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PubMed2001

Review: molecular thyroidology.

Novel disorders involving aberrations of the hypothalamic-pituitary-thyroid gland-thyroid hormone axis have been described in the last 5 to 10 years. The following topics are addressed: molecular mutations causing central hypothyroidism (isolated autosomal recessive TRH deficiency; autosomal recessive TRH-receptor inactivating mutations; TSH beta-subunit bio-inactivating mutations; Pit-1 mutations; Prop1 mutations; high molecular weight bio-inactive TSH); defects in response to TSH (mutations in the TSH receptor: TSH receptor gain-of-function mutations; TSH receptor loss-of-function mutations); defects in thyroid gland formation: transcription factor mutations (TTF-2 and Pax8); defects in peripheral thyroid hormone metabolism (defective intrapituitary conversion of T4 to T3; hemangioma consumption of thyroid hormone); and defects in tissue response to thyroid hormone (generalized thyroid hormone resistance, selective pituitary thyroid hormone resistance). While molecular diagnosis of such conditions is rarely indicated for clinical management, knowledge of the molecular mechanisms of these diseases can greatly enhance the clinical laboratory scientist's ability to advise clinicians about appropriate thyroid testing and to interpret the complex and sometimes confusing results of thyroid function tests.

Humans↗

PubMed2001

Global public goods and health: taking the agenda forward.

We examined recent special health initiatives to control HIV/AIDS, malaria, and tuberculosis, and make four policy recommendations for improving the sustainability of such initiatives. First, international cooperation on health should be seen as an issue of global public goods that concerns both poor and rich countries. Second, national health and other sector budgets should be tapped to ensure that global health concerns are fully and reliably funded; industrialized countries should lead the way. Third, a global research council should be established to foster more efficient health-related knowledge management. Fourth, managers for specific disease issues should be appointed, to facilitate policy partnerships. Policy changes in these areas have already begun and can provide a basis for further reform.

Communicable Disease Control↗

PubMed2001

[Bronchopulmonary disease in drug abusers].

Drug abuse is a growing problem in industrialized countries, opening the way to new diseases of the respiratory tract. It has been demonstrated that regular inhalation of cannabis has the same consequences as tobacco smoking. The same cannot be said for other drugs. Cocaine, amphetamines or crack expose the patient to particular toxic effects: in addition to barotrauma related to the administration route, syndromes of acute respiratory distress have been described. These result either from bronchial reactions, asthma exacerbation or eosinophil bronchopneumonia, or alveolar involvement: intra-alveolar bleeding, pulmonary edema or organized pneumonia. Respiratory complications induced by opiates, often used in injections, are related to central alveolar hypoventilation and/or the development of injury from pulmonary edema or pneumonia. The pathophysiology of these lesions is not perfectly understood. Besides these specific conditions, infection is a major problem in drug abusers, irrespective of the drug: bacterial pneumonia, tuberculosis, HIV infection are much more frequent in this high-risk group. Finally repeated intravenous injections of various drugs designed for oral intake can lead to severe complications such as pulmonary hypertension or toxic interstitial lung disease. Summarizing, respiratory diseases in drug abuses can take on a wide range of quite complex presentations. Occasional or regular use of illicit drugs can lead, not exceptionally, to severe respiratory complications requiring rapid management. Knowledge of the principal complications and the appropriate diagnostic procedures is indispensable.

Asthma↗

PubMed2001

[Basic assessment of needs for training in evidence-based medicine in Slovakia].

BACKGROUND: The health care reform in Slovakia produces a desire for greater responsibility for and control of strategic decisions and to be better able to evaluate international knowledge and experience in the specific national social and professional contexts. Evidence based medicine (EBM) provides an increasingly organised and accessible database of international knowledge in health and health care, capable of informing decisions at the macro and micro levels. AIM: The aim of this pilot study was to assess education, training and other capacity building needs in EBM and evidence based health care. METHODS: This study was primarily qualitative and based on a triangular approach, which included: (1) The analysis of the situation in pre- and postgraduate education in Slovakia aiming to the estimation of needs in EBM and critical appraisal skills training; (2) The analysis of questionnaires distributed in a sample of 50 medical doctors and university educated public health workers undergoing a postgraduate training; (3) The discussion in focused groups. RESULTS: The findings and analysis uncovered a gap in knowledge and experience of EBM approaches, particularly of searching for evidence, utilising information technology, of undertaking critical appraisals of the validity and quality of external evidence and of knowledge of English. On the other hand the findings revealed a high access to information including the Internet access at the workplace, an increasing awareness of the need for up-date information, a demand for training and potential opportunities for action. CONCLUSIONS AND RECOMMENDATIONS: The effective implementation introduction of EBM approach would require changes in broader political, cultural and behavioural contexts, including changes in pre- and postgraduate systems of professional and managerial education, changes in professional and managerial attitudes and changes in emphasis in skills and capacity building and improvements in knowledge management systems at the national level.

Education, Medical↗

PubMed2002

Surviving a merger: how four hospital libraries created a unified system.

Librarians are acknowledged as leaders in providing information and knowledge management. They recognize the importance of maintaining an awareness of the most cutting-edge information and technology to meet the challenges of new business practices and changes that inevitably occur. Working as a team, the AHS librarians have achieved a level of communication and cooperation that is an example to other departments in the system. The success of the merged libraries has created new opportunities for leadership and growth and an optimistic future.

Cooperative Behavior↗

PubMed2002

Federal health web sites: current & future roles.

An examination of the current and possible future roles of federal health Web sites, this paper provides an overview of site categories, functions, target audiences, marketing approaches, knowledge management, and evaluation strategies. It concludes with a look at future opportunities and challenges for the federal government in providing health information online.

Consumer Behavior↗

PubMed1992

Noninvasive estimation of total body water in critically ill children after cardiac operations. Validation of a bioelectric impedance method.

The understanding of fluid fluxes in pediatric cardiac critical care is crucial to effective management. Knowledge of variations in total body water in this situation would aid this understanding, but most available methods are unsuitable for routine use. Recently, estimation of total body water by a tetrapolar bioelectric impedance has been validated in older children and adolescents. We undertook a study to validate the method in the taxing conditions of pediatric cardiac critical care. A prospective comparative study was done in 16 children whose ages ranged from 6 days to 10 years (mean 23 months) after a variety of cardiac operations. Total body water was estimated by a standard isotope dilution method (deuterium oxide) and by bioelectric impedance by means of a Holtain body composition analyzer. Individual estimations of total body water were made on two successive days on each patient at varying intervals after a cardiac operation, bioelectric impedance being measured hourly during 4 hourly urine collections for the deuterium oxide method. Thirty-two simultaneous values of total body water (by isotope and by impedance) were collected. Population-specific regression relationship was established by plotting total body water (isotope) against height2/bioelectric impedance. From this data plot r = 0.911, giving this equation: total body water = 0.158 +/- 0.662 x (height2/bioelectric impedance). Levels of agreement of -1.771 to +1.725 were observed, with a standard error of measurement of 16% across the range. The data suggest that bioelectric impedance is a satisfactory and reliable method of estimating total body water in children requiring cardiac critical care. The standard error of 16% suggests that the method may be more useful for measuring trends than absolute values, but the technique should be a valuable noninvasive tool both for continuous monitoring of total body water and in longitudinal research studies of rapid fluid flux and in the assessment of capillary leak.

Body Water↗

PubMed2004

Towards clinical bioinformatics: advancing genomic medicine with informatics methods and tools.

OBJECTIVES: To summarize the challenges facing clinical applications in the light of growing research results in genomic medicine and bioinformatics. METHODS: Analysis of the contents of the Yearbook of Medical Informatics 2004 of the International Medical Informatics Association (IMIA). RESULTS: The Yearbook of Medical Informatics 2004 includes 32 articles selected from 22 peer-reviewed scientific journals. A special section on clinical bioinformatics highlights recent developments in this field. Several guest editors review the promises and limitations of available methods and resources from biomedical informatics that are relevant to clinical medicine. Integrated data and knowledge resources are generally regarded to be central and key issues for clinical bioinformatics. Further review papers deal with public health implications of bioinformatics, knowledge management and trends in health care education. The Yearbook includes for the first time a section on the history of medical informatics, where the significant impact of the Reisensburg protocol 1973 on international health and medical informatics education is examined. CONCLUSIONS: Close collaboration between bioinformatics and medical informatics researchers can contribute to new insights in genomic medicine and contribute towards the more efficient and effective use of genomic data to advance clinical care.

Computational Biology↗

PubMed2004

National and regional health information infrastructures: making use of information technology to promote access to evidence.

The vision for national and regional health information infrastructures (HII) includes provision of a framework that is supportive of access and integration of health information with the goal of improving the health and safety of individuals, public health systems, and nations. Internationally, prominent examples of national and regional HIIs exist that provide a means for achievement of this goal. However, to fully realize benefits, an explicit mechanism is needed for linking national and regional HIIs with existing knowledge, automated processes and evaluation of the ability of HIIs to meet the information needs of primary recipients. Using the United States' Na-tion Health Information Infrastructure (NHII) as an example, the authors describe expansion of the conceptual framework to explicitly acknowledge the role of access to evidence at the overlap between the three dimensions of the NHII to create an "evidence-based" link between interrelated components. The role of national measures in setting e-communication goals and evaluating the evolving infrastructure in meeting informational needs of users is discussed. Additionally, automated knowledge management tools such as practice guidelines are presented as a means by which access to critical information is delivered to users, in a format that is appropriate for their health literacy level and that provides adequate support for informed decision making.

Decision Support Techniques↗

PubMedDate not supplied

[Medical education challenged by the learning society].

This paper analyzes the limitations of dominant paradigms in education and identifies the necessity of research-situated learning in real environments and how medical education must be involved with knowledge management in real, complex, adaptive systems, and concludes with the need for constructing novel educative paradigms with regard to new educational paradigms.

Education, Medical↗

PubMed2004

[Newborn and infant nasal dyspnea].

OBJECTIVE: The aim of this study is to report our experience of causes of newborn and infant nasal obstruction. METHODS: Four cases (3 newborns, 1 infant) of nasal dyspnea are reported. For each of them, background circumstances, diagnostic and therapeutic methods and outcomes are reported. Based on a review of the literature, the main causes of nasal obstruction and their treatments are discussed. RESULTS: In all cases, the diagnosis was made by the rhinoscopy with an endoscope and CT-Scan. Choanal atresia, infectious rhinitis, bilateral lacrymo-nasal cyst and nasopharyngeal hamartoma were diagnosed, and associated with respiratory distresses or difficulties in feeding. The treatment consisted of simple removal of the nasopharyngeal hamartoma, marsupialization for the lacrymo-nasal cysts, antibiotherapy and stenting for a few weeks for the infectious rhinitis and permeabilization by puncture and stenting for the choanal atresia. The outcome was successful in all cases. CONCLUSION: Newborn and infant nasal dyspnea is a serious disease. This study underlines the importance of efficient and rapid management. Knowledge of the possible causes grouped in three categories--malformative, tumoral and infectious--is mandatory to make the appropriate choice.

Diagnosis, Differential↗

PubMed2004

Minnesota's Midwest AIDS Training and Education Center: helping health care providers remain current on a rapidly changing epidemic.

Since 1990, the number of people in Minnesota living with HIV/AIDS has been steadily increasing. The demographics of who is infected with HIV have changed, with more women and people of color being diagnosed. In addition, with new therapies and continually updated treatment recommendations, the information needed to provide quality medical care to HIV-infected patients is constantly evolving. Thus, providers who care for patients with HIV/AIDS need ongoing education about the disease. The Midwest AIDS Training and Education Center (MATEC) is a federally funded program that helps health care providers stay abreast of HIV clinical care and management knowledge. Based at the University of Illinois at Chicago, MATEC provides services in seven states, including Minnesota. This article describes how MATEC's HIV/AIDS training and education programs are being implemented in Minnesota and the different ways MATEC is delivering provider education in this important area.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Strategies for the prevention and treatment of peritoneal carcinomatosis from gastrointestinal cancer.

BACKGROUND: Peritoneal surface malignancy can result from full thickness invasion of gastrointestinal cancer through the bowel wall or from dissemination of cancer cells from the trauma of cancer surgery. In the past, this clinical situation was treated only with palliative intent. METHODS: An aggressive approach to peritoneal surface malignancy involves peritonectomy procedures, perioperative intraperitoneal chemotherapy and knowledgeable patient selection. The clinical assessments necessary for valid clinical judgements include the cancer histopathology (invasive vs. expansive progression), the preoperative abdominal and pelvic CT, the peritoneal cancer index and the completeness of cytoreduction score. Proper patient selection is mandatory for optimizing the results of treatment. RESULTS: In a series of phase II studies, appendiceal tumors with peritoneal seeding became the paradigm for success with an 85% long-term survival in selected patients. Carcinomatosis from colon cancer had an overall 5-year survival of 50% with selected patients. In all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed the greatest benefit. CONCLUSIONS: Oncologists must accept responsibility for knowledgeable management of peritoneal surface dissemination of cancer because a curative approach has been demonstrated in both phase II studies and phase III studies. All historical controls show 0% long-term survival. Surgical interventions combined with perioperative intraperitoneal chemotherapy in diseases where peritoneal surface spread occurs must be considered a treatment option.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2005

Model of good practice tools for risk reduction and clinical governance.

Information and Communication Technologies (ICT) are expected to support Healthcare Professionals in reducing medical errors, making the most relevant decisions and finding the most appropriate procedure for each patient. In particular, Knowledge Management and Decision Support Systems provide access to high quality information and to appropriate protocols. The present paper aims at comparing the approaches used in three ongoing R&D projects in order to support risk reduction and clinical governance. This comparison will lead to the presentation of a generic model of Decision Support Tools that transform shared and documented "Good Practices" into software entities that can pro-actively advice users in their daily work or when they encounter difficult situations.

Clinical Governance↗

PubMed2001

IBC's Drug Discovery Technology - Europe 2001. 23-26 April 2001, Stuttgart, Germany.

Specific sectors within the pharmaceutical industry are rapidly changing in response to technological advances. Genomics, high-throughput automated chemistry, high-throughput screening (HTS), ADME/Tox screening and informatics, provide new opportunities, but also create new bottlenecks. In addition, the selection and validation of biological targets, the proper design of compound libraries, data and knowledge management, and as the last and crucial step, the proof of therapeutic relevance by clinical trials, generates an enormous financial load on biotechnology and pharmaceutical companies. In the future, drug development costs might be reduced due to an ongoing pressure for shorter development cycles of new drugs. IBC's Drug Discovery Technology Europe 2001 conference addressed many aspects relevant to drug discovery technologies, and, along with its US partner conference, provides an annual meeting place for researchers and company executives to interact and exchange ideas.

Journal Article↗

PubMed2005

Library as place: results of a delphi study.

OBJECTIVE: An expert consensus on the future of the library as place was developed to assist health sciences librarians in designing new library spaces. METHOD: An expert panel of health sciences librarians, building consultants, architects, and information technologists was asked to reflect on the likelihood, desirability, timing, and impact on building design of more than seventy possible changes in the use of library space. RESULTS: An expert consensus predicted that the roles librarians play and the way libraries are used will substantially change. These changes come in response to changes in technology, scholarly communication, learning environments, and the health care economy. CONCLUSIONS: How health sciences library space is used will be far less consistent by 2015, as space becomes more tailored to institutional needs. However, the manner in which health sciences libraries develop and deliver services and collections will drastically change in the next decade. Libraries will continue to exist and will provide support for knowledge management and clinical trials, provide access to digital materials, and play a host of other roles that will enable libraries to emerge as institutional change agents.

Delphi Technique↗

PubMed1999

INFOTECHpharma '99--the information revolution in the pharmaceutical industry. 28-29 January 1999, London, UK.

This meeting bought together 180 directors and heads of research spanning all disciplines of the pharmaceutical industry. With the backdrop of increasing globalization, the major theme of the conference was concerned with the necessary improvement of pharmaceutical development processes. The role of new and emerging technologies in the increasing number of new leads generated, and the necessary information and knowledge management that this entails was examined from the perspective of R and D process improvement. Identifying superior clinical candidates using predictive ADME parameters, thereby avoiding costly screening processes, was addressed, while at the post-launch stage of the process the use of IT and www technology and how these can be effectively integrated into the business process to enhance productivity was reviewed.

Journal Article↗

PubMed1999

Sustaining growth and profitability--The Economist fifth annual pharmaceuticals conference. 12-13 November 1998, London, UK.

This two-day conference, organized by The Economist, focused on R and D productivity, strategic and innovative methodologies, M and A activities and knowledge management within the pharmaceutical industry. Key speakers within the industry addressed these issues to an audience of approximately 100 healthcare business executives. The first day was chaired by Barrie Haigh (Quintiles Translational Corp) and the second day by Tobias Rooney (Gemini Consulting).

Journal Article↗