PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Implementation challenges”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 901 records · Page 50Linked to original sources
PubMed2001

From translational research to improved local control and survival: the Gilbert Fletcher Award Lecture, Lugano, March 2000.

Recent clinical trials have shown us that it is possible to improve local control and survival by the concomitant use of radiotherapy and chemotherapy in a large variety of solid tumors, such as head and neck, lung, cervical, and anal cancer. The selection of drugs for this combined treatment, however, has been based on a rather empiric approach. Further research combining the clinical and laboratory expertise now offers the possibility of predicting and improving treatment efficacy for radiotherapy and systemic treatment, given alone or in combination. New methods, such as chromosome and gene expression profiling of individual tumors, are now becoming available with the comparative genomic hybridization assay and microchip DNA arrays. These assays will hopefully be of help in selecting patients for their optimal treatment regimen in the near future. Detailed knowledge of the mechanisms of action of these two treatment modalities will also lead to the development of new and more effective drugs, to be used concomitantly. It is the challenge of translational research to implement its opportunities into daily clinical practice. In analogy to the results obtained with concomitant radiotherapy and chemotherapy, this will lead to improved local control and survival rates in cancer patients.

Antineoplastic Agents, Hormonal↗
PubMed2000

Is symmetry a visual cue to attractiveness in the human female body?

Small deviations from bilateral symmetry (a phenomenon called fluctuating asymmetry [FA]) are believed to arise due to an organism's inability to implement a developmental program when challenged by developmental stress. FA thus provides an index of an organism's exposure to adverse environmental effects and its ability to resist these effects. If one wishes to choose an individual with good health and fertility, FA could be used as an index of a potential partner's suitability. To explore whether this theory can be applied to human female bodies (excluding heads), we used a specially developed software package to create images with perfect symmetry. We then compared the relative attractiveness of the normal (asymmetric image) with the symmetric image. When male and female observers rated the images for attractiveness on a scale of 1 to 10, there was no significant difference in attractiveness between the symmetric and asymmetric images. However, in a two-alternative forced-choice experiment, the symmetric image was significantly more popular. The evidence suggests a role for symmetry in the perception of the attractiveness of the human female body.

Journal Article↗
PubMed1999

Performance assessments of nuclear waste repositories: a dialogue on their value and limitations.

Performance Assessment (PA) is the use of mathematical models to simulate the long-term behavior of engineered and geologic barriers in a nuclear waste repository; methods of uncertainty analysis are used to assess effects of parametric and conceptual uncertainties associated with the model system upon the uncertainty in outcomes of the simulation. PA is required by the U.S. Environmental Protection Agency as part of its certification process for geologic repositories for nuclear waste. This paper is a dialogue to explore the value and limitations of PA. Two "skeptics" acknowledge the utility of PA in organizing the scientific investigations that are necessary for confident siting and licensing of a repository; however, they maintain that the PA process, at least as it is currently implemented, is an essentially unscientific process with shortcomings that may provide results of limited use in evaluating actual effects on public health and safety. Conceptual uncertainties in a PA analysis can be so great that results can be confidently applied only over short time ranges, the antithesis of the purpose behind long-term, geologic disposal. Two "proponents" of PA agree that performance assessment is unscientific, but only in the sense that PA is an engineering analysis that uses existing scientific knowledge to support public policy decisions, rather than an investigation intended to increase fundamental knowledge of nature; PA has different goals and constraints than a typical scientific study. The "proponents" describe an ideal, six-step process for conducting generalized PA, here called probabilistic systems analysis (PSA); they note that virtually all scientific content of a PA is introduced during the model-building steps of a PSA; they contend that a PA based on simple but scientifically acceptable mathematical models can provide useful and objective input to regulatory decision makers. The value of the results of any PA must lie between these two views and will depend on the level of knowledge of the site, the degree to which models capture actual physical and chemical processes, the time over which extrapolations are made, and the proper evaluation of health risks attending implementation of the repository. The challenge is in evaluating whether the quality of the PA matches the needs of decision makers charged with protecting the health and safety of the public.

Geological Phenomena↗
PubMed2005

Data collection systems for weight loss surgery: an evidence-based assessment.

OBJECTIVE: To evaluate the existence and efficacy of data collection systems for weight loss surgery (WLS) and establish evidence-based guidelines for the development of a statewide WLS registry in Massachusetts. RESEARCH METHODS AND PROCEDURES: We conducted two systematic searches of English language literature in MEDLINE. The first was on data collection registries related to WLS; the second was an expanded search encompassing other surgical fields (e.g., cardiac and thoracic surgery) and registries (i.e., cancer). Fourteen articles were found to be pertinent. Data were extracted, and evidence categories were assigned according to a grading system based on established evidence-based models. Recommendations were derived from these literature reviews and expert opinion. RESULTS: This task group found that there are no standardized data collection systems for WLS in Massachusetts (or any other states) and no mandated reporting of WLS-specific outcomes. We described existing WLS databases and systems in other surgical fields. Recommendations focused on the importance and feasibility of data collection for WLS and the need to conduct a pilot study and explore options for creating a statewide WLS database. DISCUSSION: A statewide WLS data collection system would optimize patient care by enabling the collection, analysis, and dissemination of best practice data. A broad-based effort is needed to meet challenges involved in defining and implementing such a system.

Data Collection↗
PubMed2005

Digital microfluidics using soft lithography.

Although microfluidic chips have demonstrated basic functionality for single applications, performing varied and complex experiments on a single device is still technically challenging. While many groups have implemented control software to drive the pumps, valves, and electrodes used to manipulate fluids in microfluidic devices, a new level of programmability is needed for end users to orchestrate their own unique experiments on a given device. This paper presents an approach for programmable and scalable control of discrete fluid samples in a polydimethylsiloxane (PDMS) microfluidic system using multiphase flows. An immiscible fluid phase is utilized to separate aqueous samples from one another, and a novel "microfluidic latch" is used to precisely align a sample after it has been transported a long distance through the flow channels. To demonstrate the scalability of the approach, this paper introduces a "general-purpose" microfluidic chip containing a rotary mixer and addressable storage cells. The system is general purpose in that all operations on the chip operate in terms of unit-sized aqueous samples; using the underlying mechanisms for sample transport and storage, additional sensors and actuators can be integrated in a scalable manner. A novel high-level software library allows users to specify experiments in terms of variables (i.e., fluids) and operations (i.e., mixes) without the need for detailed knowledge about the underlying device architecture. This research represents a first step to provide a programmable interface to the microfluidic realm, with the aim of enabling a new level of scalability and flexibility for lab-on-a-chip experiments.

Computers↗
PubMed2005

The slow-scale stochastic simulation algorithm.

Reactions in real chemical systems often take place on vastly different time scales, with "fast" reaction channels firing very much more frequently than "slow" ones. These firings will be interdependent if, as is usually the case, the fast and slow reactions involve some of the same species. An exact stochastic simulation of such a system will necessarily spend most of its time simulating the more numerous fast reaction events. This is a frustratingly inefficient allocation of computational effort when dynamical stiffness is present, since in that case a fast reaction event will be of much less importance to the system's evolution than will a slow reaction event. For such situations, this paper develops a systematic approximate theory that allows one to stochastically advance the system in time by simulating the firings of only the slow reaction events. Developing an effective strategy to implement this theory poses some challenges, but as is illustrated here for two simple systems, when those challenges can be overcome, very substantial increases in simulation speed can be realized.

Journal Article↗
PubMed2002

Fortification strategies to meet micronutrient needs: successes and failures.

Food fortification is likely to have played an important role in the current nutritional health and well-being of populations in industrialized countries. Starting in the early part of the 20th century, fortification was used to target specific health conditions: goitre with iodized salt; rickets with vitamin D-fortified milk; beriberi, pellagra and anaemia with B-vitamins and Fe-enriched cereals; more recently, in the USA, risk of pregnancy affected by neural-tube defects with folic acid-fortified cereals. A relative lack of appropriate centrally-processed food vehicles, less-developed commercial markets and relatively low consumer awareness and demand, means it has taken about another 50 years for fortification to be seen as a viable option for the less-developed countries. The present paper reviews selected fortification initiatives in developing countries to identify different factors that contributed to their successful implementation, as well as the challenges that continually threaten the future of these programmes. Ultimately, the long-term sustainability of fortification programmes is ensured when consumers are willing and able to bear the additional cost of fortified foods. There has been an enormous increase in fortification programmes over the last couple of decades in developing countries. Considerable progress has been made in reducing vitamin A and I deficiencies, although less so with Fe, even as Zn and folic acid deficiencies are emerging as important public health problems. Food fortification based on sound principles and supported by clear policies and regulations can play an increasingly large role in this progress towards prevention and control of micronutrient malnutrition.

Adult↗
PubMed2004

Health promotion interventions for disadvantaged women: overview of the WISEWOMAN projects.

BACKGROUND: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program aims to remove racial and ethnic disparities in health by addressing the screening and intervention needs of midlife uninsured women. This paper describes the WISEWOMAN program requirements, the design of the 12 projects funded in 2002, the use of a standardized data reporting and analysis system, risk factors among participants, effective behavioral strategies, and plans for the future. METHODS: The WISEWOMAN demonstration projects are examining the feasibility and effectiveness of adding a cardiovascular disease (CVD) prevention component to the early detection of breast and cervical cancer. Women aged 40-64 are eligible if they are enrolled in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in selected U. S. states and are financially disadvantaged and lack health insurance. The primary outcome measures are blood pressure, lipid levels, and tobacco use. Intermediate measures include self-reported diet and physical activity, measures of readiness for change, and barriers to behavior change. RESULTS: During 2002, the 10 projects that were fully operational screened 8164 financially disadvantaged women and developed culturally and regionally appropriate nutrition and physical activity interventions for a variety of racial and ethnic backgrounds. Twenty-three percent of the women screened had high total cholesterol, with 48% of these being newly diagnosed. Thirty-eight percent of the women had high blood pressure, with 24% being newly diagnosed. Approximately, 75% of participants were either overweight or obese, and in some sites up to 42% were smokers. CONCLUSIONS: The WISEWOMAN demonstration projects have been successful at reaching financially disadvantaged and minority women who are at high risk for chronic diseases. These projects face challenges because they are generally implemented by safety net providers who have limited resources and staff to conduct research and evaluation. On the other hand, the findings from these projects will be especially informative in reducing health disparities because they are conducted in those settings where the most socially and medically vulnerable women receive care.

Breast Neoplasms↗
PubMed2006

Ongoing challenges of a global international patient assistance program.

The Glivec International Patient Assistance Program (GIPAP) that is supported by Novartis Oncology provides Glivec (imatinib), an innovative oral therapy for chronic myelogenous leukemia and gastrointestinal stromal tumours, at no cost to patients in developing countries who could otherwise not afford treatment. Using a novel direct-to-patient approach this program is currently successfully providing Glivec to underserved patients in 81 countries. A number of challenges were faced in the implementation of this program in countries where cancer is not a priority, and where the healthcare and other infrastructure can be very limited. By working within the existing healthcare system of each country, and with any national cancer control programme that may be in place, through careful selection of qualified institutions and physicians, while maintaining a global approach to ensure consistency and quality, GIPAP has become an efficient and sustainable access program. Novartis has made a long-term commitment to GIPAP, and is currently exploring new patient access programs for other drugs.

Administration, Oral↗
PubMed2003

The quality of quality measurement in U.S. nursing homes.

PURPOSE: This article examines various technical challenges inherent in the design, implementation, and dissemination of health care quality performance measures. DESIGN AND METHODS: Using national and state-specific Minimum Data Set data from 1999, we examined sample size, measure stability, creation of ordinal ranks, and risk adjustment as applied to aggregated facility quality indicators. RESULTS: Nursing home Quality Indicators now in use are multidimensional and quarterly estimates of incidence-based measures can be relatively unstable, suggesting the need for some averaging of measures over time. IMPLICATIONS: Current public reports benchmarking nursing homes' performances may require additional technical modifications to avoid compromising the fairness of comparisons.

Nursing Homes↗
PubMed2026

Promises and pitfalls of long-read sequencing for resolving microbial complexity.

Long-read sequencing (LRS) has driven a transition in microbial genomics, overcoming the assembly fragmentation inherent to short-read sequencing. This review elucidates the impact of LRS across isolate genomics, metagenomics, and multi-omics domains. By spanning extensive repetitive regions, LRS facilitates the reconstruction of circular chromosomes and precisely resolves mobile genetic elements (MGEs). In metagenomics, LRS enables strain-level resolution, the recovery of circular metagenome-assembled genomes, and the precise localization of MGEs within host replicons. Furthermore, the single-molecule, amplification-free properties of LRS provide enhanced resolution of native epigenetic modifications and full-length transcriptomes. Despite these advancements, widespread implementation remains constrained by multidimensional challenges, including stringent high-molecular-weight DNA requirements, depth deficits, and computational overhead. Nevertheless, LRS is increasingly becoming the method of choice for isolate genomics and metagenomics. As detection technologies and algorithms progress, LRS will further improve our ability to decipher the structural and functional diversity of microbial ecosystems.

Metagenomics↗
PubMed2006

Minimally invasive pharmacokinetic and pharmacodynamic technologies in hypothesis-testing clinical trials of innovative therapies.

Clinical trials of new cancer drugs should ideally include measurements of parameters such as molecular target expression, pharmacokinetic (PK) behavior, and pharmacodynamic (PD) endpoints that can be linked to measures of clinical effect. Appropriate PK/PD biomarkers facilitate proof-of-concept demonstrations for target modulation; enhance the rational selection of an optimal drug dose and schedule; aid decision-making, such as whether to continue or close a drug development project; and may explain or predict clinical outcomes. In addition, measurement of PK/PD biomarkers can minimize uncertainty associated with predicting drug safety and efficacy, reduce the high levels of drug attrition during development, accelerate drug approval, and decrease the overall costs of drug development. However, there are many challenges in the development and implementation of biomarkers that probably explain their disappointingly low implementation in phase I trials. The Pharmacodynamic/Pharmacokinetic Technologies Advisory committee of Cancer Research UK has found that submissions for phase I trials of new cancer drugs in the United Kingdom often lack detailed information about PK and/or PD endpoints, which leads to suboptimal information being obtained in those trials or to delays in starting the trials while PK/PD methods are developed and validated. Minimally invasive PK/PD technologies have logistic and ethical advantages over more invasive technologies. Here we review these technologies, emphasizing magnetic resonance spectroscopy and positron emission tomography, which provide detailed functional and metabolic information. Assays that measure effects of drugs on important biologic pathways and processes are likely to be more cost-effective than those that measure specific molecular targets. Development, validation, and implementation of minimally invasive PK/PD methods are encouraged.

Antineoplastic Agents↗
PubMed2001

A synthesis of nine major reports on physicians' competencies for the emerging practice environment.

Medical education and training programs generally have been slow to introduce curriculum content that reflects important changes in practice organization and health services delivery. However, impetus for curricular reform is gaining momentum as national organizations endorse new content for both medical school and residency education. The authors and colleagues at Tufts Managed Care Institute reviewed nine reports by key national organizations to assess their positions on curricular reform in light of changes in practice and the system of care. The reports agree generally on the evolving nature of practice, the need to address these changes during medical school and residency training, and the description of the new curriculum content that they advocate. The authors grouped these reports' specific recommendations under ten curriculum domains: health care system overview; population-based care; quality measurement and improvement; medical management; preventive care; physician-patient communication; ethics; teamwork and collaboration; information management and technology; and practice management. They describe the reports' rationales and cite specific knowledge and skills that these national organizations identify within each domain. This domain-based framework synthesizes and complements the recommendations of these national organizations. The authors conclude that implementing curricular reform remains a challenge. The information and competencies need to be organized and sequenced for stage of training and specialty, and barriers to change require strategic and operational planning. Having a common nomenclature and framework will facilitate the introduction of new content within schools and programs, across departments, and among institutions nationwide.

Comprehensive Health Care↗
PubMed2004

HIV drug resistance surveillance: summary of an April 2003 WHO consultation.

The widespread use of any antimicrobial agent, including antiretroviral agents, has the potential to select drug-resistant populations of microorganisms. HIV drug-resistant strains have been recognized as a serious threat to the efficacy of current antiretroviral treatments and could jeopardize efforts to increase access to treatment in countries most affected by the HIV epidemic. The WHO Global HIV Drug Resistance Surveillance Programme aims at enhancing and enabling the response to the threat of antiretroviral drug resistance by assessing the geographical and temporal trends in HIV drug resistance, increasing our understanding of the determinants of HIV drug resistance, and identifying ways to minimize its appearance, evolution and spread. Based on a global network of experts and collaborating institutions, the programme is developing and field-testing tools and guidelines for the regular monitoring of the level and spread of HIV resistance, particularly in treatment-naive patients. Although relevant progress has been made, several important challenges still exist to the implementation of this essential and innovative programme.

Costs and Cost Analysis↗
PubMed1994

Cleanup protocol for 226Ra-contaminated cobbly soil at UMTRA Project sites.

The nonuniform distribution of 226Ra and other radiological contamination of cobbly soil encountered on several Uranium Mill Tailings Remedial Action Project sites is presented and discussed, and the concomitant challenges to the intent and implementation of the U.S. Environmental Protection Agency's soil cleanup standards are noted. In response to technical assessments and information presented to the U.S. Nuclear Regulatory Commission by the U.S. Department of Energy, the Nuclear Regulatory Commission has recently resolved the dilemma by concluding that compliance with Environmental Protection Agency soil cleanup standards for cobby soil at Uranium Mill Tailings Remedial Action Project sites would be adequately attained using bulk radionuclide concentrations, instead of requiring that the radionuclide concentration of the finer soil fraction passing a #4 mesh sieve met the standards. A Nuclear Regulatory Commission-approved procedure developed for cobbly soil remediation is outlined and discussed. The site-specific implementation of this procedure at Uranium Mill Tailings Remedial Action Project sites containing cobbly soil is estimated to save millions of dollars.

Colorado↗
PubMed1990

Coronary artery disease in blacks.

Coronary artery disease (CAD) is the leading cause of death in black Americans, accounting for 25% of all deaths. Risk factors for CAD that have been established in white populations also have a high prevalence in black populations. Some risk factors, such as hypertension, have a greater prevalence in blacks. Risk factor reduction for this population remains as great a problem as it is for whites and other minority groups. The major challenges for nursing lie in implementing and evaluating primary and secondary prevention strategies beginning with children and extending to the elderly.

Adolescent↗
PubMed1995

Perinatal care across the continuum: early discharge and nursing home follow-up.

Efforts to control health care costs have resulted in earlier hospital discharge of both perinatal and neonatal patients. While earlier discharge may reduce hospital charges, it can increase families' burden of care, stress, and expenses and postdischarge complications may go undetected. A number of programs of home follow-up care have been developed in response to earlier hospital discharge. Nursing's challenge is to develop and implement the most effective and cost-efficient services acceptable and available to all perinatal and neonatal patients who need them.

Continuity of Patient Care↗