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PubMed2003

Evaluation of a peer-reviewed career development and compensation program for physicians at an academic health science center.

OBJECTIVE: The Department of Pediatrics at the Hospital for Sick Children, which is funded by an alternative payment plan, has implemented a novel career development and compensation program (CDCP). Job activity profiles were used to more clearly define job expectations, benchmarks guided career development, and peer review was used to assess performance. The objective of this study was to evaluate the departmental pediatricians' satisfaction with the CDCP. METHODS: Pediatricians, all of whom had undergone CDCP annual reviews, could participate if they had undergone the in-depth triennial CDCP review. Each received a 5-point Likert scale-based questionnaire that asked how well the CDCP had conformed to the principles identified by the department during the development of the CDCP. Anonymous, confidential responses were collated and used to guide focus groups that discussed areas of greatest concern and attempted to identify solutions. Focus groups were led by external facilitators who were experienced in qualitative research. They audiotaped the sessions, transcribed the comments, and analyzed the data with the assistance of a qualitative analysis application. RESULTS: Sixty of the eligible 88 pediatricians participated, and 74% of their responses were that the CDCP had addressed the original principles "somewhat," "to a great extent," or "extremely well." The remainder indicated that some of the principles were either "not addressed" or "only to a small extent" by the CDCP. Results from the 11 focus groups (46 participants) indicated that the CDCP was an improvement over the previous method of career development and determination of the rate of remuneration. Most were also still in agreement with the purpose and design principles. Although they did not want the CDCP to undergo a major redesign, they identified areas that need improvement. Short-, medium-, and long-term action plans to address these areas are under way. CONCLUSION: Pediatricians at the health science center of the Hospital for Sick Children remain supportive of the CDCP.

Academic Medical Centers↗
PubMed2001

[Community health policy as a research area in public health and social sciences].

The community plays a central role in new public health concepts. However, local health policy has not achieved a central role in cities and counties. Therefore it seems to be both reasonable and necessary for social sciences to analyse the health options in local politics and to identify aspects for improvement. The implementation of health priorities and their realisation at the local level, the latter with regard to supporting (positive) and hampering (negative) factors, and the development of strategies to implement health programmes are suggested as main research topics. Starting from the assumption that complex organisational processes in communities need organisational support, the role of the public health service as coordinating and initialising factor for the alteration of community health programmes should be investigated more thoroughly. The public health service as a part of the administration in municipalities is also involved in the endeavour to modernize administration. A main area for research will be how far the knowledge about participation of citizens and new management theories support health as a task of local politics.

Community Health Planning↗
PubMedDate not supplied

Recent developments in electrospray mass spectrometry including implementation on an ion trap.

Mass spectrometry (MS) may be the ultimate detection technique when combined with modern condensed phase separation sciences. The technique combines sensitivity with excellent specificity, so the pharmaceutical analyst can obtain definitive information regarding components separated in a mixture. Thus, mass spectrometric detection not only provides evidence of a chromatographic peak, but it also provides important information including molecular weight and structural information enabling identification of the components. The coupling of an atmospheric pressure ionization (API) mass spectrometer to most of the separation science techniques offers a simpler alternative from earlier non-routine, less sensitive systems where the vacuum systems struggled to handle the liquid effluent from these systems. Contemporary sensitive and analytically rugged API systems can be operated unattended for extended periods of time thus reducing the cost per sample to a reasonable value especially given the wealth of information provided. Although the mass spectrometer is more complicated than conventional spectroscopic detectors, present day API systems effectively decouple the liquid-phase separation inlet from the high-vacuum system where mass analysis occurs. The ability to form gas-phase ions at atmospheric pressure and sample primarily the analyte ions into the mass spectrometer promises a bright future for combining on-line condensed phase separation science techniques with mass spectrometry. The increasing ease of performing these experiments offers new analytical opportunities for pharmaceutical laboratories.

Carbohydrate Sequence↗
PubMed2000

Changes in nutrition knowledge among first- and second-year medical students following implementation of an integrated nutrition curriculum.

Existing studies suggest that many of the objectives called for by the National Academy of Sciences in its 1985 report are not being addressed in medical student education. Members of the Nutrition Curriculum Working Group at the UCLA School of Medicine prepared a list of proficiencies in nutrition and developed a coordinated, vertically integrated, two-year nutrition education curriculum to address those objectives. To assess the impact of the curriculum on students' knowledge, the authors tested a cohort of students at repeated intervals over a two-year period using a Nutrition Progress Survey drawn from the Nutrition Test-Item Bank developed at the University of Alabama. There was a significant increase in knowledge over the three administrations of the Progress Survey as measured by total score. This was largely accounted for by an increase in the number of correct responses, which rose from 39% at pre-test to 62% at delayed follow-up. In spite of a significant increase in nutrition knowledge, the low percentage correct indicates that nutritional content should be threaded throughout the core clerkship curriculum as well.

Curriculum↗
PubMed1991

Basic science and clinical application in the athlete's shoulder. A preventative program focusing on the glenohumeral joint.

This program can be implemented as either a preventative program or a rehabilitative program for the upper extremity in the throwing athlete or in nonthrowing athletes involved in overhead activities. The authors have found this program to be easily employed in a university setting. The keystone to its effectiveness is the participating individual. For optimal results, it should be performed as specifically outlined. The likelihood that shoulder symptomatology will develop is higher now that more people are participating in recreational and team sports for cardiovascular fitness. It is, therefore, imperative that a preventative program be developed in both the recreational and professional athletic population.

Athletic Injuries↗
PubMed2006

[The German competence network stroke: researching -- promoting -- networking].

BACKGROUND: Stroke is the most frequent neurologic disease, one of the most frequent reasons for disability and the third most frequent cause of death in Germany. Only the coordination of prevention, therapy in the acute setting and rehabilitation will improve the socioeconomic burden of stroke. IMPLEMENTATION AND RESULTS: The Competence Net Stroke (www.schlaganfallnetz.de) substantially contributes to these efforts by linking leading research groups together, improving communication, exchanging knowledge between clinicians, researchers and patients, as well as advancing public health science and quality assurance. Since the initiation of the Competence Net Stroke by the German Ministry of Education and Research in 1999, researchers and clinicians have implemented and expanded corporate databanks that jointly answer pressing questions in stroke imaging, epidemiology, and genetics. The progress that has been made is largely due to the formation of joint standard protocols at several independent institutions. The multicenter approach enabled the competence net to build up specialized criteria in magnetic resonance imaging (MRI). These criteria guide the clinician to those patients, who profit from thrombolysis beyond the 3-h time window. In addition, the Competence Net Stroke succeeded in reliably detecting cerebral hemorrhage with MRI. PROGRESSION AND PERSPECTIVES: Since 2005, and the beginning of the third funding period, the Competence Net Stroke consists of nine sub-nets. The integrative, rather than dominating, structure eases flexible reactions to new developments and findings in research. The Competence Net Stroke can more straightforwardly adopt new, promising research areas and end funding of those which are unsuccessful. The future and continuity of the Competence Net Stroke are secured by the acquisition of alternative funding such as "Sonderforschungsbereiche", the sixth European framework program, industrial partners, and health insurance.

Clinical Competence↗
PubMed2006

A new methodological approach to nonverbal behavior analysis in cultural perspective.

The measurement of human behavior is a complex task, both for psychologists and human sciences researchers and with respect to technology, since advanced and sophisticated instruments may have to be implemented to manage the plurality of variables involved. In this article, an observational study is presented in which a quantitative procedure, the external variables method (Duncan & Fiske, 1977), was integrated with a structural analysis (Magnusson, 1993, 2000) in order to detect the hidden organization of nonverbal behavior in Italian and Icelandic interactions. To this aim, Theme software was introduced and employed. The results showed that both the frequency and the typology of gestures deeply change as a function of culture. Moreover, a high number of patterns was detected in both Italian and Icelandic interactions: They appeared to be complex sequences in which a huge number of events were constantly happening and recurring. In this domain, Theme software provides a methodological progression from the quantitative to the structural approach.

Adult↗
PubMed1996

Problem-based medical education in general practice and health care quality assurance.

States that health systems globally are in transition, for which also a correspondingly reformed education is required, involving new--and renewed--basic sciences, principles, skills and methods. To that end, demonstrates how problem-based learning in general practice is almost ideal, although still sparsely implemented, and has much in common with health care quality assurance. Contends that primary care in many ways comprises the most important platform and vehicle of modern health services and their interaction with the population. Uses the example of the Faculty of Health Sciences in Linköping, where all curricula are integrated, community-oriented, problem-based and have a focus on primary care and general practice. Represents a useful and hitherto insufficiently recognized widening of the overall field of health care quality assurance, and summarizes some of the experiences therein. Also provides a brief overview of the literature.

Competency-Based Education↗
PubMed2001

Pediatric length of stay guidelines and routine practice: the case of Milliman and Robertson.

BACKGROUND: Guidelines for inpatient length of stay (LOS) have been developed by Milliman and Robertson (M&R) and are widely applied by health plans. This study was designed to compare LOS for several pediatric conditions with the M&R LOS criteria using recent data and to determine if concordance of actual practice with M&R LOS criteria varied between children and adults. DESIGN: Administrative data from Pennsylvania hospitals from 1996 through 1998 were used to examine LOS for hospital discharges for 12 selected diagnoses for which M&R published guidelines for children and adults. PATIENTS: Discharge data for all patients discharged from public and private hospitals in Pennsylvania for which 1 of 12 selected diagnoses were examined. MAIN OUTCOME MEASURE: Length of stay. RESULTS: In Pennsylvania hospitals from 1996 through 1998, pediatric LOS was divergent for all conditions examined, although not to the extent found in a previous study examining data from New York State. Of note, median LOS for some conditions was shorter than M&R LOS criteria. The percentage of pediatric hospital discharges that exceeded the M&R LOS criteria ranged from 25% for pneumonia to 84% for meningitis. Adult hospital discharges exceeded M&R LOS criteria to a greater extent than did pediatric discharges for all conditions except for sickle cell crisis and meningitis. CONCLUSIONS: The M&R LOS criteria were divergent from routine practice for both children and adults. Greater divergence of adult discharges illustrates the need to consider comorbid conditions when implementing these guidelines. Thus, patient care may suffer if guidelines are implemented in an uninformed way. These findings emphasize the importance of using the best possible science when producing guidelines such as these.

Adult↗
PubMed1998

Common mechanism of toxicity: a case study of organophosphorus pesticides.

The Food Quality Protection Act of 1996 (FQPA) requires the EPA to consider "available information concerning the cumulative effects of such residues and other substances that have a common mechanism of toxicity ... in establishing, modifying, leaving in effect, or revoking a tolerance for a pesticide chemical residue." This directive raises a number of scientific questions to be answered before the FQPA can be implemented. Among these questions is: What constitutes a common mechanism of toxicity? The ILSI Risk Science Institute (RSI) convened a group of experts to examine this and other scientific questions using the organophosphorus (OP) pesticides as the case study. OP pesticides share some characteristics attributed to compounds that act by a common mechanism, but produce a variety of clinical signs of toxicity not identical for all OP pesticides. The Working Group generated a testable hypothesis, anticholinesterase OP pesticides act by a common mechanism of toxicity, and generated alternative hypotheses that, if true, would cause rejection of the initial hypothesis and provide criteria for subgrouping OP compounds. Some of the alternative hypotheses were rejected outright and the rest were not supported by adequate data. The Working Group concluded that OP pesticides act by a common mechanism of toxicity if they inhibit acetylcholinesterase by phosphorylation and elicit any spectrum of cholinergic effects. An approach similar to that developed for OP pesticides could be used to determine if other classes or groups of pesticides that share structural and toxicological characteristics act by a common mechanism of toxicity or by distinct mechanisms.

Animals↗
PubMed2004

Radiofrequency glow-discharge devices for direct solid analysis.

The enormous potential of radiofrequency glow discharges (rf-GD) as photon, atom, or ion sources, coupled to spectrometric techniques, for rapid direct analysis of almost any conductor, semiconductor, or insulating material with good in-depth resolution has been demonstrated world-wide. This outstanding performance has prompted a great effort to develop and characterise rf-GD for direct materials analysis in recent years. The state of the art of rf-GD coupled to atomic absorption spectrometry, optical emission spectrometry, and mass spectrometry for direct solid analysis is reviewed here. A description of the principles of operation of the rf-GD and attempts to model these discharges are also given. Rf-GD instrumentation, both developed at research laboratories and commercially available, is described. Several practical examples are given demonstrating the capabilities of these techniques for bulk and depth-profile analysis. Finally, the research gaps to be filled for full implementation of rf-GD spectrometric techniques in industry and research centres alike for materials science studies and technical development are discussed.

Journal Article↗
PubMed2026

Proteomic profiling of bone for the estimation of post-mortem interval and post-mortem submersion interval: a systematic review.

Accurate estimation of the Post-Mortem Interval (PMI) and Post-Mortem Submersion Interval (PMSI) remains a persistent challenge in forensic science, especially when traditional morphological and entomological methods fail due to advanced decomposition or in aquatic environments. Proteomic profiling of bone tissues has recently emerged as a promising approach, leveraging the predictable degradation patterns of bone proteins to estimate time since death more reliably. This systematic review, conducted in accordance with PRISMA guidelines, analyzed 24 peer-reviewed studies focusing on the application of proteomic techniques to bone tissue for PMI and PMSI estimation. The included studies were evaluated based on sample type, analytical techniques used, identified biomarkers, environmental conditions assessed, and the overall reliability and reproducibility of the findings. The review found that specific bone proteins, particularly collagen, osteocalcin, fetuin-A, etc. exhibited consistent degradation patterns that correlated strongly with elapsed post-mortem time. Cortical bone was identified as a more stable and informative matrix compared to trabecular bone. Mass spectrometry, especially LC-MS/MS, emerged as the predominant analytical technique due to its high sensitivity and accuracy in detecting low-abundance proteins over extended PMIs and PMSIs. However, protein degradation rates were significantly influenced by environmental variables such as temperature, humidity, soil pH, and microbial activity. This review also emphasizes the transformative role of bone proteomics in advancing forensic science while identifying key gaps that must be addressed to achieve global standardization and practical implementation in diverse forensic contexts. The integration of proteomics with other emerging technologies, such as machine learning algorithms and computational modeling, may further enhance the precision of PMI and PMSI estimation in future applications.

Postmortem Changes↗
PubMed1991

The professional role for nurses in clinical trials.

This article has examined the role of the nurse in clinical trials, particularly the clinical, administrative, and research roles. Components of each role and characteristics essential for the implementation of each role have been examined. The nursing role in clinical trials research is undergoing major transformation from the perception of the nurse as a data collector for medical research to the recognition of the nurse as an essential member of the research team with a multifaceted role. Miaskowski identifies two factors influencing the development of oncology nursing practice; scientific and technological advances and societal factors relating to the perception of cancer as a disease and changes in the nursing profession. Certainly it is recognized that progress in basic science research will lead to an increase in the complexity and number of clinical trials. Nurses have clearly implemented the roles necessary to be vital participants and have contributed to answering questions leading to improved treatments for the patients with cancer.

Clinical Trials as Topic↗
PubMed1997

Dynamical Neural Networks that Ensure Exponential Identification Error Convergence.

Classical adaptive and robust adaptive schemes, are unable to ensure convergence of the identification error to zero, in the case of modeling errors. Therefore, the usage of such schemes to "black-box" identification of nonlinear systems ensures-in the best case-bounded identification error. In this paper, new learning (adaptive) laws are proposed which when applied to recurrent high order neural networks (RHONN) ensure that the identification error converges to zero exponentially fast, and even more, in the case where the identification error is initially zero, it remains equal to zero during the whole identification process. The parameter convergence properties of the proposed scheme, that is, their capability of converging to the optimal neural network model, is also examined; it is shown to be similar to that of classical adaptive and parameter estimation schemes. Finally, it is mentioned that the proposed learning laws are not locally implementable, as they make use of global knowledge of signals and parameters. Copyright 1997 Elsevier Science Ltd. All Rights Reserved.

Journal Article↗
PubMed1998

Education and training of medical informatics in the medical curriculum.

The teaching of medical informatics is of importance for students in medicine and health care, realizing that they will be the health professionals of the future. Training in medical informatics is also of value for practicing clinicians who are overwhelmed by the avalanche of systems that are available on the market. Some examples of operational systems are presented here to indicate that health care has changed dramatically over the last decades. This paper intends to contribute to the drafting of IMIA guidelines for teaching medical informatics by (1) reporting on the experience at the Faculty of Medicine and Health Sciences of the Erasmus University Rotterdam as part of the curriculum, (2) reporting on the implementation of guidelines for teaching medical informatics in The Netherlands since these guidelines were drafted in 1986, and (3) by introducing the teaching material contained in the new Handbook of Medical Informatics and on its Web site.

Curriculum↗
PubMed2001

Reflecting on the use of student portfolios.

The use of portfolios in nursing has increased during recent years. We reflect upon the design and implementation of a portfolio for pre-registration nursing students in the School of Care Sciences(1)at the University of Glamorgan. The portfolio was introduced as the result of the need to address the theory-practice divide and to provide nurse students with the skills to maintain a professional profile upon registration. We also discuss other potential benefits associated with using the portfolio. These include the use of a portfolio as a focus for discussion between the student and their preceptor or personal tutor, a vehicle for the development of reflective skills and a means of assessment. We acknowledge that along with benefits, there are a number of potential problems and limitations in their use, for example, an increase in the workload for the student, preceptor and personal tutor. We include preliminary findings of an evaluation of our portfolio, revealing that both students and staff value the introduction of the portfolio, although currently it is not a high priority in terms of the course as a whole.

Documentation↗
PubMed2001

School meals in Catalonia: surveillance and quality control.

The Education Council of the Catalonian government drew up a programme to improve the quality control of school canteens in Catalonia. The objectives of this programme were to contribute to developing healthier eating habits in school children through school canteens and to improve school canteen services considering other aspects such as service, operation, management, end-users, frontline staff and supervisors of menu planning. This paper deals with two programme components aiming at introducing Nutrition in the school syllabus and school menu assessment. Various departments, organisations and associations were involved in programme development and implementation. Initial analysis was based on information collected from formal administrative reports completed by a survey on 100 primary schools. From this preliminary analysis it was concluded that problem identification needs to be completed by an understanding of underlying reasons in order to design adequate solutions and guarantee implementation.

Adolescent↗