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PubMed1990

[The integration of the behavioral sciences and biomedicine: the need for a metatheory].

Theoretical tensions and difficulties in the implementation of the biopsychosocial approach in health care uncover a problematic relationship between biomedicine and the behavioral sciences. The different professionals involved (e.g., psychologists and physicians) can interact through competition, collaboration, and integration and may be considered to represent health care subsystems, defined by profiles of their access to primary and secondary resources. Traditional institutionalization assigns the physician the hegemony in the system. Current challenges to this view underscore the need for a conceptual reformulation which should not only integrate--in a dialectical and complementary way--the contribution of physicians and other professionals, but also explicitly incorporate ethical and epistemological aspects derived from their relationship. Along with indications about the roles of metatheory, its relevance in the Latin American context is indicated.

Behavioral Sciences↗
PubMed1993

A developing country's university oriented toward strengthening health systems: challenges and results.

OBJECTIVES: The Aga Khan University in Karachi has a mission to educate leaders and to contribute to the development of health systems for Pakistan amid challenges of scarcity and complexity. METHODS: Its key activities are (1) to design and test urban and rural health system prototypes, (2) to develop faculty in medical and nursing postgraduate community health sciences programs, and (3) to design and implement community-based undergraduate medical and nursing curricula. RESULTS: The university has developed equity-based, cost-effective primary health care prototypes in Karachi slums. With government counterparts it has tested village-, facility-, and district-level interventions in a poor rural district. Federal policymakers have taken models from each for widespread replication. The university is training 49 medical and 19 nursing faculty for postgraduate programs in community health sciences. Most faculty retain institutional leadership positions, including teaching community-based, problem-solving, community health sciences as 20% of the medical and nursing undergraduate curriculum. CONCLUSIONS: The mission and experience of the Aga Khan University in population-based health systems design and health sciences education can guide universities in both developing and developed countries.

Child, Preschool↗
PubMed1995

Emerging trends in the application of the social sciences to health and medicine.

Tensions are inevitable between funders seeking to solve specific health care issues within existing frameworks and many social scientists who see health and health care as reflections of societal stratification and processes of power and control. Many current and impending issues require deep scrutiny of values and meaning systems as they relate to class, gender, ethnicity and other forms of social differentiation. Interdisciplinary efforts provide social scientists important problem-solving opportunities but also occasions to refine disciplinary theories and methods. In recent years such efforts have resulted in increased sensitivity to demographic imperatives, prospective investigations, social experimentation, a growing appreciation of the complexity of life trajectories, development of more complex models of causation and remediation, and a revival of interest in meaning systems and their effects on ultimate outcomes. Social scientists have come to play a variety of roles in health services and policy research that contribute to a fruitful interplay of theory and practice. Major roles include helping to frame issues and how they are attacked; anticipating emerging trends, issues and problems; monitoring health and the provision of health services; evaluation and assessment; and implementation processes. The contributions of the social sciences to understanding complex organizational arrangements, structures, cultures, managerial approaches, financial arrangements and regulatory processes are increasingly evident and part of a culture of informed thinking.

Delivery of Health Care↗
PubMedDate not supplied

Reorganization of a burn unit in response to underutilization: a critical assessment.

The incidence of burn injury in the United States has declined over the past few years, resulting in a dramatic decrease in the number of admissions to burn centers. This decrease has generated considerable concern, leading to a variety of proposals to modify burn units to control the cost of inpatient care. In 1986 Albany Medical Center Hospital, a 654-bed regional academic health sciences center, closed its burn unit and implemented a program to manage thermally injured patients in the intensive and progressive care areas of the medical center. A retrospective study was performed to compare patient outcomes and length of stay for the dedicated burn unit and the integrated burn program. Between the year before and the year after this change there was no significant difference in mortality rate, length of stay, or number of positive blood cultures. The relationship between burn severity and length of stay was unaltered by the burn program change. A comparison of data collected just after the change to those collected 2 years later again showed no difference, except that the annual census had dropped more than 50%. The results suggest that burn units can be converted to integrated burn programs without compromising patient care outcomes, although the lack of a cohesive burn team and the unavailability of beds designated for patients with burns ultimately resulted in a deemphasis of the burn program and consequent marked reduction in the number of patients with burns seen in the institution.

Burn Units↗
PubMedDate not supplied

[The development, transfer and use of medical technology as a special subject of research].

Regardless of the real exposion of scientific findings and information concerning medical sciences, research in the field, especially fundamental one, has rather insignificant influence on the development of new technologies, applicable in everyday medical practice (pull technologies). Far greater significance has been put on research in other fields, usually initiated with other purposes. "Side product" of that research is the development of these technologies which are best applicable in medicine (push-technologies). This is not the only reason why, as a rule, there is no direct connection between researchers and those supposed to apply and use new technologies. Initiation of evaluational research in the field of medical technologies will be the only way to establish the relationship between the two groups of actors: researchers and implementators.

Medical Laboratory Science↗
PubMed1991

Providing access to blacks and Hispanics in dietetics education.

To increase the number of blacks and Hispanics in dietetics and three other health professions, the Health Sciences Recruitment and Retention Program was developed and implemented in 1985 by the College of Health at Florida International University in Miami. The coordinated undergraduate program assisted in a federal grant to accomplish the objectives of recruiting and retaining minority students. High school and community college students were recruited using a slide/tape presentation featuring black and Hispanic professionals. In addition, the college offered a summer course entitled "Perspectives of the Health Sciences Professions" to students entering their senior year in high school. In this course, students learned how dietitians, medical laboratory scientists, and physical and occupational therapists treat various disease states. Field trips and site visits provided additional exposure to the professions. A summer orientation and tutorial program was established to retain minority students enrolled in the coordinated undergraduate program. We recommend that this program be considered as a model for dietetics educators to use in developing other programs to increase the number of minorities in the profession.

Black or African American↗
PubMed1979

The LeMoyne-Owen College--UTCHS cooperative educational program: a model for minority recruitment.

A program of cooperative education between LeMoyne-Owen College and the University of Tennessee Center for the Health Sciences (UTCHS) was designed to attract students from the undergraduate institution to the various health professional schools at UTCHS. The program was initiated by a black faculty member at UTCHS. It involved a faculty exchange between the two institutions and the implementation of several changes in the pre-health science curriculum at the undergraduate institution. Other components of the program included: the gift of equipment and supplies to LeMoyne-Owen College by UTCHS; counseling of LeMoyne-Owen students by UTCHS faculty members; the generation of private funds by the faculty and staff at UTCHS for the support of LeMoyne-Owen students participating in the cooperative education program; and broad exposure of LeMoyne-Owen students to the laboratories and clinical facilities at UTCHS.

Black or African American↗
PubMed1985

A proposed expert system for nursing practice. A springboard to nursing science.

The knowledge on which nursing practice is based comes largely from traditional sources, expert nurses passing on the wisdom of their experience to novices. Nursing research, although increasing, is usually parallel to nursing practice, and its findings, at best, are implemented only after long delays. Consequently, the most effective nursing responses to a particular client problem may be undiscovered or unknown. Nursing information systems reflect the nature and usage of nursing knowledge. They offer standard care plans, but the knowledge and decision structures for individualizing care remain exclusively in the mind of the nurse. Nurses may have great freedom to enter information into the information system, but the information is rarely retrievable in a form suitable for evaluation or research. Nursing practice, and the knowledge on which it is based, could be enhanced through the use of a novel expert system. This paper describes how such a system could be developed, with examples from the authors' prototype programs. Taxonomies of data, diagnoses, objectives, and interventions would make it possible to compare patients and to determine the relative effectiveness of nursing interventions. A built-in evaluation component would provide feedback and correction. Everyday nursing practice would become a field for research, and the knowledge gained from research would immediately be fed back into practice. In its development and in its implementation, this kind of system would help to build nursing science.

Computers↗
PubMedDate not supplied

Quantitative methods for quality improvement.

Measuring clinical and financial outcomes in health care is a science in the early stages of development and implementation. Many tools and techniques are derived from industry models of continuous quality improvement and epidemiology. Epidemiologic (enumerative) and statistical process control (analytic) methods are effective alternatives to traditional quality assurance methods of evaluating patient care that encompass clinical and financial outcomes. Their use has resulted in significant improvement of clinical outcomes and financial performance, and has increased physician involvement in the process. Although cost will be the driving force of health care reform for the next few years, demonstration of high-quality care by providers through outcomes measurement will differentiate long-term from short-term winners in an environment of managed competition. This fact will make the science of outcomes management increasingly more important.

Chicago↗
PubMed1979

The implementation of a large-scale self-instructional course in medical information resources.

The implementation of library orientation and bibliographic instruction in health sciences centers presents some interesting as well as perplexing problems. The Rowland Medical Library at The University of Mississippi Medical Center had to confront and reexamine these problems when faced with the requirement to teach 298 freshman and sophomore medical students in one ten-week quarter. This paper outlines the development and implementation of a large-scale self-instructional approach to library instruction. The package consisted of an audiotape, a videotape, a written program, self-teaching quizzes, a performance test, and a student evaluation. Performance test results and student evaluation data are presented which indicate that this format can successfully be employed to meet course objectives and to be accepted by students.

Audiovisual Aids↗
PubMed1989

A parallel implementation of the ALOPEX process.

Optimization techniques have found many applications in science, engineering, and industry. In all applications, the best value of a "cost function" is sought in a well-defined domain; this cost function in general depends on many parameters. An iterative optimization technique has been developed (ALOPEX) that uses feedback in order to optimize the response of a system. The cost function for this process is problem dependent and therefore quite flexible. The method has been applied successfully to different optimization problems such as pattern recognition, receptive field studies in the visual system of animals, curve fitting, etc. We present two special purpose hardware implementations for ALOPEX. The first method takes time O(logN + logm) and uses O(mN2) processing elements. The second method takes O(logN + m) time and uses O(N2) processing elements. Our basic architecture is a binary tree with N2 leaves (equal to the length of the vectors) and therefore had depth O(logN). Different implications of the two approaches will be discussed including similarities with the biological visual process.

Algorithms↗
PubMed1991

The impact of economic issues on Nigerian health sciences libraries.

Economic issues are among the most important factors affecting health sciences libraries in Nigeria. These issues are influenced by the political, cultural, geographic, and demographic characteristics of the country. Significant economic issues are the dependence of the national economy on a single commodity, large foreign debt and spiraling inflation, stringent foreign exchange control measures, and inadequate realization by authorities of the role and importance of health sciences libraries. With shrinking budgets, resources, and staff, health sciences libraries can neither grow nor afford library automation. Health sciences librarians must take initiatives for cooperative activities to increase and make the most of resources, pursue nontraditional methods of fund-raising, educate authorities about the role and importance of libraries, and develop and implement a plan for the development and growth of health sciences libraries in the country.

Financing, Government↗
PubMed1989

The science of public health surveillance.

Improved public health surveillance can lead to earlier implementation of prevention and control measures. Better surveillance data lead to a more rational establishment of priorities. More timely and accurate data facilitate earlier epidemic detection and control. With better surveillance data, the impact of intervention activities and other public health programs can be evaluated more accurately. In this paper we describe how to improve the science of surveillance in terms of data collection, analysis, and dissemination and its application to public health practice. We then discuss the potential benefits and costs of such efforts and suggest methods for evaluating alternative approaches. The argument for science in surveillance, on the other hand, may be subject to excess. Surveillance is not an end unto itself, but rather a tool. This tool should be refined and modified to adapt to the goals of a particular public health program. It is the development of methods to apply creative ideas to surveillance, and the rigorous assessment of the process, that will benefit from the application of scientific principles.

Data Interpretation, Statistical↗
PubMed1983

Clinical instruction in medicine: a national survey.

In this paper the authors report on the medicine phase of three parallel studies undertaken to investigate clinical teaching skills in medicine, dentistry, and nursing. The intent of the overall study was to gather and assess broad-based information useful in the design and implementation of clinical teaching improvement programs in the health sciences. A 14-member consortium representing five schools each in medicine and dentistry and four in nursing collaborated by using a modified Delphi technique to resolve conflict and differences, through group judgments, in preferences to choices among educational goals and activities. Based upon an educational needs assessment, the design of the study and of the research methodology allows replication at individual institutions and provides a systematic approach for designing and implementing faculty development programs with specific skill emphasis at the clinical level.

Clinical Competence↗
PubMed1994

Applications of medical informatics in antibiotic therapy.

The Infectious Disease Society of America is concerned about the excessive and inappropriate use of antibiotics in U.S. hospitals. Applications of Medical Informatics can help improve the use of antibiotics and help improve patient care by monitoring and managing enormous amounts of patient information. Monitoring the duration of every antibiotic ordered in the hospital or keeping tract of the antibiotic susceptibilities for five years are examples of tasks better performed by computers. The impact of computers in medicine is seen by some as disappointing. The computer revolution has not had the impact in medicine experienced by other areas. The acceptance and use of computers by medicine will be evolutionary rather than revolutionary. In 1979, the MYCIN project demonstrated that the computer could aid physicians in the selection of antibiotics. However, MYCIN was never clinically used because physicians were require to enter all patient information into the computer. The development of computerized medical records is an essential step to further the development and implementation of computer-aided decision support. The science of Medical Informatics is still relatively new but is emerging as a distinct academic field. A few hospitals are now installing information systems and have determined that these systems will play an essential role in their ability to survive into the next century. The telephone and the automobile have been recognized as two of the most important tools for improving medical care during the past 100 years. People could more readily get medical care and the time to transmit medical information was greatly reduced through physician use of the telephone and automobile. The computer is a tool that can be used to help physicians manage the great amount of medical information being generated every day. The computer can also alert the physician of patient conditions that need attention. However, it is the physician who must use and apply the computer provided information. Thus, the computer will assist but not replace physicians in providing medical care.

Anti-Bacterial Agents↗
PubMed1986

Preliminary experiment with computerized anamnesis in gynecology and reproductive health.

The Hospital of the Faculty of Medical Sciences of the State University of Campinas is implementing an Integrated Health Care Programme, whose objectives are early detection of risk factors of several diseases and the evaluation of the patient's reproductive health at the moment of the first visit to the Hospital. The initial results of this program encouraged us to try to apply it all to our own clientele. The present lack of material resources and qualified manpower leads us to concentrate all our attention on the patient's immediate complaints. This situation indicated to us that the only way to implement the program should be by means of a computerized questionnaire able to detect diseases and risk factors early. This paper presents the preliminary results of the application of computerized questionnaires to evaluate health risks. The authors conclude: The application of a computerized questionnaire met with very favorable reception by the clientele; In some segments of the population, the questionnaire can be answered by the patients in direct interaction with the computer; Programmes which evaluate risk factors need to be carefully revised before being put to use; The system operates on a relatively low cost basis, which could bring undeniable benefits to primary health care.

Computers↗
PubMed1986

Establishment of medical surveillance in industry: problems and procedures.

The establishment of standard history-taking will be discussed and will include examples of such histories developed in the clinic. The development of a protocol for performing and recording physical examinations will also be described. Special tests, such as pulmonary function and sputum cytology, will then be discussed. The integration of medical data into a data base will also be discussed with examples taken from the program in Pittsburgh. Presentation of the problems of obtaining adequate early medical information leads to the conclusion that medical surveillance programs must be integrated with industrial hygiene surveillance. The use of exposure measures to make and implement preventive medical decisions is essential until medical science provides tests with enhanced sensitivity and specificity for use in early detection of workplace disease.

Clinical Laboratory Techniques↗