Geriatric pharmacotherapy : optimisation through integrated approach in the hospital setting

Since older patients are more vulnerable to adverse drug-related events, there is a need to ensure appropriate prescribing in these patients in order to prevent misuse, overuse and underuse of drugs. Different tools and strategies have been developed to reduce inappropriate prescribing; the available measures can be divided into medication assessment tools, and specific interventions to reduce inappropriate prescribing. Implicit criteria of inappropriate prescribing focus on appropriate dosing, search for drug-drug interactions, and increase adherence. Explicit criteria are consensus-based standards focusing on drugs and diseases and include lists of drugs to avoid in general or lists combining drugs with clinical data. These criteria take into consideration differences between patients, and stand for a medication review, by using a systematic approach. Different types of interventions exist in order to reduce inappropriate prescribing in older patients, such as: educational interventions, computerized decision support systems, pharmacist-based interventions, and geriatric assessment. The effects of these interventions have been studied, sometimes in a multifaceted approach combining different techniques, and all types seem to have positive effects on appropriateness of prescribing. Interdisciplinary teamwork within the integrative pharmaceutical care is important for improving of outcomes and safety of drug therapy. The pharmaceutical care process consists offour steps, which are cyclic for an individual patient. These steps are pharmaceutical anamnesis, medication review, design and follow-up of a pharmaceutical care plan. A standardized approach is necessary for the adequate detection and evaluation of drug-related problems. Furthermore, it is clear that drug therapy should be reviewed in-depth, by having full access to medical records, laboratory values and nursing notes. Although clinical pharmacists perform the pharmaceutical care process to manage the patient’s drug therapy in every day clinical practice, the physician takes the ultimate responsibility for the care of the patient in close collaboration with nurses

Control system software, simulation, and robotic applications

All essential existing capabilities needed to create a man-machine interaction dynamics and performance (MMIDAP) capability are reviewed. The multibody system dynamics software program Order N DISCOS will be used for machine and musculo-skeletal dynamics modeling. The program JACK will be used for estimating and animating whole body human response to given loading situations and motion constraints. The basic elements of performance (BEP) task decomposition methodologies associated with the Human Performance Institute database will be used for performance assessment. Techniques for resolving the statically indeterminant muscular load sharing problem will be used for a detailed understanding of potential musculotendon or ligamentous fatigue, pain, discomfort, and trauma. The envisioned capacity is to be used for mechanical system design, human performance assessment, extrapolation of man/machine interaction test data, biomedical engineering, and soft prototyping within a concurrent engineering (CE) system

Systems design analysis applied to launch vehicle configuration

As emphasis shifts from optimum-performance aerospace systems to least lift-cycle costs, systems designs must seek, adapt, and innovate cost improvement techniques in design through operations. The systems design process of concept, definition, and design was assessed for the types and flow of total quality management techniques that may be applicable in a launch vehicle systems design analysis. Techniques discussed are task ordering, quality leverage, concurrent engineering, Pareto's principle, robustness, quality function deployment, criteria, and others. These cost oriented techniques are as applicable to aerospace systems design analysis as to any large commercial system

On Engineering Support for Business Process Modelling and Redesign

Currently, there is an enormous (research) interest in business process redesign (BPR). Several management-oriented approaches have been proposed showing how to make BPR work. However, detailed descriptions of empirical experience are few. Consistent engineering methodologies to aid and guide a BPR-practitioner are currently emerging. Often, these methodologies are claimed to be developed for business process modelling, but stem directly from information system design cultures. We consider an engineering methodology for BPR to consist of modelling concepts, their representation, computerized tools and methods, and pragmatic skills and guidelines for off-line modelling, communicating, analyzing, (re)designing\ud business processes. The modelling concepts form the architectural basis of such an engineering methodology. Therefore, the choice, understanding and precise definition of these concepts determine the productivity and effectiveness of modelling tasks within a BPR project. The\ud current paper contributes to engineering support for BPR. We work out general issues that play a role in the development of engineering support for BPR. Furthermore, we introduce an architectural framework for business process modelling and redesign. This framework consists of a coherent set of modelling concepts and techniques on how to use them. The framework enables the modelling of both the structural and dynamic characteristics of business processes. We illustrate its applicability by modelling a case from service industry. Moreover, the architectural framework supports abstraction and refinement techniques. The use of these techniques for a BPR trajectory are discussed

NASA/DOD Aerospace Knowledge Diffusion Research Project. Paper 19: Computer and information technology and aerospace knowledge diffusion

To remain a world leader in aerospace, the US must improve and maintain the professional competency of its engineers and scientists, increase the research and development (R&D) knowledge base, improve productivity, and maximize the integration of recent technological developments into the R&D process. How well these objectives are met, and at what cost, depends on a variety of factors, but largely on the ability of US aerospace engineers and scientists to acquire and process the results of federally funded R&D. The Federal Government's commitment to high speed computing and networking systems presupposes that computer and information technology will play a major role in the aerospace knowledge diffusion process. However, we know little about information technology needs, uses, and problems within the aerospace knowledge diffusion process. The use of computer and information technology by US aerospace engineers and scientists in academia, government, and industry is reported

Set-based approach to passenger aircraft family design

Presented is a method for the design of passenger aircraft families. Existing point-based methods found in the literature employ sequential approaches in which a single design solution is selected early and is then iteratively modified until all requirements are satisfied. The challenge with such approaches is that the design is driven toward a solution that, although promising to the optimizer, may be infeasible due to factors not considered by the models. The proposed method generates multiple solutions at the outset. Then, the infeasible solutions are discarded gradually through constraint satisfaction and set intersection. The method has been evaluated through a notional example of a three-member aircraft family design. The conclusion is that point-based design is still seen as preferable for incremental (conventional) designs based on a wealth of validated empirical methods, whereas the proposed approach, although resource-intensive, is seen as more suited to innovative designs

An Integrated Engineering-Computation Framework for Collaborative Engineering: An Application in Project Management

Today\u27s engineering applications suffer from a severe integration problem. Engineering, the entire process, consists of a myriad of individual, often complex, tasks. Most computer tools support particular tasks in engineering, but the output of one tool is different from the others\u27. Thus, the users must re-enter the relevant information in the format required by another tool. Moreover, usually in the development process of a new product/process, several teams of engineers with different backgrounds/responsibilities are involved, for example mechanical engineers, cost estimators, manufacturing engineers, quality engineers, and project manager. Engineers need a tool(s) to share technical and managerial information and to be able to instantly access the latest changes made by one member, or more, in the teams to determine right away the impacts of these changes in all disciplines (cost, time, resources, etc.). In other words, engineers need to participate in a truly collaborative environment for the achievement of a common objective, which is the completion of the product/process design project in a timely, cost effective, and optimal manner. In this thesis, a new framework that integrates the capabilities of four commercial software, Microsoft Excel™ (spreadsheet), Microsoft Project™ (project management), What\u27s Best! (an optimization add-in), and Visual Basic™ (programming language), with a state-of-the-art object-oriented database (knowledge medium), InnerCircle2000™ is being presented and applied to handle the Cost-Time Trade-Off problem in project networks. The result was a vastly superior solution over the conventional solution from the viewpoint of data handling, completeness of solution space, and in the context of a collaborative engineering-computation environment

Principles of models based engineering

This report describes a Models Based Engineering (MBE) philosophy and implementation strategy that has been developed at Los Alamos National Laboratory`s Center for Advanced Engineering Technology. A major theme in this discussion is that models based engineering is an information management technology enabling the development of information driven engineering. Unlike other information management technologies, models based engineering encompasses the breadth of engineering information, from design intent through product definition to consumer application

A distributed knowledge-based approach to flexible automation : the contract-net framework

Includes bibliographical references (p. 26-29)

Aircraft optimization by a system approach: Achievements and trends

Recently emerging methodology for optimal design of aircraft treated as a system of interacting physical phenomena and parts is examined. The methodology is found to coalesce into methods for hierarchic, non-hierarchic, and hybrid systems all dependent on sensitivity analysis. A separate category of methods has also evolved independent of sensitivity analysis, hence suitable for discrete problems. References and numerical applications are cited. Massively parallel computer processing is seen as enabling technology for practical implementation of the methodology