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PubMed2005

The pharmacologic therapy of rosacea: a paradigm shift in progress.

A number of topical and systemic pharmacologic therapies, some of which remain investigational, have been used to treat rosacea. The pathophysiology of rosacea appears to be inflammatory, and most of the interventions modulate the inflammatory process in some way. Topical agents include various formulations of sodium sulfacetamide and sulfur, metronidazole, azelaic acid, and benzoyl peroxide/clindamycin. Oral agents include antibiotics in conventional and subantimicrobial doses. A paradigm shift in progress in the management of rosacea encompasses the use of these and other agents either alone or, increasingly, in different combinations, based on the subtype of rosacea.

Adrenal Cortex Hormones↗

PubMed2005

Periodontal disease pathogenesis: genetic risk factors and paradigm shift.

Periodontitis is a widespread disease caused by oral bacteria and their interaction with lifestyle and genetic risk factors. The focus of periodontal research has expanded over the past few years to include significant progress in the understanding of genetic processes provided by the Human Genome Project. This presentation summarizes recent views on periodontal pathogenesis and the genetic risk factors involved in the disease. Additionally, it describes the paradigm shift in periodontal care, which is evolving from a repair-based to a wellness-based model.

Genetic Predisposition to Disease↗

PubMed1999

Paradigm shift, metamorphosis of medical ethics, and the rise of bioethics.

Both the increasing incorporation of medical technology and new social demands (including those for health care) beginning in the 1960s have brought about significant changes in medical practice. This situation has in turn sparked a growth in the philosophical debate over problems pertaining to ethical practice. These issues no longer find answers in the Hippocratic ethical model. The authors believe that the crisis in Hippocratic ethics could be described as a period of paradigm shift in which a new set of values appears to be emerging. Beginning with the bioethics movement, the authors expound on the different ethical theories applied to medical practice and conclude that principlism is the most appropriate approach for solving the new moral dilemma imposed on clinical practice.

Abortion, Legal↗

PubMed2004

Classical radiation biology dogma, bystander effects and paradigm shifts.

A classical dogma of radiation biology asserts that all effects of radiation on cells are due to it's direct, immediate actions. But evidence accumulated over the last 50 years shows that radiation also has, indirect 'non-target' actions including 'bystander' effects in which effects of radiation on cells or media are transported to cells or tissues that were not 'hit' by the radiation, leading to changes in their function. This important but heretical recognition of radiation actions has been referred to, probably incorrectly, as a 'paradigm shift.' What these signals are and how they induce changes is not well understood. Also not clear is how, or if, bystander effects might affect risk estimates for exposure to low doses of radiation. These issues are reviewed and explored in this series of papers.

Animals↗

PubMed2006

TIPS (trigger an IIF paradigm shift).

CHALLENGE: New Mexico Corporate Services (NMCS) recordable injuries have been averaging 2-4 per year for the last 5 years with no statistical improvement. However, we believe all NM employees must go home incident and injury free every day and just as healthy as they came to work. In addition, we have received feedback from several sources, that indicates some employees are reluctant to report injuries. These indicators showed us that continuing our current strategies, making incremental improvement and changes, would not give us the improvement desired. We needed a paradigm shift to get everyone completely engaged in the IIF (Incident & Injury Free) culture, in order to achieve true IIF results. METHODS/STRATEGIES: We formed a small (3-person) taskforce consisting of safety representatives from EHS, Site Services and CS Operations. We reviewed 5 years worth of data to determine what was injuring our people. We also decided to review all injuries, not simply those classified as recordable by OSHA standards. First we identified the types of injury information needed to get a true picture of our safety issues. We analyzed IRB (Incident Review Board) data showing us the following factors and whether any of them contributed to the injury: - Date - Incident Description - Severity - Root Cause - Type of Injury - Season - Work Group/Shift - Area - Improper evaluation of hazard - Inadequate work procedures - Incorrect Mental Model - Inadequate PPE Requirement - Failure to Follow or Unaware of PPE Requirement - Shortcut or Schedule Pressure - Last or First Day of Shift or Adjacent to Holiday - OT - Aggravate Existing Condition - Inadequate Training or Passdown - Experience in Task - Corrective Action Taken - Overall Quality of Response. Once this information was collected for all injuries in an Excel file, we graphed it several ways to help reveal trends: Shift 7 had double the injuries of shift 5. Night shift injuries were relatively high but lower than Shift 7. Shift 5 had no severe (recordable) injuries. Biggest total injury type was ergonomic. Biggest recordable injury type (58%) was cuts/lacerations. Chemical exposure and inhalations resulted in no recordables. Biggest root cause category was behavioral. Biggest behavioral root cause was "Failure to Evaluate Hazards". Biggest administrative controls root cause was "Inadequate Procedures". Biggest engineering controls root cause was "Unrecognized Workplace Hazard". Majority of injuries occurred in Spring/Summer which accounted for 86% of recordables. Response was inadequate or poor for 25% of injuries. Number of injuries by workgroup were about equal. Work area injuries were mostly in the CUB and Subfab but CUB injuries favored cuts/lacerations while Subfab favored ergonomic injuries. These learnings and gaps were used to develop our New Mexico Site Safety Action Plan for 2005. It has also been used by individual managers and supervisors in their day-to-day business meetings, activities, and communications, for a more focused IIF message and effort. RESULTS: [graph: see text]. CONCLUSIONS/RECOMMENDATIONS: Challenges are different amongst shifts. Shift culture may be stronger than workgroup culture. Work areas pose different challenges that all should be aware of and prepared for. We should prepare ourselves for challenges posed by the Spring and Summer seasons as well. We should be aware of and prepare for the different challenges and cultures characteristic of each shift. Supervisors need to spend more time in the field with their people to help them address safety issues and help make IIF a more consistent component of daily workgroup culture. Each site should analyze their data and look for their unique safety challenges. This will allow customized, focused action plans that meet the unique needs of each site.

Accidents, Occupational↗

PubMed2000

Electronic journals: are they a paradigm shift?

Ejournals are becoming an accepted and necessary means of meeting the demands for the dissemination of knowledge. This introductory article discusses the recent "explosion" of ejournals and provides an explanation of what is meant by an "ejournal." Ejournals are explored within the traditional context of scholarship and a discussion of the "serials crisis" that promoted the inception of ejournals is presented. After laying the groundwork for discussing scholarship in this new age of dissemination of scholarly information, the article discusses whether this digital form of publication can be called a "paradigm shift" in Kuhn's (1970) traditional sense of the word.

Periodicals as Topic↗

PubMed2002

[Paradigm shift from standard surgery to damage control surgery in major trauma].

"Damage control surgery (DCS)" is currently the most commonly used term to describe the surgical strategy for major trauma. Standard surgical approaches to trauma consist of a priority-driven sequence of steps, including exposure, homeostasis, repair, resection, and reconstruction. Patients with massive exsanguination, however, will not survive complex procedures. It is well known that those patients are more likely to die from intraoperative physiological deterioration resulting from a failure to complete surgical repair. The surgical team must undergo a paradigm shift, focusing on saving life or resuscitation. DCS has three separate components. The first is abbreviated resuscitative surgery for rapid control of hemorrhage and contamination. This is achieved as quickly as possible in the operating room, but traditional repairs are deferred in favor of rapid measures that control hemorrhage, restore flow where needed, and control or contain contamination. The second step in DCS is systemic management in the ICU, where the care consists of ongoing core rewarming, correction of coagulopathy, fluid resuscitation, and optimization of hemodynamic status, as well as reexamination to diagnose all injuries. When normal physiology has been restored, reoperation is undertaken for definitive repairs of injuries and abdominal closure. In addition to the above three components, an earlier phase before the initial operation, referred to as "DC ground zero" has recently been added.

Acidosis↗

PubMed2003

Medical education in Nigeria: are we ready for the paradigm shift?

The information revolution is changing the way medicine is practised globally. Patients can now access the storehouses of knowledge, which hitherto were out of bounds, to acquire, process and use the medical evidence from a variety of sources such as the World Wide Web. The way medicine is being taught is changing. Many medical and dental schools have revised, or are in the process of revising their curricula. The ability to access information resources and apply up to date information, diagnosis and therapeutic protocols to their practice calls for a paradigm shift. Cybermedicine is fast becoming the twenty-first century practice. The challenge is real. If emphasis is being placed on fluency with information technology in the developed countries, learning to use the computer remains, in our opinion, the place to start from in the developing countries.

Computer Literacy↗

PubMed2006

Syndromal complexity, paradigm shifts, and the future of validation research: comments on Nichols and Rogers, Sewell, Harrison, and Jordan.

In this comment, I address a number of the points raised in the reviews of the MMPI-2 Restructured Clinical (RC; Tellegen et al., 2003) Scales by Nichols (2006/this issue) and Rogers, Sewell, Harrison, and Jordan (2006/this issue), and I advocate for changes in assessment validation research. There is little evidence that the "syndromal complexity" Nichols ascribes to the original MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Clinical Scales is worth preserving. Although their construction does not constitute the paradigm shift claimed by Rogers et al., the RC Scales are promising, psychometrically defensible measures of core features of the original MMPI-2 Clinical Scales. However, validation of inferences from multiscale inventories such as the MMPI-2 is limited at present by a disconnection between the integrative manner in which MMPI-2 profiles are interpreted and the scale-by-scale nature of most MMPI-2 validation studies. Q-sort procedures show promise for operationalizing integrated MMPI-2 interpretations, with both research and teaching applications.

Humans↗

PubMed2006

Neuroplasticity after spinal cord injury and training: an emerging paradigm shift in rehabilitation and walking recovery.

Physical rehabilitation after spinal cord injury has been based on the premise that the nervous system is hard-wired and irreparable. Upon this assumption, clinicians have compensated for irremediable sensorimotor deficits using braces, assistive devices, and wheelchairs to achieve upright and seated mobility. Evidence from basic science, however, demonstrates that the central nervous system after injury is malleable and can learn, and this evidence has challenged our current assumptions. The evidence is especially compelling concerning locomotion. The purpose of this perspective article is to summarize the evidence supporting an impending paradigm shift from compensation for deficits to rehabilitation as an agent for walking recovery. A physiologically based approach for the rehabilitation of walking has developed, translating evidence for activity-dependent neuroplasticity after spinal cord injury and the neurobiological control of walking. Advanced by partnerships among neuroscientists, clinicians, and researchers, critical rehabilitation concepts are emerging for activity-based therapy to improve walking recovery, with promising clinical findings.

Humans↗

PubMed2003

The contribution of vegetarian diets to health and disease: a paradigm shift?

Advances in nutrition research during the past few decades have changed scientists' understanding of the contribution of vegetarian diets to human health and disease. Diets largely based on plant foods, such as well-balanced vegetarian diets, could best prevent nutrient deficiencies as well as diet-related chronic diseases. However, restrictive or unbalanced vegetarian diets may lead to nutritional deficiencies, particularly in situations of high metabolic demand. If some vegetarian diets are healthier than diets largely based on animal products, this constitutes an important departure from previous views on dietary recommendations to prevent disease conditions. Based on different paradigms, 3 models are presented depicting the population health risks and benefits of vegetarian and meat-based diets. This series of models encapsulates the evolution of scientific understanding on the overall effects of these dietary patterns on human health. Recent scientific advances seem to have resulted in a paradigm shift: diets largely based on plant foods, such as well-balanced vegetarian diets, are viewed more as improving health than as causing disease, in contrast with meat-based diets.

Diet, Vegetarian↗

PubMed2006

[Assessment of progression and regression of coronary atherosclerosis by intravascular ultrasound. A new paradigm shift?].

Intravascular ultrasound (IVUS) has emerged as a powerful imaging modality for the assessment of the arterial wall and it's response to the accumulation of atherosclerotic plaque. The ability to image the coronary arteries on a serial basis provides a unique opportunity for IVUS to monitor the impact that potential anti-atherosclerotic strategies exert on plaque burden. As a result, studies incorporating serial IVUS imaging as the primary endpoint have demonstrated that therapeutic strategies that modify LDL, HDL and blood pressure in patients with established coronary artery disease can have a profound impact on the progression of atherosclerotic plaque. This heralds a paradigm shift that emphasizes plaque regression as a potential target in the development of preventive strategies.

Coronary Artery Disease↗

PubMed1998

Osteoporosis--the need for a paradigm shift.

Osteoporosis is a potentially devastating illness and causes morbidity and mortality from fragility fractures at the wrist, spine and hip. Currently, the illness can be detected before the fractures occur using dual energy X-ray absorptiometry and many preventive and therapeutic options exist. Efforts should be directed at helping the population at large achieve a healthy peak bone mass and adopt lifestyle habits which benefit bone mass. For those at high risk of fractures or who have already suffered an osteoporotic fracture, many pharmacological agents have been shown to reduce the risk of subsequent fractures. Hormone replacement therapy and bisphosphonates have the best efficacy data at present but there are likely to be more options in the near future. Hence, there is a need for a paradigm shift in that osteoporosis should not be thought of as an illness that starts at the point of fracture. Instead, it should be actively assessed and treated before fractures occur.

Absorptiometry, Photon↗

PubMed2006

Cancer stem cells: an old idea--a paradigm shift.

Although the concept that cancers arise from "stem cells" or "germ cells" was first proposed about 150 years ago, it is only recently that advances in stem cell biology have given new impetus to the "cancer stem cell hypothesis." Two important related concepts of this hypothesis are that (a) tumors originate in either tissue stem cells or their immediate progeny through dysregulation of the normally tightly regulated process of self-renewal. As a result of this, (b) tumors contain a cellular subcomponent that retains key stem cell properties. These properties include self-renewal, which drives tumorigenesis, and differentiation albeit aberrant that contributes to cellular heterogeneity. Recent experimental evidence in a variety of tumors has lent strong support to the cancer stem cell hypothesis that represents a paradigm shift in our understanding of carcinogenesis and tumor cell biology. This hypothesis has fundamental implications for cancer risk assessment, early detection, prognostication, and prevention. Furthermore, the current development of cancer therapeutics based on tumor regression may have produced agents that kill differentiated tumor cells while sparing the rare cancer stem cell population. The development of more effective cancer therapies may thus require targeting this important cell population.

Animals↗

PubMed2000

Use of tamoxifen in hepatocellular carcinoma: a review and paradigm shift.

Hepatocellular carcinoma is often diagnosed at a late, inoperable stage for which there are no uniformly efficacious treatment available presently. The oral anti-oestrogen drug, tamoxifen, has been used in such patients, based on the belief that the growth of hepatocellular carcinoma is promoted by endogenous oestrogen via a receptor-mediated process. In this review, we examine the trials reported in the literature using tamoxifen in hepatocellular carcinoma. Randomized controlled trials with tamoxifen have so far revealed mixed results. We propose that this may be due to the fact that the mechanism of action of tamoxifen in hepatocellular carcinoma is via an oestrogen-receptor independent pathway that requires much higher doses of tamoxifen for activation than those used in the trials so far. Thus there must be a paradigm shift to dissociate the action of tamoxifen from oestrogen receptors in hepatocellular carcinoma. This means that future trials with tamoxifen in hepatocellular carcinoma should use higher doses of tamoxifen, at least four to eight-fold that of the dose that is efficacious in an oestrogen-receptor dependent mechanism.

Antineoplastic Agents, Hormonal↗

PubMed2001

"Unexplained" somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift?

Medically unexplained functional or somatization symptoms are somatic disorders that are not adequately explained by physical disease processes. The way in which these disorders have been understood and managed has varied over the history of medicine. However, only in the past 100 years has the "mental" explanation predominated. A benefit of this trend has been the development of effective treatments in the form of "antidepressant" drugs and cognitive-behavioral therapies; a cost has been limited integration of these treatments into medical practice and lack of acceptability to patients. We suggest that there is much to learn from physicians of the pre-Freudian era. Their etiologic theories are now supported by new scientific evidence, and their clinical practice provided ways of making psychological treatment acceptable to patients. We propose a paradigm shift in which unexplained symptoms are remedicalized around the notion of a functional disturbance of the nervous system and treatments currently considered "psychiatric" are integrated into general medical care.

History, 17th Century↗

PubMed1996

A paradigm shift in myelodysplastic syndromes.

A poorly defined transforming event(s) affects the pluripotential bone marrow (BM) stem cell in myelodysplastic syndromes (MDS), conferring a growth advantage upon it which leads eventually to monoclonal hematopoiesis. The progeny of this transformed ancestor undergo recognizable albeit dysplastic maturation. We propose that this picture is further complicated by a variety of cytokines, tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta (TGF-beta) and interleukin 1beta (IL-1beta) which exert a dual effect on the diseased cells. The immature CD34+ cells are stimulated to proliferate, while their later differentiated daughters are induced to undergo apoptosis accounting for the clinical syndrome of pancytopenia despite hypercellular BMs. Studies directed at measuring the rates of proliferation and apoptosis as well as the levels of TNF-alpha, TGF-beta and IL-1beta confirm this hypothesis and are presented in greater detail. A novel approach towards MDS therapy emerges as a result of this paradigm shift based upon the premise that anti-cytokine therapy would prevent excessive intramedullary apoptosis and result in improved cytopenias as well as cause a slowing down of the diseased precursor cell proliferation resulting in resumption of polyclonal hematopoiesis. Because a number of cytokines function through common lipid second messengers, interruption of this pathway should theoretically cause disruption in the signalling of a cascade of cytokines.

Apoptosis↗

PubMed1995

Resilience and thriving in response to challenge: an opportunity for a paradigm shift in women's health.

The purpose of this article is to move beyond the vulnerability/deficit model of women and to focus on women's strengths and their ability to thrive in the face of adversity. Thriving is a dynamic process of adaptation, influenced by numerous individual and social factors; it emerges and changes over the life course and may be identified in behavioral, cognitive, or affective domains. The foundation of this concept comes from the literature on resilience, but it goes beyond the common view of resilience as homeostasis. It suggests, instead, a value-added construct whereby challenge provides an opportunity for change and growth. Understanding the concept and process of thriving can provide an important basis for theoretical development, empirical research, and clinical intervention. Thriving can provide a framework within which to examine the antecedents and consequences of differential reactions to health-related challenges. Knowledge of the factors that promote thriving can provide an important foundation for a paradigm shift away from a focus on illness and pathology toward one that understands, explains, and nurtures health.

Adaptation, Psychological↗