9 research outputs found
Automating Spacecraft Analysis: The Era of Ontological Modeling & Simulation
Verification by analysis is a predicted compliance of a design to imposed requirements. The levels of performance specified by performance requirements can be related to Technical Performance Measures (TPM) in a Model-Based Systems Engineering (MBSE) environment, but engineers performing verification by analysis are not commonly versed in professional Systems Engineering (SE) techniques or modeling languages such as SysML. As the formal application of Systems Engineering (SE) results in a diminution of time, effort, and money for large-scale projects, enabling technical engineers performing verification by analysis to contribute to MBSE improvements in the course of their daily work is financially incentivized. Ontologies applied to technical analysis methodologies are shown to improve the quality of verification by analysis activities while adhering to professional organization standards such as the International Council on Systems Engineering (INCOSE) SE Handbook and the National Aeronautics and Space Administration (NASA) standard 7009A: Standard for Models and Simulations
Hospitalisations at the end of life: using a sentinel surveillance network to study hospital use and associated patient, disease and healthcare factors
<p>Abstract</p> <p>Background</p> <p>Hospital deaths following several hospital admissions or long hospital stays may be indicative of a low quality of dying. Although place of death has been extensively investigated at population level, hospital use in the last months of life and its determinants have been studied less often, especially in Europe and with a general end-of-life patient population. In this study we aim to describe hospital use in the last three months of life in Belgium and identify associated patient, disease and healthcare factors.</p> <p>Methods</p> <p>We conducted a retrospective registration study (13 weeks in 2004) with the Belgian Sentinel Network of General Practitioners, an epidemiological surveillance system representative of all GPs in Belgium, covering 1.75% of the total Belgian patient population. All registered non-sudden or expected deaths of patients (aged one year or older) at the GPs' practices were included. Bivariate and regression analyses were performed.</p> <p>Results</p> <p>The response rate was 87%. The GPs registered 319 deaths that met inclusion criteria. Sixty percent had been hospitalised at least once in the last three months of life, for a median of 19 days. The percentage of patients hospitalised increased exponentially in the last weeks before death; one fifth was admitted in the final week of life. Seventy-two percent of patients hospitalised at least once in the final three months died in hospital. A palliative treatment goal, death from cardiovascular diseases, the expression of a wish to die in an elderly home and palliative care delivery by the GP were associated with lower hospitalisation odds.</p> <p>Conclusion</p> <p>Hospital care plays a large role in the end of patients' lives in Belgium, especially in the final weeks of life. The result is a high rate of hospital deaths, showing the institutionalised nature of dying. Patients' clinical conditions, the expression of preferences and also healthcare characteristics such as being treated as a palliative care patient, seem to be associated with hospital transfers. It is recommended that hospitalisation decisions are only made after careful consideration. Short admissions in the final days of life should be prevented in order to make dying at home more feasible.</p