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PubMed2001

Potency tests of combination vaccines.

Combination vaccines differ from single-component vaccines in composition and in how they are manufactured, which poses significant challenges to implementing effective quality-control tests, including measurement of potency. Because each combination vaccine is unique, existing guidelines often fail to provide sufficient information to overcome the inevitable problems encountered when developing and implementing potency tests. Success depends on careful consideration of scientific and regulatory issues. Significant problems may occur if potential interactions between different components in the vaccine are not taken into account during product and test development. Thorough analysis of critical assay parameters and attention to scientific and statistical justifications for the test increase the likelihood of its acceptance. Practical approaches based on experience include rational design of validation studies, complete evaluation and documentation of the potency tests under the conditions in which they are to be applied, and establishing the relationship between production lots of vaccine and lots used in clinical trials.

Antigens↗
PubMed2000

Hospice in prison: the Louisiana State Penitentiary Hospice Program.

This article by the hospice case manager and inmate volunteer coordinator at the Louisiana State Penitentiary (LSP) hospice program describes the program's major features, how it was started and is sustained within the confines and culture of prison life, and how the challenges to implementing a hospice program within a maximum security prison continue to be met. Recommendations are offered for undertaking a hospice initiative in a correctional facility. The LSP Hospice Program was honored in May 2000 with the Circle of Life Award from the American Hospital Association. This article is excerpted from a thematic issue, "Hospice in Prison," Volume 2, Number 3, 2000 of the online journal, Innovations in End-of-Life Care at http://www.edc.org/lastacts/

Journal Article↗
PubMed2003

Role of the National Cholesterol Education Program Adult treatment panel III guidelines in managing dyslipidemia.

Using recently updated guidelines to evaluate and manage lipid disorders is discussed. Coronary heart disease (CHD) is a costly chronic condition associated with significant morbidity and mortality. Epidemiologic data further indicate that dyslipidemia and associated conditions, which may lead to CHD, are grossly undertreated. In 2001, the third National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) released updated guidelines for the evaluation and treatment of lipid disorders. Significant changes to the updated guidelines include designation of a CHD risk equivalent category identifying patients who require aggressive management, recommendation of Framingham-based CHD risk assessment in patients with multiple risk factors, revised target levels for several of the lipids and lipoproteins, and criteria for the identification of patients with the metabolic syndrome. Low-density lipoprotein cholesterol (LDL-C) continues to be the primary target of therapy. In addition, non-high-density lipoprotein cholesterol (HDL-C) is now defined as a secondary treatment target in patients with hypertriglyceridemia. Increased emphasis is placed on the metabolic syndrome, low HDL-C levels, and the presence of multiple and emerging risk factors in guiding the intensity of therapy. The NCEP ATP III guidelines acknowledge challenges in implementing and maintaining patient adherence to both lifestyle changes and pharmacotherapy regimens and provide strategies for increasing treatment success. Implementation of these new guidelines will likely enhance identification, management, and treatment success rates among patients at risk for CHD in the United States.

Cholesterol, LDL↗
PubMed2000

Academic and Social Benefits of a Co-enrollment Model of Inclusive Education for Deaf and Hard-of-Hearing Children.

Deaf and hard-of-hearing (d/hh) students are traditionally educated within self-contained programs at residential or special day schools, within self-contained or resource classrooms in public schools, or within regular education classrooms with support provided by an itinerant teacher. The co-enrollment model offers a promising alternative in which these students are educated within a regular education classroom composed of both d/hh and hearing students and team-taught by a teacher of the deaf and a regular education teacher. This article examines the development of one such program and the social and academic performance of the d/hh students within the program. Data on social interaction between d/hh and hearing classmates suggest that specific instructional strategies that promoted students' sign language development, identified d/hh students as "sign language specialists" and grouped d/hh and hearing students during academic activities resulted in increased interaction between these two groups of students. Stanford Achievement Test scores in the areas of reading vocabulary, reading comprehension, mathematical problem solving and procedures indicate that although d/hh students scored below the national normative hearing group, reading comprehension levels exceeded the national normative sample of d/hh students during both years two and three of the program. We discuss the challenges of implementing a co-enrollment program.

Journal Article↗
PubMed2001

Advances in nephrology: successes and lessons learnt from diabetes mellitus.

The introduction of recombinant erythropoietin (Epo, epoetin) has resulted in a shift in focus from the treatment to the prevention of anaemia. This shift in treatment goals has provided nephrologists with the challenge of implementing preventative strategies in clinical practice. While this area of nephrology is still developing, a lot can be learned from the methods applied by clinicians involved in the prevention of other diseases, particularly non-insulin-dependent (type 2) diabetes mellitus. The prevention of type 2 diabetes has become a major aim of healthcare providers globally due to the epidemic proportions of the disease. In order to reverse this worrying trend, diabetologists have had to develop effective management strategies based upon their current knowledge. Nephrologists must now adopt a similar approach if the increasing threat from diabetic nephropathy is to be reversed. This should include strict normotension, the prescribing of angiotensin-converting enzyme (ACE) inhibitors, administration of lipid-lowering agents, and the near-normalization of anaemia with epoetin. However, the implementation of treatment strategies alone is unlikely to be sufficient. Indeed, an effective programme of education is required to ensure that patients understand the seriousness of their condition and remain compliant with treatment. Similarly, educating the general public may help to reduce the burden of type 2 diabetes and the subsequent problems associated with the disease, including renal disease.

Anemia↗
PubMed2000

Vision 2000: the transformation of professional practice.

This century has seen miraculous advances in health care. Despite all our progress, however, there are some serious flaws in today's health care systems that demand our attention. This article describes the approach our integrated delivery system has taken to meet this challenge through implementation of the Transformational Model for Professional Practice, and the outcomes we have achieved.

Delivery of Health Care, Integrated↗
PubMedDate not supplied

Martha Rogers' model in associate degree education.

This article describes the first associate degree nursing program in the country to adopt Martha Rogers' science of unitary humans as the conceptual model for the program. The authors discuss the rationale for choosing the model, the curriculum design, the special challenges to implementation, and student and faculty reactions to the model.

Attitude↗
PubMed2000

Etiology and treatment of pneumonia.

BACKGROUND: Lower respiratory tract infections are a common cause of morbidity among children. Among these infections pneumonia is the most serious illness and can be difficult to diagnose. The etiology of pneumonia is still partly unknown, primarily because of difficulty in obtaining adequate samples and lack of reliable diagnostic methods. ETIOLOGY OF PNEUMONIA: Streptococcus pneumoniae is recognized as an important cause of pediatric pneumonia regardless of age in both the inpatient and outpatient setting. In developed countries S. pneumoniae probably accounts for 25 to 30% of cases of pediatric community-acquired pneumonia. Viruses (mostly respiratory syncytial virus) are responsible for approximately 20% of cases, and Chlamydia pneumoniae and Mycoplasma pneumoniae occur commonly in older children. FUTURE CHALLENGES: Despite the effectiveness of antimicrobial therapy, the emergence of resistant bacterial pathogens has resulted in increased interest in developing more effective vaccines. If conjugate pneumococcal vaccines prove effective at eradicating carriage of pneumococci in the nasopharynx, immunization may be an important tool against the spread of pneumococcal disease. Future challenges include implementation of effective intervention strategies, production of simple diagnostic tools and development of effective vaccines.

Anti-Bacterial Agents↗
PubMed1993

Assessment of supercritical fluids for drug analysis.

Supercritical fluid (SF) CO2 is receiving a great deal of interest in the scientific and engineering community as a replacement for toxic organic solvents. Analytical chemists employ large quantities of organic solvents during preparation of the sample for analysis. The application of SF extraction with CO2 and modified CO2 to the isolation of active drug components and metabolites from various pharmaceutical and biological matrices is reviewed. Studies are described that deal with spiked drugs in animal feed, residual solvent in drug formulations, and active ingredients in over-the-counter products. The experimental challenges to implementing this technology for trace analysis are discussed. While much of the impetus for working with SFs is prompted by regulatory issues, it would appear that SFs afford the analyst a better-cheaper-faster-safer way of performing drug analysis.

Animal Feed↗
PubMed2000

Coalition, partnership, and constituency building by a state public health agency: a retrospective.

This article is a retrospective that traces the development of an evolutionary process for a state health agency in addressing the challenge of implementing core public health functions and the provision of essential services. Coalition, partnership, and constituency building were critical elements in the process. Various initiatives are described and their importance as building blocks to a larger process of organizational change is explained. Key lessons from the process are outlined.

Adolescent↗
PubMed2002

Leadership development: working together to enhance collaboration.

The Turning Point Leadership Development National Excellence Collaborative has completed the first year of a 4-year efforts. This article reports the results of the first year of work, including the formation of the collaborative and its goals, vision, and mission. The article goes on to discuss the primary focus area, collaborative leadership, and some of the challenges of implementing this style of leadership in the public health field and initial implementation activities.

Community Health Planning↗
PubMed2005

Beyond screening: identifying new barriers to early onset group B streptococcal disease prevention.

BACKGROUND: Group B streptococcal infections remain an important cause of morbidity and mortality in newborns. METHODS: Neonatal group B streptococcal cases were identified by active surveillance in 4 urban Tennessee counties. Medical records of mothers of cases and a sample of other pregnant women with live births from the same population were reviewed to determine whether the screening or risk-based approach was used for prevention of early onset group B streptococcal disease and to assess other factors affecting preventability of cases. RESULTS: During 1998 and 1999, 43% of women underwent prenatal group B streptococcal screening. County of residence was the only factor independently associated with not being screened [odds ratio, 7.85; 95% confidence interval (4.69, 13.16)]. Ten affected babies were born to screened mothers (0.40 per 1000). In 9 of these 10, problems were identified: mothers had positive screening cultures but did not receive optimal intrapartum antibiotics (n = 3 of 4); mothers had negative screening cultures (n = 4); and mothers were screened, but the results were unknown, and intrapartum antibiotics were not given (n = 2). CONCLUSIONS: Challenges to implementation of group B streptococcal screening and prophylaxis include insufficient screening, suboptimal intrapartum antibiotics, disease despite negative screening cultures and timely communication of screening results at delivery. An awareness of such problems may lead to supplemental measures to further reduce group B streptococcal disease.

Adult↗
PubMed2006

Challenges of electronic medical record implementation in the emergency department.

TARGET AUDIENCE: Physicians, nurse practitioners and physician assistants who care for infants and children in the emergency department or in other ambulatory and acute care settings. In particular, physicians with administrative responsibilities will find this information useful. OBJECTIVES: 1. Describe the purpose and scope of an electronic medical record. 2. Point out the unique demands that the emergency department places upon an EMR. 3. List the advantages and disadvantages of computerized charting.

Emergency Service, Hospital↗
PubMed2004

Musculoskeletal education in physical medicine and rehabilitation residency programs.

OBJECTIVE: To characterize current musculoskeletal (MSK) education experiences in physical medicine and rehabilitation residency programs and to identify perceived barriers to providing more extensive MSK education experiences. In addition, to establish utilization patterns for the PASSOR Physical Examination Core Competencies List. DESIGN: Between March and November 2003, all 81 physical medicine and rehabilitation residency program directors were asked to complete an MSK education survey developed by the authors. RESULTS: A total of 69 of 81 program directors (86%) responded after multiple contacts. The most frequently utilized MSK education formats were MSK lecture series, MSK departmental conferences, and physical examination workshops. Potential barriers to expanded MSK education included money, time, and staff number. Given unlimited resources, most residency programs would greatly increase utilization of visiting lecturers, CD-ROMs/DVDs, objective structured clinical examinations, and physical examination videos. Of the 30 program directors who recalled receiving the Core Competencies List, only 40% (12 of 30) have formally integrated the list into their residency training. Barriers to implementation included logistical challenges and lack of direction regarding implementation. CONCLUSIONS: Residency program directors indicate a strong interest in expanding resident MSK education through the use of CD-ROMs/DVDs, physical examination videos, objective structured clinical examinations, and visiting lecturer programs. CD-ROMs/DVDs and videos represent particularly attractive educational formats for supplementing resident MSK education due to the advantages of central production, nominal costs, widespread distribution, multimedia capabilities, and accessibility. These educational formats should be considered for targeted educational initiatives to enhance resident MSK education, regardless of residency program size or resources.

Clinical Competence↗
PubMed2006

Family interventions for drug and alcohol misuse: is there a best practice?

PURPOSE OF REVIEW: Recent developments in research and practice have highlighted the effectiveness of family interventions in substance misuse treatment. The present paper will critically review studies of family approaches published over the past 12 months, assess the current state of this field and suggest future directions. RECENT FINDINGS: Family interventions lead to positive outcomes for both misusers and family members. Some recent interventions have widened the focus also to include other members of the user's social networks and have focused on a range of treatment goals. SUMMARY: An increasingly robust evidence base supports family-focused and social network-focused interventions in substance misuse treatment. Recent studies have continued to show that family and network approaches either match or improve outcomes when compared with individual interventions. Research needs (and is starting) to consider a broader set of outcomes relevant to family and network interventions, besides simply making an impact on substance use. The major challenge involves implementation of family approaches in routine service provision; interventions with most evidence supporting them are not used routinely in practice. Research studies and policy initiatives need to focus on dissemination of family approaches and their integration into treatment services.

Crisis Intervention↗
PubMed2004

A political history of medicare and prescription drug coverage.

This article examines the history of efforts to add prescription drug coverage to the Medicare program. It identifies several important patterns in policymaking over four decades. First, prescription drug coverage has usually been tied to the fate of broader proposals for Medicare reform. Second, action has been hampered by divided government, federal budget deficits, and ideological conflict between those seeking to expand the traditional Medicare program and those preferring a greater role for private health care companies. Third, the provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 reflect earlier missed opportunities. Policymakers concluded from past episodes that participation in the new program should be voluntary, with Medicare beneficiaries and taxpayers sharing the costs. They ignored lessons from past episodes, however, about the need to match expanded benefits with adequate mechanisms for cost containment. Based on several new circumstances in 2003, the article demonstrates why there was a historic opportunity to add a Medicare prescription drug benefit and identify challenges to implementing an effective policy.

Centers for Medicare and Medicaid Services, U.S.↗