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

In reading this book and others on W2tQ, I must make the following points:

  * my need to remember the purely USA context (I have never worked there);
  * my healthcare, nursing, informatics experience is NHS-based;
  * this review (and others) is motivated by the project here - Hodges' model;
  * as a result, I will be quoting heavily, there is much to bring to your attention.

As noted in post (i) there is much to whet the appetite, a paradigm shift, 'comprehensive, collaborative, and integrated care' (p.11) certainly have become popular topics in the medical literature. Not only that but 'interpersonal and intersubjective treatment models' too (p.12).

The role of 'Case Managers' is highlighted, plus the Case Management Society of America, which is committed to:

•  Improved Consumer Health Outcomes
•  Professional Diversity, Equity, and Inclusion
•  Cultural Competency and Humility
•  Advocacy for the Health Consumer
•  Integrity and Ethical Principles
•  Promoting Health Equity
•  Educating Case Managers Across the Care Continuum
•  Evidence-based Quality Care
•  Holistic, Compassionate Care
•  Fostering Communication and Collaboration
•  Advancing Research, Innovation, and Use of Technology
•  Fiscal Accountability [ https://cmsa.org/about/ ]

Whether the USA influences global trends in the structure and form of healthcare is another post, but there is a UK Case Management Society too: https://www.cmsuk.org. I can see a fit here [UK] with the development in recent decades on social prescribing. A different role, of course but part of a complex jig-saw.

As expected definitions are provided: 

'Roger Kathol has eloquently defined "health complexity" as "the interference with the achievement of expected or desired health and cost outcomes, due to the interaction of biological, psychological, social and health systems factors when patients are exposed to standard care delivered by their doctors" [1].' p.10. 

Roger G. Kathol, Rachel L. Andrew, Michelle Squire, Peter J. Dehnel (2018) The Integrated Case Management Manual: Value-Based Assistance to Complex Medical and Behavioral Health Patients. 2nd ed. Basel: Springer.

I can see where this definition comes from, but for me, it does not sit right. The problem when there is 'interference' is the assignment of responsibility and consequence that blame can follow. We've seen this, and in mental health too), with the recover model^. Some of the terms here may be completely innocuous politically speaking (which is the author's intent of course), but they can also be 'weighted'. Hence they can become concrete terms of judgement. Think about it: achievement, expected, desired, cost (and) outcomes, standard care, delivered (by doctors)? Or, am I over-thinking again.

In the margin I pencilled/drew:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Standard -	care
Other -	factors

As ever, the individual patient is our focus. The individual is supported (literally) by the social and political (infra-)structures that act as a scaffold, safety-net for most.

Time flies, I can't believe it was 2007 I posted 

Plush HQ foyer, shame about the mannequins!

I had this notion of life-size cardboard cutouts representing the average people who use a given health service provider (local, or not so local these days?). The data will be there in statistical annual reports. I'd noticed the displays - analogue and digital that greeted visitors at a local NHS Trust HQ. This would be the book's 'routine patients' who receive standard care. 

Chapter 3 introduces 'variables' which again is brief, but imporant as variables recur throughout the book. The 'Clinical Field' is first outlined, as in:

• Sources of clinically relevant factors;
• Dynamic factors;
• and: Variables representing contributions from practitioner(s).

Abstract variables are differentiated from those that are concrete. It's reassuring to read there is no true simplicity within the clinical field, and the author's goal is to 'unpack complexity so it remains as true to life as possible, not just manageable conceptually.' p.18.

Frankel et al. are primed to go beyond this. Maths, as in statistical procedures are one tool. Chapter 4 adds to this with a theoretical model to guide clinical understanding of patients with biopsychosocial complexities, the foundations of our paradigm shift. p.23.

If you have an understanding of Hodges' model you can picture my response to this. But, staying grounded, the whole book and paradigm shift represents a form of scientific "emergence". It is frustrating that literature searches fail to pick out Hodges' model. 

Frustrating too as reading of "awe", also on page 23, I have experienced this many times (over say 1977 - 2019 ...). So, I held on to my dummy (pacifier!?) and read on ...  

Chapter 4 Technical Considerations is one the longest and contributes all of Part III. Here you can read about science, measurement, statistics, empirical, operational definitions, intelligence, reliability. I often see a chapter, book section as a useful primer for students and the same applies here; with inter-judge realiability, validity, control, null hypothesis, statistical methods and much more. Reference to mathematics (axiomatic too) had me hoping for more. I picked out Structural Equation Modelling:

 'We would also like to suggest that following the steps involved in "structural equation modeling" (path analysis) is a good way of conceptualizing and reasoning about complex clinical variables altogether. For example, constructing a clinical model informally (intuitively, loosely from data) and thinking about (diagramming) how the variables involved may moderate and mediate each other can be a useful activity for clarifying the nature and requirements of a complicated clinica1 situation. 
 

 In simplest terms, an independent variable is the causal or influential variable that impacts and effects the dependent variable. A moderating variable is a dichotomy, and refers to two comparison groups (e.g., male/female; passed/fail; religious/nonreligious; tall/short; high versus low socioeconomic status) that display significantly different degrees of magnitude on a correlated relationship. For example, the relationship between a specific treatment for a medical disorder and treatment outcomes may be moderated by socioeconomic differences. The treatment outcome relationship may be stronger and more positive for individuals with elevated socioeconomic standing who therefore have better support systems and access to medical professionals, and fewer economic stressors.' p.36.

I think from this the authors might be sympathetic to giving 'life' to the POLITICAL domain and Hodges' model; after all it lives in people's daily experience - acknowledged or not. The book's structure works thus far: Chapter 5 Nature-Nurture (n.b. no escape!)  and the Epigenome. The structure - flow - works, as at just over four pages, it begs further reading (beyond the listed references). I still have my copy of:

Fritjof Capra and Pier Luigi Luisi (2014) The Systems View of Life - A Unifying Vision. Cambridge: Cambridge University Press.

 

With the epigenome being added to the 'patient complexity equation' in chapter 5, I wondered whether this was predictable, a promise, or a tease?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

nature?	NATURE?
NURTURE?	nurture?

 

Previously: 'complex' : 'nature' : 'mental health' : 'person(-centred)'

More to follow ...

^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311. 

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.

Wittgenstein's - Tractatus

Apparently, Wittgenstein walked away from philosophy after publication of the Tractatus. He thought he had solved the problems of philosophy, logic and reality.

In trying to ‘see’ Hodges’ model, in mathematical terms, there may be lessons in Wittegenstein’s approach, both in content and style. Of course, as a non-mathematician, I probably should leave well-alone; and stick to nursing. But that is the problem: from 1987-88 there is a need for a different perspective, even if this is a personal challenge. As with many ‘reviews’ here, we can look at Wittengenstein’s work, reflect upon it, and consider how it relates to the purposes, structures and content of Hodges’ model.

The Tractatus’s first line then, offers a warm welcome.

‘The world is everything that is the case.’ [I]

Making the decision to become a nurse and enrolling as a student makes you an educational and workforce demographic case.

Once a student in the university lecture theatre, you hopefully whether consciously, or not are exposed to the theory – practice gap; as you yearn to be on your first placement. Now it you who is seeking ‘cases’. As we live, and statistics roll and tally, the question of caseness (and categories) is key, one that is carried around even if not always active, recognised as such.

As noted in the previous post, we can for Hodges’ model (and other models, frameworks it must be said) think of ‘case’ as a, or the situation. 

A mathematical approach to Hodges’ model involves looking at things, concepts, people as objects. This includes patients and carers. In terms of a project worthy of pursuing in nursing and other disciplines involved in healthcare, this mathematization presents a non-trivial challenge. A fully-deserved response would be: 'What have you done to the aptitude for care and caring attitude? You've cancelled - subtracted it!' Humour aside:

'In order to know an object, I must know not its external but all its internal qualities.' [2.01231] 

Is this equivalent to us getting to know our patient / client and their socio-political context? 

‘The way in which objects hang together in the atomic fact is the structure of the atomic fact.’ [2.032] 

It is a help that Wittgenstein points to structure (crumbs of understanding are welcome here, as incremental steps). In formulating Hodges’ model we first identify the axes. It is the axes that then provide a space, four domains in total, to frame the objects that we decide; or, as the situation dictates, what concepts are placed in the domains of Hodges' model.

There is a successive series that follows, combining place, space and logic: ‘The proposition determines a place in logical space: the existence of this logical place is guaranteed by the existence of the constituent parts alone, by the existence of the significant proposition.’ [3.4]

‘The propositional sign and the logical coordinates : that is the logical place.’ [3.41]

‘The geometrical and the logical place agree in that each is the possibility of an existence.’ [3.411]

‘Although a proposition may only determine one place in logical space, the whole logical space must already be given by it.
(Otherwise denial, the logical sum, the logical product. etc., would always introduce new elements -in co-ordination.) 
(The logical scaffolding round the picture determines the logical space. The proposition reaches through the whole logical space.)' [3.42]

While Wittgenstein came to view ‘the picture theory of meaning’ as incorrect, as a conceptual framework and diagrammatic resource Hodges’ model is closely tied to this form of representation.

Of course, the logic at work here, is far from mathematical, but there is surely a logic.

'Formal concepts cannot, like proper concepts, be presented by a function.' [4.126]

'There is therefore really a sense in which in philosophy we can talk of a non-psychological I.
The I occurs in philosophy through the fact that the "world is my world'".
The philosophical I is not the man, not the human body or the human soul of which psychology treats, but the metaphysical subject, the limit - not a part of the world.' [5.641] 

'Although the spots in our picture are geometrical figures, geometry can obviously say nothing about their actual form and position. But the network is purely geometrical, and all its properties can be given a priori.

Laws, like the law of causation, etc., treat of the network and not of what the network describes.' [6.35]

There is much more in this work, and much that remains a challenge. Many commentators have written and said in interviews that the Tractatus rewards re-reading and some sentences stay with you for life (The Great Philosophers BBC TV). 

I'm still seeking mine.

https://www.gutenberg.org/files/5740/5740-pdf.pdf

iv WCCS26: World Conference on Complex Systems 20-22nd April

Day 1: Panel 2 - Rethinking Knowledge in the Age of Complexity

• Helena Knyazeva - Dancing with Complexity: How the World Thinks Through Us
• Carlos Gershenson - The Implications of Complexity
• Leonardo Rodríguez Zoya - Can Statistics Think? Complexity, Future, and Freedom in the Age of Large Language Models
  Panel Chair: Nigel Gilbert 

Courage is one of the 6Cs in nursing, and was on display at WCCS26.

Carlos Gershon began by offering two references, the first:

De Domenico, et al., (2019). Complexity explained: A grassroot collaborative initiative to create a set of essential concepts of complex systems. https://complexityexplained.github.io

This is a brief 20 pages, larger text, and provides a helpful primer to complexity and related concepts covering:

Interactions
Emergence 
Dynamics 
Self-organization
Adaptation
Interdisciplinarity
Methods

For each concept, the authors explain:

Definition/Description
Examples
Relevant Concepts
References

Plus, secondly:

Gershenson, C. The Implications of Interactions for Science and Philosophy. Found Sci 18, 781–790 (2013). https://doi.org/10.1007/s10699-012-9305-8

I liked the practical feel here, the encouragement to think anew, and perhaps taste the "flavors of emergence": synchronic - space; diachronic - time, weak and strong feedback, transversal of scale - upwards and downwards.

There is further conference on complexity later this year (and also online!):

CCS 2026:
The 2026 Conference on Complex Systems
OCTOBER 9 - 16, 2026 BINGHAMTON, NY, USA & ONLINE

In my search I also found:

Carlos Gershenson; Complexity, Artificial Life, and Artificial Intelligence. Artif Life 2025; 31 (3): 289–303. doi:https://doi.org/10.1162/artl_a_00462

Gershenson, C. Self-organizing systems: what, how, and why?. npj Complex 2, 10 (2025). https://doi.org/10.1038/s44260-025-00031-5

Leonardo Rodríguez Zoya's presentation helpfully connected social practice, interdisciplinary bridges, statistical rationality, complex (human) rationality and the future(s): desirable, possible, latent and probable.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

COMPLEX (HUMAN) RATIONALITY   cognition	STATISTICAL RATIONALITY Techopraxis LLMs - technology
socio- HUMAN PROBLEMS SOCIAL PRACTICE PRACTICE (one of the 4Ps)	ELECTION - CAMPAIGN SPENDING PEACE NEGOTIATIONS ISLAND ECONOMY CRYPTOCURRENCY

To answer the prompt - 

"Give me a less likely but more fruitful interpretation of this [concept]*."

*Replace with a significant concept in your practice

Would it might help to have a simple, and yet complexity (and simplicity!) primed conceptual framework to assist reflection, argumentation, and progress?

 

I missed the poster at the afternoon break, and followed track 1. I greatly enjoyed Julian Arevalo's - Adaptive Readiness: an Agent-Based Model of Peace Negotiations. Perhaps this accounts for my having no notes or photos for this track except for one. I realise now we did speak, sitting together for the conference dinner. I'm sure I remember Negotiation Lab 1.0 - 

https://www.comses.net/codebases/1256dc74-9ae4-4f49-a235-1ec129be1930/releases/1.0.0/

 

This past week I heard discussion (BBC Radio 4) of the 'income' Norway obtains from its expertise and engagement in peace negotiations.

 

Nicholas Roxburgh, and colleagues Rachel Creaney, Mindi Premarathne and Ruth Wilson through 
Exploring Interdependencies in an Island Economy, reminded me of public engagement in research. Especially when it involves their community; and that community is somewhat rural, or remote.

 

Remah Dahdoul, with Jan Korbel and Stefan Thurner presented -

Campaign-Spending Driven Polarization Transition in a Double-Random Field Model of Elections. The following paper brings home the mathematics in complex systems. The reference is:

 

Jan Korbel and Remah Dahdoul and Stefan Thurner. (2026) Empirical validation of the polarization transition in a double-random field model of elections. arXiv. https://arxiv.org/abs/2510.00612.  doi.org/10.1103/9gjj-1df6.

 

The paper by Saida Hachimi El Idrissi and Mohamed Nemiche is not open access, but the abstract follows. 

 

S. H. El Idrissi and M. Nemiche, "Formation of Complex Societies: An Agent-Based Model Inspired by Freudian Theory," 2024 World Conference on Complex Systems (WCCS), Mohammedia, Morocco, 2024, pp.1-6, doi: 10.1109/WCCS62745.2024.10765573.

Abstract: The rise and emergence of complex societies in the Old World mark a pivotal chapter in human history, characterized by the transition from small, kin-based communities to large, hierarchical states. This transformation raises fundamental questions: How did human societies progress from small, cohesive groups characterized by face-to-face cooperation to the expansive, anonymous societies of today, often organized as states? What factors account for the significant variation in different human populations' capacity to construct stable and functional state structures? To address these questions, we developed an agent-based model grounded in Freud's hypothesis, which posits that civilization could neither emerge nor evolve without the repression of human desires. In the context of social evolution, this repression of desires can be interpreted as the repression of intra-societal competition, ultimately strengthening the society and facilitating the formation of complex social structures. We implemented this model within a realistic representation of the Afroeurasian landmass, incorporating various geographical factors. To validate our model, we compared our simulated results with historical data. The model-predicted pattern of expansion of complex societies demonstrated remarkable congruence with the observed historical patterns in the Old World. The emergence, growth, and distribution of large-scale societies predicted by our computational model showed remarkable consistency with the archaeological and historical record.

keywords: {Analytical models; Computational modeling; Predictive models; Data models; Agriculture; Rivers; History; Complex systems; component; Agent-based Modeling; Repression of satisfaction; cooperation; competition; Social Simulation},
URL: https://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=10765573&isnumber=10765499 

Unless you are a microsurgeon (increasingly with robotic co-workers), is the word practice, more likely to manifest what is larger, the big picture, a sense of space, even at a societal or continental scale? In reading, I came across four forms of attractors. For me, how they fit into the question of scale makes this paper worthy of seeking out. 

M. Nemiche was unable to attend the conference, and was greatly missed.

'Our broken sticks' c/o Roger Lewin "Complexity: life at the edge of chaos"

Chapter 4 Explosions and Extinctions

  'Is Stu being led astray? I asked. "There's something called the broken stick model in statistics," said Dave. In this trick, a random number generator "breaks'' a stick a hundred inches long at twenty-five points, and produces twenty-six short sticks. Measure them, count the number that are one inch long, the number two inches long, and so on, and draw a histogram. You get a skewed distribution, toward the short end, just like many natural phenomena, including the distribution of sizes of U.S. cities, for instance. "One thing you have to remember about extinctions is that some species are more likely than others to die out, just because they exist as small, isolated populations,'' explained Dave. "This sort of statistical quirk can skew your results, easily." So, you would be suspicious of anything that looks like a power law? "I would, because it's common, just in the nature of statistics. It may tell you that a system is poised at a critical point, whatever that means, but it may not. In any case, when Stu says that the curve he gets from my data is close to a power law, he knows that there are many other mathematical models that could fit equally well."
  Clearly, there were many reasons to be cautious about drawing the conclusion that global ecosystems are poised at the edge of chaos, using just the extinction data.' p.80.

 

Hodges' model: Axes (structure) and Domains (content)

If we take the axes of Hodges' model, and break them at twenty-five points, I wonder what we end-up (or start) with?

 

Lewin, Roger. (1993) Complexity: life at the edge of chaos. London : Phoenix [Dent, 1993] ISBN: 1857990285.

Previously: 'complexity' : 'system'

Florence Nightingale Commemoration Service

Supporting nurses and midwives to promote health, improve care and save lives Florence Nightingale Commemoration Service

The second group of public tickets for the Florence Nightingale Commemoration Service will be available at 13:00 GMT on 24 March. Click the button below as soon as possible after this time, to complete the form to apply. 

You will be able to request a maximum of 2 tickets and you will need to complete the form with your name and email address. If you are requesting two tickets you will also need to give the name and email address of the second person. 

Please note that if you provide guest details they will then receive an email with an invitation and will need to RSVP themselves in order to secure their ticket. 

If you have further queries please visit our Frequently Asked Question page.

🔷

INDIVIDUAL

|

    INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

On Wednesday in Waterstones, Deansgate, Manchester, I spotted this book. Opening it randomly - I kid you not - it fell to pp.204-205, and Florence Nightingale's contribution.

The Mathematicians' Library The Books That Unlocked The Power Of Numbers

'At that time, the idea of visualizing data in order to make its messages clearer to non-mathematicians (including politicians) in order to change minds and inform opinions had started to gain traction in Europe but was not common in England. Nightingale continued to use statistical diagrams to communicate stories hidden in data, and while this clearly contributed to improvements in health and mortality in British military encampments at home and abroad (and by extension in the population in general), it is also undoubtedly the case that she helped to popularize the use of appropriate data visualization methods to expand the reach of statistical information beyond specialist audiences. A testament to the influence of her work is that the Royal Statistical Society had the honour of accepting Florence Nightingale as their first female member in 1859.' p.204.

 

Thomas K. Briggs. (2025) The Mathematicians' Library The books that unlocked the power of numbers Hardback. Part of the Libri Historici series. Ivy Press.

 

Previously: 'Nightingale' : 'math' 

My source: Waterstone, Deansgate, Manchester and email Florence Nightingale Foundation.

NANDA-I Newsletter - theme of clinical reasoning

'This month at NANDA-I, we have been exploring the theme of clinical reasoning.

Clinical reasoning is at the heart of nursing; it’s how nurses make sense of complex patient information and choose the best path forward. While many nurses think of diagnosis as the centerpiece, it’s really the thinking that leads up to it, gathering cues, interpreting what matters most, and then safely determining goals and actions, that makes all the difference in outcomes. Strong reasoning helps nurses notice subtle changes and act with confidence.

As healthcare grows more complex, understanding how nurses think, not just what tools they use, helps elevate care for every patient. We’ll be sharing insights throughout the year to help you stay connected to nursing knowledge and its impact on care delivery and education.'

 

Teaching Tip: Clinical Reasoning in Practice

Start With Assessment to Improve Reasoning

When nurses work with standardized languages and clinical judgment tools, it’s tempting to dive right into diagnosis. But the most accurate and useful nursing judgments always come from strong, systematic assessment first. Quality assessment supports better interpretation of patient needs and more precise identification of nursing responses. Quick Tip: Use a flexible assessment framework, whether it’s a conceptual model or a tool like functional health patterns, to make sure you’re capturing the data that matters most first. When you build a solid foundation with assessment, everything that follows (including diagnostic thinking) becomes clearer and more grounded.

 

My source: 'Friends of NANDA®-I Newsletter' subscription (with my emphasis).

See also:
https://nanda.org/2025/12/nanda-360-for-educators-and-researchers-strengthening-nursing-knowledge-through-diagnosis-centered-reasoning/

Assessment, plus planning, implementation - action, evaluation (plus, formulation).

Functional and cognitive [Health, Illness, Climate, Poverty, Political, Security, Prevention, Self-care, ...] patterns.

'... make sure you’re capturing the data that matters most first' - Situated, Context, Salience.

For a competent practitioner an assessment can also be 'therapeutic' for the patient.

Previously: 'classification' : 'diagnosis' : 'NANDA' : 'ICD'

Descartes - alive and well ...

... within the Incident Reporting System

'Policy guidance on recording patient safety events and levels of harm 

This guidance is for users of the new Learn from Patient Safety Events (LFPSE) service, to provide context and guidance on selection of appropriate categories when recording incidents. It focuses on which Event Type is appropriate for different circumstances, and how to select the most appropriate options for the Levels of Harm categorisation required within Patient Safety Incidents.'

Previous harm grades

No harm

Low harm

Moderate harm

Severe harm

Death

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

New psychological harm grades No psychological harm Low psychological harm  Moderate psychological harm Severe psychological harm n/a	New physical harm grades No physical harm Low physical harm Moderate physical harm Severe physical harm Fatal

Q. 'n/a'. Discuss.

CPD reading.                      

Careif report: The Health Needs of the Indo-Caribbean Community in the United Kingdom

'The Indo-Caribbean community has played a key part in the life of the United Kingdom, but this has not often been recognised. Little is known about this populations’ physical and mental health needs and its experience of health and social services in the UK.

This report, The Health Needs of the Indo-Caribbean Community in the United Kingdom, examines the history of the Indo-Caribbean community in the UK, the prevalence of mental health conditions among the community, barriers to accessing mental health services, and the existing services available.'



Includes:

"The absence of a unique category designating ‘Indo-Caribbean’ as a unique category in the UK Census was identified as a major barrier to obtaining vital epidemiological data on the UK’s Indo-Caribbean population."

Above text:
https://www.careif.org/news-and-events/2025-10-9-careif-report-the-health-needs-of-the-indo-caribbean-community-in-the-united-kingdom

n.b. 
In my community mental health nursing career in Chorley, Preston, and West Lancashire as services were established, the diversity of the local populations was evident, but there was an assumption that many communities were essentially 'closed': one explanation for lack of referrals from specific racialised communities - was that some communities 'looked-after their own'.

Of course this can be racism (acute or subtle), an excuse for inaction, delayed response, lack of action - outreach and translation services. There were marked examples of intervention. I have seen first-hnad interpreting and translation services in action since full-time retirement and the services offered are amazing for the insights and care delivery they can facilitate. Is this why we also need mental health nurses and the team? To translate in challenging circumstances, even by being there, seeking avenues, giving time - especially in instances of psychoses and doing so safely (for all)?

In addition to the main body of Careif's report and its recommendations, it may be helpful to consider the report's key terms relating them to the domains of Hodges' model? I also note reference to the bio-medical model as an explanatory framework. A conference abstract has been submitted today for April 2026, highlighting the need for bio-psycho-socio-political model / framework (Hodges' model - of course?).

See also:

RCN North West Multicultural Group

'Politics as a science' ...

'The science of politics is the oldest of the social sciences but still perhaps the most dependent: it derives much of its methodology from statistics (the science of the state turned into the science of numerical data), from economics and from sociology and it steals much of its substance from anthropology, from history and from law. Yet there is little doubt about the core of the subject: it focuses on the ways in which decisions are taken by men acting within territorially or functionally defined networks and constellations of organizations. And the hallmark of the discipline is 'its systematic analysis', whether couched in verbal and literary terms or in the formalized language of statistics or of mathematical logic.' Preface vii

Hayward R. Alker, Karl W. Deutsch, Antoine H. Stoetzel (eds.), Mathematical Approaches to Politics, Amsterdam, Elsevier, 1973, pp. 475.

HIFA Discussion: Alcohol Use Disorders - Language 'being drunk'

----- Forwarded message -----
From: Peter Jones, UK <hifa AT hifaforums.org>
To: HIFA - Healthcare Information For All <hifa AT hifaforums.org>
Sent: Sunday, 25 February 2024 at 06:35:47 GMT
Subject: [hifa] Alcohol Use Disorders (86)

This morning on Times Radio UK, Hugo Rifkind 1000-1300 from 10.58:30 UTC:

 https://www.thetimes.co.uk/radio/show/20240224-26978/2024-02-24 

- there was mention of research in Germany on language, finding that there are over 540 words for 'drunkenness' being drunk. Apparently, the key is adding -ed to many words.

https://www.research-in-germany.org/idw-news/en_US/2024/2/2024-02-19__I_m_gonna_get_totally_and_utterly_X-ed.__OR__Can_you_really_use_any_English_word_to_mean__drunk__

This stood out for me as Hodges' model can potentially encompass the full corpus of a language, with the various contexts in which language is applied/used.

Significant of course informationally, in evidence-based practice, and research, were 'definition of terms' are (usually?) essential.

Also reminded of national variation in clinical/medical terminology. Scottish slang for injection includes 'jag'.

For health communication and HIFA, clearly language is fundamental and presents a real 'can of worms' (sorry!) in sense-making, creating 'noise' in the communication channels.

Should health services/systems effect a (gradual) change (shift) of emphasis to education and prevention - with the requisite policy support (utopic?) then this will need to be addressed.

In checking this news, it appears Germany has a more acute problem with alcohol. Can anyone 'local' - please shed any light on this?

I will post again about the HIFA discussion with a week ... left and highlight the above.

Many thanks

Peter Jones
Community Mental Health Nurse and Researcher
CMHT, Prescott House, Salford NW England, UK (Mon-Tues)
Blogging at "Welcome to the QUAD"
http://hodges-model.blogspot.com/
http://twitter.com/h2cm

h2cmuk AT yahoo.co.uk

HIFA discussion on Alcohol Use Disorders, 5 Feb - 17 Mar 2024

Dear all on HIFA,

It's just 4 days to go before the official launch of our deep-dive discussion on Alcohol Use Disorders, 5 February to 17 March 2024.

Please forward this message to your contacts and networks and invite them to join! www.hifa.org/joinhifa

More information here:
https://www.hifa.org/news/hifa-announces-deep-dive-discussion-alcohol-use-disorders-starts-5-february-2024

HIFA is grateful for sponsorship from the Ulrich and Ruth Frank Foundation for International Health known online as NextGenU.org.

Note: We have opportunities for further sponsored discussions in 2024. We have 20 working groups on standby to plan and implement a discussion [ https://www.hifa.org/projects ]. Or we can start a new group to address a topic that is important to you. Also new in 2024 there is the option to have live webinars to complement our forum discussions.

To discuss possibilities, please contact: neil AT hifa.org

With thanks, Neil

HIFA Partnerships and Projects working group: https://www.hifa.org/projects/partnerships-and-projects

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization.

"Registered Nurse RN": What is in a Title?

or, Here is Saturday's Multidisciplinary Team selection;
Registered Nurses on the subs bench;
On the Roll, or Roll with the Times?

While never a union/professional body (formal) representative, I have as a nursing assistant then student nurse been aware of the 'political' in health. Once again perhaps another way in which I was primed to the reality of staff as a key (the) resource and hence the centrality of the workforce. Abbreviations are ever present and I remember RAWP - Resource Allocation Working Party; which also drew attention to geography and scale. Unfortunately, the vitality of the workforce has suffered with workforce planning inconsistently exercised.

Once again, I also recall a presentation by Derek Hoy on the need for information systems (data - information - knowledge . . .) through nurse informatics to help make nursing visible. It seems this is still an issue, for example:

Lyu, XC., Huang, SS., Ye, XM. et al. What influences newly graduated registered nurses’ intention to leave the nursing profession? An integrative review. BMC Nurs 23, 57 (2024). https://doi.org/10.1186/s12912-023-01685-z

Leamy, M., Sims, S., Levenson, R. et al. Intentional rounding: a realist evaluation using case studies in acute and care of older people hospital wards. BMC Health Serv Res 23, 1341 (2023). https://doi.org/10.1186/s12913-023-10358-1

Stadnicka, S.K., Zarzycka, D. Perception of the professional self-image by nurses and midwives. Psychometric adaptation of the Belimage questionnaire. BMC Nurs 22, 412 (2023). https://doi.org/10.1186/s12912-023-01564-7

 
Last month on a trip to Hay-on-Wye I picked up some back-issues of London Review of Books. Needless to say, in light of space and the clearing exercise I was very selective. The pearl of an essay cited below prompted me to wonder on the silence, quietness, lack of noise - invisibility even - of certain wards where registered nurses are present: or not? How and what data is captured and interpreted for reporting purposes and how meaning is gleaned and by whom? Making a difference in terms of patient safety and the quality of care:

LRB 45:18

"Call​ it the Jaap Stam conundrum. The story is told in Rory Smith’s entertaining book about the use of data in football, Expected Goals. Stam was a very talented but ageing central defender who had for three years been crucial to the success of Alex Ferguson’s Manchester United. Stam got into Ferguson’s bad books, and Ferguson decided to get rid of him, backed by data showing that Stam was now making fewer tackles. Stam was sold to Lazio for £16.5 million. Simon Kuper, co-author of Soccernomics (2009), about the use of numbers in football, wrote that this might have been the first deal in football based partly on data. It was, as Ferguson later admitted, a ‘bad decision’. Stam went on to have several productive years at the top of Italian football. The mistake was based on the fact that the data were Delphic. The question Man U wanted to have answered was ‘Should we keep Stam?’ Instead, the oracle answered the question ‘How many tackles is Stam making?’ But, as Smith writes,

'the best defenders do not need to make many tackles. The tackle itself is an act of last resort; great defenders intervene long before anything so tawdry is required. That Stam was making fewer tackles was not a sign that he was getting worse; if anything, it may have been a sign that his anticipation and his positioning and his reading of the game were all improving.'

Football, like Mao’s China, has discovered that getting hold of the data is one thing, interpretation of the data is another. The terms ‘data’ and ‘analytics’ are used interchangeably in sport, Smith points out, but in fact the gathering of data, fuelled by surging interest from sports teams and professional gamblers, has tended significantly to outpace the intelligent analytic use of that data."

("Delphic. It answers the question you ask, but it doesn’t tell you what to do.")

John Lanchester. Get a rabbit. Vol. 45 No. 18 · 21 September 2023.
https://www.lrb.co.uk/the-paper/v45/n18/john-lanchester/get-a-rabbit 

See also:

Gorsky M, Millward G. Resource Allocation for Equity in the British National Health Service, 1948-89: An Advocacy Coalition Analysis of the RAWP. J Health Polit Policy Law. 2018 Feb 1;43(1):69-108. doi: 10.1215/03616878-4249814. PMID: 28972019; PMCID: PMC6312698.

RAWP

https://www.kcl.ac.uk/sspp/assets/icbh-witness/rawp.pdf

Whether, wherever, whatever you shave - you need Occam's razor

Can Hodges' model be honed by students from day #1 - 'Intro lecture 101',
 across all curricula to function as a form of Occam's razor -
a reflective and critical thinking tool
to last a lifetime's learning (and unlearning)?
 

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

Occam's razor: "entities should not be multiplied beyond necessity". "It urges us to choose the simplest explanations or models for any phenomenon we observe." William of Ockham, born around 1285.	"It has been a tool for scientific progress, not to mention a guiding principle for our thoughts, right up to the present day."
Hodges' model: a tool for individual learners and communities of practice.	"He was, I believe, the first person to so clearly separate science from its religious tethers, a move crucial to science's subsequent secular development."

McFadden, J. (2021) Razor sharp, New Scientist, 18-25 December. 252:3365/66. pp.70-71.

"Why models go wrong" BYTE, 1985

Why models go wrong
BYTE

 

"A model can be a physical object: a scale-model of an ancient settlement inferred from archeological evidence, or a physical anthropologist's reconstruction of a skeleton from a few bones and fragments. Most social models, however, are mathematical isomorphisms that specify one-to-one relationships between elements of the model and observable processes or entities. This abstractness gives models great versatility, but it also opens doors to potential problems. You don't need to be a naval architect to see that a model battleship has no bottom, but flaws in an equally defective sociometric model that repeatedly factors a large covariance matrix might escape casual scrutiny." p.151.

My source:
Houston, T.R. 1985. Why models go wrong. BYTE 10(10) : 151-164.

2021/22 Human Development Report: Uncertain Times, Unsettled Lives: Shaping our Future in a Transforming World

On Friday, 9 September 2022 at 00:37:02 BST, Dennis Raphael <draphael@yorku.ca> wrote:

Canada ranked 15^th… UK 18^th…

From: Pophealth <pophealth-bounces AT mailman13.u.washington.edu> On Behalf Of Stephen Bezruchka
Sent: Thursday, September 08, 2022 6:21 PM
To: pophealth AT u.washington.edu
Subject: [Pophealth] 2021 Health Olympics & vast US Health decline

Today the UN released its human development report with life expectancy for 2021. You can access it (Table 1) at http://report.hdr.undp.org.s3-website-us-east-1.amazonaws.com/

I've been using the UN rankings to create the health Olympics since the early 1990s for consistency. The U.S. ranks 44th, down from tied for 36 in 2019.  We are 7.6 years behind the longest lived country, Japan.  If we eradicated our three leading killers (heart disease, cancer, and COVID-19), we would be close to the first in the finish line.  In the UN rankings Thailand is now ahead of us!  And quite a few poorer nations.  

Trying to get action on our not being dead first is challenging.  

Stephen

Stephen Bezruchka MD, MPH
Departments of Health Systems and Population Health & of Global Health
School of Public Health 
Box 357660 
University of Washington 
Seattle, Washington 98195-7660

********************

My source - Dennis Raphael: draphael AT yorku.ca (with additional image c/o UNDP).

Politics of Health Group Mail List Messages

Visit the PoHG website for lots of interesting links and publications: http://www.pohg.org.uk/

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Webinar: WHO Classification of Self-Care Interventions for Health - Feb 14th

Webinar to present the WHO Classification of self-care interventions 

 09:00 Washington / 15:00 Geneva

This classification aligns with a people-centred approach to health and well-being outlined in the WHO global Guideline on Self-Care Interventions for Health and Well-being. This classification has a health system focus and aims to promote an accessible and bridging language for researchers, policymakers, donors and health programme managers working on self-care. 

Please register here:

https://attendee.gotowebinar.com/register/7796921047088796688

WHO resources on self-care interventions: 

 https://www.who.int/health-topics/self-care#tab=tab_1

WHO Classification of self-care interventions: 

https://www.who.int/publications/i/item/9789240039469

We look forward to your participation! 

Ados V. May, MPA | WHO/IBP Network

Senior Technical Advisor

email: ados.may AT phi.org

 

  Self - Individual - Person
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Community - Group - Population

Classification of Self-Care Interventions for Health	Classification of Self-Care Interventions for Health
Service planning and development Public engagement Informal carers Social care Care Givers Accountability Value for Money Population Health Users Patient - Self - Citizen Research?	Health For All Human Rights Health Services Reporting, Statistics and Planning, Standards Information Systems Infrastructure Governance, Regulation Population Health Finance, Value for Money Outcomes - Policy: National - International Sustainability

 

My source: IBP Network

Forgotten Rationales ... ?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

"One of the earliest attempts to systematically classify disease began with John Graunt’s mid-seventeenth-century examination of London’s Bills of Mortality (1939[1662]). London’s series of bubonic plague outbreaks in the first half of the seventeenth century served as the backdrop for Graunt’s statistical analysis. His primary objective was to develop a more comprehensive picture of London’s mortality in order to construct a disease-incident baseline from which to better understand the effects of plague, which tended to overshadow other causes of death. Essential to these objectives were the broader concerns for creating "population profiles through a study of causes of death" (Alter and Carmichael 1999, 121), which Graunt accomplished by estimating London’s population through a geographical analysis, allowing him to calculate crude mortality rates." p.96.

UK coronavirus: care providers allege Covid-19 death toll underestimated Care operators warn coronavirus may  already be in more than 50% of nursing homes (Robert Booth and Rowena Mason, Wed 15 Apr 2020 07.09 BST. The Guardian)

"Sydenham designed his nosology with the needs of the physician rather than those of the statistician in mind. Accordingly, Sydenham and Graunt produced different classification systems based on the distinct purposes for which they were intended. This distinction (clinical vs. demographic) played a more significant role in the nineteenth century, foreshadowing some of the tensions and cross-purposes that informed the development of modern classification systems. As Alter and Carmichael (1999, 121) note: 'The problematic relationship between causes of morbidity and causes of mortality thus presented an ideological barrier between the concerns of physicians and the interests of statisticians. ...one group were lumpers, the other splitters.'" p.97.

Beemer, Jeffrey Keith, "Social Meanings of Mortality: The Language of Death and Disease in 19th Century Massachusetts" (2011). Open Access Dissertations. 428.
https://scholarworks.umass.edu/open_access_dissertations/428

Q. Is the state of social care and the applicable policy and legislation under which it operates an example of an 'inverted ring-fence'? Discuss & debate, justifying key policy and legislation as you see it and the implications amid the COVID-19 crisis and future (health and social care) policy.
https://twitter.com/h2cm/status/1250405469929328647?s=20

Remember(?) also:
Forgotten Streams ...  

Paper: Rose, G. "Sick Individuals and Sick Populations" 1985

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

Sick Individuals	Sick Individuals
Sick Populations	Sick Populations

Geoffrey Rose, Sick individuals and sick populations, International Journal of Epidemiology, Volume 30, Issue 3, June 2001, Pages 427–432, https://doi.org/10.1093/ije/30.3.427


My source - with thanks:
Stewart Brock - message on FutureNHS Collaboration Platform

Data matters in Malaria prevention

INDIVIDUAL

|

INTER-PERSONAL : SCIENCES

HUMANISTIC -------------------------------------------------- MECHANISTIC

SOCIOLOGY : POLITICAL

|

GROUP

"The number of cases reported for 2000 has gone up in every  single World Malaria Report." Prof. Nicholas White, University of Oxford	Infections 2000 286m Infections 2018 228m   "It is impossible to interpret trends when the methodology  and systems change." p.4. Prof. Richard Price, Menzies School of Health Research, Australia
Burden of malaria on health and [socio-] economic development. Social Determinants of Health Sustainable Development Goals Social Capital Universal Health Coverage Health Services	World Malaria Report - WHO

My source:
Jack, A. Doubts cast on data showing progress of malaria prevention, FT Weekend, 7-8 December 2019, p.4.


[If climate change can affect the transmission of vectors and vectorial capacity, it is essential that due diligence and governance is also applied to prevent 'data creep - contagion'. The challenges in data gathering, statistic analysis are complex enough in theory, practice, policy and management. PJ]