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Results for “Paradigm shift”

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PubMed1997

[Home care and nursing administration in community health nursing--the integration of individual health care with community health care].

There has been a paradigm shift in community health nursing. In 1992, visiting nursing stations were first introduced. In 1994, the Community Health Act came into force and in recent years public health care insurance has become a major issue. In this paradigm shift, one of the roles of nursing in the community is to train people to become more autonomous as consumers of health care services, and to design and implement a system that enhances community members' health and provides support when they are ill. In 1990 and 1996, the national nursing curriculum was revised to reflect changes in the age of the population. Community health nursing now faces the challenge of developing a new nursing model that is in tune with Japanese cultural values. Dr. Katsunuma (1996) proposed two alternative approaches to health care services: the public health approach and the clinical approach. In this paper, it is suggested that home care offers a third alternative, which integrates the clinical approach with the public health approach. This third approach provides a paradigm for community health nursing that integrates individual health care with community health care. New roles and specialties for public health nurses include care management, care planning, community health nursing administration, and supervision. Community-based nursing centers that cooperate with schools of nursing will provide a setting and a concept for community health nursing.

Case Management↗

PubMed2006

The case for patient-centered care in orthopaedics.

Now is a critical time to develop a patient-centered care model in the field of orthopaedic surgery. Patient-centered care is defined by the American Academy of Orthopaedic Surgeons as the provision of safe, effective, and timely musculoskeletal care achieved through cooperation between the orthopaedic surgeon; an informed, respected patient (and family); and a coordinated health care team. Patient-centered care, a paradigm shift from disease-centered care, is being championed by government agencies, patient advocacy groups, and insurance companies. Orthopaedic organizations must develop a comprehensive education program to provide surgeons the tools they need to navigate this paradigm shift.

Adult↗

PubMed2007

Paradigms lost?

Thomas Kuhn (1957, 1962) explored the issues of paradigm shifts, scientific revolutions, and the relationship between them. Written before the techniques and practices of the complexity sciences were developed, Kuhn described what he termed the Copernican Revolution as the last scientific revolution signifying a paradigmatic shift in society. We will explore whether New Science approaches in nonlinear dynamics and complexity research signify postmodern science perspectives, and examine the role of New Science in what may be the on-going evolution of the next paradigm shift.

Journal Article↗

PubMed2002

Reactive oxygen species and protein oxidation in aging: a look back, a look ahead.

The existence of free radicals, as chemical entities, was inferred 100 years ago but not universally accepted for some 30-40 years. The existence and importance of free radicals in biological systems was not recognized until the mid 1950s, by a small number of visionary scientists who can be credited with founding the field of reactive oxygen biochemistry. For most of the remaining 20th century, reactive oxygen species (ROS) were considered a type of biochemical "rusting agent" that caused stochastic tissue damage and disease. As we enter the 21st century, reactive oxygen biochemistry is maturing as a discipline and establishing its importance among the biomedical sciences. It is now recognized that virtually every disease state involves some degree of oxidative stress. Moreover, we are now beginning to recognize that ROS are produced in a well-regulated manner to help maintain homeostasis on the cellular level in normal, healthy tissue. This review summarizes the history of reactive oxygen biochemistry, outlining major paradigm shifts that the field has undergone and continues to experience. The contributions of Earl Stadtman to the recent history of the field (1980-present) are especially highlighted. The role of ROS in signal transduction is presented in some detail as central to the latest paradigm shift. Emerging technologies, particularly proteomic technologies, are discussed that will facilitate further evolution in the field of reactive oxygen biochemistry.

Aging↗

PubMed2001

An international biodiversity observation year.

The International Geophysical Year (IGY), which took place between July 1957 and December 1958, helped us to rethink the world. At a time when there was a major paradigm shift in our understanding of the physical world, the international collaboration of the IGY helped to reset the discipline. The International Biodiversity Observation Year (IBOY) is now occurring at a time when our dependence on, and understanding of, biodiversity is being acknowledged as a paradigm shift in our present view of the world. Although the benefits of IGY were initially intellectual with practical effects remaining unknown until many years later, the benefits of greater knowledge of biodiversity will support efforts towards sustainability and affect the quality of life, both now and in the future. By providing the framework for international collaborations between scientists involved in every aspect of life on Earth, IBOY has the potential to redefine our current understanding of biodiversity in a manner similar to how IGY helped redefine the geophysical world.

Journal Article↗

PubMed2000

The new millennium brings nursing informatics into the OR.

Will the perioperative arena step out of the dark ages and into the new millennium with informatics? A paradigm shift must occur in both the perioperative arena and health care organizations. Health care organizations must realize the value of informatics and the importance of integrating the informatics nurse into the organizational information system's team. This article discusses how the informatics nurse can accelerate the paradigm shift in the perioperative arena if given the opportunity. The informatics nurse's proactive involvement in the perioperative environment will ensure that information handling technologies benefit the perioperative specialty and, ultimately, enhance patient care.

Documentation↗

PubMed1999

Women and anger.

Through gender role socialization, women have learned to suppress anger. This leads to somatization and a denial of a sense of self. To teach women how to express anger, methods of anger acknowledgment and expression have been provided. Through the teaching of these techniques, nurses can assist women to experience a paradigm shift: from the belief that "others are responsible for meeting women's needs" to the belief that "women are personally responsible for meeting their own needs." By teaching women assertive communication, nurses can provide women with effective tools to regain control of their life experiences. The "Exercise Application" presents an example of a paradigm shift for the experience of anger.

Anger↗

PubMedDate not supplied

The Neuman Systems Model: application in a Canadian HIV setting.

In healthcare research, education and practice there is evidence of a paradigm shift away from disease and illness towards an emphasis on wellness and health. The Neuman Systems Model (NSM) is a nursing model that has been used in a variety of settings with individuals, families and communities. The focus of this model on the prevention of illness and the promotion of health is congruent with the paradigm shift that has occurred in all areas of health care. A review of the literature revealed limited information on the use of nursing models in the clinical area of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). This article describes the application of the NSM in an HIV practice setting with reference to the current and future trends in health care in Canada.

Canada↗

PubMed1994

Implementation of an event-related sterility plan.

A paradigm shift from a time-related sterility method to an event-related sterility assurance plan is possible if the nurse manager's approach to OR staff members is well researched and properly presented. Following research protocols and providing a methodology and rationale to staff members will enhance the success of the implementation process. A successful paradigm shift to an event-related sterility system has the potential of increasing knowledge, improving practice, empowering staff members, and saving money, time, and effort.

Data Collection↗

PubMedDate not supplied

Shifting the healthcare paradigm: the case manager's opportunity and responsibility.

Recent shifts in the healthcare system reflect a shift in thinking from sickness to wellness. This article reviews the paradigm shift, incentive system, and issues related to cost and quality. The role of case management in facilitating this transition is discussed. The article concludes with a discussion of the challenge to use nursing's unique disciplinary perspective that is focused on health to develop new approaches and strategies and the opportunities for case management to expand its scope of practice.

Case Management↗

PubMed2003

What would T. H. Huxley have made of prion diseases?

T. H. Huxley was "Darwin's bulldog," and took the offensive in championing the cause of evolution against skeptical scientists and outraged theologians. As such, he took part in one of the great "paradigm shifts" of biology, at the end of the nineteenth century. Huxley was a rigorous scientist and wrote important articles on scientific method, as well as publishing extensively on a wide range of subjects in natural history. In the second half of the twentieth century, the "prion hypothesis" was put forward to explain the pathogenesis of a curious group of diseases known as the transmissible spongiform encephalopathies. This also involved a "paradigm shift" because the prion hypothesis postulated that biologically relevant information could be enciphered in protein conformation (rather than encoded in nucleic acid base sequences), and could be transmitted from one molecule to another, thereby causing infectious disease. This article examines a few of Huxley's remarks to speculate on how he might have responded to the scientific debate about prion disease had he lived a century later.

Biological Evolution↗

PubMed2004

Educating the pediatrician of the 21st century: defining and implementing a competency-based system.

PURPOSE: The final product of the Accreditation Council for Graduate Medical Education (ACGME) Outcomes Project is to improve health care through ensuring the competence of physicians during their training and beyond. Its success depends on a paradigm shift to a competency-based model of medical education. This article presents an overview of the model and describes the first stages of this multistep transition in a university setting. Our hope is to raise awareness of the impact on the pediatric community at large and provide a foundation on which other educators can continue to build. METHODS: The ACGME established 6 domains of competence as the first step in the paradigm shift. To begin work on the second step of establishing benchmarks for evaluation of competence and thresholds at which they should be achieved, the educational leadership from the primary care departments formed a work group with the support of a Health Resources and Services Administration grant. RESULTS: Review of the literature led us to embark on a stepwise process for initiating a competency-based system of medical education. We established the benchmarks by a process of individual effort followed by group consensus. These benchmarks, in the aggregate, permit an evaluator to determine whether a given competency has been achieved. The next phases of step 2 required setting thresholds for the demonstration of competence and finally establishing consensus regarding the threshold for competence at each level of training for each specific benchmark. To accomplish the latter, we surveyed the program directors of the 202 accredited pediatric training programs that are members of the Association of Pediatric Program Directors. Eighty-one members (40%) completed our survey. Although some controversy existed for thresholds during the postgraduate-year-1 level, majority consensus was reached for nearly all benchmarks at the upper levels of training. Impact of the shift to competencies for medical students and practicing physicians is also reviewed. CONCLUSION: Having defined the benchmarks and thresholds for the 6 ACGME domains of competence, we are well positioned to move to step 3: developing the necessary tools to evaluate competence. The move to competency-based education impacts the entire pediatric community. Lessons learned from our experience may be generalized and thus be of value to the community at large.

Benchmarking↗

PubMed2003

Closing the gap and widening the scope. New directions for research capacity building in primary health care.

BACKGROUND: Research capacity building initiatives abound within primary health care to increase the research base of the many component health professionals and organisations. Most initiatives aim to close the gaps between research, policy and practice. Many of these approaches have been unable to build the necessary skills among primary health care researchers to fully integrate research evidence into clinical practice, and ultimately to inform policy in this complex arena. OBJECTIVE: To propose a paradigm shift in the content of capacity building as a step toward closing the gaps between research, policy and practice. DISCUSSION: The complexity of the primary health care environment and the concept of development as a means to understanding and operating within primary health care research, policy and practice environments is discussed. A small pilot study was used to identify the underlying skills required in research, evaluation and development. In order to facilitate the paradigm shift an organisational development model was utilised that demonstrated congruency with this skill set. Further research is required to validate and apply this model in a primary health care research capacity building context.

Australia↗

PubMed2006

Collection and preparation of molecular databases for virtual screening.

Drug discovery and development research is undergoing a paradigm shift from a linear and sequential nature of the various steps involved in the drug discovery process of the past to the more parallel approach of the present, due to a lack of sufficient correlation between activities estimated by in vitro and in vivo assays. This is attributed to the non-drug-likeness of the lead molecules, which has often been detected at advanced drug development stages. Thus a striking aspect of this paradigm shift has been early/parallel in silico prioritization of drug-like molecular databases (also database pre-processing), in addition to prioritizing compounds with high affinity and selectivity for a protein target. In view of this, a drug-like database useful for virtual screening has been created by prioritizing molecules from 36 catalog suppliers, using our recently derived binary QSAR based drug-likeness model as a filter. The performance of this model was assessed by a comparative evaluation with respect to commonly used filters implemented by the ZINC database. Since the model was derived considering all the limitations that have plagued the existing rules and models, it performs better than the existing filters and thus the molecules prioritized by this filter represent a better subset of drug-like compounds. The application of this model on exhaustive subsets of 4,972,123 molecules, many of which have passed the ZINC database filters for drug-likeness, led to a further prioritization of 2,920,551 drug-like molecules. This database may have a great potential for in silico virtual screening for discovering molecules, which may survive the later stages of the drug development research.

Computational Biology↗

PubMed2003

The role of reflective practice in pharmacy.

CONTEXT: There has been a considerable paradigm shift from a product-centred focus towards a patient-centered focus in pharmacy. Pharmaceutical care practice (Cipolle et al., 1998) can be seen as the latest proposal to transform the profession as mandated by most major professional associations in pharmacy. Pharmaceutical care is an innovative way of practicing pharmacy that has the potential to make drug-therapy safer, more effective, and more convenient for the patient. Even though pharmacists' time spent on customer communication has increased over time (Savage, 1999), this alone will not be sufficient to bring about a paradigm shift in view of what the pharmacist actually does to provide quality patient care. It appears equally important to reflect on how pharmacists practice pharmacy. METHODS/OBJECTIVES: It is the aim of this discussion paper to argue for the importance of linking education and practice as a core part of the teaching of pharmaceutical care. CONCLUSION: In order for pharmacists to partake in truly interdisciplinary health care teams and the profession of pharmacy to demonstrate its unique and indispensable contribution to quality health care, pharmacy curricula would teach toward reflective practice, be problem-based, be positioned in collaborative teams, and have an outside (authentic) focus.

Education, Pharmacy↗

PubMed2004

Novel treatments in non-small cell lung cancer.

Although it has been exciting for lung cancer doctors to observe objective remissions with gefitinib and erlotinib in heavily pretreated NSCLC patients, all of the reported phase III trials testing noncytotoxic, targeted therapies in NSCLC have been negative. Two basic strategies have been employed in developing and conducting these randomized studies. In the case of gefitinib and the matrix metalloproteinase inhibitors, phase III trials were launched based on preclinical data. The second strategy was based on survival results from phase II trials involving regimens consisting of the targeted agent and chemotherapy. Unfortunately, negative results have been observed with the first phase III study (chemotherapy +/- ISIS 3521), which was based on the results of a phase II trial. The initial negative results with targeted agents suggest that a paradigm shift in cancer drug development is needed. Typically, the development of a cytotoxic agent involves determination of the maximum tolerated dose, followed by an assessment of activity as defined by the objective response rate in specific tumor types. "Active" drugs are then moved into phase III testing to determine the effect on survival. Other than targeting the specific tumor type and defining the usual eligibility parameters, no attempt is made to select patients for treatment with new agents. It seems unlikely that there will be significant progress with the targeted therapies unless there is a paradigm shift from this classic model of cancer drug development to a model in which much greater effort is directed toward identifying the target or targets in preclinical models. Intensive effort should be devoted to the development of reliable, clinically applicable assays for the targets that could identify patients who are most likely to benefit from a specific treatment. Rothenberg et al recently made similar recommendations with respect to improving the drug discovery process for cancer. These investigators have emphasized testing new agents in the most appropriate setting, increasing efforts to understand the role of the target, and collection of tissue in an effort to select appropriate patients. Although results from initial randomized trials of targeted therapies in NSCLC have been relatively disappointing, this is not a time to be discouraged. Rather, it is a time to increase the collaborative efforts between basic scientists and clinical investigators.

Antineoplastic Agents↗

PubMed2002

Teaching of evidence-based medicine to medical undergraduates.

Medical practice is changing, and the foundations of the paradigm shift lie in the development in research over the last four decades. Today, it is no longer adequate to treat a patient purely on clinical experience alone without a clear demonstration of evidence based on research, particularly the use of randomised controlled clinical trials. What is thought to be an effective mode of treatment currently may not necessarily hold true by the time medical students begin his/her medical practice. As a consequence, many medical schools worldwide are increasingly promoting evidence-based medicine (EBM) teaching in their medical curriculum along with problem-based learning (PBL). Teaching of EBM requires a paradigm shift in itself, as students must possess additional skills that are not traditionally part of medical training. These include the ability to acquire the skills in 'means of answering questions' than just 'knowing the answer to questions'. This paper aims to describe what EBM is and to highlight the formative experience of the teaching of EBM at the medical undergraduate level in the University of Malaya. Challenges and opportunities towards successful adoption of evidence-based practice are discussed.

Education, Medical, Undergraduate↗

PubMed2005

Metastasis--an alternative hypothesis.

The currently accepted models of metastasis are inconsistent with many clinical observations of the natural history of cancer and its response to therapy. Specifically, the authors suggest that it is time for a "paradigm shift." It is time to reject the "local, regional, systemic hypothesis" of cancer and replace it with a hypothesis more consistent with the clinical facts, specifically, that cancer exists in many different forms (i.e. localized disease arising from locally acting carcinogens, which can spread locally and should be treated locally, and cancer that arises as localized disease but evolves to more malignant invasive disease [the current model of metastasis]). The other forms of cancer are systemic disease, which is induced by systemic carcinogens, and cancer arising in multiple cells and multiple sites, giving rise to a picture described as metastatic cancer. The importance of this paradigm shift is that more attention would be focused on identifying systemically acting carcinogens as they relate to etiology and to molecular abnormalities in the neoplastic cells that might be targeted clinically. Recent advances in cancer treatment have demonstrated that molecules that target cancer cell molecular abnormalities (rather than tissue of origin, lymph node, or metastasis) such as bcr-abl or mutations in a cellular receptor such as c-kit or epidermal growth factor possess curative potential. In addition, more attention should be devoted to distinguishing between local tumors and systemic disease, using sophisticated molecular biologic techniques. Perhaps most important, there is a need to devise therapeutic strategies that would treat cancer as a systemic illness and hopefully have a substantial impact on overall cancer mortality.

Animals↗