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PubMed2004

The route to atomic and quantum standards.

Over the past half-century, there has been a shift away from standards based on particular artifacts toward those based on physical effects, the most stable being based on quantum properties of systems. This change was proposed at the end of the 19th century but is still not complete at the start of the 21st. We discuss how this vision has been implemented through recent advances in science and metrology and how these may soon lead to an SI system finally free from artifact standards, with a consistency based on fundamental constants.

Journal Article↗

PubMed2004

The next phase of healthcare improvement: what can we learn from social movements?

To date, improvement in health care has relied mainly on a "top down" programme by programme approach to service change and development. This has spawned a multitude of different and often impressive improvement schemes and activities. We question whether what has been happening will be sufficient to achieve the desired scale of change within the time scales set. Is it a case of "more of the same" or are there new and different approaches that might now be usefully implemented? Evidence from the social sciences suggests that other perspectives may help to recast large scale organisational change efforts in a new light and offer a different, though complementary, approach to improvement thinking and practice. Particularly prominent is the recognition that such large scale change in organisations relies not only on the "external drivers" but on the ability to connect with and mobilise people's own "internal" energies and drivers for change, thus creating a "bottom up" locally led "grass roots" movement for improvement and change.

Australia↗

PubMed2004

Training the next generation of informaticians: the impact of "BISTI" and bioinformatics--a report from the American College of Medical Informatics.

In 2002-2003, the American College of Medical Informatics (ACMI) undertook a study of the future of informatics training. This project capitalized on the rapidly expanding interest in the role of computation in basic biological research, well characterized in the National Institutes of Health (NIH) Biomedical Information Science and Technology Initiative (BISTI) report. The defining activity of the project was the three-day 2002 Annual Symposium of the College. A committee, comprised of the authors of this report, subsequently carried out activities, including interviews with a broader informatics and biological sciences constituency, collation and categorization of observations, and generation of recommendations. The committee viewed biomedical informatics as an interdisciplinary field, combining basic informational and computational sciences with application domains, including health care, biological research, and education. Consequently, effective training in informatics, viewed from a national perspective, should encompass four key elements: (1). curricula that integrate experiences in the computational sciences and application domains rather than just concatenating them; (2). diversity among trainees, with individualized, interdisciplinary cross-training allowing each trainee to develop key competencies that he or she does not initially possess; (3). direct immersion in research and development activities; and (4). exposure across the wide range of basic informational and computational sciences. Informatics training programs that implement these features, irrespective of their funding sources, will meet and exceed the challenges raised by the BISTI report, and optimally prepare their trainees for careers in a field that continues to evolve.

Computational Biology↗

PubMed2002

Improving the health of workers in indoor environments: priority research needs for a national occupational research agenda.

Indoor nonindustrial work environments were designated a priority research area through the nationwide stakeholder process that created the National Occupational Research Agenda. A multidisciplinary research team used member consensus and quantitative estimates, with extensive external review, to develop a specific research agenda. The team outlined the following priority research topics: building-influenced communicable respiratory infections, building-related asthma/allergic diseases, and nonspecific building-related symptoms; indoor environmental science; and methods for increasing implementation of healthful building practices. Available data suggest that improving building environments may result in health benefits for more than 15 million of the 89 million US indoor workers, with estimated economic benefits of $5 to $75 billion annually. Research on these topics, requiring new collaborations and resources, offers enormous potential health and economic returns.

Air Pollutants, Occupational↗

PubMed2006

Student and community outcomes in service-learning: part 1--student perceptions.

Service-learning has a long and distinguished history of providing valuable experiences to students across all academic levels. Professional disciplines are well situated to provide students with opportunities related to service-learning while also providing needed health care services to communities. This article and Part 2 on pages 516-518 of this issue describe a service-learning initiative implemented in a bachelor of science in nursing program. Part 1 details students' perceptions of outcomes realized from the program, and Part 2 describes community outcomes. The purposes of the program were to enhance students' skills in history-taking, blood pressure and heart rate assessment skills, and beginning counseling skills, as well as provide the university community with blood pressure screening and counseling in a convenient and accessible location. Data on students' perceptions were collected for each semester of the program and for 1 year after students' participation in the program. Students perceived gains in blood pressure and heart rate skill performance, beginning counseling skills, their understanding of tailored client action plans, and their professional commitment to the health of the community.

Community Health Services↗

PubMed2005

Lessons learned: a successful distance learning collaborative between the Department of Veterans Affairs and the Department of Defense.

Academic, business, and government organizations are increasingly looking to distance education to meet workforce learning needs. This modality differs from classroom education, however, and simply transferring content from a traditional classroom to a distance learning application can result in poor outcomes. The Department of Veterans Affairs and the Uniformed Services University of the Health Sciences Graduate School of Nursing implemented a program preparing adult nurse practitioners solely through the medium of distance education, with no university "in-residence" requirement. Lessons learned from this success can prove useful to organizations that are planning distance education initiatives.

Curriculum↗

PubMedDate not supplied

Bridging the "theory-practice gap" in renal nursing: establishing a renal professional practice model. Experiences of the Adam Linton Dialysis Unit.

The renal program (RP) at the London Health Sciences Centre (LHSC) chose to implement a professional practice model (PPM). This paper examines the implementation and maintenance issues of the renal professional practice model (RPPM) at the Adam Linton Dialysis Unit (ALU), one unit of several dialysis units affiliated with the LHSC RP. The discussion includes primary nursing as the care delivery system for the RPPM. Attention is paid to experiences post program transfer--when the renal programs from St. Joseph's Health Centre and LHSC merged. The final focus of this paper is on the practical experiences of nurses at the ALU while using this model. Included are: Systems in place to support the success of this model. How leadership and staff contributed to the model's success. How this model might have improved patient outcomes. How this model could enhance both patient and staff satisfaction.

Clinical Nursing Research↗

PubMed2005

WHO framework convention on tobacco control and its relevance to the dental professions in South Africa.

One in nine deaths in South Africa is related to tobacco use. Recognition of the need for global partnership to curb the tobacco epidemic has led to the WHO member states' adoption of the first global public health treaty--the framework convention for tobacco control (FCTC). Relevant to the dental profession, within the FCTC's guiding principle of the need to protect all persons from the initiation, maintenance or increase of tobacco use are articles 12 and 14. These challenge parties to take action to train health workers and to secure treatment for tobacco dependence. Preventing initiation of tobacco use by youths is as fundamental to the prevention of periodontal disease and oro-pharyngeal cancer as providing fluoride and dental sealants for the prevention of dental caries. Tobacco control, whether in private practice or in public service, must be viewed within the context of an ethical obligation for primary prevention. There are science-based clinical guidelines for implementing tobacco prevention and tobacco cessation. Dentists who implement an effective cessation programme in their practices can expect to achieve quit rates of 10-15% each year. However, this primary prevention effort can be no better than the knowledge, skills and values of the practitioners providing the service. The FCTC may change the environment that dentistry is practised in globally. The relevant stakeholders in the dental profession should therefore assume stewardship by providing support for the training of dental professionals in tobacco counselling and advocate for the adequate reimbursement of practitioners providing such services.

Adult↗

PubMedDate not supplied

[Catastrophe hygiene, its contents and place in the federal surveillance service system in the protection of consumers' rights and human well-being].

In the past two decades, there has been an increase in the number of earthquakes, tidal waves, accidents at chemically dangerous enterprises, and other types of catastrophes, which have posed an emergency survival problem for society. The scientific development of this problem has given rise to a new area of preventive medicine--catastrophe hygiene that is designed to eliminate (reduce) the poor influence of emergency factors and to offer the suffered population safe conditions of accommodation and/or life, water supply, nutrition, and other elements of survival under these conditions. The paper defines the subject and objects of studies in catastrophe hygiene. It characterizes the value and role of this science in the organization and implementation of preventive measures to liquidate the medicosanitary consequences of emergencies, as well as the place of hygienic facilities and research institutes within the framework of the Russian emergency service.

Emergencies↗

PubMed1999

Analysis and interpretation of short tandem repeat microvariants and three-banded allele patterns using multiple allele detection systems.

The Palm Beach County Sheriffs Office (PBSO) Crime Laboratory and the Alabama Department of Forensic Sciences (ADFS) have validated and implemented analysis of short tandem repeat (STR) sequences on casework using silver staining kit and SYBR Green I detection systems and are presently validating fluorescently tagged STR alleles using the Hitachi FMBIO 100 instrument. Concurrently, the Broward County Sheriff's Office (BSO) Crime Laboratory is validating the ABI Prism310 Genetic Analyzer capillary electrophoresis STR detection system (ABI CE310) from Perkin Elmer Applied BioSystems. During the course of analyzing over 10,000 individuals for the STR loci CSF1PO, TPOX and THO1 (CTT) using silver staining for allele detection, 42 samples demonstrated alleles that were "off ladder," contained three-banded patterns at a single locus, or exhibited an apparent THO1 "9.3,10" allele pattern. PBSO, ADFS and BSO Crime Laboratories have collaborated on the verification of the allele patterns observed in these 42 samples using the following allele detection systems: (1) manual silver staining, (2) SYBR Green I staining, and/or (3) fluorescently tagged amplified products separated by polyacrylamide gel electrophoresis or capillary electrophoresis followed by laser detection. Regardless of the CTT allele detection system utilized, concordant results were obtained for 41 of the 42 samples. The only exception was a sample in which a wide band within the THO1 locus was identified as a THO1 "9.3, 10" genotype by silver staining kit and SYBR Green I staining but was verified to be a THO1 "9.3" homozygote by all other allele detection systems. Manual allele detection could readily identify microvariants, as a visual assessment of stained gels clearly shows that alleles do not migrate coincident with well-characterized allele size standards. As would be predicted, however, the manual detection systems did not provide adequate resolution to approximate the basepair size for off-ladder variants. All fluorescent software program systems were consistent in designating alleles "not in range" or "off ladder," thereby indicating true microvariants. All single-locus three-banded patterns were detected using all of the STR multiplex systems. In addition, individual locus-specific primers verified multiplexed amplified products were specific for the locus in question.

Alleles↗

PubMed2006

Understanding health care organization needs and context. Beyond performance gaps.

Significant efforts have been invested in improving our understanding of how to accelerate and magnify the impact of research on clinical practice. While approaches to fostering translation of research into practice are numerous, none appears to be superior and the evidence for their effectiveness is mixed. Lessons learned from formative evaluation have given us a greater appreciation of the contribution of context to successful implementation of quality improvement interventions. While formative evaluation is a powerful tool for addressing context effects during implementation, lessons learned from the social sciences (including management and operations research, sociology, and public health) show us that there are also powerful preimplementation tools available to us. This paper discusses how we might integrate these tools into implementation research. We provide a theoretical framework for our need to understand organizational contexts and how organizational characteristics can alert us to situations where preimplementation tools will prove most valuable.

Delivery of Health Care↗

PubMed2006

Developing an innovative undergraduate curriculum--responding to the 2002 National Review of Nursing Education in Australia.

The Australian government responded to the recent global critical shortage of registered nurses by initiating a national review into nursing education. The 36 recommendatons of the review report published in 2002 supported one or more of three strategies: building a sustainable workforce throuh partnership; maximising health outcomes through quaality education; and capacity building. The review drew extensively on the international research literature, invited submissions, previous reviews and commissioned research. This paper articulates the key features of a new innovative undergraduate nursing curriculum that incorporates several of the recommendations of the national review, specifically a new approach in delivery of the clinical component of the curriculum. The curriculum model emerged from a strategically planned partnership between a university and heath care providers committed to improving graduate outcomes and transition into professional practice. The curriculum was implemented in 2004 in a Faculty of Health Sciences that had not previously offered nursing programs. It is anticipated that the newly implemented undergraduate nursing program, modelled on a clinical schools partnership approach, will graduate registered nurses able to face the challenges of a rapidly changing health sector. The objective of this paper is to describe the key features of the program and share new insights that might challenge traditional curriculum approaches in undergraduate nursing.

Australia↗

PubMed2004

Weaving basic and social sciences into a case-based, clinically oriented medical curriculum: one school's approach.

Southern Illinois University School of Medicine recently completed its fourth year of a resource-session-enhanced, case-based, tutor-group-oriented curriculum. As an example of a curricular unit, the authors describe the implementation of the basic and clinical sciences in one of the four units in year one, and detail that unit's organization, logistics, content, rationale, and other characteristics. The Sensorimotor Systems and Behavior (SSB) unit is preceded by a cardio-respiratory-renal unit and is followed by an endocrine-reproductive-gastrointestinal unit. A Doctoring unit temporally spans each of these three units. The SSB unit is allotted an 11.5-week period that includes an aggregate of 2.5 weeks of available clinical time, 1.5 weeks for examinations and exam study time, and approximately 8.5 weeks for tutor-group sessions, mandatory laboratory sessions, and self-directed learning. Optional resource sessions are offered during a two- to four-hour block on a single morning each week. Clinical training in the SSB unit augments self-directed, laboratory, and tutor-group learning of neuroscience, gross anatomy, cell biology, physiology, biochemistry, behavioral and social science, embryology, limited pharmacology and genetics, and basic clinical neurology for first-year students. Although it is fast-paced and places heavy responsibility for independent learning on the students, the SSB unit culminates in significant achievement in the basic and clinical sciences. The unit provides substantial clinical training and practical experience in physical and neurological examinations that directly integrate with basic science knowledge. The unit reduces lecture-based instruction, demands self-determination, and promotes experience in team effort, professionalism, peer interaction, empathy in clinical medicine, and practical use of basic science knowledge.

Curriculum↗

PubMed1988

Integrated Academic Information Management Systems (IAIMS). Part II. Planning and implementing integrated information services. Integration and outreach: Integrated Academic Information Management Systems (IAIMS) at Maryland.

The University of Maryland Campus for the Professions is now realizing the first benefits of integrated academic information management systems (IAIMS). With the support of the National Library of Medicine, the information Resources Management Division has joined with the Health Sciences Library to plan and to implement change. Within the information utility concept, networked data communications and end-user computing function as the means to integration. Plans call for new 370-based software to extend system capabilities. Mechanisms for outreach ensure that the potential of integration is realized. These mechanisms include technology assisted learning centers, informatics program development, special programs (geriatrics, hypertension pilot), and new applications (conferencing system, voice mail, videodisc development, interinstitutional resource sharing).

Academic Medical Centers↗

PubMed1993

1992 AAD Award for Excellence in Education: The Integrated Basic and Clinical Science Conference Series at the University of Texas Southwestern Medical Center.

This article was written to share information concerning the establishment and implementation of a successful, integrated basic and clinical science conference series for resident trainees in dermatology. We discuss the underlying philosophy and describe the concepts employed in, and the dynamics that have resulted from, this educational experiment. Finally, we include the schedule and references for the 1993-1994 academic year.

Academic Medical Centers↗

PubMed2001

Endocrine PBL in the year 2000.

The Southern Illinois University School of Medicine (SIU-SOM) has utilized problem-based learning (PBL) in its curriculum since 1981, when Dr. Howard Barrows joined the faculty. From 1989 to 2000, SIU-SOM implemented two parallel curricula for the basic science years (years I and II), one curriculum being a problem-based learning curriculum (PBLC). An executive decision to design and implement a single curriculum, to begin in Fall 2000, fostered a review of existing pedagogy upon which to base this new curriculum: C2000. The results of this review, which considered formal outcome measures as well as internal review in consideration of the institutional mission, led to PBL becoming the predominant pedagogy for C2000, albeit with some modifications from its PBLC predecessor. C2000, then, represents the third iteration of PBL in use at SIU-SOM, and its design and rationale offer insight for the teaching of Endocrine Physiology in a PBLC.

Education, Medical↗

PubMed2004

Developing and systematically implementing participatory action research.

Participatory Action Research (PAR) is a collaborative approach to conducting research that recently emerged as a paradigm for bridging science and clinical practice. The key characteristic of this approach--collaboration between consumers and researchers--often increases the relevance of research while maintaining the standards of scientific rigor. Although PAR is receiving increased attention from researchers and consumers in social science and public health, it has not been implemented widely. Some of the reasons for a limited application of PAR in the field include lack of knowledge about PAR and strategies for its implementation. This article defines PAR, provides an overview of the characteristics of this approach, and discusses 4 elements for systematic incorporation of the PAR approach into the research process. The elements are (1) participant selection and recruitment, (2) role and relationship clarification for researchers and participants, (3) research team education, and (4) management and support.

Community Participation↗

PubMed2000

Community-based curriculum in psychiatric nursing science.

As community-based health care delivery is now a prominent feature of the health care system in South Africa, nursing curricula are being challenged to prepare student nurses for community-based nursing roles and responsibilities. The purpose of this study was to describe guidelines for a community-based curriculum in psychiatric nursing science for a nursing college in KwaZulu-Natal. A qualitative, quantitative, exploratory, descriptive and contextual design was employed. To reach the purpose of the study, a situational analysis was done in three phases to identify the principles for a community-based curriculum for psychiatric nursing science. PHASE I: A document analysis of relevant government policies and legislation. PHASE II: Statistics from psychiatric hospitals and community psychiatric clinics. PHASE III: Focus group interviews with nurse educators and literature control and conceptual framework. The principles obtained from the three phases were used to formulate the guidelines for a community-based curriculum in psychiatric nursing science. (PHASE IV): Eight guidelines with practical implications are described for the implementation of a Community-based curriculum in Psychiatric Nursing Science.

Attitude of Health Personnel↗