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The changing landscape of antiparasitic drug discovery for veterinary medicine.

Changes in economic imperatives in the pharmaceutical industry have led to a wave of consolidation, which has had the unintended side effect of shrinking the resource devoted to antiparasitic drug discovery in animal health companies. Scientific changes have altered the way in which drugs could be discovered in the future. New science and business models will need to be implemented to address the demand for innovative antiparasitic drugs in veterinary medicine. Novel drugs are needed to combat drug resistance and for currently non-addressed problems. At the center of the future for this field, however, lies the need for more support into the basic research on the biology of parasites.

Animals↗

Re-engineering: a prescription for hospitals.

Previously applied mostly in large, private sector corporations, "re-engineering" is fast becoming a tool that hospitals can use to break away from the old to find a new and better way of doing things. Re-engineering, however, first requires strong leadership which is committed to employee involvement and re-inventing the process design to meet the needs of the customers. Once the transition has been completed, the processes and the organization must continue to be managed differently. This article reviews the processes involved in re-engineering, and discusses the implementation of the initiative at the Sunnybrook Health Science Centre in Toronto.

Hospital Restructuring↗

Slipping through sky holes: Yurok body imagery in northern California.

Yurok perceptions of the body as the inscribed surface of social and environmental change are explored in this paper. To the violence and brutality of Spaniards, fur traders, gold miners, American soldiers, and Indian policies of the US government since the eighteenth century, Yurok women attribute the high incidence of degenerative diseases, drug abuse and criminality in northern California. This piece contemplates the lives of eight generations of sixteen Yurok extended families, mapping intergenerational shifts in Yurok social relations and political practices. It considers the mutation of knowledge in the constitution of the natural and social sciences and the effects of this knowledge when implemented in Yurok country. Here, Foucault's genealogical method values what anthropology and biomedicine, for example, tend to disregard in the analysis of descent: the correlation between body and history. This historico-critical investigation shows how certain events mark their power and engrave memories on individuals' bodies. It is within a hybrid set of cross-cultural and interdisciplinary practices that a more fruitful understanding of Yurok body imagery can be fashioned.

Body Image↗

The cultural adaptation of prevention interventions: resolving tensions between fidelity and fit.

A dynamic tension has developed in prevention science regarding two imperatives: (a) fidelity of implementation-the delivery of a manualized prevention intervention program as prescribed by the program developer, and (b) program adaptation-the modification of program content to accommodate the needs of a specific consumer group. This paper examines this complex programmatic issue from a community-based participatory research approach for program adaptation that emphasizes motivating community participation to enhance program outcomes. Several issues, key concepts, and implementation strategies are presented under a strategic approach to address issues of fidelity and adaptation. Despite the noted tension between fidelity and adaptation, both are essential elements of prevention intervention program design and they are best addressed by a planned, organized, and systematic approach. Towards this aim, an innovative program design strategy is to develop hybrid prevention programs that "build in" adaptation to enhance program fit while also maximizing fidelity of implementation and program effectiveness.

Adolescent↗

Nationwide implementation of guided supermarket tours in The Netherlands: a dissemination study.

The purpose of this study was to assess adoption, implementation and maintenance of a guided supermarket tour program of nutrition education by Dutch Public Health Services (PHSs), and the factors associated with program dissemination. A first questionnaire was sent to all 60 PHSs, and measured program adoption, perceived program attributes, and characteristics of the adopting organization and person. A second questionnaire was only sent to adopting PHSs, and measured extent and success of implementation, intentions to continue the program, and characteristics of the main implementing person. Of the 59 PHSs who responded, 30 adopted the program and 17 implemented it sufficiently. Perceived program complexity, social influence within the PHS toward program participation and existence of a separate health education department were predictors of adoption. Perceived program complexity was also a predictor of extent of implementation. The number of health educators within each PHS was a predictor of sufficient implementation. It was concluded that adoption and implementation of the program was reasonable, considering the limited dissemination strategy. Dissemination might have been more successful if the program had been less complex and required less effort, if positive social influence had been generated, and if specific attention had been given to PHSs without a separate health education department.

Attitude of Health Personnel↗

Ambulatory care nursing courses.

As healthcare delivery moves into ambulatory and community-based settings, nurses need preparation for professional-level practice in these new environments. The University of Arkansas for Medical Sciences (UAMS) College of Nursing has designed and implemented its own ambulatory care nursing course to educate nurses for this growing practice setting. The author discusses the design and implementation of the courses.

Ambulatory Care↗

Establishment of medical surveillance in industry: problems and procedures.

The establishment of standard history-taking will be discussed and will include examples of such histories developed in the clinic. The development of a protocol for performing and recording physical examinations will also be described. Special tests, such as pulmonary function and sputum cytology, will then be discussed. The integration of medical data into a data base will also be discussed with examples taken from the program in Pittsburgh. Presentation of the problems of obtaining adequate early medical information leads to the conclusion that medical surveillance programs must be integrated with industrial hygiene surveillance. The use of exposure measures to make and implement preventive medical decisions is essential until medical science provides tests with enhanced sensitivity and specificity for use in early detection of workplace disease.

Clinical Laboratory Techniques↗

Developing a framework for comprehensive cancer prevention and control in the United States: an initiative of the Centers for Disease Control and Prevention.

The Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, is working with state health agency staff and other stakeholders to develop a comprehensive and integrated approach to cancer control. To help stakeholders visualize the approach, a graphic model was developed based on stakeholder input and a literature review of existing models. Phases of the model include setting optimal objectives (data driven), determining optimal strategies (science driven), establishing feasible priorities (capacity driven), and implementing effective strategies (outcome driven). The model currently is being validated through case studies of state-level cancer planning in six states.

Centers for Disease Control and Prevention, U.S.↗

Adherence to antiretroviral therapy among patients with HIV: a critical link between behavioral and biomedical sciences.

Rapid advances in biomedical science, such as pharmaceutical developments for HIV disease, must be integrated with advances in behavioral science to further our understanding of medication adherence. This article evaluates the current state of the science in adherence to antiretroviral therapy for persons with HIV. The primary objectives are to 1) identify critical determinants of adherence, and 2) describe interventions to improve adherence. Adherence is a complex dynamic behavior influenced by characteristics of the patient, treatment regimen, disease, patient-provider relationship, and clinical setting. Therefore, the most promising interventions are multifaceted and target different locations in this matrix simultaneously. Unfortunately, nonadherence remains a formidable barrier in the management of HIV, resulting in the development of resistance and drug failure. Moreover, adherence is a public health concern, with implications for the transmission of HIV in general and the transmission of drug-resistant strains of HIV specifically. Despite substantial attention to adherence in recent years, much more remains to be done to better understand and promote adherence to antiretroviral therapy through effective interventions. From this integration of biomedical and behavioral science, effective clinical interventions can be developed and implemented to enhance the health of patients with HIV.

Antiretroviral Therapy, Highly Active↗

Getting there from here: evidentiary quandaries of the US outcomes movement.

The US outcomes movement assumes, and sometimes argues, the primacy for medical practice of probabilistic knowledge derived from methodologically rigorous statistical studies. 'Evidence-based medicine,' then, is considered a course of clinical medicine prescribed by such research. Implementation of evidence-based medicine as recently been uneven in the US, manifesting not only the expected 'obstacles to implementation' but several theoretical weakness of the applied science model of medical care. Outcomes researchers claim to provide certainty - certainty of what is probable, as it turns out - in a world of clinical uncertainty. This paper argues that outcomes research actually exacerbates the inferential uncertainty of practising physicians who would use knowledge for practice. Two quandaries are discussed: whether to privilege rigorous or relevant research, and whether to privilege universal or local knowledge. In each case, the logic of 'evidence-based medicine' is insufficient to resolve the quandary and would seem to support conflicting resolutions. Recent developments in US health policy are cited as manifestations of these quandaries. Finally, the reader is asked not to disregard the political implications of the outcomes movement.

Clinical Competence↗

It's difficult to change the way we teach: lessons from the Integrative Themes in Physiology curriculum module project.

The Integrative Themes in Physiology (ITIP) project was a National Science Foundation-funded collaboration between the American Physiological Society (APS) and the Human Anatomy and Physiology Society (HAPS). The project goal was to create instructional resources that emphasized active learning in undergraduate anatomy and physiology classrooms. The resources (activity modules and professional development) addressed two factors thought to be limiting science education reform: instructors' knowledge of how to implement active learning instruction and time to design innovative curricula. Volunteer instructors with a strong interest in using active learning in their classrooms were recruited to use the ITIP modules and provide ease-of-use feedback and student assessment data. As the study unfolded, instructor attrition was higher than had been anticipated, with 17 of 36 instructors withdrawing. More surprisingly, instructors remaining with the project failed to use the modules and reported specific obstacles that precluded module use, including lack of support from academic leadership, unplanned class size increases and heavy teaching loads, a union strike, insufficient time to develop a mindset for change, inadequate technology/funding, an adverse human subjects ruling, incompatibility of modules with instructors' established content and expectations, and personal factors. Despite the lack of module use and obstacles, 8 of 19 site testers began independently to introduce new active learning instruction into their classrooms. In the larger picture, however, it is important to note that only 8 of the initial 36 volunteers (22%) actually ended up changing their instruction to include opportunities for student active learning. These findings underscore the difficulty of implementing instructional change in college classrooms.

Curriculum↗

Comprehensive assessment of professional competence: the Rochester experiment.

BACKGROUND: A required 2-week comprehensive assessment (CA) for 2nd-year medical students that integrates basic science, clinical skills, information management, and professionalism was implemented. DESCRIPTION: The CA links standardized patients (SPs) with computer-based exercises, a teamwork exercise, and peer assessments; and culminates in student-generated learning plans. EVALUATION: Scores assigned by SPs showed acceptable interrater reliability. Factor analyses defined meaningful subscales of the peer assessment and communication rating scales. Ratings of communication skills were correlated with information gathering, patient counseling, and peer assessments; these, in turn, were strongly correlated with the written exercises. Students found the CA fair, with some variability in opinion of the peer and written exercises. Useful learning plans and positive curricular changes were undertaken in response to the CA results. CONCLUSION: A CA that integrates multiple domains of professional competence is feasible, useful to students, and fosters reflection and change. Preliminary data suggest that this format is reliable and valid.

Adult↗

Analysis of reference transactions using packaged computer programs.

Motivated by a continuing education class attended by the authors on the measurement of reference desk activities, the reference department at Scott Memorial Library initiated a project to gather data on reference desk transactions and to analyze the data by using packaged computer programs. The programs utilized for the project were SPSS (Statistical Package for the Social Sciences) and SAS (Statistical Analysis System). The planning, implementation and development of the project are described.

Computers↗

Successfully integrating human papillomavirus testing into your practice.

Integrating human papillomavirus (HPV) testing into the practice of cervical cancer screening is a continuous process that begins and ends with education. An understanding of the basic science and clinical relevance are critical to proper implementation. One must have knowledge of one's own laboratory statistics, clinician awareness, and market forces before the final steps are taken. Additional logistical issues are often laboratory specific or state specific, but are addressed here.

Cytodiagnosis↗

Education review: applied medical informatics--informatics in medical education.

The importance of informatics training within a health sciences program is well recognized and is being implemented on an increasing scale. At Chicago Medical School (CMS), the Informatics program incorporates information technology at every stage of medical education. First-year students are offered an elective in computer topics that concentrate on basic computer literacy. Second-year students learn information management such as entry and information retrieval skills. For example, during the Introduction to Clinical Medicine course, the student is exposed to the Intelligent Medical Record-Entry (IMR-E), allowing the student to enter and organize information gathered from patient encounters. In the third year, students in the Internal Medicine rotation at Norwalk Hospital use Macintosh power books to enter and manage their patients. Patient data gathered by the student are stored in a local server in Norwalk Hospital. In the final year, we teach students the role of informatics in clinical decision making. The present senior class at CMS has been exposed to the power of medical informatics tools for several years. The use of these informatics tools at the point of care is stressed.

Attitude to Computers↗

Recent advances in pediatric HIV.

Pediatric human immunodeficiency virus (HIV) infection is a disease of mother-to-infant transmission. The World Health Organization estimates there will be ten million HIV-infected children by the end of this century. It is now thought that both intrauterine and intrapartum transmission of HIV occurs. Infants infected in utero develop clinical signs and symptoms at an earlier age than those who are infected at the time of delivery. We describe two cases that demonstrate early-onset and late-onset pediatric HIV disease, respectively. Recently, it was determined that perinatal transmission of HIV can be significantly reduced by the administration of the antiretroviral drug, zidovudine (ZDV), to HIV-positive pregnant women and their newborns, making HIV screening of pregnant women more desirable than ever. A program of universal voluntary HIV testing for pregnant women has been successfully implemented at the University of Arkansas for Medical Sciences. Details of this program are described herein.

Fatal Outcome↗

[Assessment of the community health nursing curriculum in relation to the modified Stake curriculum evaluation model].

The modified Stake curriculum evaluation model was implemented in practice to evaluate the Community Nursing Science curricula of three Nursing Colleges and the method used is outlined. Some of the results obtained regarding the model's description matrix are: . students are not familiar with the philosophy of Community Nursing Science; . students doubt their readiness for clinical work directly after training; . only one of the tutors in Community Nursing Science had applicable clinical experience in community nursing; . satisfaction regarding the content and evaluation of Community Nursing Science exists amongst students. The purpose of the evaluation was to identify shortcomings in the curricula and and to facilitate curriculum improvement.

Clinical Competence↗

Developing a quality assurance program for online services.

A quality assurance (QA) program provides not only a mechanism for establishing training and competency standards, but also a method for continuously monitoring current service practices to correct shortcomings. The typical QA cycle includes these basic steps: select subject for review, establish measurable standards, evaluate existing services using the standards, identify problems, implement solutions, and reevaluate services. The Claude Moore Health Sciences Library (CMHSL) developed a quality assurance program for online services designed to evaluate services against specific criteria identified by research studies as being important to customer satisfaction. These criteria include reliability, responsiveness, approachability, communication, and physical factors. The application of these criteria to the library's existing online services in the quality review process is discussed with specific examples of the problems identified in each service area, as well as the solutions implemented to correct deficiencies. The application of the QA cycle to an online services program serves as a model of possible interventions. The use of QA principles to enhance online service quality can be extended to other library service areas.

Computer Systems↗