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PubMed1995

Educating physicians to use the digital library.

Skill in creating, finding, managing, and using biomedical information is a vital component of modern medical practice. Medical schools recognize the revolutionary implications of computing technology and use a number of different strategies to integrate "informatics education" into their curricula. In many institutions, leadership for this effort rests with the health sciences library and/or the department of medical informatics. Examples are presented of how nine medical schools have implemented informatics education; no single informatics-education strategy prevails, and these schools' strategies do not exhaust the possibilities. Informatics education programs will require better planning and integration in the future because of the need to keep pace with curriculum reform, the changing context of medical practice, and the speed of technological innovation.

Education, Medical↗

PubMed2006

The Council on Chiropractic Education's new wellness standard: a call to action for the chiropractic profession.

BACKGROUND: The chiropractic profession has long considered itself to be a preventive science. Recently the Council on Chiropractic Education (CCE) has defined a set of standards that must be implemented at all US chiropractic colleges as of January of 2007. These are specific to wellness measures and health promoting efforts that should be performed by chiropractors. This will mandate traditional health promotion and prevention methods be taught to students at accredited colleges and to practicing chiropractors. OBJECTIVE: To present the idea of performing traditional health promotion and wellness-concepts in chiropractic practice as a call to action for clinicians and generate discussion on the topic. DISCUSSION: This manuscript discusses relevant topics of health promotion and prevention for chiropractors and other practicing clinicians that should be made priorities with patients in order to enhance both patient health and community and population health. CONCLUSION: All practicing chiropractors, as well as other clinicians should take these new standards from the CCE as a call to action to begin helping patients address the removable causes of morbidity, disability and premature mortality where they exist, in addition to treating their painful spinal conditions.

Editorial↗

PubMed2006

CSI-ISC--Concepts for smooth integration of health care information system components into established processes of patient care.

OBJECTIVES: The introduction of information system components (ISCs) usually leads to a change in existing processes, e.g. processes of patient care. These processes might become even more complex and variable than before. An early participation of end users and a better understanding of human factors during design and introduction of ISCs are key factors for a successful introduction of ISCs in health care. Nonetheless no specialized methods have been developed until now to systematically support the integration of ISCs in existing processes of patient care while taking into account these requirements. In this paper, therefore, we introduce a procedure model to implement Concepts for Smooth Integration of ISCs (CSI-ISC). METHODS: Established theories from economics and social sciences have been applied in our model, among them the stress-strain-concept, the contrastive task analysis (KABA), and the phase model for the management of information systems. RESULTS: CSI-ISC is based on the fact that while introducing new information system components, users experience additional workload. One essential aim during the introduction process therefore should be to systematically identify, prioritize and ameliorate workloads that are being imposed on human beings by information technology in health care. To support this, CSI-ISC consists of a static part (workload framework) and a dynamic part (guideline for the introduction of information system components into existing processes of patient care). CONCLUSIONS: The application of CSI-ISC offers the potential to minimize additional workload caused by information system components systematically. CSI-ISC rationalizes decisions and supports the integration of the information system component into existing processes of patient care.

Germany↗

PubMed2005

The development of HIV research laboratories in the Royal Thai Army Medical Department.

The development of HIV research laboratories at the Armed Forces Research Institute of Medical Sciences (AFRIMS), Royal Thai Army Medical Department in supporting of HIV-1 vaccine trials in Thailand was implemented in 1991. The collaboration between AFRIMS, Royal Thai Army Medical Department, and the US Military HIV Research Program with the ultimate goal to conduct the HIV-1 vaccine trial phase III. The HIV serology lab was set up for surveillance program in military recruits. Then, there was a need to strengthen more on the existing laboratories by training personnel to cope with the confidentiality of the lab results, specimen processing and data management which are critical. Later on, the necessary laboratory for measuring of vaccine immunogenicity was developed, such as lymphoproliferation assay. Additionally, a molecular biology lab was also developed. The HIV research laboratory management must include an ability to deal with some problems, such as late specimen receiving, fluctuating of power supply, technical staffs maintained. Good laboratory practices and safety must be strictly implemented. Communication network among facilities also played an important role in HIV laboratory strengthening at AFRIMS.

Academies and Institutes↗

PubMed1987

Monitoring of community health status: experience from a case study in Tanzania.

The experience from the first four years of a longitudinal study on interrelations between nutrition, parasitic infections, immunity and environmental factors in a rural community, Kikwawila village (southeastern Tanzania) is reviewed. Two elements supported the implementation of the project. Firstly, the multidisciplinary approach with surveys across a range of biomedical and agricultural science disciplines has enabled the elucidation of part of the complexity of the mutually reinforcing, changing interrelations which can affect child health. Secondly, the primary health care component based on village health workers which paralleled the research project has facilitated the longitudinal character of the study and has triggered some community participation. The studies also indicated that the indigenous perceptions of disease, signs and symptoms may be used as an integrative tool to monitor health care programmes. Already during an initial stage of a project, the indigenous health perspectives could become indicators for community participation and could help to determine the strategy of applied research and control measures within primary health care.

Health↗

PubMed1983

The Beer Sheva experience: integration of medical care and medical education.

The Beer Sheva experience refers to an innovative system that merges comprehensive medical care for a total region with the education of varied health manpower. The academic institution participates in the planning and implementation of all levels of health services. The curriculum for all medical students includes training in basic sciences, clinical medicine and public health throughout the six years of study. Emphasis is placed on the primary care aspect of practice and on basic skills in community medicine.

Community Medicine↗

PubMed1994

Using a computerized patient record to reengineer an outpatient clinic.

By employing process flow analysis and work redesign techniques during the design and implementation of a computerized patient record in the pediatric outpatient clinics at the University of Virginia Health Sciences Center, we have developed a database of clinical observations while simultaneously shortening the time that patients spend waiting in the pediatric clinics and decreasing the number of support staff employed within the clinics.

Ambulatory Care Information Systems↗

PubMed1996

Networking consumer health information: bringing the patient into the medical information loop.

The Library of the Health Sciences at the University of Illinois at Chicago obtained a grant from the Illinois State Library to implement a statewide demonstration project that would provide consumer health information (CHI) using InfoTrac's Health Reference Center CD-ROM database. The goals of the project were to cooperate with targeted public libraries and clinics in providing CHI at the earliest point of need; to provide access to the database via a dial-up network server and a toll-free telephone number; and to work with targeted sites on database training, core CHI reference sources, and referral procedures. This paper provides background information about the project; describes the major systems and technical issues encountered; and discusses the outcomes, impact, and envisioned enhancements.

CD-ROM↗

PubMed1997

The pitfalls of field trials in fish vaccinology.

Field trials are essential for accurately assessing the worth of a vaccine under actual conditions of use. Compared with the laboratory, the dynamics of the host, pathogen, and environment in a production setting can produce both subtle and dramatic differences on the performance of the vaccine and the immune response. Because of this, field trials are conducted by manufacturers in vaccine development and are required by many national regulatory agencies to evaluate safety and/or efficacy before granting vaccine licenses. Aquaculture producers, veterinarians and fish health professionals can use field trials to analyse the cost-benefit of a vaccination programme for a facility, or to compare competitive products. Vaccine field trials are more than merely using the products in the field. Small efficacy effects can result in considerable cost reductions to the fish farmer. Proper field trial design, conduct and analysis is critical to detecting these effects. However, field trials are also fraught with many pitfalls that can result in failure or misleading conclusions. The discussion regarding possible pitfalls of vaccine field trials in aquaculture is divided into two parts: 1) the art and 2) the science of successful field trials. The art of successful field trials involves dealing with the "people" aspect which is necessary for initial and continuing compliance. Meticulous planning is essential, including a written protocol to which everyone agrees by signature. The bottom line to the art of field trials is anticipation and discussion of all possible eventualities together with constant communication with the farmer and site supervisor. The science of successful fields trials involves anticipating and realizing the logistical and statistical difficulties in design and implementation. Problems often encountered are: lack of stated quantifiable purpose; low power of the test due to inherent small sample size, large variation and small margin of effect; lack of estimate for anticipated results in controls and unpredictable challenges; non-blinding design with bias and unequal treatment; one or few measures of outcome; lack of redundancy in sites selected; poor statistical design and analysis with violation of assumptions; herd effects; inability to assess long-term effects through several production cycles; and manufacturer/producer expense.

Animals↗

PubMed2000

Continence for women: evaluation of AWHONN's third research utilization project.

OBJECTIVE: To develop an evidence-based protocol for initial evaluation and treatment of urinary incontinence and to design procedures that would facilitate the protocol's implementation into clinical practice. DESIGN: Descriptive report of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Continence for Women Project. SETTING: Twenty-one public, private, and other women's health sites. Participants: Women in ambulatory care settings (N = 1474) provided demographic statistics. METHODS: The protocol was developed, sites were selected, site coordinator training was provided, data collection was facilitated by project-specific teleforms, and the overall process was evaluated by the science team. MAIN OUTCOME MEASURES: Site representation, patient representation, site coordinator feedback on the training program, and site coordinator experience during project implementation. RESULTS: The process yielded a representative mix of site and patient diversity appropriate for testing of the protocol. Site coordinators felt well-prepared to implement the protocol and experienced increased professional satisfaction because of therapeutic benefits achieved for patients and positive collaboration with physicians. CONCLUSIONS: The Continence for Women Project demonstrated the potential for developing and testing evidence-based protocols for clinical practice when the resources of an organization such as AWHONN and the research community are combined.

Journal Article↗

PubMedDate not supplied

Continence for women: evaluation of AWHONN's third research utilization project. Association of Women's Health Obstetric and Neonatal Nurses.

OBJECTIVE: To develop an evidence-based protocol for initial evaluation and treatment of urinary incontinence and to design procedures that would facilitate the protocol's implementation into clinical practice. DESIGN: Descriptive report of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Continence for Women Project. SETTING: Twenty-one public, private, and other women's health sites. PARTICIPANTS: Women in ambulatory care settings (N = 1,474) provided demographic statistics. METHODS: The protocol was developed, sites were selected, site coordinator training was provided, data collection was facilitated by project-specific teleforms, and the overall process was evaluated by the science team. MAIN OUTCOME MEASURES: Site representation, patient representation, site coordinator feedback on the training program, and site coordinator experience during project implementation. RESULTS: The process yielded a representative mix of site and patient diversity appropriate for testing of the protocol. Site coordinators felt well-prepared to implement the protocol and experienced increased professional satisfaction because of therapeutic benefits achieved for patients and positive collaboration with physicians. CONCLUSIONS: The Continence for Women Project demonstrated the potential for developing and testing evidence-based protocols for clinical practice when the resources of an organization such as AWHONN and the research community are combined.

Adult↗

PubMed1999

Implementation of a four-year multimedia computer curriculum in cardiology at six medical schools.

The pressures of a changing health care system are making inroads on the commitment and effort that both basic science and clinical faculty can give to medical education. A tool that has the potential to compensate for decreased faculty time and thereby to improve medical education is multimedia computer instruction that is applicable at all levels of medical education, developed according to instructional design principles, and supported by evidence of effectiveness. The authors describe the experiences of six medical schools in implementing a comprehensive computer-based four-year curriculum in bedside cardiology developed by a consortium of university cardiologists and educational professionals. The curriculum consisted of ten interactive, patient-centered, case-based modules focused on the history, physical examination, laboratory data, diagnosis, and treatment. While an optimal implementation plan was recommended, each institution determined its own strategy. Major goals of the project, which took place from July 1996 to June 1997, were to identify and solve problems of implementation and to assess learners' and instructors' acceptance of the system and their views of its value. A total of 1,586 students used individual modules of the curriculum 6,131 times. Over 80% of students rated all aspects of the system highly, especially its clarity and educational value compared with traditional lectures. The authors discuss the aspects of the curriculum that worked, problems that occurred (such as difficulties in scheduling use of the modules in the third year), barriers to change and ways to overcome them (such as the type of team needed to win acceptance for and oversee implementation of this type of curriculum), and the need in succeeding years to formally assess the educational effectiveness of this and similar kinds of computer-based curricula.

Attitude to Computers↗

PubMed1995

DNA forensic science 1995.

After digression by a National Research Council committee, forensic use of DNA identification is returning to methods that do not violate population genetics and statistics. Polemic has been replaced by normal science as advances are made in molecular techniques and presentation of evidence. Rigorous quality control over the chain of custody and likelihood calculations still need to be implemented, and evidence extended on the structure of forensic populations and the operating characteristics of alternative tests.

Confidence Intervals↗

PubMed1994

Towards an optimal teaching programme for supportive care.

The changes occurring in medical education have led to important principles being identified that are relevant to teaching in supportive care. Many of these principles are already an integral part of the Newcastle, NSW, Medical Faculty undergraduate course and are being applied to the teaching of oncology and supportive care. The same principles can be applied to curriculum development and implementation in other settings. A curriculum is proposed that builds on a general background of oncology knowledge. Factual knowledge is limited to the precarious clinical problems requiring optimal supportive care, the priority oncology syndromes, palliative care and principles of psychosocial and behavioural science interventions. The curriculum also includes critical reasoning, special skills including counselling, communication, self-directed learning, team management, health-service resources and structure, and relevant management skills. To implement the curriculum, consideration must be given to teaching methods (teaching in context and in small groups, problem-based learning and problem solving). The needs of students, quality of the teachers, when and where the teaching and learning will occur and methods of assessment should also be considered to ensure the curriculum can be used optimally.

Clinical Competence↗

PubMed1994

Regulatory environment: incentive or impediment to developments in food science and technology.

The regulatory environment is one of several key factors that impact successful technological development and commercialization. The current process of developing and implementing regulations is extremely complex and does not always apply the principle of benefit:risk and balance protection with progress. Although the current system is effective in protecting consumers, it tends to impede technological innovation. To help improve balance and effectiveness, an independent "food regulatory board" is recommended.

Animals↗

PubMed2005

Making evaluation an integral part of injury programme implementation.

Uncertainty about the nature of evaluation can lead to injury prevention programme evaluations being poorly resourced and poorly conducted. The aim of this paper is to demystify programme evaluation and, by stressing its function, offer a perspective on evaluation that may encourage its more widespread integration in the general activity of injury prevention and control. Programme evaluation is best understood simply as the process of getting answers to essential questions about a programme. Methodology used in evaluation needs to be based in empirical science but is otherwise unrestricted except by the chosen question and the practical circumstances relating to the programme and the community in which it is implemented. Discussion about which methodology is appropriate for evaluation research is (unwittingly) a debate about 'which questions should you be asking?'. If the right people ask the right (and properly formulated) questions and build the means of obtaining the information to answer these questions (using appropriate methodology) into the conduct of the programme then evaluation will no longer be a problem but an essential component of the overall effort to reduce the community burden of injury.

Causality↗

PubMedDate not supplied

Graduate students with marginal abilities in communication sciences and disorders: prevalence, profiles, and solutions.

UNLABELLED: This paper addresses the special challenges encountered when working with graduate students whose academic and/or clinical performance is marginal or less than satisfactory. From a variety of perspectives including instructional, professional, financial, ethical, and legal, among others, working effectively with marginal students deserves serious and systematic consideration. The purpose of this paper is to present the results of a national survey that explore the prevalence, profiles, and documented impact of marginal students on professional training programs in speech-language pathology and audiology. Current strategies for prevention and intervention, factors inhibiting implementation of such strategies, and implications for the student and the program are discussed. LEARNING OUTCOMES: (1) To learn the prevalence, profiles, and documented impact of marginal students on professional preparation programs in communication sciences and disorders. (2) To become familiar with current strategies for prevention and intervention with marginal students, factors inhibiting implementation of such strategies, and implications for the student and the program. (3) To understand professional preparation as a system of academic, clinical, and supervisory instruction, including evaluation and due process; namely, a student's right, a program's responsibility. (4) To identify critical questions generated by this study that must be addressed by the professions and individual programs.

Achievement↗

PubMedDate not supplied

Arizona Telemedicine Program: implementing a statewide health care network.

The Arizona Telemedicine Program was established in July 1996 by the Arizona state legislature. The organizational center for the program is the Arizona Health Sciences Center in Tucson. Key goals for the program include increased access to specialty services for rural, underserved populations; development of cost-effective telemedicine services; and expansion of opportunities for education of health professionals in rural areas. The program provides several levels of services based on both store-and-forward and real-time interactive applications. The telecommunication infrastructures is provided by two methods: The first is a private asynchronous transfer mode network established and operated by program personnel. The second is dial-up access via the public switched telephone network. After an extensive period of organization and vendor evaluations, most of the private network was implemented between June and December 1997. This paper describes experiences establishing the asynchronous transfer mode network.

Arizona↗