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Results for “Implementation challenges”

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At least 559 records · Page 31Linked to original sources

PubMed2003

Linking molecular diagnostics to molecular therapeutics: targeting the PI3K pathway in breast cancer.

Modulation of the signaling pathways that are aberrant in cancer cells has the potential to provide an effective nontoxic approach to patient management in a broad range of cancers. This quest has taken a major leap forward with the demonstration that STI-571 (imatinib mesylate) induces clinical and molecular remissions in the majority of patients with interferon-refractory chronic myelogenous leukemia and gastrointestinal stromal tumors through inhibition of the Bcr/Abl fusion protein required for the initiation and progression of chronic myelogenous leukemia and inhibition of a mutant, activated c-kit present in gastrointestinal stromal tumors. Support for the concept of targeting products of fusion genes found in specific cancers was first provided by the efficacy of all-trans retinoic acid in acute promyelocytic leukemia where the RARalpha all-trans retinoic acid target is the target of multiple different chromosomal rearrangements. In breast cancer, trastuzumab, which alters the function of the HER2 proto-oncogene overexpressed in a portion of breast cancers, provides an additional example of targeting specific molecular aberrations present in cancer cells. Although the target for these signal transduction modulators is functional in normal cells, acceptable therapeutic indices sufficient to prevent tumor growth without unacceptable toxicities have been observed. Whether STI-571 and other signal transduction modulators also target the stroma, and specifically the neovasculature, in addition to the tumor remains an open question. The presence of the target in the cancer cells or in the surrounding stroma appears to be required but not sufficient for the action of molecular therapeutics. Thus, linking molecular diagnostics to identify patients where the target is amplified or activated and driving the pathophysiology of the patients' tumor to effective molecular therapeutics will be necessary to translate these concepts into approaches that will alter the outcome for breast cancer patients. This review will focus on the phosphatidylinositol 3-kinase pathway and novel molecules targeting this pathway to illustrate the questions and challenges underlying the implementation of molecular therapeutics in breast cancer.

Animals↗

PubMed2004

Mammalian target of rapamycin.

Targeted molecular therapeutics are tailored toward the genetic abnormalities that cause tumor progression. Modulation of certain signaling pathways that are aberrant in cancer cells has the potential to provide an effective, nontoxic approach to therapy in a broad range of cancers. Agents targeting BCR-ABL (imatinib mesylate [formerly known as STI-571], Gleevec; Novartis Pharmaceuticals Corp, East Hanover, NJ), retinoid receptor fusion proteins (all-trans retinoic acid), ErbB-2 or HER2/neu (trastuzumab, Herceptin; Genentech, Inc, South San Francisco, CA), epidermal growth factor receptor (IMC-C225 and ZD1839), and the phosphatidylinositol 3-kinase pathway (CCI-779) have all induced remarkable, nontoxic responses in a subset of patients with cancer and abnormalities in the corresponding signal transduction cascades. To achieve successful individualized therapy, the specific components within the aberrant signaling pathways that are driving the pathophysiology of the tumors must be identified in each patient. Molecular diagnostics can identify patients in whom the target is aberrant; linking molecular diagnostics with effective molecular therapeutics will be necessary to translate these concepts into approaches that will alter the outcome for patients with cancer. In addition, intermediary markers and/or molecular imaging techniques must be used to identify the biologically relevant dose that is sufficient to inhibit the target of interest. This review focuses on the P13K pathway, and novel molecules targeting this pathway, to illustrate the questions and challenges underlying the implementation of molecular therapeutics in breast and ovarian cancer.

Animals↗

PubMed2001

Introducing the routine use of outcomes measurement to mental health services.

Significant progress has been made in preparing for the introduction of the routine use of outcome measurement instruments to mental health services. However, limited attention has been paid to the linked issues of the practical challenge of their implementation and their possible uses in clinical practice. This paper reports on a qualitative study examining the views of clinicians, service managers, consumers and carers on how to effectively introduce a suite of measures to a public mental health service and use ratings generated by them in clinical practice. These findings are combined with practical experience gained in introducing a suite of outcome measures in order to suggest future strategies for implementation.

Attitude of Health Personnel↗

PubMed1998

Protecting patient confidentiality in hospitals.

As new methods of electronic data storage and distribution appear in hospitals, new challenges in protecting confidentiality have emerged. At the same time, demands for 'seamless' care and the desire to share information between clinicians are motivating hospitals to relax barriers to the transfer of patient information. Increasing numbers of users at multiple sites compound the difficulty of ensuring information systems security. Hospital policy may demand that requests by patients to restrict the distribution of personal information be respected, while existing electronic systems are not able to deliver on this promise. Compliance with the Information Privacy Principles of the Commonwealth Privacy Act 1988 and the Australian Standard 4400-1995 'Personal privacy protection in health care information systems' will provide a useful framework for managing these challenges. However, their implementation will require some forethought.

Australia↗

PubMed2025

raxtax: a k-mer-based non-Bayesian taxonomic classifier.

MOTIVATION: Taxonomic classification in biodiversity studies is the process of assigning the anonymous sequences of a marker gene (barcode) or whole genomes (metagenomics) to a specific lineage using a reference database that contains named sequences in a known taxonomy. This classification is important for assessing the diversity of biological systems. Taxonomic classification faces two main challenges: first, accuracy is critical as errors can propagate to downstream analysis results; and second, the classification time requirements can limit study size and study design, in particular when considering the constantly growing reference databases. To address these two challenges, we introduce raxtax, an efficient, novel taxonomic classification tool for barcodes that uses common k-mers between all pairs of query and reference sequences. We also introduce two novel uncertainty scores which take into account the fundamental biases of reference databases. RESULTS: We validate raxtax on three widely-used empirical reference databases and show that it is 2.7-100 times faster than competing state-of-the-art tools on the largest database while being equally accurate. In particular, raxtax exhibits increasing speedups with growing query and reference sequence numbers compared to existing tools (for 100 000 and 1 000 000 query and reference sequences overall, it is 1.3 and 2.9 times faster, respectively), and therefore alleviates the taxonomic classification scalability challenge. AVAILABILITY AND IMPLEMENTATION: raxtax is available at https://github.com/noahares/raxtax under a CC-NC-BY-SA license. The scripts and summary metrics used in our analyses are available at https://github.com/noahares/raxtax_paper_scripts. The source code, sequence data, and summarized results of the analyses are available at https://doi.org/10.5281/zenodo.15057027.

Software↗

PubMed1998

A standardized menu for Goal Attainment Scaling in the care of frail elders.

Goal Attainment Scaling (GAS), an individualized measurement approach, is particularly attractive for the evaluation and care planning of frail elders, who often experience multiple, complex problems. Some service providers find GAS too unwieldy for routine use. A modified version of GAS that uses a standardized menu of goals and attainment levels has been developed by the Geriatric Assessment and Rehabilitation Unit of a regional referral hospital in Nova Scotia, Canada. This article reviews the development, implementation, benefits, and challenges of the standardized menu, as well as the results of a retrospective descriptive study of its measurement properties. The standardized menu appears to be a feasible, valid, and responsive alternative to traditional GAS, while retaining much of its individualized nature.

Activities of Daily Living↗

PubMed2006

Development of a universally applicable household food insecurity measurement tool: process, current status, and outstanding issues.

The United States Public Law 480 Title II food aid program is the largest U.S. government program directed at reducing hunger, malnutrition, and food insecurity in the developing world. USAID and Title II implementing partners face challenges in measuring the success of Title II programs in reducing household food insecurity because of the technical difficulty and cost of collecting and analyzing data on traditional food security indicators, such as per capita income and caloric adequacy. The Household Food Insecurity Access Scale (HFIAS) holds promise as an easier and more user-friendly approach for measuring the access component of household food security. To support the consistent and comparable collection of the HFIAS, efforts are under way to develop a guide with a standardized questionnaire and data collection and analysis instructions. A set of domains have been identified that is deemed to capture the universal experience of the access component of household food insecurity across countries and cultures. Based on these domains, a set of questions has been developed with wording that is deemed to be universally appropriate, with minor adaptation to local contexts. These underlying suppositions, based on research in multiple countries, are being verified by potential users of the guide. The key remaining issue relates to the process for creating a categorical indicator of food insecurity status from the HFIAS.

Anxiety↗

PubMed1998

The use of "vertical integration groups" to help define and update course/clerkship content.

Faculty at many medical schools are working hard to improve the quality of their curricula. While the world "curriculum" means different things to different people, curricular change often includes improving the structure of the teaching/learning environment (e.g., seminars or problem-based learning groups vs lectures), the content of courses and clerkships (the core set of knowledge, skills, and attitudes that should be learned), and the manner in which student learning of knowledge and skills is evaluated (the sense that evaluation can help "drive" the curriculum). The author describes how "vertical integration groups" have been used over four years at Dartmouth Medical School to improve and modernize the content of courses and clerkships. In this approach, students and faculty work together to address and improve content areas that normally are not associated with traditional, discipline-centered courses or clerkships. The author discusses the advantages of this approach, the challenges encountered during implementation, and examples of how the approach has been put into action.

Clinical Clerkship↗

PubMedDate not supplied

Advanced dementia research in the nursing home: the CASCADE study.

Despite the growing number of persons with advanced dementia, and the need to improve their end-of-life care, few studies have addressed this important topic. The objectives of this report are to present the methodology established in the CASCADE (Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life) study, and to describe how challenges specific to this research were met. The CASCADE study is an ongoing, federally funded, 5-year prospective cohort study of nursing [nursing home (NH)] residents with advanced dementia and their health care proxies (HCPs) initiated in February 2003. Subjects were recruited from 15 facilities around Boston. The recruitment and data collection protocols are described. The demographic features, ownership, staffing, and quality of care of participant facilities are presented and compared to NHs nationwide. To date, 189 resident/HCP dyads have been enrolled. Baseline data are presented, demonstrating the success of the protocol in recruiting and repeatedly assessing NH residents with advanced dementia and their HCPs. Factors challenging and enabling implementation of the protocol are described. The CASCADE experience establishes the feasibility of conducting rigorous, multisite dementia NH research, and the described methodology serves as a detailed reference for subsequent CASCADE publications as results from the study emerge.

Aged↗

PubMed2001

Addressing the burden of heart failure in Australia: the scope for home-based interventions.

The growing burden of heart failure (HF) challenges health practitioners to implement and evaluate models of care to facilitate optimal health related outcomes. Australia supports a publicly funded universal health insurance system with a strong emphasis on primary care provided by general practitioners. The burden of chronic HF, and a social and political framework favoring community-based, noninstitutionalized care, represents an ideal environment in which home-based HF programs can be implemented successfully. Cardiovascular nurses are well positioned to champion and mentor implementation of evidence-based, patient-centered programs in Australian communities. This paper describes the facilitators and barriers to implementation of best practice models in the Australian context. These include the challenge of providing care in a diverse, multicultural society and the need for clinical governance structures to ensure equal access to the most effective models of care.

Aged↗

PubMed1997

Providing developmentally supportive care in the newborn intensive care unit: an evolving challenge.

Clearly, the great majority of premature infants currently survive their neonatal course in the hospital. The major challenge facing neonatal health care providers is to combine the necessary technologic intensive care for the newborn with a sensitive and individualized approach to facilitate neurobehavioral development while acknowledging and supporting the parents of these infants in their role as primary advocates and long-term caregivers. This challenge has been met in a variety of ways over time, and a new history of providing developmentally supportive care is being created. A multidisciplinary collaborative approach based on the synactive theory of newborn development incorporates both environmental and caregiving modifications to enhance infant and family outcomes. The article reviews the history of this approach to care, the current state of the art and practice, and the current challenges for future implementation.

Child Development↗

PubMedDate not supplied

A decade of distance education: RN to BSN.

TELETECHNET represents a major commitment on the part of the university. The university's strategic plan and resource allocations indicate that this educational strategy is a growing enterprise. Although challenges exist in implementing a nursing education program by television, the TELETECHNET program provides opportunities for the place-bound student to achieve advanced education.

PubMed1997

An overview of HIV prevention in the United States.

Despite recent promising results with protease inhibitors and combinations of drugs in treating HIV-infected persons, a cure or vaccine for AIDS is unlikely within the next several years. Therefore, prevention remains the most realistic strategy for dealing with the HIV epidemic. However, HIV prevention efforts in the United States face enormous challenges. Translating knowledge about effective HIV prevention strategies into sound HIV prevention policy must be a priority. For example, AIDS prevention experts must dispel the myth that needle exchange programs for injection drug users encourage drug use. Such programs may, however, decrease the risk for HIV transmission. Another challenge is to implement effective sex education programs. It is well established that early sex education does not lead to promiscuity among young people; in fact, it may actually decrease overall sexual activity and decrease high-risk sexual activities. Finally, prevention programs must reach those most at risk. Surveillance data indicate that these include young gay men, Hispanic and African Americans, and the economically disadvantaged. Prevention policy too often is formed on the basis of opinion or anecdote rather than on the basis of science. Sound and strong science is needed to ensure that the best programs and policies can be put into place.

Adult↗

PubMed2006

Nonsurgical management of osteolysis: challenges and opportunities.

Osteolysis remains a common mode of total hip arthroplasty failure. In vitro and animal models have been used to determine the pathophysiology of osteolysis by carefully dissecting the biochemical pathways leading to particulate wear debris and periprosthetic bone loss. Numerous cytokines and inflammatory mediators, including TNF-alpha and IL-1, are critical participants in this cascade and may represent prime targets for pharmacologic intervention. Osteoclasts, the end effector cells involved in the osteolytic process, also represent potential targets. Cell surface receptors on osteoclast precursors, such as receptor activator of NF-kappaB (RANK) (on osteoclasts) and RANK-ligand (RANKL) (on stromal cells), provide opportunities to arrest osteoclast maturation. Enhancing the naturally occurring osteoprotegerin is another recent attempt at modulating osteoclast behavior and a possible target for pharmacologic therapies. Other nonoperative strategies include intercepting tumor necrosis factor-alpha activity, interfering with the RANK-RANKL interaction necessary for osteoclast development and maturation, bisphosphonate therapy, and using viral vectors to deliver genes. Although each of these approaches has potential benefits, there are substantial challenges to effective implementation. Until there is convincing evidence of efficacy in human clinical trials, we recommend vigilant screening and appropriate surgery with component loosening or substantial likelihood of loosening, periprosthetic fracture, or major bone loss.

Animals↗

PubMed2006

Advances in clinical 3-tesla neuroimaging.

Three-tesla magnetic resonance (MR) imaging represents one of the major forefronts of diagnostic neuroradiology today. Heat deposition, changes in T1 relaxation rates, susceptibility differences, and greater inherent sensitivity to motion artifacts represent challenges to clinical implementation. However, the situation appears remarkably similar to that encountered almost 15 years ago as the field of MR transitioned from 0.3-0.6 T to 1.5 T units. Current-generation 3 T MR units already provide markedly improved imaging of the brain as compared with 1.5 T units. This is illustrated in the article that follows, together with many of the advanced techniques now available and in the pipeline to deal with the difficulties inherent at 3 T.

Adult↗

PubMed2003

Cost and outcome analysis and cost determinants of liver transplantation in a European National Health Service hospital.

BACKGROUND: Liver transplantation has become established therapy for end-stage liver disease. Survival rates are satisfactory and the current challenge is the implementation of cost-optimization policies. METHODS: This study was a cost-outcome and cost-determinant analyses in an Italian National Health Services liver transplantation unit. Collection of data related to survival and costs in 235 adult transplant recipients from 1997 to 2000. Costs included consumption-related costs (e.g., diagnostics, medication) and structure-related costs (e.g., staff, general costs, and overhead) allocated individually according to hospital patient days. The main variables were average cost per patient alive at the end of each year, average cost per month of patient alive, and average cost per transplantation. RESULTS: Two hundred fifty-two transplantations were performed in 235 adults (mean follow-up, 16.5 months). Average cost per patient alive was constant (e107,014-e117,782), whereas average cost per month of patient alive progressively diminished to e7,098. Costs differed according to reason for transplantation, being lower in nonviral (mainly alcoholic) hepatitis and higher in fulminant hepatic failure and in rare liver diseases. Higher costs were also observed in patients with portal thrombosis and high pretransplant serum creatinine. The average cost per transplantation was fairly constant (e75,747-e83,846) and plateaued after 120 to 140 transplantations. CONCLUSIONS: The optimization of the cost-to-outcome ratio is linked to a reasonably high number of transplants per year, which allows early achievement of a cost-per-transplant plateau associated with a better survival rate, in addition to careful consideration of risk factors and diagnoses.

Adult↗

PubMed2003

An update on falls.

PURPOSE OF REVIEW: Falls among elderly persons create immense social problems because of their association with physical decline, serious psychosocial consequences, negative impact on the quality of life, and markedly reduced survival. In addition, falls pose high costs to the public health service. For these reasons, falls remain a popular topic for research. Here, we review several interesting developments that have been published during the past year. RECENT FINDINGS: Considerable attention has been focused on early identification of fallers and prevention strategies for falls or injuries. A remaining challenge is to implement such strategies into daily clinical practice, at acceptable costs and with good acceptance. New evidence has been generated to suggest the importance of high-level processing for postural control, but it remains difficult to predict falls based upon a simple dual tasking test. Neuroimaging studies are now beginning to provide new insights into the role of cortical structures in balance regulation, and how cortical dysfunction might contribute to falls. Posturography studies using multidirectional moving platforms or computer models of balance have provided new insights into falling mechanisms, in particular the role of abnormal protective responses (stepping or grasping) and the negative effects of stiffening. Other studies have shown how a fear of falling, a common sequel to falls, may lead to secondary degeneration of postural control, thus completing a vicious loop. SUMMARY: While these examples illustrate that falls research is very much ongoing, one cannot speak of true progress until the scientific evidence can be implemented into real life, with falls being prevented effectively in individual cases.

Accidental Falls↗

PubMed1995

Information strategy in the NHS: issues and challenges.

There has been considerable discussion of the nature and scope of information that purchasers and providers must acquire and use in the post-review NHS. Somewhat surprisingly, this has not been complemented by discussion of the potential for computer systems to support information management. This in spite of the publication of the NHS Information Management and Technology Strategy, which seems set to shape the way in which purchasers and providers manage data into the next century, and expenditure on computer systems which will be in the order of hundreds of millions of pounds over the next few years. Discusses some of the key challenges involved in implementing an IT infrastructure across the NHS, and identifies five issues which will substantially determine the success of the strategy.

Computer Systems↗