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At least 955 records · Page 53Linked to original sources
PubMed1985

Laboratory animal medicine. Changes and challenges.

Less than three decades have elapsed since the specialty of laboratory animal medicine was first formally recognized. Tremendous progress and maturation has occurred in this short time frame due in large part to the foresight of early pioneers in the field, attention to the moral and ethical use of animals, and the recognition by the biomedical research community of the indispensable role played by the laboratory animal medicine specialist in forging new knowledge in the biomedical sciences. The ability of laboratory animal medicine specialists to properly balance their efforts in collaborative and independent research, clinical services and teaching, offers exciting challenges and opportunities for veterinarians entering the specialty. Undoubtedly, another challenge to the specialty, currently and in the foreseeable future, is the debate over animal rights which began to ferment in the late 1970's, after lying relatively dorment since the 1950's. A growing number of Americans, including some scientists, contend that animals have inherent rights to a full life, free of intentional pain, even when done in legitimate scientific pursuits; some ardent anti-vivisectionists state that the use of animals in experimental research is immoral. The laboratory animal medicine specialist will have to effectively deal with the administrators of institutions using research animals, the attendant federal and state guidelines and laws regulating their use, and defend the use of laboratory animals to a polarized public, while at the same time ensure the humane care and use of animals under their purview. Certainly, the specialty is squarely placed in a hotly debated dilemma, fraught with ethical, moral, medical, philosophical, religious, and political complexities. I believe the specialty has the vision and maturity, and is indeed ready, to successfully meet that challenge - to assuage public concern, implement new federal policy regarding animal care and use, and maintain the excellent progress in laboratory animal medicine realized in the last 75 years.

Animals↗
PubMed1993

Integration of hepatitis B immunization in the Expanded Program on Immunization of the Child Survival Project.

The Expanded Program on Immunization (EPI) is a component of the Child Survival Project (CSP) whose objectives are to reduce the incidence rates of six childhood diseases (Measles, Diphtheria, Pertussis, Tetanus, Tuberculosis, Poliomyelitis) and to reduce the number of infant deaths from those diseases by increasing effective vaccination coverage. In 1991, the CSP/EPI developed a national plan to introduce national immunization of infants against hepatitis B in an attempt to control the magnitude and seriousness of the damage which viral hepatitis causes in terms of morbidity, mortality and serious sequelae as hepatitis B is an endemic disease in Egypt causing an important public health problem which requires urgent control. This presentation will discuss the integrated effort undertaken to plan and implement the program, the different challenges it faces, control studies being performed as well as the proposed objectives of the hepatitis B vaccination program.

Child↗
PubMed1993

The platelet-refractory bone marrow transplant patient: prophylaxis and treatment of bleeding.

Refractoriness to platelet transfusions remains a significant problem for oncology patients, occurring in 30% to 70% of multiply transfused recipients with bone marrow failure. Nonimmune causes are often present and include disseminated intravascular coagulation, concurrent use of amphotericin B, infection, presence of palpable spleen, use of antibacterial antibiotics, bleeding, veno-occlusive disease, and fever. Immune causes are also commonly responsible for refractoriness, with HLA alloimmunization dominating the list of immune factors. HLA antibodies can be identified in 25% to 30% of transfused leukemia patients and can be present in as many as 80% of aplastic anemia patients. Developing a consistent approach to managing these refractory patients is essential to preventing and treating bleeding manifestations. An HLA type should be obtained for all patients anticipated to have chronic transfusion requirements. Screening for lymphocytotoxic antibodies can confirm suspected HLA alloimmunization. Histocompatible platelets (cross-match compatible and HLA matched) should be provided for all patients with HLA antibodies. A number of other therapeutic modalities have been used in an effort to manage the alloimmunized patient; most of these methods have had little or no proven benefit. When bleeding develops in the alloimmunized patient, there are few therapeutic choices. If histocompatible platelets are unavailable or unsuccessful, massive platelet transfusions of pooled platelet concentrates are commonly used, although this practice is of no proven benefit. While antifibrinolytic agents have been available for over 30 years, they are only recently being applied to control bleeding in chronic thrombocytopenia. We have successfully managed bleeding episodes in thrombocytopenic bone marrow transplant recipients with the use of epsilon aminocaproic acid. A number of these patients were platelet refractory with demonstrable platelet antibodies. Platelet refractoriness continues to plague multiply transfused oncology patients. While preventative measures may ultimately benefit some patients, this problem will continue to manifest itself. A consistent approach to transfusion support needs to be implemented to best manage this challenging patient population.

Aminocaproic Acid↗
PubMedDate not supplied

Health promotion and disease prevention strategies.

The rapid growth and relative youth of the Latino population of the United States, soon to become the largest ethnic-racial group in the country, presents numerous opportunities and a special challenge to those concerned with the health and well-being of this segment of people. The challenge is to develop and implement efficacious strategies for improving Latino health at a time when the overall socioeconomic profile of this population is in striking contrast to that of the rest of the American people. Much can be done to improve Latino health by implementing health promotion and disease prevention interventions designed to achieve Latino parity in reaching year 2000 national health care objectives. The problems encountered by Latinos in obtaining health promotion and disease prevention services, previous recommendations on how these problems could be addressed, and new strategies for implementing more effective services for Latinos are summarized.

Health Promotion↗
PubMed1995

Diet regimen in the treatment of food allergy.

Adverse reactions to food may be mediated by immunological or non immunological mechanisms. The term "food allergy" describes an event in which a definite immunopathological process can be demonstrated and a cause and effect relationship must be present. Symptoms and signs of food allergy may appear in any organ system, depending in part on the age of the subject and on the allergen involved. At present it is generally agreed that the only effective therapy for food allergy is strict elimination of the offending food antigen. Institution of a food elimination diet should be considered comparable to prescribing a medication, which carries along definite risk-benefit ratio. Consequently, appropriate diagnostic measures base on history, skin test, or radioallergosorbent test (Rast) and blind food challenges, must be utilized before implementing special diets. The allergist and other health care professionals must recognize the advantages of elimination diets (improvement of symptoms) as well as disadvantages (increase of the time required to purchase food and prepare meals, impossibility to eat at restaurants, at friends' houses or at school with consequent possible social isolation, nutritional disorders) and choose the most appropriate elimination diet.

Child↗
PubMedDate not supplied

From repairing the consequences of disease to managed wellness: lessons from 20 years of managing dental care.

As the 21st century approaches, dentistry will be challenged by multiple pressures. The demographic trends of a growing population are outpacing the supply of dental manpower. Economic trends, including fewer family wage jobs, less full-time employment, and more single-parent families, create pressure on the ability to afford dental care. Competitive and reform pressures continue in the health-care field and are gaining momentum in dental care. Even without these pressures, traditional dental approaches have not been able to address the bulk of the needs of the population, as indicated by published assessments of the dental health of various segments or the overall use of dental services in the country. The challenge created by these demographic, economic, and competitive pressures on the KPDCP and the dental profession as a whole is to shift away from the individual patient, disease-model repair and improve management of dental wellness as the means of improving access to dental services for an even greater number of people. This challenge can be met by implementing the currently neglected clinical knowledge contained in our dental literature, taking action to find answers for the things we do not know, and by applying our knowledge to preventing the onset and/or progression of dental disease, decreasing unneeded and/or ineffective treatments, and avoiding premature entrance into the cycle of rerestoration.

Dental Care↗
PubMed1994

Transfusion and HIV.

Over a decade has passed since the first cases of AIDS were reported in hemophiliacs and transfusion recipients. Studies published over the past year offer an increasingly clear understanding of the extent of the early transfusion-associated AIDS epidemic, and of the effectiveness of progressive donor screening measures in safeguarding the blood supply from HIV. Although a number of recent studies have confirmed that the residual risk of HIV infection from blood and blood components is very small, effort continues toward development of new screening tests and viral inactivation procedures. Deciding whether these procedures warrant implementation will be a major challenge in the upcoming years.

Blood Donors↗
PubMed1998

Mental health nursing support during Operation Sea Signal: Cuban/Haitian humanitarian mission.

Joint military humanitarian missions provide challenges and rewards for mental health nursing not found in the garrison mission. A primary challenge is to develop and implement programs that benefit the various populations inherent in such missions. During Operation Sea Signal, several programs, such as migrant adult day treatment, halfway house, outreach, and inpatient, led to the overall enhancement of mental health nursing care for the Cuban and Haitian migrants. It also gave the participating mental health nursing team of professionals and enlisted technicians the opportunity to develop their nursing expertise and sensitivity in a culturally diverse situation.

Cuba↗
PubMed2007

Studying the emergence of autism spectrum disorders in high-risk infants: methodological and practical issues.

Detecting early signs of autism is essential for timely diagnosis and initiation of effective interventions. Several research groups have initiated prospective studies of high-risk populations including infant siblings, to systematically collect data on early signs within a longitudinal design. Despite the potential advantages of prospective studies of young children at high-risk for autism, there are also significant methodological, ethical and practical challenges. This paper outlines several of these challenges, including those related to sampling (e.g., defining appropriate comparison groups), measurement and clinical implications (e.g., addressing the needs of infants suspected of having early signs). We suggest possible design and implementation strategies to address these various challenges, based on current research efforts in the field and previous studies involving high-risk populations.

Autistic Disorder↗
PubMedDate not supplied

Implementation of the prevention of mother-to-child transmission of HIV programme in Zimbabwe: achievements and challenges.

Recent scientific developments have led to feasible and effective interventions to reduce the risk of mother to child transmission of HIV. Even in resource poor countries, PMTCT programmes are being articulated as a priority in the national strategic frameworks. Thus PMTCT programmes are moving from being pilot projects to national programmes comprehensively integrated into other reproductive health programmes or HIV and AIDS prevention, care and support programmes. In Zimbabwe the prevention of mother-to-child transmission (PMTCT) of HIV infection has become an important national task. The 2001 national survey of HIV prevalence among women attending antenatal care revealed that 29.5% of the women were HIV positive. While an effective PMTCT programme using nevirapine can reduce the rate of this transmission by 50%, the Zimbabwe PMTCT National Expansion Programme has had its share of achievements and challenges since its launch in 2002.

Female↗
PubMed2006

Managing depressed patients with comorbidities and dual-eligibility benefit status.

OBJECTIVE: To discuss the challenges and requirements in developing and implementing strategies for the appropriate management of depression in a subpopulation of dual-eligible patients with comorbidities. SUMMARY: Treating patients with comorbidities who are dually eligible for Medicare and Medicaid services is challenging. In this vulnerable population, condition management strategies should address new patient cost-sharing responsibilities, improve or minimize the disruptions in access to medications, monitor for potential adherence issues, and, most importantly, strive to maintain, if not improve, overall health outcomes. Complicating these essential strategies are concerns about defining who is responsible for providing treatment to dual-eligible patients and the potential loss of vital services at various levels, including transition of care or the possible discontinuation of or severe limitations on reimbursement for key services. CONCLUSION: Condition management strategies should be developed to deal with the unique needs of the dual-eligible population to ensure continuity of care. Additionally, an organizational infrastructure is necessary to give providers useful tools to help them deliver better-coordinated care to the dual-eligible population that struggles with depression.

Comorbidity↗
PubMed1992

Implementing managed care in a pediatric setting.

A challenge in the current nursing environment is the ability to provide care cost-effectively and yet achieve desired patient outcomes. The managed care delivery system facilitates achievement of these goals. The system incorporates management of time, resources, and personnel so that patient outcomes are achieved within appropriate time frames. This article describes the design and implementation of a managed care delivery system in a children's hospital.

Hospitals, Pediatric↗
PubMed2003

Issues in implementing school nutrition policies.

The implementation of school nutrition policies poses a challenge to dietitians as they work with schools to increase the availability of nutritious foods. An analysis of the implementation of the Food and Nutrition Policy for New Brunswick Schools, proclaimed by the department of education in 1991, revealed four factors that influenced implementation: selling food for profit, student choice, interpretation of the policy, and the approach to implementation. From 1997 to 1999, data were obtained from 50 participants at the provincial, district, and school levels through semi-structured interviews; supporting evidence was obtained through a review of pertinent documents. The policy goal was to develop good eating habits among schoolchildren. The policy objective to have all food services follow national guidelines for healthy eating was so controversial that implementation was inconsistent and had little impact on school foods. Opponents objected when the sale of certain foods was curtailed, felt the policy limited student choice, were unsure how to interpret it, and resented the department's top-down approach. Dietitians, who had minimal involvement with the New Brunswick policy, need to consider carefully how to work with educational agencies to combine support and pressure to foster the capacity and willingness of schools to implement nutrition policies.

Canada↗
PubMed2002

Prevention and control of iron deficiency: policy and strategy issues.

Substantial efforts have been made in the past several decades to implement programs to reduce iron deficiency. Yet, compared with other micronutrients such as vitamin A and iodine, overall progress in reducing iron deficiency has been limited. Such limited progress is not attributed to a lack of scientific knowledge about the prevalence, causes or consequences of iron deficiency, but to limited implementation of effective interventions and ineffective communication tools. The challenge is to coordinate and balance research efforts more constructively with the implementation of practical and effective intervention programs. More attention must be paid to evaluating the operational feasibility of various intervention strategies to demonstrate their effectiveness under normal field conditions. Moreover, intervention efforts must be supported by substantially increased attention to communications to achieve effective advocacy for policy support and resource mobilization, foster partnerships and alliances, clarify priority target groups, including infants and young children, and support behavioral change. Through collaboration, researchers, program implementers and communicators can achieve substantial progress in reducing iron deficiency.

Adult↗
PubMed2005

Conducting HIV interventions for Asian Pacific Islander men who have sex with men: challenges and compromises in community collaborative research.

This article describes the process of implementing a community collaborative HIV prevention intervention research project targeting Asian and Pacific Islander (API) men who have sex with men (MSM). This article traces the genesis of the project--which linked university researchers with an API--focused community based organization--starting from its original concept and study design to the actual implementation and evaluation. This project provides a case study for analyzing the challenges and barriers encountered in community collaborative HIV intervention. Strategies and best practices for building community capacity in evaluation research are provided, and theoretical considerations for conducting community-based health interventions are raised.

Adolescent↗
PubMedDate not supplied

A nursing perspective to design and implementation of electronic patient record systems.

Achievements in informatics and use of new technologies are important to develop knowledge from clinical nursing practice. At the same time, progress in design and implementation of clinical information systems such as comprehensive Electronic Patient Record (EPR) systems can be complemented by attention to and examination of information processes as well as the health care constituencies' characteristics. In this article, selected issues and challenges related to EPR design and implementation are reviewed with a particular emphasis on those related to nursing practice and nursing leadership.

Computational Biology↗
PubMed1998

Screening for hemochromatosis in primary care settings.

Interest in including screening for hemochromatosis in the routine medical care of adults has grown in recent years. In March 1997, at a meeting on iron overload at the Centers for Disease Control and Prevention, the directors of four hemochromatosis screening programs described the major challenges that they faced and the lessons that they learned in implementing their programs. Seven issues were consistently described as important challenges: 1) changes in case definitions of hemochromatosis, 2) selection of screening threshold values and identification of false-positive cases, 3) variability and lack of standardization in screening test measurements, 4) physician education, 5) informed consent and concerns about medical and genetic discrimination, 6) patient compliance with screening and therapy, and 7) incidental detection of iron deficiency. The two programs that have been completed report a prevalence of iron overload from hemochromatosis of 4.2 to 4.5 per 1000 persons screened; this is consistent with findings in the recent literature. All programs report that screening is feasible and propose that hemochromatosis be defined by repeated elevated serum transferrin saturation values(with or without DNA test results) rather than by the clinical outcome of excessive iron in tissue. The goal of screening programs is to diagnose iron status disorders, particularly hemochromatosis, before they lead to iron overload and chronic disease states. Further research is needed on the ability of genetic and phenotypic tests to predict the clinical expression of hemochromatosis. The experiences outlined in this report highlight practical issues that need to be addressed when iron status screening for hemochromatosis is implemented. It is hoped that this information will facilitate similar efforts in other health care settings.

Adult↗