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PubMed2006

What's next for translation research?

The National Institutes of Health (NIH) are under increasing pressure to identify practical, cost-effective interventions, therapies, and medications. Overall, the public health impact could be substantial if effective science-based prevention and treatment programs were implemented on large scales with sufficient fidelity. Yet penetration of even the most successful interventions rarely occurs at a quick pace. Research-to-practice gaps are pervasive throughout various fields of behavioral health and safety. In this article the authors explore factors contributing to the pace of translation and reaffirm that research advances or retreats the progress of scientific discovery as data accumulate in what can be described as a translational research loop that is iterative and bidirectional. They also touch on the challenges inherent in deploying science to the marketplace, and in an attempt to foreshadow what's next for translational efforts, they conclude by offering some ideas about how researchers might more accurately conceptualize "best practices."

Diffusion of Innovation↗

PubMedDate not supplied

Histology teachware for the Web site of the University of Medicine and Pharmacy "Gr. T. Popa" Iaşi.

Design and implementation of Web educational materials for medical sciences are discussed starting from a brief presentation of the current trends in using Internet facilities and placing emphasis on the specific case of the www page constructed for the Department of Histology. The paper focuses on the development of teaching-aids for the morphological study of organs and systems, illustrated by the creation of Histology Album, including photographs and explanatory texts, which is accessible via this www departmental page. Relevant aspects for the construction of the Histology Album are detailed in terms of both logical structure and physical implementation, based on HTML techniques. Outcomes are expected in achieving a noticeable progress in students' instruction, as a result of diversifying the documentation possibilities and increasing the role of the individual work (by avoiding the permanent supervision of an instructor). Further improvements of this www page are commented in the light of the recently proposed frameworks for distance learning, relying on specialized software tools that allow student's interactive work.

Academic Medical Centers↗

PubMed1997

Information management & decision support systems in the intensive care unit.

Management of the vast array and sheer volume of clinical data generated during the care of the critically ill patient is a formidable task. Not only must the data be acquired accurately, but it must be retrievable readily and in an interpretable form. Such characteristics are essential features, but the mere uncritical compilation of biomedical data barely takes advantage of the enormous computing power that is available at the bedside. A complete medical informatics package can assist the caregiver with clinical decision making, suggest or even carry out changes in management, and provide continuous, always vigilant surveillance for both dangerous alterations in physiology or ill-advised orders. For optimal implementation, knowledge of the origin, synthesis, and utility of clinical information is essential. A successful implementation using the skills of physicians, nurses, biomedical engineers, computer scientists, and hospital administrators must be collaborative. The characteristics of a clinical information system were defined recently by the Institute of Medicine of the National Academy of Sciences (Table 1). However, even the ideal system, implemented and administered by a harmonious and committed team, will not ensure clinical acceptance. The issue of accessibility can become paramount. If the system is not responsive to the needs of the occasional user, a great deal of expensive hardware will not be used to its full capability.

Journal Article↗

PubMedDate not supplied

Science and policy implications of defining environmental justice.

Although 'environmental justice' is an increasingly important issue for policy makers and researchers, it remains for many a vague and abstract notion that is hard to define in practical, real-world terms. Part of the problem is that environmental justice is a complex, multidimensional construct that cannot easily be defined. Our aim in this article is to identify fundamental dimensions of environmental justice and highlight the resulting questions that are an inherent part of putting principles into practice. We argue that to have a constructive and informed debate about this emotionally charged topic, it is necessary to have a clear and workable definition of environmental justice. We do not propose our own definition, but instead point out that there are many possible legitimate definitions depending on one's beliefs, opinions, and values. The central point is not that a particular definition is right or wrong, but rather than choosing a definition has distinct implications for the formulation, implementation, and evaluation of both policy and science. These critical choices should be made explicit so that public dialogue can focus on the substance of this important policy issue.

Environmental Health↗

PubMed1995

Emerging trends in the application of the social sciences to health and medicine.

Tensions are inevitable between funders seeking to solve specific health care issues within existing frameworks and many social scientists who see health and health care as reflections of societal stratification and processes of power and control. Many current and impending issues require deep scrutiny of values and meaning systems as they relate to class, gender, ethnicity and other forms of social differentiation. Interdisciplinary efforts provide social scientists important problem-solving opportunities but also occasions to refine disciplinary theories and methods. In recent years such efforts have resulted in increased sensitivity to demographic imperatives, prospective investigations, social experimentation, a growing appreciation of the complexity of life trajectories, development of more complex models of causation and remediation, and a revival of interest in meaning systems and their effects on ultimate outcomes. Social scientists have come to play a variety of roles in health services and policy research that contribute to a fruitful interplay of theory and practice. Major roles include helping to frame issues and how they are attacked; anticipating emerging trends, issues and problems; monitoring health and the provision of health services; evaluation and assessment; and implementation processes. The contributions of the social sciences to understanding complex organizational arrangements, structures, cultures, managerial approaches, financial arrangements and regulatory processes are increasingly evident and part of a culture of informed thinking.

Delivery of Health Care↗

PubMed1999

Reassessing the role of epidemiology in public health.

This commentary examines the scope of epidemiology and delineates the role of epidemiology in relation to public health. Epidemiology is a science; public health is a mission that is implemented through societal action. The implications of this difference are considered, and the sufficiency of epidemiology for guiding public health is evaluated in relation to other scientific disciplines and nonscientific considerations. The authors conclude that epidemiology is not the basic science of public health but one of many contributors to guiding action. The need for public health decisions despite scientific uncertainty and the potential for epidemiologic certainty's failing to provide clear guidance to public health action emphasize the distinctiveness of these endeavors. Criticisms that epidemiology fails to solve major public health problems, such as tobacco use; that it overemphasizes methods; that it fails to meet the needs of public health practitioners; and that it isolates itself from public health ethics are unwarranted. However, epidemiology should focus on addressing issues that directly affect public health decisions and should clearly communicate information about such issues to public health workers. Public health is far more complex than merely applying epidemiology.

Epidemiology↗

PubMed2002

The Modular Resource Center: integrated units for the study of the anatomical sciences in a problem-based curriculum.

The Modular Resource Center (MRC) at the College of Veterinary Medicine at Cornell University was created in 1993 as a way to provide visual resources in support of a newly implemented problem-based curriculum in which the anatomical sciences are taught primarily in the first tutorial-based course, The Animal Body. Over two dozen modules have been created specifically in support of this course, whereas additional modules have been created in support of other basic science courses. The basic unit of organization of the MRC is a module presented in a carrel that provides students a way to study, either alone or in groups, a given topic. The topic is presented through a script and an integrated set of anatomical materials including plastinated dissected specimens, vascular casts, skeletal preparations, models, radiographs, histological slides, and photo- and electron micrographs. The key feature of this resource center is that it is not a museum; rather it is more analogous to an interactive library, that can be used for reference, study, and review, not only by veterinary students but also by faculty, interns, residents, and undergraduates. A unique aspect is that all materials have been made by veterinary students working with faculty during the summer. Although started as a resource in support of a tutorial-based curriculum, the MRC has evolved over a decade into an anatomy resource that would be highly valued in any curricular format.

Anatomy↗

PubMed1996

A successful university-school-district partnership to help San Francisco's K-12 students learn about science and medicine.

The Science and Health Education Partnership (SEP) is a program at the University of California, San Francisco, established in 1987 to support the San Francisco School District ("the District") in its efforts to improve science education in grades K-12. A large cadre of active biomedical scientists and health professionals and a core program staff provide support to 90-95% of the District's schools. The District's students are from a variety of racial and ethnic groups, including a large percentage from underrepresented minorities (URMs). The SEP program has numerous components, some designed to help teachers (e.g., a clinician or scientist forms an ongoing partnership with a teacher to enrich classroom instruction) and some involving direct work with students (e.g., a contest where teams of students design and present lessons on science or health to their peers; activities related specifically to the encouragement of URM students). The SEP's perspective has evolved from an emphasis on assisting individual teachers and students to one of supporting systemic change throughout the District (e.g., supporting full implementation of hands-on, inquiry-based science instruction throughout the District via professional development). During this evolution, the kinds of issues facing program staff have changed and a great deal has been learned about fostering successful partnership activities. For example, (1) having a coordinator is crucial to make such a program work well; (2) it is easier to find start-up funding than to find continuing funding for ongoing activities that are working; and (3) it is important to work with the volunteering scientists and the teachers to help them understand what each has to offer the partnership and to encourage explicit dialogue about roles and expectations. The author concludes with advice for starting a new partnership: think big but start small, and work toward a long-term association based on communication and trust.

Adolescent↗

PubMedDate not supplied

[From scientific knowledge of clinical research to the bedside: clinical practice guidelines and their implementation].

Clinical practice guidelines (CPG) are targeted at health professionals and patients providing information for decision-making. They are aimed at reducing variations in medical practice in order to guarantee an optimum level of quality and improve health care. CPG are based on systematic reviews of biomedical literature and they recommend different clinical intervention strategies depending on the quality of scientific evidence on which they are based. However, we must bear in mind that scientific knowledge is only one of the elements that influence medical practice. Thus, it is not easy neither to recommend an intervention strategy for a specific circumstance (reality) from what has been studied in some rather ideal conditions (randomized controlled trial), nor to translate the context-dependent research evidence --effectiveness or cost-effectiveness studies- into a recommendation. These difficulties will be always present, as each patient (and his/her circumstances) is different from the others; but they can be lessened if more research is carried out to reduce uncertainty in clinical decision making. Finally, another difficulty that should be mentioned is that of CPG implementation, and in order to succeed in it, there is still much left to do in the health sciences field. Nevertheless, if there is not a good product to implement, the strategies used to do it will not be very helpful. Thus, we need to focus our efforts on the development of high quality CPG.

Biomedical Research↗

PubMed2005

National Occupational Standards in clinical embryology: implementation in 2005?

In 2001 the UK Department of Health initiated the National Occupational Standards Project in Healthcare Science. This project incorporates the 43 disciplines of healthcare science with the aim of developing a framework for competent performance in all areas of healthcare science, thereby standardising the delivery of services in this area. The whole of the project relies on the concept of function, and using the process of functional analysis each discipline is broken down into key work areas. The standards are derived from a further breakdown of these key work areas. Each standard gives expected requirements for the competent performance of the function, along with the relevant knowledge required. It is envisaged that the implementation of National Occupational Standards will ensure that individuals performing healthcare science functions throughout the UK, whether they are healthcare scientists themselves or not, will be performing these functions to an adequate standard. Since work began on the project 63 standards, and associated assessment guidance, have been drafted the whole of healthcare science. The National Occupational Standards are due to be implemented in 2005 by Skills for Health, an organisation that defines and monitors skills in healthcare both in the NHS and the private sector.

Humans↗

PubMed2006

[Democracy and science advice: the case of environmental health risks].

Science advice, in the context of environmental health, is an activity consisting in bringing together and evaluating available scientific data at a given moment on a particular question or concern regarding the hazardous nature of an agent or substance--whether it be of a physical, chemical or microbiological nature. Science advice also relates to assessing health risks linked to the quality of the environment, in vue of rendering this information useful to those in charge of decision making and risk management. Naturally, many groups are interested by a potential hazard or risk, and they all would like to effectively intervene over the course of the process in order to influence the decision or measure taken. In this article, the author recalls that risk is an entity which is both scientific and political by nature. Hence, this demand is well founded. Nevertheless, he proposes and explicates a series of different steps, whether concurrent or successive, throughout the entire process of science advice in support of decision-making on matters related to environmental risk. He justifies why hazard and risk assessment, followed by risk analysis, requisites a clear delineation of the roles of the various actors so that their own responsibilities could be clearly attributed. The "procedural" approach of science advice, which is more and more frequently implemented within international expert groups in the international arena, satisfactorily achieves the target of objectivity, transparency and accountability.

Decision Making↗

PubMedDate not supplied

The Scholarship of Engagement in nursing.

We propose the time is right for the Scholarship of Engagement to serve as a model of scholarship in schools of nursing given the shift towards community-based research and the emphasis of community-based research in the recently published National Institutes of Health (NIH) roadmap initiative. Thus, this article addresses the need of nursing academe to embrace a broader paradigm of scholarship, the Scholarship of Engagement, in order to expand knowledge development via implementation of the NIH roadmap. The need for implementation of a broader paradigm of nursing science within the context of nursing academics' roles is discussed.

Benchmarking↗

PubMed2006

Community participation in AIDS vaccine trials: empowerment or science?

For future AIDS vaccines to be successfully tested and implemented, extensive participation in vaccine trials will be necessary. Central to the challenges associated with such participation is concern for protection of participant wellbeing. This short report examines the tension that is sometimes found between the pragmatic need for recruitment into trials, and a more general social good concerning community participation in health. Community empowerment and trial participation are sometimes assumed to go hand in hand, but are potentially contradictory. Recognizing the possible disjunction between empowerment and trial participation allows for clearer discussion of and planning for ethical, scientifically valid trials.

AIDS Vaccines↗

PubMed1993

Interactive videodisc and compact disc-interactive for ophthalmic basic science and continuing medical education.

BACKGROUND: The authors designed and implemented a complete curriculum in ophthalmic pathology using IBM- and Macintosh-based interactive videodisc (IVD) technology. They also redesigned a portion of this curriculum for a new television-based platform, compact disc-interactive (CD-I). METHODS: The following issues were addressed: curriculum design, instructional design, the assembly of illustrations and the ownership of such materials, the generation of computer-based medical art and animation, and programming. The issue of academic credit for faculty participating in this effort also was considered. RESULTS: The computer-based IVD program provides the following features: (1) rapid access to thousands of high-quality illustrations with the option of superimposing graphic labels and text directly over pictures; (2) the ability to view enlargements of photographs; (3) an online glossary to view definition of terms coupled with high-quality photographs; and (4) a dynamic introduction to pathophysiology using interactive animation sequences. The authors were able to incorporate the same interactive features into the CD-I version. High-quality medical illustrations can be used effectively on the CD-I platform. CONCLUSIONS: Computer-based multimedia workstations are relatively expensive for personal use but may be useful if the equipment can be shared in a learning center or library. Compared with interactive computer-based solutions, consumer-oriented television-based technology such as CD-I is a relatively inexpensive vehicle for providing continuing medical education programs intended for use in the individual practitioner's office or home.

Compact Disks↗

PubMed2001

Problem-based learning in a new Canadian curriculum.

Problem-based learning (PBL) is a method of group learning that uses true-to-life problems as a stimulus for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences. This article documents the design and implementation of PBL in a second year course in the new curriculum of the University of Ottawa School of Nursing's Generic Program. The learning and teaching experiences of students and facilitators in this PBL course are described. As a way to determine students' perception of their learning using PBL, they were asked to respond to four questions. The most frequently described thinking processes were problem solving, nursing process and group process. When asked to describe the learning they derived from PBL, as differentiated from other instructional methods, students identified group process and problem solving most often. The most frequently identified factors that influenced performance and learning in PBL were positive attitude and group effort. The factors that affected the facilitators' performance of their role were large group size, insufficient practice of facilitator skills and PBL preparation. To enhance group process, facilitators modelled and shared roles. They fostered student motivation and development through formative evaluation. PBL produced clear benefits for students, such as increased autonomous learning, critical thinking, problem solving and communication. For facilitators, PBL was a liberation from the traditional role of 'content expert and super consultant'.

Communication↗

PubMed2002

Post-genomic opportunities for understanding nutrition: the nutritionist's perspective.

Until 15-20 years ago, many nutritionists were mainly interested in the effects of diet on health-related variables such as blood pressure and serum cholesterol concentrations. Without doubt, these studies have made an important contribution to our current understanding of the relationship between diet and health. For many reasons, however, few researchers have tried to explain these effects at the molecular level. Nowadays, however, it seems that the picture has been reversed; much research is being directed towards studying the effects of dietary components at the molecular level. This type of research has been made possible by, among other factors, the implementation of techniques from the more fundamental sciences into nutrition research. Also, the availability of genome sequences has accelerated this shift of interest. The aims of these studies are to obtain detailed information on the molecular and metabolic responses of cells and tissues, or even the whole organism, to dietary components. In these studies, also, the interactions between diet and genetic background, and between diet and different physiological and pathological conditions need to be addressed. However, it is not only important to obtain information on mechanisms, but also on the functional consequences for the organism. One ultimate question, however, is whether this information can be used to develop tests that can form the basis of dietary advice for specific subpopulations. These challenging questions can only be tackled through an integrated approach that combines the expertise from various disciplines.

Animals↗

PubMedDate not supplied

The CSAT methamphetamine treatment program: research design accommodations for "real world" application.

The Methamphetamine Treatment Program (MTP), funded by the Center for Substance Abuse Treatment, has the objectives of implementing the Matrix outpatient model and evaluating that model in comparison to the existing community "treatments as usual." Seven organizations in three western states (California, Montana, and Hawaii) were selected to participate in this randomized, controlled, multisite project in what constitutes the largest trial to date of treatment for methamphetamine (MA) dependence. One hundred fifty MA-dependent patients recruited at each site are randomly assigned to receive either the Matrix model, a manualized program of intensive outpatient treatment, or the site's standard treatment, "treatment as usual." Participants are evaluated at admission, weekly during treatment, at the time of scheduled discharge, and at six and 12 months after admission. Dependent measures assess changes in drug use, HIV risk behaviors, quality of life, and patient satisfaction. Cost analyses to quantify treatment costs and determine the association between costs and clinical outcomes will be conducted. A number of adjustments in the original study design have been necessitated by the realities of community sites' strengths and limitations. Experiences from this multisite project will also provide a model for other efforts to transfer research-based treatments into community settings. This article describes the main aims of the project, the background and rationale for the study design, a brief description of the research plan, and methods implemented to protect the integrity of the science.

Central Nervous System Stimulants↗

PubMed1997

The influence of accreditation on educational change in U.S. medical schools.

The authors examined the influence of accreditation on educational change and reform in U.S. medical schools in the past decade, by reviewing the survey databases and site visit reports of 90 schools that had comprehensive accreditation surveys by the Liaison Committee on Medical Education (LCME) between July 1992 and June 1997. In this study, substantive change was defined as centralizing the design and management of the curriculum, as well as one or more of the following reforms: integrating basic and clinical science instruction and/or conversion to interdisciplinary courses; implementing methods of active, small-group, independent, and hypothesis-based learning; and substantially increasing students' exposure to ambulatory and primary care. Accreditation reports were reviewed to determine the extent to which the LCME previously had admonished schools for shortcomings in their educational programs and advised curricular changes. Notice was taken of grant support by national foundations promoting educational reform, in relation both to the correction of accreditation deficiencies and to curricular reform undertaken by schools on their own initiative. The study also scrutinized the evolution of accreditation standards promoting educational reform, and the LCME's support of initiatives for shortening the period of medical education and promoting performance-based teaching and the assessment of clinical skills. On entering the 1990s, the LCME toughened the standards for design and management of the medical curriculum and for the evaluation of educational program effectiveness that schools must conduct. The greater assessment rigor identified educational shortcomings in 61 of 90 medical schools coming up for accreditation surveys during 1992-1997. On those occasions, 34 of the 61 schools had instituted reforms or were on the verge of doing so. Twenty-five of the schools carrying out reforms (73%) had received major foundation grants, compared with ten of the 27 schools (37%) that had accomplished little. Fifteen schools that had not been reproached earlier were found on the 1992-1997 surveys to have undertaken substantial innovation on their own initiative, five with the help of major foundation awards. The study also shows that a number of schools implemented parts of more sweeping reforms with the help of smaller foundation grants for more discrete purposes. In some instances, it has not been possible to differentiate the influence of the LCME as a force for educational reform from the incentives for change created by national foundations. Overall, the LCME, through its standards and assessment practices, and in synergy with schools and kindred agencies promoting change, is now on the leading edge of improved education and evaluation in the nation's medical schools.

Accreditation↗