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PubMedDate not supplied

Acupuncture for the treatment of cocaine addiction. Investigation of a needle puncture control.

We conducted a 6-week, single-blind study of acupuncture for cocaine dependence in methadone-maintained patients (N = 40) for the purpose of identifying an appropriate needle puncture control for use in future large-scale clinical trials. Patients were randomly assigned to receive daily acupuncture in three auricular sites plus one body site (LI-4), or in control sites within 2-3 mm of the four active sites. Overall, there was a positive response to treatment on a variety of drug-related and psychosocial measures. Cocaine use decreased significantly for patients in both needle puncture groups. The only statistically significant difference between the two types of needle puncture was on ratings of craving. Subjects rated each type of needle puncture as equally credible and perceived no significant differences on the acute effects of the two types of needle insertions. Power calculations based on these findings suggest that very large sample sizes would be required to detect treatment differences between this control condition and active acupuncture. Alternative controls are suggested, and the challenges inherent in implementing controlled clinical trials of acupuncture are discussed.

Acupuncture Points↗

PubMed2006

[The TomoTherapy Hi.Art System for sophisticated IMRT and IGRT with helical delivery: Recent developments and clinical applications].

The advent of 3D conformal radiotherapy and intensity modulated radiation therapy (IMRT) make possible the dose optimization to complex target volumes close to sane organs at risk. IMRT's introduction of numerous small radiation fields inherently increases delivery inaccuracies. As a consequence, the use of IMRT without precise localization of the tumor and sensitive structures, at both the planning and delivery stages, and the absence of continuous verification represent the most significant challenges to the implementation of IMRT in routine clinical use. Intensity modulated (or not) conformal radiotherapy delivery requires better precision in the definition of treatment volume, frequently if necessary. Helical tomotherapy has been designed to use CT imaging technology to plan, deliver, and verify that the delivery has been carried out as planned. The image-guided and intensity modulations processes of helical tomotherapy that enable this goal are described.

Humans↗

PubMed2006

Regulatory challenges: lessons from recent West Nile virus trials in the United States.

Delays in research on emerging infections could deprive the public of appropriate therapies. This report describes challenges encountered in implementing two multicenter protocols of West Nile virus (WNV) infections in the United States during 2003. Protocol development times, federal regulatory approvals, and local Institutional Review Boards (IRB) approvals were compiled. Twenty eight institutions participated in a natural history study and 27 in a therapeutic trial of WNV developed through the National Institute of Allergy and Infectious Disease Collaborative Antiviral Study Group (CASG). The CASG compiled protocol development times, federal regulatory approvals, and local IRB approvals. Additional information on the local IRB process was obtained by survey of the investigators. Because of the lengthy development and approval process, protocols were distributed after the start of the epidemic season, most sites were unable to enroll subjects at the peak of the season, and a number of sites lacked IRB approval at the end of the season.

Clinical Protocols↗

PubMed2006

'Clean Care is Safer Care': the Global Patient Safety Challenge 2005-2006.

BACKGROUND: Each year the treatment and care of hundreds of millions of patients worldwide is complicated by infections acquired during healthcare. The impact of healthcare-associated infection may imply prolonged stays in hospital, long-term disability, massive additional financial burden, and deaths. ACTION: Patient safety is a global issue that affects both developed and developing countries. In October 2004, the World Health Organization launched the World Alliance for Patient Safety to co-ordinate and accelerate improvements in patient safety internationally. A core element of the Alliance is the identification of a topic to be addressed as a Global Patient Safety Challenge over a two-year cycle. The first topic chosen for 2005-2006 is healthcare-associated infection. PERSPECTIVES: The Challenge aims at implementing several actions to tackle healthcare-associated infections worldwide, regardless of the level of development of healthcare systems and the availability of resources. Implementation strategies include the integration in different healthcare settings of multiple interventions in the areas of blood safety, injection safety, and clinical procedure safety, as well as water, sanitation, and waste management, with the promotion of hand hygiene in healthcare as the cornerstone.

Blood Transfusion↗

PubMed2005

Clinical cognition and biomedical informatics: issues of patient safety.

Recent developments in biomedical informatics research have afforded possibilities for great advances in health care delivery. These exciting opportunities also present a number of challenges to the implementation and integration of technologies in the workplace. As in most domains, there is a gulf between technologic artifacts and end users, which compromises the culture of safety in the workplace. Because clinical practice is a human endeavor, there is a need for bridging disciplines to enable clinicians to benefit from rapid technologic advances. This, in turn, necessitates a broadening of disciplinary boundaries to consider cognitive and social factors related to the design and use of technology. The authors argue for a place of prominence for cognitive science in understanding nursing factors associated with patient safety. Cognitive science provides a framework for the analysis and modeling of complex human performance. Studies of clinical cognition can meaningfully inform and shape design, development and assessment of information systems. Furthermore, they have a decisive impact on whether information technology has a positive influence on human performance and are especially important in understanding and promoting safe practices. These issues are discussed in the context of clinical informatics with a focus on nursing practice.

Biomedical Engineering↗

PubMed1982

Health care for handicapped adolescents: international legislative and policy trends.

Between 1970-1976, 45 countries enacted or made adjustments to laws on health care for the handicapped. This article explores some of the legal arrangements made to address the issue of health care for the handicapped adolescent. It reviews the legal definition of "handicapped" and analyzes the legislative support created for health care programs. Most programs are comprehensive. They focus on prevention, detection and reporting, as well as treatment and rehabilitation. Better care for disabled adolescents is one of the more important intended results of recent legislation directed to the handicapped. Rehabilitation has been increasingly recognized as a right. Prevention is an increasing focus. Legislation, however important, is only a beginning; it expresses the political will be create programs to address the issue. The challenge is to implement the law.

Adolescent↗

PubMed1997

Application of NASA's advanced life support technologies in polar regions.

NASA's advanced life support technologies are being combined with Arctic science and engineering knowledge in the Advanced Life Systems for Extreme Environments (ALSEE) project. This project addresses treatment and reduction of waste, purification and recycling of water, and production of food in remote communities of Alaska. The project focus is a major issue in the state of Alaska and other areas of the Circumpolar North; the health and welfare of people, their lives and the subsistence lifestyle in remote communities, care for the environment, and economic opportunity through technology transfer. The challenge is to implement the technologies in a manner compatible with the social and economic structures of native communities, the state, and the commercial sector. NASA goals are technology selection, system design and methods development of regenerative life support systems for planetary and Lunar bases and other space exploration missions. The ALSEE project will provide similar advanced technologies to address the multiple problems facing the remote communities of Alaska and provide an extreme environment testbed for future space applications. These technologies have never been assembled for this purpose. They offer an integrated approach to solving pressing problems in remote communities.

Alaska↗

PubMedDate not supplied

Treatment-seeking behaviour for malaria: a typology based on endemicity and gender.

A main component of current malaria control strategies to reduce malaria-related mortality and severe morbidity is early diagnosis and treatment at peripheral health services such as village health posts and dispensaries. This strategy has been promoted mainly by sensitising the population with regard to the available service offered and by providing classical biomedical descriptions of symptoms and signs of malaria. This strategy represents important challenges for successful implementation and maintenance. Early treatment depends upon prompt recognition of symptoms and signs of malaria in the household, i.e. mainly by women. Early treatment also requires that appropriate health services and medication are accessible and used. In this paper we argue that the success of malaria control depends upon an approach that is gender-sensitive and takes into account the level of endemicity in a given setting. The level of endemicity determines which group of the population is at highest risk for infection, morbidity and mortality, and is strongly related to gender considerations. The paper develops a typology that combines the key factors of gender variables with epidemiological features. It consequently outlines an approach to community-based, effective malaria control tailored to a given endemic setting. Finally, we suggest that the proposed framework could be validated for its potential application to the control of other communicable diseases.

Culture↗

PubMed2001

Challenges in research with incarcerated parents and importance in violence prevention.

Incarcerated parents present several risk factors for later violence by their children. This study uses comparison groups and repeated measures to evaluate an inmate parenting program. Subjects are inmates at a county detention center, their children, and primary caregivers. Challenges to program implementation and longitudinal research with inmates were identified, along with recommendations to assist future research and programming. Training material should use illustrated, basic language format. Acceptance and participation by inmates and staff require ongoing outreach and communication. Severed relationships are common and future research on inmates with stable family relationships is recommended. Because of inmate transience, integrating parent training into post-release programming is suggested.

Child↗

PubMed2001

Assessing the omnipotence of inositol hexakisphosphate.

This review assesses the authenticity of inositol hexakisphosphate (InsP(6)) being a wide-ranging regulator of many important cellular functions. Against a background in which the possible importance of localized InsP(6) metabolism is discussed, there is the facile explanation that InsP(6) is merely an "inactive" precursor for the diphosphorylated inositol phosphates. Indeed, many of the proposed cellular functions of InsP(6) cannot sustain a challenge from the implementation of a rigorous set of criteria, which are designed to avoid experimental artefacts.

Animals↗

PubMed2003

Early assessments of SCHIP's effect on access to care for adolescents.

PURPOSE: To examine implementation issues and challenges affecting access to care for adolescents during the first year of SCHIP operation in five states (California, Connecticut, Maryland, Missouri, and Utah). METHODS: Information was obtained through on-site interviews with senior SCHIP program staff members, medical directors, and other key staff members from managed care organizations; key staff members from behavioral health subcontractors or the state's behavioral health plans; a variety of physical and mental health providers; and families. Analysis of relevant SCHIP documents and available enrollment, capitation, and quality data was also conducted. RESULTS: The five states generally have focused little attention in the start-up phase to the unique service needs of adolescents. Although primary care was readily available, concerns were raised about training and experience in serving this population and the availability of multidisciplinary practice arrangements. Access to family planning did not appear to be a problem. However, access to mental health services and dental services was seriously affected by limited provider participants. CONCLUSIONS: Because adolescents constitute a sizeable proportion of the SCHIP population, states and managed care organizations need to consider ways to increase the participants of adolescent providers and to identify various financial and other incentives to address the serious shortages in mental health services and dental care.

Adolescent↗

PubMed2003

Broadband phase modulation by adiabatic pulses.

The use of inhomogeneous but spatially correlated static and radiofrequency (RF) magnetic fields offers a potential methodology for performing magnetic resonance spectroscopy of samples placed outside the bore of the magnet. However, its practical implementation still presents challenging problems, among them the control of nuclear spins over broad frequency offset intervals. The present study introduces an efficient method of encoding the phase of the magnetization when the variation of the static field along the sample is much larger than the RF amplitude. The procedure is based on the use of consecutively applied full-passage adiabatic pulses. The induced phase modulation is broadband and selective because it does not depend on the offset relative to the central frequency and the limits can be sharply defined. Finally, the encoded phase depends almost linearly on the local RF amplitude. All these features enable the recovery of an inhomogeneity-free spectrum with amplitudes close to the theoretically attainable maximum.

Journal Article↗

PubMed2003

Implementing practical interventions to support chronic illness self-management.

BACKGROUND: Self-management support (SMS) is the area of disease management least often implemented and most challenging to integrate into usual care. This article outlines a model of SMS applicable across different chronic illnesses and health care systems, presents recommendations for assisting health care professionals and practice teams to make changes, and provides tips and lessons learned. Strategies can be applied across a wide range of conditions and settings by health educators, care managers, quality improvement specialists, researchers, program evaluators, and clinician leaders. Successful SMS programs involve changes at multiple levels: patient-clinician interactions; office environment changes; and health system, policy, and environmental supports. PATIENT-CLINICIAN INTERACTION LEVEL: Self-management by patients is not optional but inevitable because clinicians are present for only a fraction of the patient's life, and nearly all outcomes are mediated through patient behavior. Clinicians who believe they are in control or responsible for a patient's well-being are less able to adopt an approach that acknowledges the central role of the patient in his or her care. SUMMARY AND CONCLUSIONS: Self-management should be an integral part of primary care, an ongoing iterative process, and patient centered; use collaborative goal setting and decision making; and include problem solving, outreach, and systematic follow-up.

Chronic Disease↗

PubMed1997

Pharmaceutical processing with supercritical carbon dioxide.

Replacement of traditional solvents with "environmentally benign" carbon dioxide is receiving increased attention in pharmaceutical processing. Among the reported applications, particle formation with dense carbon dioxide and the "clean" synthesis of drug compounds using carbon dioxide as a reaction medium hold immense potential for large-scale application in the pharmaceutical industry. This paper provides an overview of these rapidly emerging technologies along with examples of the wide variety of relatively contaminant-free pharmaceutical compounds that have been processed via these technologies on a laboratory scale. Challenges facing successful implementation in practice include demonstration of continuous production and harvesting of particles with desired and reproducible product characteristics. Mathematical models aimed at a better fundamental understanding of the underlying thermophysical phenomena are essential for rational design and scale-up of these technologies.

Carbon Dioxide↗

PubMed1999

Normative comparisons for the evaluation of clinical significance.

Normative comparisons are a procedure for evaluating the clinical significance of therapeutic interventions. This procedure, consisting of comparing data on treated individuals with that of normative individuals, is described, and a step-by-step statistical methodology for conducting normative comparisons in the context of treatment-outcome research is presented. Four examples of the methodology are outlined in detail. Attention is paid to potential theoretical, statistical, and methodological challenges to the implementation of normative comparisons, as well as to the advantages of normative comparisons in providing evidence for the beneficial gains of treatment.

Case-Control Studies↗

PubMed2006

Growth factor signalling in prostatic growth: significance in tumour development and therapeutic targeting.

The intricate balance maintained between cell growth and proliferation factors and apoptosis-inducing factors is fundamental to the regulation of prostate growth. Disruptions in this homeostasis often trigger the loss of apoptosis and the over-expression of factors promoting cell survival and proliferation, inevitably leading to tumorigenesis and cancer. Deregulation of prostate growth during prostate cancer development and progression is characterized by apoptotic evasion, uncontrolled proliferation, and increased invasive potential. Thus, in advanced stages of disease progression, surviving prostate tumour cells acquire the ability to migrate and invade heterotopic tissues, with the bone and lymph nodes being the most common sites for human prostate cancer metastasis. The challenges in the implementation of effective therapeutic strategies for the treatment of advanced metastatic prostate cancer reflect the multidimensional nature and functional significance of antiapoptotic pathways in the emergence of therapeutic resistance of prostate tumours. In this chapter, we discuss the current understanding of the molecular mechanisms governing growth factor signalling pathways with often overlapping functions that contribute to loss of apoptosis control and activation of cell proliferation towards aggressive prostate tumorigenic growth and metastatic behaviour. While a full understanding of the prosurvival characteristics of these growth factor pathways is still evolving, the impact that growth factors such a epidermal growth factor and transforming growth factor-beta can be recognized by the vigorous attempts at therapeutic targeting of their key signalling steps.

Animals↗

PubMed2001

Community perceptions of a mass administration of an antimalarial drug combination in The Gambia.

To test the hypothesis that widespread treatment with artemisinin derivatives can reduce malaria transmission, a mass drug administration (MDA) campaign was undertaken in an area of The Gambia in 1999. Coverage of 85% of the target population was achieved, but the intervention did not reduce overall malaria transmission. We studied the perceptions, knowledge and attitudes of the community to the MDA campaign. A validated questionnaire was administered to randomly selected MDA participants (n = 90) and MDA refusers (n = 71). Individuals who believed in the importance of the MDA (adjusted OR 58.3%; 95% CI 17.4-195.8) and those who were aware that a high level of participation was needed for the MDA to be successful (adjusted OR 28.1; 95% CI 10.3-75.9) were more likely to participate. Understanding that the purpose of the MDA was to reduce malaria (adjusted OR 13.9; 95% CI 5.5-35.1) and knowledge of the fact that malaria is transmitted by mosquitoes and of the clinical signs of malaria (adjusted OR 3.4; 95% CI 3.1-9.0) were associated with participation. Individuals who discussed the MDA with other villagers (adjusted OR 5.5; 95% CI 2.2-13.5) and those who attended the sensitization meeting (adjusted OR 2.6; 95% CI 1.1-6.0) were also more likely to participate. Women were significantly more likely to participate in the MDA than men (adjusted OR 3.1; 95% CI 1.5-6.2). Individuals who refused to participate were unlikely to plan participation in future MDAs. One of the most difficult challenges in the implementation of a malaria control strategy such as an MDA is to convince villagers to participate and to make them aware that a high level of participation by the community is needed for success. We found that our sensitization meetings could be improved by giving more information on how the MDA works and finding means to generate small group discussions after the meeting.

Adolescent↗

PubMed2000

Is Australian rural practice changing? Findings from the National Rural General Practice Study.

The National Rural General Practice Study (NRGPS) was the first comprehensive national study covering rural and remote general practitioners throughout Australia. It was undertaken in 1996-1997 and drew on data from existing sources such as the Australian Bureau of Statistics and the Australian Institute of Health and Welfare, together with a postal survey of general practitioners in rural and remote areas. There was a 75% response rate to the survey, which covered professional issues, personal and social issues, personal background, patient issues, recruitment and retention programs and changing health services. Overall, the study findings confirmed those of previous individual State-based studies in the early 1990s and showed that there had been some changes since those previous studies. In particular, access to continuing medical education has improved, the rural medical workforce appears to be ageing, the proportion of women rural doctors is increasing and the projected length of stay in rural practice is decreasing. Whereas in the early 1990s the projection for rural doctor numbers was continuing decline, the NRGPS projected overall numbers in rural practice as staying approximately the same over the next 5 years. In the light of these trends, the challenge is to implement targeted initiatives that improve the recruitment and retention of rural and remote general practitioners.

Adult↗