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PubMed1998

Integrating the teaching of basic sciences, clinical sciences, and biopsychosocial issues.

In this chapter, the author describes integrating the teaching of the basic sciences, clinical sciences, and biopsychosocial issues in medical education as part of the curricular reform efforts initiated by schools that participated in The Robert Wood Johnson Foundation's project "Preparing: Physicians for the Future: Program in Medical Education." The author focuses on the approaches the eight schools adopted, the challenges they encountered, and the lessons they learned in attempting to implement more integrated curricula. Integration was promoted both within and among various components of medical education. For example, in some cases discipline-based courses in the basic sciences were replaced with interdisciplinary courses. Further, efforts were made both to bring clinical relevance to the basic sciences and to strengthen basic science in the clinical years. All the schools also promoted the study of the humanities and biopsychosocial sciences throughout the curriculum. The author describes problems encountered in these endeavors, resources needed to support interdisciplinary courses, the benefits of integration, and common lessons learned by the eight schools.

Biology↗

PubMed1998

When science and politics listen to each other: good prospects from a new school breakfast program in Peru.

This article provides an overview of a school breakfast program implemented in 1993 in the Peruvian Andes. The program, designed by the Instituto de Investigación Nutricional in Lima and supported by the government of Peru, constitutes a clear departure from previous school feeding programs, which were heavily politicized and poorly documented. From the program's inception, nutritionists, managers, and social scientists have collaborated to produce a sound nutritional design, efficient distribution mechanisms, and effective evaluation methods. During the program's first year, controlled evaluations conducted in several Andean regions documented improved dietary intake and a significant decline in the prevalence of anemia. An educational evaluation also found improved verbal skills, higher school attendance, and lower dropout rates among recipients of the school breakfast. The results have prompted the Peruvian government to continue supporting the program, thus setting a new standard for the effective management of social expenditure in the context of economic adjustment.

Anemia↗

PubMed2005

Utilizing data grid architecture for the backup and recovery of clinical image data.

Grid Computing represents the latest and most exciting technology to evolve from the familiar realm of parallel, peer-to-peer and client-server models. However, there has been limited investigation into the impact of this emerging technology in medical imaging and informatics. In particular, PACS technology, an established clinical image repository system, while having matured significantly during the past ten years, still remains weak in the area of clinical image data backup. Current solutions are expensive or time consuming and the technology is far from foolproof. Many large-scale PACS archive systems still encounter downtime for hours or days, which has the critical effect of crippling daily clinical operations. In this paper, a review of current backup solutions will be presented along with a brief introduction to grid technology. Finally, research and development utilizing the grid architecture for the recovery of clinical image data, in particular, PACS image data, will be presented. The focus of this paper is centered on applying a grid computing architecture to a DICOM environment since DICOM has become the standard for clinical image data and PACS utilizes this standard. A federation of PACS can be created allowing a failed PACS archive to recover its image data from others in the federation in a seamless fashion. The design reflects the five-layer architecture of grid computing: Fabric, Resource, Connectivity, Collective, and Application Layers. The testbed Data Grid is composed of one research laboratory and two clinical sites. The Globus 3.0 Toolkit (Co-developed by the Argonne National Laboratory and Information Sciences Institute, USC) for developing the core and user level middleware is utilized to achieve grid connectivity. The successful implementation and evaluation of utilizing data grid architecture for clinical PACS data backup and recovery will provide an understanding of the methodology for using Data Grid in clinical image data backup for PACS, as well as establishment of benchmarks for performance from future grid technology improvements. In addition, the testbed can serve as a road map for expanded research into large enterprise and federation level data grids to guarantee CA (Continuous Availability, 99.999% up time) in a variety of medical data archiving, retrieval, and distribution scenarios.

Diagnostic Imaging↗

PubMed2005

Ensuring a scientific basis for community interventions for asthma.

Community based interventions are an important part of public health management of many diseases, including asthma. However, there are few scientifically proven and readily available community interventions for asthma. In an effort to increase the number of available interventions, we have identified ongoing asthma intervention research, identified potentially effective asthma interventions based on completed research, and prepared several of the effective interventions for widespread implementation through a process called "translation." We provide an example of one of these effective interventions now available for widespread implementation, "Creating a medical home for asthma." This intervention grew out of need for an intervention in New York City Department of Health (NYCDOH) clinics. The intervention includes training all clinic staff in a comprehensive, preventive approach to asthma care. All of the materials needed to implement the intervention are available to all through the NYCDOH web site (www.nyc.gov/ html/doh/html/cmha/index.html). This example points to the importance of making the tools needed to implement effective interventions available across the country and the role of public/private partnerships to assure the availability of science-based interventions for asthma control.

Asthma↗

PubMed2006

Usefulness of biomarkers in population studies: from exposure to susceptibility and to prediction of cancer.

From a review of decades of intensive biomarker research and prospective validation studies, it becomes clear that only a limited number of biomarkers can be used to provide reliable documentation of excessive exposure to environmental mutagenic agents, expression of detrimental biological effects from the exposure and increased risk for cancer. These studies also demonstrate that expression of each biomarker represents an integrated response to the exposure that is influenced by susceptibility factors, and an integral component of the complex carcinogenic pathway. A current interest is in the use of phenotypic functional assays to improve and complement the assessment of cancer risk. A recommended approach includes assays that indicate DNA repair deficiency, i.e. host-cell-mediated reporter gene and challenge (mutagen-sensitivity) assays. The usefulness and limitations in biomarker investigations will be discussed. The review emphasizes the need for carefully designed investigations that involve adequate sample sizes and a combination of appropriate biomarkers to generate reproducible results that can be translated into more reliable cancer risk assessment. The assessment can be used to drive the implementation of disease prevention and intervention activities. Such an approach is consistent with the current priority in translating basic science knowledge into health applications.

Biomarkers↗

PubMed2000

Roles of experimental marine ecology in coastal management and conservation.

The paper reviews the main findings of rocky shore and subtidal nearshore experimental marine ecology (EME) in cold and temperate marine ecosystems during the past four decades. It analyzes the role of EME in coastal management and conservation. The historical development of strategies for managing single or multispecies fisheries are reviewed. The published results show over-exploitation and depletion of more than 60% of the fish stocks and a lack of connection between the management of fisheries and results derived from experimental marine ecology. This is mainly due to: (a) the different temporal and spatial scale at which most marine ecologists and fishery managers operate; (b) the lack of long-term fishery monitoring and adaptive techniques for management; and (c) limitations in the design of experiments on fisheries. Large-scale oceanic perturbations, due to combinations of excessive resource exploitation and environmental variability coupled with present trends in management approaches are discussed. Modern approaches and tools for management of fisheries, such as Adaptive Management (AM), Territorial User Rights in Fisheries (TURFs), Individual Transferrable Quotas and Non-Transferrable Quotas (ITQs, INTQs) are discussed in the context of small-scale fisheries and EME. Published views on limits of applied ecological research with regards to management of fisheries are discussed. Linkages between EME, marine conservation and the establishment of Marine Protected Areas (MPAs) and experimental exclusions of humans are highlighted. Results derived from MPAs, such as: (a) species or community trophic cascades, and (b) the role of key-stone species and species interaction strengths, are discussed. It is concluded that the role of EME in conservation has been greater than has been the case in management of fisheries. The potential to link EME, conservation and the management of fisheries is exemplified through the proposed establishment in Chile of a connected network of Scientific Reserves, MPAs and TURFs sites. The final conclusion is that to cross-fertilize EME, conservation and management, there are three main challenges: (1) to end the traditional view of approaching the management of fisheries and marine conservation as contradictory/antagonizing issues; (2) to improve communications between experimental marine ecology and the management of fisheries through the implementation of experimentation and adaptive management; (3) to improve linkages between marine conservation, the management of fisheries and social sciences.

Journal Article↗

PubMedDate not supplied

Knowledge of severe acute respiratory syndrome among community physicians, nurses, and emergency medical responders.

INTRODUCTION: The preparedness levels of front-line clinicians including physicians, nurses, emergency medical responders (EMRs), and other medical staff working in clinics, offices and ambulatory care centers must be assessed, so these personnel are able to deal with communicable and potentially lethal diseases, such as severe acute respiratory syndrome (SARS). In order to determine the knowledge of these clinicians, a survey of their understanding of SARS and their use of educational resources was administered. METHODS: A questionnaire was distributed to physicians, nurses, and EMRs attending conferences on SARS in the summer of 2003. Questions related to information sources, knowledge of SARS, and plans implemented in their workplace to deal with it. Statistical analysis was performed using the Statistical Package for the Social Sciences (10.1 Program, SPSS Inc., Chicago, Illinois). RESULTS: A total of 201 community healthcare providers (HCPs) participated in the study. A total of 51% of the participants correctly identified the incubation period of SARS; 48% correctly identified the symptoms of SARS; and 60% knew the recommended infection control precautions to take for families. There was little difference in knowledge among the physicians, nurses, and EMRs evaluated. Media outlets such as newspapers, journals, television, and radio were reported as the main sources of information on SARS. However, there appears to be a growing use of the Internet, which correlated best with the correct answers on symptoms of SARS. Fewer than one-third of respondents were aware of a protocol for SARS in their workplace. A total of 60% reported that N-95 masks were available in their workplace. CONCLUSION: These findings suggest the need for more effective means of education and training for front-line clinicians, as well as the institution of policies and procedures in medical offices, clinics, and emergency services in the community.

Community Health Services↗

PubMed2004

Combating tropical infectious diseases: report of the Disease Control Priorities in Developing Countries Project.

Infectious diseases are responsible for >25% of the global disease toll. The new Disease Control Priorities in Developing Countries Project (DCPP) aims to decrease the burden of these diseases by producing science-based analyses from demographic, epidemiologic, disease intervention, and economic evidence for the purpose of defining disease priorities and implementing control measures. The DCPP recently reviewed selected tropical infectious diseases, examined successful control experiences, and defined unsettled patient treatment, prevention, and research issues. Disease elimination programs against American trypanosomiasis (Chagas disease), onchocerciasis, lymphatic filariasis, leprosy, trachoma, and measles are succeeding. Dengue, leishmaniasis, African trypanosomiasis, malaria, diarrheal diseases, helminthic infections, and tuberculosis have reemerged because of inadequate interventions and control strategies and the breakdown of health delivery systems. Application of technologies must be cost-effective and intensified research is essential if these and other scourges are to be controlled or eliminated in the 21st century.

Biomedical Research↗

PubMed2003

An integrated biopsychosocial approach to palliative care training of medical students.

In 1996 the University of Rochester School of Medicine, Rochester, New York, began a major curricular reform called the Double Helix Curriculum, integrating basic science and clinical training over 4 years of medical school. This transition provided a unique opportunity to develop and implement a fully integrated, comprehensive palliative care curriculum. In this three-part paper, we will describe: (1) our process of finding curricular time, setting priorities, and deciding on pedagogical strategies; (2) an overview of how palliative care teaching was integrated into the general curriculum, including examples of different teaching opportunities; and (3) our evaluation process, and some ongoing challenges. Because palliative care is a core element in the care of all seriously ill patients, we chose to integrate our teaching into multiple courses over 4 years of undergraduate medical education, and not isolate it in a particular course. We view this report not as an ideal curriculum to be emulated in its entirety but as a work in progress that may be somewhat unique to our institution. We intend to illustrate a process of incremental curriculum building, and to generate some fresh teaching ideas from which palliative care educators can select depending on their own curricular needs and objectives.

Curriculum↗

PubMed2026

EMTscore infers divergent EMT pathways from omics data and enables rapid screening for EMT-associated gene sets.

MOTIVATION: Quantitative analyses of epithelial-mesenchymal transition (EMT) have been widely used in several areas of biomedical sciences due to its importance in development and cancer progression, but its multi-contextual nature requires standardization and implementation of gene set scoring methods beyond capacities of conventional tools. RESULTS: We developed EMTscore, a package that provides an efficient implementation of unbiased scoring methods for multiple EMT pathways using individual single-cell or bulk omics data, and the package allows rapid screening for cellular processes correlated with EMT. AVAILABILITY AND IMPLEMENTATION: EMTscore is available from GitHub https://github.com/wenmm/EMTscore under the GNU General Public License, and is uploaded on Zenodo with a DOI 10.5281/zenodo.19487376.

Epithelial-Mesenchymal Transition↗

PubMed1993

A training program in universal precautions for second-year medical students.

BACKGROUND: A training program in universal precautions was developed and implemented in 1991-92 for second-year students at the George Washington University School of Medicine and Health Sciences. The students were required to participate in a three-hour session that consisted of lecture, demonstration, and practice components focused on the risks of bloodborne-disease exposure and the techniques of phlebotomy and intravenous insertion using universal precautions. METHOD: All 135 second-year students participated in the lecture component, but only 120 students, who were unfamiliar with the procedures, were required to participate in the demonstration and practice components. Each of these students was asked to answer pre- and postsession knowledge questions and to rate his or her preparedness on a five-point Likert scale, ranging from 1, "not prepared at all," to 5, "well prepared." Paired t-tests were used to compare the pre- and postsession knowledge scores and self-assessed preparedness scores. At the end of the training program, the students were offered the opportunity to volunteer for additional, individualized training with the hospital phlebotomy service. Unpaired t-tests were used to compare differences between the postsession knowledge scores of the volunteers and nonvolunteers. RESULTS: A total of 103 students completed both pre- and posttests. The students' knowledge scores increased from means of 64.7% to 88.5% (p = .001). Their self-assessed preparedness scores also increased, ranging from a low of means of 1.6 presession and 3.4 postsession for intravenous insertion to a high of means of 3.19 presession and 4.26 postsession for addressing personal concerns about possible exposure. The 43 students who volunteered for additional training scored significantly better on the postsession knowledge questions than did the nonvolunteers, suggesting that those who may have needed it most failed to sign up for additional training. CONCLUSION: The training session significantly improved the students' knowledge and sense of their own competency.

Curriculum↗

PubMedDate not supplied

Lay home visiting may improve pregnancy outcomes.

Home visiting may be a promising strategy to improve pregnancy outcomes, and home visiting by lay workers may be more accepted by pregnant women. Lay workers may impact on social and environmental risk factors as well as on health care utilization. As with any primary prevention strategy, these programs may be more successful if implemented with responsibility shared between the health care system and the community. This article reviews the state of the science related to lay home visiting during pregnancy in the United States. Using a variety of search terms, an exhaustive review of the literature was conducted using several large electronic databases. Studies of lay home visiting during pregnancy have documented mixed results. Many weaknesses exist in the studies available, including use of descriptive or quasi-experimental designs in most of the studies, absence of a clearly specified set of interventions, and lack of cost analysis. Gaps in our knowledge of the impact of lay home visitors on pregnancy outcomes persist.

Female↗

PubMed2002

Seizure prediction and the preseizure period.

Beginning in the 1970s engineers designed systems to predict epileptic seizures based upon quantitative changes in the electroencephalogram, which they hypothesized began well in advance of clinical seizure onset. These efforts flourished in the 1990s, as independent laboratories demonstrated evidence of a 'preseizure period' up to 20 min prior to clinical symptoms in patients implanted with intracranial electrodes during evaluation for epilepsy surgery. Years later, clinical and laboratory experiments leave little doubt that a preseizure period exists in temporal lobe and perhaps other forms of epilepsy. Its existence, however, raises fundamental questions about what constitutes a seizure, what brain regions are involved in seizure generation, and whether discrete interictal, preictal, ictal and post-ictal physiologies exist, or blend together in a continuous process. Pressing milestones, necessary for clinical utility, are: (1) demonstrating prospective seizure prediction from prolonged human data sets, (2) elucidating mechanisms underlying seizure precursors and (3) implementing these algorithms on implantable hardware platforms. The notion of a preseizure state is catalyzing new clinical and basic science research, which has the potential to dramatically increase our understanding of epilepsy, and to generate exciting new therapies for patients.

Brain↗

PubMed2006

Human papillomavirus infection: an old disease, a new vaccine.

Human papillomavirus (HPV) infection is common and causes a wide spectrum of disease. With recent advances in the development of prophylactic HPV vaccines, it is likely that these will be licensed for use in the near future. This review focuses on the science behind HPV vaccines, published clinical trial results for both prophylactic and therapeutic HPV vaccines, important issues relevant to implementation and cost-effectiveness models of HPV vaccination programs. It may be that an HPV vaccine that protects against the complications of HPV infection such as cervical cancer will be one of the most significant public health initiatives of this decade.

Female↗

PubMed2004

An investigative laboratory course in human physiology using computer technology and collaborative writing.

Active investigative student-directed experiences in laboratory science are being encouraged by national science organizations. A growing body of evidence from classroom assessment supports their effectiveness. This study describes four years of implementation and assessment of an investigative laboratory course in human physiology for 65 second-year students in sports medicine and biology at a small private comprehensive college. The course builds on skills and abilities first introduced in an introductory investigations course and introduces additional higher-level skills and more complex human experimental models. In four multiweek experimental modules, involving neuromuscular, reflex, and cardiovascular physiology, by use of computerized hardware/software with a variety of transducers, students carry out self-designed experiments with human subjects and perform data collection and analysis, collaborative writing, and peer editing. In assessments, including standard course evaluations and the Salgains Web-based evaluation, student responses to this approach are enthusiastic, and gains in their skills and abilities are evident in their comments and in improved performance.

Computer-Assisted Instruction↗

PubMed1998

Changing causes of death of elderly people in the United States, 1950-1990.

BACKGROUND: Causes of death have changed greatly in the United States during the 20th century. OBJECTIVE: To detail these changes in elderly people during 1950-1990. METHODS: The source of data was 'Vital Statistics of the United States' for the years discussed. Mortality rates for several causes were calculated for the 85-89 age group, and the percentage of deaths attributed to several causes was calculated. RESULTS: There are large peaks about 1970 in both the mortality rate of ischemic heart disease and the percentage of total deaths attributed to this cause. The peaks have been followed by declines. Death rates from cancer and the percent of deaths attributed to cancer have increased during 1950-1990. CONCLUSIONS: The above changes coincide with major changes in medical science and care, the identification of the risk factors predisposing to ischemic heart disease and cerebrovascular diseases, and the implementation of Medicare, a program of health care benefits to all people 65 and over that is supported by the United States government.

Aged↗

PubMedDate not supplied

The science of professional development.

In this commentary, I discuss the science of professional development. A great deal is already known about how to provide professional development that supports teachers' implementation of evidence-based practices and the factors that enhance or inhibit teachers' sustained use of the practices. I summarize the work of researchers who have achieved some success in facilitating teachers' learning of new practices, highlighting my own research with colleagues. Professional development is known to be most successful when (a) researchers work closely with school districts, so that everyone is on the same page, and the practices that researchers are teaching are aligned with the district's curriculum and standards; (b) student outcome data showing that the practice works are provided to all; (c) administrative support is clearly evident; (d) long-term support is provided for teachers (including demonstrations and coaching); and (e) teachers take ownership of the practices and responsibility for mentoring their peers.

Humans↗

PubMed2005

Research-design issues in cancer-symptom-management trials using complementary and alternative medicine: lessons from the National Cancer Institute Community Clinical Oncology Program experience.

PURPOSE: To identify major research-design issues in proposals submitted by investigators in the Community Clinical Oncology Program (CCOP) for clinical trials of complementary and alternative medicine (CAM) for cancer-symptom management. METHODS: We conducted content analysis of all scientific reviews of concepts and protocols submitted by the CCOP to the National Cancer Institute (NCI) to identify research challenges in conducting clinical trials designed to evaluate CAM interventions for cancer-symptom management. RESULTS: Since the inception of the NCI Office of Cancer Complementary and Alternative Medicine in 1998, a total of 46 symptom-management studies using CAM interventions have been proposed by CCOP investigators, with 20 studies now in progress comprising 22% of the current total CCOP symptom-management portfolio. Proposals fell into four categories: complex natural products; nutritional therapeutics; mind-body interventions; and alternative medical systems. The most significant research-design issues arose as a consequence of the lack of preclinical data for CAM interventions and the lack of quality-control standards comparable with those used in regulating new pharmaceutical agents. CONCLUSION: Across the different types of CAM interventions, the most common problems found in proposed research designs are related to unwarranted assumptions about the consistency and standardization of CAM interventions, the need for data-based justifications for the study hypotheses, and the need to implement appropriate quality control and monitoring procedures during the course of the trial. To advance the state of the science, future research must address these critical issues if CAM interventions are to be evaluated rigorously and have a consequent impact on clinical practice and general public awareness.

Cancer Care Facilities↗