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PubMed2006

Single cell volume measurement by quantitative phase microscopy (QPM): a case study of erythrocyte morphology.

The measurement of the volume of intact, viable cells presents challenging problems in many areas of experimental and diagnostic science involved in the evaluation of cellular morphology, growth and function. This investigation details the implementation of a recently developed quantitative phase microscopy (QPM) method to measure the volume of erythrocytes under a range of osmotic conditions. QPM is a computational approach which utilizes simple bright field optics to generate cell phase maps which, together with knowledge of the cellular refractive index, may be used to measure cellular volume. Rat erythrocytes incubated in imidazole-buffered solutions (22 degrees C) of graded tonicity were analysed using QPM (n=10 cells/group, x63, 0.8 NA objective). Erythrocyte refractive index (1.367) was measured using a combination of phase and morphological data obtained from cells adopting spherical geometry under hypotonic conditions. Phase-computed volume increased with decreasing solution osmolality: 42.8 +/- 2.4, 48.7 +/- 2.3, 62.6 +/- 2.3, 90.8 +/- 7.7 microm3 in solutions of 540, 400, 240, and 170 mosmol/kg respectively. These volume changes were associated with crenated, bi-concave and spherical morphological states associated with increasing tonicity. This investigation demonstrates that QPM is a valid, simple and non-destructive approach for measuring cellular phase properties and volume. QPM cell volume analysis represents a significant advance in viable cell experimental capability and provides for acquisition of 'real-time' data - an option not previously available using other approaches.

Animals↗

PubMedDate not supplied

The engineering of endovascular stent technology: a review.

The evolution of minimally invasive endovascular technology has initiated a significant paradigm shift in the treatment of vascular disease. A fundamental understanding of the science and engineering behind the technology of endovascular stents is a key to their appropriate implementation in practice. Furthermore, the rapid influx of new devices into the field requires practitioners to make their decisions on a foundation of the relative strengths and weaknesses of the various products. Although the principles of their use are not complex, the device design can have a profound effect on the device's functionality. Shape, thickness, coating, material selection, and imaging are just a few of the factors to consider in stent design. Subtle differences may have profound results. This review is designed to provide the reader with an overview of fundamental concepts that will aide the assessment of new technology.

Biocompatible Materials↗

PubMedDate not supplied

Start out: building healthcare careers for minority teenagers.

BACKGROUND: The healthcare industry is currently experiencing a severe shortage of nurses and other allied healthcare professionals. To compound this crisis, the current workforce does not mirror the growing linguistic and cultural diversity of the population needing health care. This article describes a community partnership approach to creating educational and career opportunities in nursing and other health sciences for young, multicultural, bilingual teenagers. METHOD: Several community organizations joined together to design and implement an 8-week summer program entitled "Start Out," which served to integrate life planning, mentorship, nursing assistant training, and college application assistance while providing summer salary stipends and work scholarship opportunities. Twenty-seven students participated in the program. RESULTS: Twenty-four bilingual, economically disadvantaged teenagers 16 to 19 years old, from the greater Seattle metropolitan area, completed the first session of this innovative program and passed the certified nursing assistant examination. CONCLUSION: Culturally focused assistance programs may provide an avenue to meet the current nursing shortage and provide healthcare workers who can be sensitive to the cultural and linguistic needs of the growing ethnic population.

Adolescent↗

PubMed1978

Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research.

Major health care problems such as patient dissatisfaction, inequity of access to care, and spiraling costs no longer seem amenable to traditional biomedical solutions. Concepts derived from anthropologic and cross-cultural research may provide an alternative framework for identifying issues that require resolution. A limited set of such concepts is described as illustrated, including a fundamental distinction between disease and illness, and the notion of the cultural construction of clinical reality. These social science concepts can be developed into clinical strategies with direct application in practice and teaching. One such strategy is outlined as an example of a clinical social science capable of translating concepts from cultural anthropology into clinical language for practical application. The implementation of this approach in medical teaching and practice requires more support, both curricular and financial.

Adult↗

PubMed2001

Informing river management policies and programs with science.

Conventional wisdom has it that we already have enough science to address the problems causing degradation of our environment, including rivers. This is not true. However it is the case that we could be using existing knowledge better, and that we could be doing more to learn the lessons from the huge sums being spent on river restoration and management. Informing good policy and practical on-ground management with R&D outputs has proven to be is difficult, but essential. This paper reviews some of the history of water and river management in Australia and how perceptions of rivers have evolved. It discusses the challenge of enhancing the linkages between science, policy and practice in river management. It outlines the knowledge exchange, R&D and capacity building strategies of the National Rivers Consortium--a new initiative whose founding partners are LWRRDC, the MDBC, CSIRO Land and Water and the Western Australian Waters and Rivers Commission. This strategic collaboration between policy makers, river managers and scientists brings together organisations with responsibility and expertise to improve the health and management of Australian rivers. The National Rivers Consortium is making a major investment in knowledge exchange and capacity building, based on direct personal contact and learning by doing. The Consortium is establishing a program of training activities targeting river managers and policy makers, based on the best available science and high quality information products. It will support river managers as they plan and implement river restoration and protection projects. The paper concludes with a discussion of the key knowledge gaps that remain impediments to the better management of Australia's unique and diverse river landscapes.

Australia↗

PubMed2002

Role of genetic and expression profiling in pharmacogenomics: the changing face of patient management.

As the determination of gene sequences and their function gains speed at the dawn of the third millennium, biomedical research efforts are oriented towards definition of the genetic and molecular expression patterns that may drive different disease. A major part of these efforts is addressed to the definition of inter-individual variations that are expected to become integral for treatment planning, in terms of efficacy and adverse effects of drugs. It is this thrust on genome-based 'rational therapeutics' that is hoped to progressively lead to the era of 'personalized medicine'. This approach uses the technological expertise from genomics and functional genomics to define, predict and monitor the nature of the response of an individual to drugs, and to rationally design newer drugs. In the present review we will conduct our readers through an understanding of the fundamentals of pharmacogenomics and of the technologies currently available that are advancing this relatively new science. Conversely, there are issues raised that concern how medical practice is preparing itself to implement new alternatives for therapeutical interventions and finally, how to respect patient confidentiality and rights.

Antimetabolites, Antineoplastic↗

PubMed2002

Adoption of three Rs alternatives for regulatory testing of vaccines in the developing world: possibilities and barriers.

Animals have been widely used in the development, production and quality control of vaccines. The availability of newer vaccines consisting of well-defined, purified antigens has facilitated the use of in vitro techniques for establishing vaccine potency. At the same time, increased awareness and social concern has lead to attempts to reduce the use of animals, refining animal-based methodologies to decrease distress and/or replacing animal tests by alternatives. Substitute procedures for "potency testing" of diphtheria and tetanus toxoid-containing vaccines have been developed that require fewer animals and preclude the use of lethal challenge. The Pan American Health Organization has been working together with RIVM to assist countries in the Region of the Americas to implement these procedures in their regulatory quality control activities. There have been important advances in this programme. Although difficulties may arise in the implementation process, due to the perception that these alternatives may be costlier, the use of "Good Practices for the Use of Animals" may show this idea to be incorrect. The final decision for implementation will be taken on the basis of common sense and application of the best science available.

Americas↗

PubMed2004

Incorporating bioterrorism training into dental education: report of ADA-ADEA terrorism and mass casualty curriculum development workshop.

Numerous areas have been identified in which the dental profession may be called upon to assist in the event of a major terrorism attack. In order to successfully fulfill these roles, dentists and dental students must be adequately prepared. Dental schools play a vital role in this preparation. Participants in an ADA-ADEA workshop reached consensus that all dental students should be trained in a core set of competencies enabling them to respond to a significant bioterrorism attack, help contain the spread of the attack, and participate in surveillance activities as appropriate upon direction of proper authorities. Further emergency response training should be available to individuals interested in gaining additional knowledge and skills to assist in response to an attack. Participants also concluded that, where possible, training should be seamlessly implemented into the current curriculum without the addition of new courses; however, the group also recognized the possible need for alternative models at some dental schools. Challenges to implementing bioterrorism training into the dental school curriculum include regional variation, management of the basic science curriculum, and financial considerations. The development of an exportable training package will be considered and funding sources explored in moving forward with the development of a curriculum.

American Dental Association↗

PubMed1977

Internal review as a means of maintaining quality education in a medical school.

In order to focus attention on education, the University of Texas Medical Branch at Galveston adopted a system of internal review. The process was initially conducted for courses in the basic sciences by an ad hoc dean's committee consisting of representatives from the teaching faculty, administration, and student body as well as experts in medical education. As a consequence of the experience with the review of the basic science courses, the internal review process was applied to the clinical science courses and the elective programs at UTMB. The activities of the internal review process have resulted in improvements in instructional procedures and structural changes in the medical school's approach to educational planning, implementation, and evaluation.

Curriculum↗

PubMed2006

[Medical risk management].

An error-control management (management of technical errors) is well established, tested and approved in sectors of high risk, such as aviation and nuclear industry. Although medical science likewise represents a sector of high risk, a similar region-wide control management is still missing. The reasons are multifaceted: by implementation of an error-control management, the negotiation of psychological obstacles and the investment of financial resources have to be faced. The profit from overcoming these obstacles is gained only in the long term. The intention of this survey is to give an overview of the current state of knowledge of errors in medical science as well as to give an introduction (adoption) of the basic principles of systemic error description, detection and prevention by evaluating the available studies.

Evidence-Based Medicine↗

PubMed2000

KIDSCARE: a network for children with special health care needs.

In December 1997, Arkansas Medicaid in cooperation with Title V and Children's Medical Services (CMS) implemented guidelines for the preauthorization of therapy services for Children with Special Health Care Needs (CSHCN). The University of Arkansas for Medical Sciences (UAMS) in partnership with Arkansas Medicaid (MCD), and Chidren's Medical Services (CMS) were given the charge of developing clinical practice guidelines for physical therapy (PT), occupational therapy (OT), and speech/language therapy (SLP) for this population based on primary diagnosis and age appropriateness. This process involved the implementation of a statewide, internet-based, clinical information support network. The objective of this article is to describe KIDSCARE, a clinical information support network, currently under development, for the determination of medical necessity and allocation of therapy services for CSHCN.

Academic Medical Centers↗

PubMed1999

Institutional Analysis and Ecosystem-Based Management: The Institutional Analysis and Development Framework.

/ Scholars, government practitioners, and environmentalists are increasingly supportive of collaborative, ecosystem-based approaches to natural resource management. However, few researchers have focused their attention on examining the important administrative and institutional challenges surrounding ecosystem-based management. This paper describes how the institutional analysis and development (IAD) framework can be used to better understand the institutional arrangements used to implement ecosystem-based management programs. Some of the observations emanating from previous research on institutional design and performance are also discussed. The paper's central argument is that if this new resource management paradigm is to take hold and flourish, researchers and practitioners must pay closer attention to the questions surrounding institutional design and performance. This should help improve our understanding of the relationship between science and human values in decision making. It should also help researchers avoid making faulty policy recommendations and improve the implementation of ecosystem-based management programs.KEY WORDS: Ecosystem management; Watershed management; Common pool resources; Implementation; Institutional analysis; Evaluation; Policy analysishttp://link.springer-ny.com/link/service/journals/00267/bibs/24n4p449.html</HEA

Journal Article↗

PubMedDate not supplied

Use of the equity implementation model to review clinical system implementation efforts: a case report.

This paper presents the equity implementation model (EIM) in the context of a case that describes the implementation of a medical scheduling system. The model is based on equity theory, a well-established theory in the social sciences that has been tested in hundreds of experimental and field studies. The predictions of equity theory have been supported in organizational, societal, family, and other social settings. Thus, the EIM helps provide a theory-based understanding for collecting and reviewing users' reactions to, and acceptance or rejection of, a new technology or system. The case study (implementation of a patient scheduling and appointment setting system in a large health maintenance organization) illustrates how the EIM can be used to examine users' reactions to the implementation of a new system.

Appointments and Schedules↗

PubMed2003

Public policy and evidence-based practice.

The time has come to add to the body of EBP implementation knowledge at multiple levels, including knowledge about policy, program priorities, clinician practice, consumer adherence, and family member support. Implementation at the policy level, however, is primary and paramount. The national initiative supporting EBP implementation is one of the most important innovations on the mental health horizon. It will serve as the testing ground for what can be learned about bridging the gap between science and service. This important initiative will not go far if it is not supported by mental health policies--at state and federal levels--that create the organizational and financial incentives to implement EBPs. In addition, it will be a time-limited activity if it also does not yield lessons about how to adapt to new evidence and on-going systemic changes. Organizations must be flexible and able to learn and adapt. The promise of decades of research must be realized in practice. There is an opportunity to combine quality improvement with accountability through performance measurement and the implementation of effective new services and treatments. The Surgeon General simultaneously identified this research's promise and documented its shortcomings. His report outlines courses of action for policymakers that should guide clinicians away from service disparities and toward the implementation of EBP.

Age Factors↗

PubMed1989

The McMaster M.D. program: a case study of renewal in medical education.

This paper presents four aspects of health professions education at McMaster University: (1) a review of the key elements of the history and distinctive approach of the Doctor of Medicine (M.D.) program; (2) a description of the process and substance of curriculum change over the past decade, focusing on a major revision of the M.D. program that began in 1983; (3) a summary of the findings of follow-up studies of McMaster M.D. program graduates; and (4) an analysis of the current context within which the Faculty of Health Sciences (of which the M.D. program is a part) is operating and a description of strategies for renewal that are being implemented. The evidence and experience to date support the assertion that satisfactory--and in some ways special--physicians can be prepared using the "McMaster approach" to medical education, but that continuous review and periodic major revisions of the educational program are both necessary and possible; they must occur in concert with developments in other sectors of Faculty of Health Sciences activities.

Attitude of Health Personnel↗

PubMed1998

Deployable teleradiology: Bosnia and beyond.

The United States military has been an effective proponent of digital imaging and teleradiology for the past 15 years [1]. A digital imaging network that eliminates the use of x-ray film makes military medicine requirements simpler. X-ray film requirements include storage of new, unexposed films, storage and use of chemicals and water for processing, and disposal of chemicals. In some deployed situations, the chemical discharge needs to be collected and shipped out of the area. Therefore, the ability to implement electronic imaging and eliminate or greatly reduce the dependence on film, chemicals, and water are intrinsically important to military medicine. In December 1995, the United States government began deployment of 20,000 United States troops to Bosnia-Herzegovina as part of NATO's peacekeeping implementation force (IFOR) operation. A full complement of military medical support facilities was established in Bosnia. An army base in Hungary was the location from which the deployment was staged. The project to deploy telemedicine and teleradiology capabilities to the medical treatment facilities (MTF) in Bosnia and Hungary became known as PrimeTime III [2]. This paper deals with the deployable teleradiology (DEPRAD) system that was installed by the Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown Medical Center, Washington, DC, at a number of facilities to implement filmless radiology and teleradiology services in support of PrimeTime III.

Bosnia and Herzegovina↗

PubMed1987

Design, implementation, and evaluation of a longitudinal cancer curriculum.

The University of Massachusetts Medical School's two year preclinical curriculum is organized by organ system and controlled by the basic science departments. It is followed by two years of required and elective clinical clerkships. An evaluation of cancer teaching in the preclinical curriculum using criteria derived from the Cancer Education Objectives for Medical Schools was conducted. Deficiencies in cancer teaching were documented and the need for an organized cancer education program established. The administration then allotted 18 hours for cancer teaching spread over the two years of the preclinical curriculum. Supported by an R25 Cancer Education Grant, the Longitudinal Cancer course (LCC), was developed in an attempt to effectively utilize the scattered class time to meet a significant number of American Association for Cancer Education Objectives. In addition, interdisciplinary teaching of the more common cancers was facilitated and faculty were supported in their use of cancer related examples to illustrate relevant materials in the basic sciences. Evaluation of the LCC after a three-year trial has shown that, without strong administrative support, it is a very inefficient method of cancer teaching. While students appreciated class content and met a significant number of course objectives, they found the longitudinal format of the course unsatisfactory and recommended that the course be consolidated into a block. R25 grant support was being sought to implement a proposal to consolidate cancer teaching when the R25 program was suspended. Without external support, implementation will be difficult because it will require serious disruption of an established course. Such a change will require resources that are not readily available in this era of fiscal constraint.

Curriculum↗

PubMed1992

Design and implementation of an image management and communications system (IMACS) for dentomaxillofacial radiology.

An Image Management and Communications System for digital dentomaxillofacial radiology is under development at the Department of Dental Diagnostic Science at the University of Texas Health Science Center at San Antonio, Texas, USA. In its final stage, the system will provide a method of integrating different direct digital image acquisition modalities such as intraoral, panoramic and extraoral radiography. A review of the design criteria necessary for establishing such a system for clinical dentistry is discussed and the first phase of its implementation described.

Computer Communication Networks↗