for instructions on how to prepare and submit manuscripts for publishing in SSMJ.

Thanks to everyone who supports SSMJ - authors, editors, and, especially, our peer reviewers.

The SSMJ team
Email: southsudanmedicaljournal AT gmail.com
Website: http://www.southsudanmedicaljournal.com
Follow us on Twitter@SSMedJournal and our Facebook Group,

SSMJ is published by the Health and Social Science Research Institute of South Sudan (HSSRI-SS)

Copyright © 2025 South Sudan Medical Journal, All rights reserved

Previously on W2tQ:

Guinea worm announcement

Be proactive: Evidence supporting proactive care for older people with frailty

'These BGS publications outline evidence and delivery recommendations for proactive care and support for older adults with moderate to severe frailty. 

We set out how to deliver proactive care against core components and key enablers, with recommendations for success of a proactive care service. Building on NHS England's proactive care guidance, Proactive care: providing care and support for people living at home with moderate or severe frailty, we also outline key recommendations for the successful implementation of proactive care services across the UK. 

We hope that users will be able to use all three documents when designing proactive care services, with the NHS England guidance document acting as key framework and starting point, BGS’s Be proactive: Evidence supporting proactive care for older people with frailty as a business case, and Be proactive: Delivering proactive care for older people with frailty  as a roadmap for implementing the NHS England framework and delivering services. ...'

https://www.bgs.org.uk/ProactiveCare

[All best Charlie (on your Christening Day), Casper and Jamie]. #hope #love #future #action #HealthCareer #LifeChances

HC@AIxIA: AI&Health Seminar Series (2024) - 16 September

Generative AI in sequencing: enhancing models by synthetic omics data

 
16 September 2024 - 04:30PM CET

Speaker: Giuseppe Jurman, Head of DSH (Data Science for Health) Unit, Fondazione Bruno Kessler – FBK (Trento, Italy)

Title: Generative AI in sequencing: enhancing models by synthetic omics data.

• Abstract: Synthetic data have recently gained momentum in several scientific areas as an effective solution to dealt with several aspects of data poverty and missingness. In translational medicine, biomedical images and EHR data have been the first to benefit from synthetic augmentation techniques through generative AI algorithms such as GANs or, more recently, Diffusion-like models. Extension of these methods to omics data poses further challenges due to the nature of the signal, such as the need of taking into account sample variability and multilevel omics coherence. In this talk, we will present an overview of the state-of-the-art of the synthetic data in the omics universe, including the generative methodologies, the future perspectives, and the related caveats, concluding with some applicative use cases. (joint work with Marco Chierici and Silvia Menchetti)
• Short Bio: Giuseppe Jurman is a mathematician, with a PhD in Algebra, currently Head of the Data Science for Health (DSH) Unit at FBK. His main interest is the development and the application of artificial intelligence, machine learning and complex network models for diagnosis, prognosis and prediction in medicine, life science and computational biology, starting from EHRs, omics data and biomedical images, including digital pathology, with a particular emphasis on reproducibility and explainability. He is also interested in scientific programming with Python and other computing languages, and he teaches Data Visualization at the M.Sc. in Data Science at the University of Trento. 
• Flyer: link
• Link for participating: webex link + details
• VIDEO: available afterwards
  

c/o: Francesco Calimeri, Mauro Dragoni, Fabio Stella
(coordinators of the HC@AIxIA working group)