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PubMed2002

John M. Eisenberg Patient Safety Awards. System innovation: Concord Hospital.

BACKGROUND: The Cardiac Surgery Program at Concord Hospital (Concord, NH) restructured clinical teamwork for improved safety and effectiveness on the basis of theory and practice from human factors science, aviation safety, and high-reliability organization theory. A team-based, collaborative rounds process--the Concord Collaborative Care Model--that involved use of a structured communications protocol was conducted daily at each patient's bedside. METHODS: The entire care team agreed to meet at the same time each day (8:45 AM to 9:30 AM) to share information and develop a plan of care for each patient, with patient and family members as active participants. The cardiac surgery team developed a structured communications protocol adapted from human factors science. To provide a forum for discussion of team goals and progress and to address system-level concerns, a biweekly system rounds process was established. RESULTS: Following implementation of collaborative rounds, mortality of Concord Hospital's cardiac surgery patients declined significantly from expected rates. Satisfaction rates of open heart patients scores were consistently in the 97th-99th percentile nationally. A quality of work life survey indicated that in every category, providers expressed greater satisfaction with the collaborative care process than with the traditional rounds process. Practice patterns in the Cardiac Surgery Program at Concord Hospital have changed to a much more collaborative and participatory process, with improved outcomes, happier patients, and more satisfied practitioners. A culture of continuous program improvement has been implemented that continues to evolve and produce benefits.

Awards and Prizes↗

PubMedDate not supplied

Perspective: a program to improve protein biomarker discovery for cancer.

Biomarkers for cancer risk, early detection, prognosis, and therapeutic response promise to revolutionize cancer management. Protein biomarkers offer tremendous potential in this regard due to their great diversity and intimate involvement in physiology. An effective program to discover protein biomarkers using existing technology will require team science, an integrated informatics platform, identification and quantitation of candidate biomarkers in disease tissue, mouse models of disease, standardized reagents for analyzing candidate biomarkers in bodily fluids, and implementation of automation. Technology improvements for better fractionation of the proteome, selection of specific biomarkers from complex mixtures, and multiplexed assay of biomarkers would greatly enhance progress.

Animals↗

PubMed2004

Forensic genetics and ethical, legal and social implications beyond the clinic.

Data on human genetic variation help scientists to understand human origins, susceptibility to illness and genetic causes of disease. Destructive episodes in the history of genetic research make it crucial to consider the ethical and social implications of research in genomics, especially human genetic variation. The analysis of ethical, legal and social implications should be integrated into genetic research, with the participation of scientists who can anticipate and monitor the full range of possible applications of the research from the earliest stages. The design and implementation of research directs the ways in which its results can be used, and data and technology, rather than ethical considerations or social needs, drive the use of science in unintended ways. Here we examine forensic genetics and argue that all geneticists should anticipate the ethical and social issues associated with nonmedical applications of genetic variation research.

Bioethics↗

PubMed2003

Accomplishments in HIV prevention science: implications for stemming the epidemic.

The past two decades have witnessed substantial advances in the science of preventing HIV infection. Although important issues remain and there is a need for continuing research, arguably the biggest challenge in preventing HIV transmission is the full implementation of existing preventive interventions worldwide.

Anti-HIV Agents↗

PubMed2025

HI-FEVER: a Nextflow pipeline for the high-throughput discovery and annotation of endogenous viral elements.

SUMMARY: Endogenous viral elements (EVEs) offer valuable insights into virus and host evolution, but their detection remains computationally and biologically challenging. We present HI-FEVER, a user-friendly Nextflow pipeline for the discovery of EVEs in eukaryotic host genomes. HI-FEVER is highly parallelizable and customizable, ensuring computational efficiency while allowing researchers to fine-tune parameters to their specific needs. Its output provides a comprehensive analysis of discovered EVEs, including detailed annotations which can provide evolutionary insights. HI-FEVER scales seamlessly to handle millions of viral protein queries across multiple host genomes on both laptops and high-performance computing nodes. AVAILABILITY AND IMPLEMENTATION: The HI-FEVER source code is available on GitHub at https://github.com/PaleovirologyLab/hi-fever. Minimal reference databases, test datasets and benchmarking results are hosted on the Open Science Framework at https://osf.io/y357r. A detailed wiki is available at https://github.com/PaleovirologyLab/hi-fever/wiki, including usage instructions, parameter descriptions, and guidance on interpreting outputs. The pipeline includes a Pixi environment compatible with Conda and Apptainer containerization, and Docker images. HI-FEVER has been tested on Linux, Windows (via WSL2), and macOS (Intel and ARM64).

Software↗

PubMedDate not supplied

Guidelines for appraisal and publication of PDSA quality improvement.

Plan-do-study-act (PDSA) quality improvement is the application of the scientific method to implement and test the effects of change ideas on the performance of the health care system. Users of quality improvement could benefit with markers to gauge the "best" science. Four core questions can determine the value of a quality improvement study: Is the quality improvement study pertinent and relevant? Are the results valid? Are appropriate criteria used to interpret the results? Will the study help you with your practice or organization of care? A set of guidelines is provided to help answer these questions. Similar guidelines exist for randomized clinical trials and clinical-epidemiologic observational studies. Analogous to these existing research guidelines, the PDSA quality improvement guidelines will provide researchers and reviewers with succinct standards of methodological rigor to assist in critical appraisal of quality improvement protocols and publications.

Guidelines as Topic↗

PubMed1992

The search: body, mind, and human purpose.

Psychiatry's appropriate agenda and severe distractions in sustaining it are presently a concern and have historically been so as we struggle with the issues of linking body, mind, and human purpose. Biology requires behaving, variability, and the development of regulations to implement "purpose" in coping with the milieu. Psychiatry begins and ends with our patients--with their diseases and dysfunctions, their biographies and aspirations--which, as a clinical medical science, we must systematically study. Doing that, we will borrow from and pose problems for all the life sciences. New knowledge about how cells and biological systems acquire, code, and exchange information challenges all of medicine. In assessing our advances and future, we consider the history of biological issues in psychiatry and the "sins" of biologism or reductionism. We will see that research questions and strategies in the current study of disease and therapeutics have not fundamentally shifted from Freud and Meyer to modern molecular neurobiology. The tension between the socially conditioned purposive self and impersonal biological processes is an inescapable intrinsic tension for psychiatry of which we must be cognizant as we continue the search.

Biology↗

PubMed2000

The invited review ? or, my field, from my standpoint, written by me using only my data and my ideas, and citing only my publications.

Do you feel scientifically isolated? Do you find yourself sitting on the side-line while others take the field by the nose and lead it? Are you unable to publish a model that summarizes your data and ideas because reviewers label it as being too speculative and unsupported? Can't get those experiments published in any regular journal? Do you find that nobody is citing your papers? Haven't published in your field for some time, but want to show that you are still a player? Well, no need to worry! There is a special category of publication for you, 'the invited review', and even specialized journals, the 'review journals', that cater to every part of your neurosis. The major difference between many invited reviews and regular articles in journals ? this journal being an exception ? is that the invited review is generally not critiqued by outside, independent referees. In those rare cases when a review is critiqued, the letter from the editorial staff that accompanies the manuscript usually contains a disclaimer: "While we are interested in your critical evaluation of this manuscript, you should know that this review was solicited by the Editorial Board, and, therefore, we allow some latitude in the content and opinion expressed." What's the point of reviewing it when the writer has been given some sort of carte blanche to say what they want? Are you surprised? I have critiqued reviews to no affect (but then that's true also for research papers!), suggested that the writing was too biased, that the appropriate references were not cited and that the proposed model must have been conjured up while the writer was inebriated. Of course, all the critiques for my reviews were taken seriously, and I made all the suggested changes ? right! So, what kinds of review are there? As a postdoc, I got introduced to two extremes in one conversation. I was asked to write a review by my mentor. Not being very opinionated (at the time), I read hundreds of papers and cited them, and wrote a discussion of the results without providing a, how shall I say, personal opinion. My mentor scanned the manuscript, and said: "Great! Now start again. This time, write a review that contains lots of ideas and models, minimal referencing, and by all means speculate wildly on where we think the field is moving. Oh, don't throw away this one. We can use it another time for one of those 'Annual Reviews' journals." Great mentoring, huh? So, what's the point of an invited review? Well, for the lazy ? sorry I meant busy ? it is a way to keep up with publications, ideas, trends, and models in a specific field. But of course, this is exactly where the problem lies. Unless the reviews are balanced (i.e. unbiased), complete in citing publications (i.e. not just the author's papers), scholarly in the presentation of models (i.e. present competing models), what sort of intelligent way is this to 'keep up with a field'? What we need is a more critical approach to reading published papers. That's right, we should discuss the fact that a certain experiment doesn't make sense, a control was missing, and an interpretation based on the data presented is crazy. Ah, but that would be so impolitic, wouldn't it! I have two suggestions. First, let's get people to write reviews outside their own specific field of interest. There are many advantages to this. There would not be a bias, or a limited interpretation based on 'reading between the lines' or on unsupported experiments. The review would be a critical evaluation of data presented (only) in peer-reviewed research papers available to the average reader and comprise a balanced discussion of all the data from competing labs. There is of course a major disadvantage: who has the time or gumption to do this (just wait for the reprisals)? Well, most of us participate in some sort of journal club in which papers outside our field are presented. Perhaps, these discussions should be published (on the Internet?). [Some journals provide 'sound-bites' of papers (Paper Alert, or some such heading), but these tend to regurgitate the paper's abstract and are hardly critical.] Second, without implementation of the first suggestion, I think that we should add a warning sign to invited reviews: "WARNING. THE CONTENTS OF THIS REVIEW MAY BE DANGEROUS TO YOUR SCIENCE. THIS REVIEW CONTAINS STATEMENTS, IDEAS AND OPINIONS THAT MAY BE UNSUBSTANTIATED. THE MODELS HEREIN REFLECT THE STATE OF THE AUTHOR'S LOOSE GRASP OF REALITY, AND SHOULD NOT BE CONFUSED WITH FACTS. PROCEED WITH CAUTION." Invited reviews are no substitute for reading the primary literature and critically forming your own opinion. An occasional column, in which Caveman and other troglodytes involved in cell science emerge to share their views on various aspects of life-science research. Messages for Caveman and other contributors can be left at caveman@biologists.com. Any correspondence may be published in forthcoming issues. Previous Sticky Wickets can be viewed at: www.biologists.com/JCS/caveman/index.html jcs6024

Journal Article↗

PubMedDate not supplied

Community genetics: a new discipline and its application in Brazil.

Community genetics is a new discipline which aims to provide genetic services to the community as a whole. As a science, community genetics encompasses all research needed to develop and evaluate its application. There is no question that the development of community genetics is necessary in Brazil. The implementation of such programs in our country, especially for hemoglobinopathies, has been recommended by the World Health Organization and other international organizations. Apart from the need for and appeal of community genetics programs, some aspects require serious review. This article discusses various cultural, social, psychological, and economic factors that can make genetic screening an invasion of individual privacy.

Brazil↗

PubMed2000

The Croatian telemedicine.

Telemedicine developed in Croatia in two phases. The first phase during the 1970s was limited because of insufficient technology and scarce resources. But that phase was important as a learning process and the preparatory stage for the promising future. The communications infrastructure was heavily destroyed during the 1991-92 war but it was reconstructed and rebuilt as a modern technology based on optical fibres. The new technical and technological infrastructure was the base for the development of CARNet (Croatian Academic and Research Network). CARNet was linked to the Internet and enabled the international exchange of information for the scientific community. Telemedicine projects started firstly as pilot projects around the same time as in other countries. They were financially covered mostly by the Ministry of Science either directly or through the CARNet. The telemedicine projects, like telepathology, teleradiology, teleneurosurgery, teleeducation, developed in a very sophisticated way and are now in the phase of implementation into the routine health practice. Some projects are still in the pilot phase, but thanks to highly trained professionals, they are promising and it can be expected that with the growing economic stuation they will be implemented soon.

Computer Communication Networks↗

PubMed2004

Evaluating the effectiveness of clinical medical librarian programs: a systematic review of the literature.

OBJECTIVE: This study was undertaken to determine if a systematic review of the evidence from thirty years of literature evaluating clinical medical librarian (CML) programs could help clarify the effectiveness of this outreach service model. METHODS: A descriptive review of the CML literature describes the general characteristics of these services as they have been implemented, primarily in teaching-hospital settings. Comprehensive searches for CML studies using quantitative or qualitative evaluation methods were conducted in the medical, allied health, librarianship, and social sciences literature. FINDINGS: Thirty-five studies published between 1974 and 2001 met the review criteria. Most (30) evaluated single, active programs and used descriptive research methods (e.g., use statistics or surveys/questionnaires). A weighted average of 89% of users in twelve studies found CML services useful and of high quality, and 65% of users in another overlapping, but not identical, twelve studies said these services contributed to improved patient care. CONCLUSIONS: The total amount of research evidence for CML program effectiveness is not great and most of it is descriptive rather than comparative or analytically qualitative. Standards are needed to consistently evaluate CML or informationist programs in the future. A carefully structured multiprogram study including three to five of the best current programs is needed to define the true value of these services.

Clinical Medicine↗

PubMed1988

Requests for proposals for library automation.

Many health sciences libraries are now considering integrated automated systems for an investment of several hundred thousand dollars. The request for proposals (RFPs) is the usual method of selecting candidate vendors for close inspection of promising systems. This paper draws upon the experience of the Library of Rush University and that of twelve other health sciences libraries. The libraries were interviewed by telephone using a short questionnaire that asked them to compare the RFPs with the systems actually obtained and their experiences in implementing them. The libraries were also asked, with the benefit of hindsight, what would they have done differently. Four vendors were also interviewed by telephone, in order to get their point of view.

Chicago↗

PubMed1983

Community cooperation among a university, a community college, a hospital, and a high school: a new model for allied health education.

The University of Texas Health Science Center at Dallas, School of Allied Health Sciences, has designed and established a linkage plan that could help solve the health personnel shortages in many cities. This plan joins several schools to (1) stimulate the implementation of programs to provide limited numbers of trained health professionals, (2) establish a coordinated system whereby technologists and technicians can be trained, (3) prepare qualified persons to staff the local hospitals, and (4) provide a ladder for advancing motivated and qualified health professionals. Coordination of efforts among the university, the seven-member Dallas Community College District, and the Dallas Independent School District's High School for Health Professions facilitates solid academic instruction at these institutions, which is followed by well-supervised clinical experiences in the local hospitals under highly qualified professionals. To date, the program includes the education of nuclear medicine technologists, radiation therapy technologists, electroencephalographic technologists, and histologic technicians. This mode of education is one solution to the health professional shortage.

Allied Health Personnel↗

PubMed1978

Fees for information services to hospitals: a California experience.

The project was directed toward planning, developing, and implementing a subregional biomedical information network among the forty-three health care facilities (hospitals) of the four-county area served by Loma Linda University's health sciences library. The project coordinator contacted administrators and health care professionals in the forty-three institutions to present a plan for the network. The health care facilities were encouraged to support the continuation of the network through contract fees. The availability of specific information services was assured through contractual agreements. It was anticipated that the subregional network would be self-supporting after the twelve-month project period (December 1, 1976-November 30, 1977). The working territory (40,429 square miles) encompassed Mono, Inyo, Riverside, and San Bernardino counties. The project resulted in nine of the forty-three hospitals signing annual contracts for library services. It is recommended that projects of this kind extend beyond a year's duration in order to educate health professionals concerning the value of access to biomedical literature in improving patient care.

California↗

PubMedDate not supplied

Ecologic study of children's use of a computer nutrition education program.

The purpose of this research was to describe the context created by students as they worked in groups on a nutrition computer-assisted instruction (CAI) program. Students worked on the program in groups of three. Observational methods were used to collect data from students in two sixth-grade classrooms that were part of an experimental program designed to restructure the educational process. Thirty-two students, from 12 groups, were observed as they completed the program. The groups were assigned by the teachers according to standard principles of cooperative learning. Students completed "Ship to Shore," a program designed specifically for this research. The program required three to five 50-minute classroom periods to complete. The objectives of the program were to change children's knowledge structure of basic nutrition concepts and to increase children's critical thinking skills related to nutrition concepts. We collected observational data focused on three domains: (1) student-computer interaction, (2) student-student interaction, and (3) students' thinking and learning skills. Grounded theory methods were used to analyze the data. Specifically, the constant-comparative method was used to develop open coding categories, defined by properties and described by dimensions. The open coding categories were in turn used in axial coding to differentiate students' learning styles. Five styles of student interaction were defined. These included (1) dominant directors (n = 6; 19%), (2) passive actors (n = 5; 16%), (3) action-oriented students (n = 7; 22%), (4) content-oriented students (n = 8; 25%), and (5) problem solvers (n = 5; 16%). The "student style" groups were somewhat gender specific. The dominant directors and passive actors were girls and the action-oriented and content-oriented students were boys. The problem solvers group was mixed gender. Children's responses to computer-based nutrition education are highly variable. Based on the results of this research, nutrition educators may recommend that nutrition CAI programs be implemented in mixed gender groups.

Adolescent↗

PubMedDate not supplied

Intensive care and limits of technology.

The development of technology in the area of intensive care has allowed a fundamental improvement in patient care and supervision and has increased nursing staff's opportunity for autonomy. However the nurses state that they are poorly equipped to utilize or implement resources which they say would benefit the consumer.

Critical Care↗

PubMed1998

Prevention research at the National Institutes of Health.

Prevention of disease and disability and preservation of health are compelling strategies that are endorsed by the public, health care providers, and researchers. Despite this general acceptance of the concept, the "devil is in the details." What can and should be recommended with confidence to the public and health care providers regarding prevention and how can these recommendations be implemented? Prevention programs should be based on durable evidence of efficacy and should assure that the benefits of interventions and changes exceed the risks. The latter is particularly important for population-based primary prevention because many are influenced but fewer may benefit. Prevention research must provide the evidence of benefit and risk. The responsibility of the National Institutes of Health (NIH) is to develop the scientific basis for prevention and to train prevention scientists who are responsible for creating this science base. The interpretation and dissemination of information from research studies are important and necessary aspects to assure translation of the science into personal and public health practices. The components of prevention research are investigation of the factors that place individuals and groups at risk of disease and disability; trials of the interventions that can modify this risk; and testing the approaches that can effectively implement beneficial changes. NIH is committed to addressing these endeavors, and its individual Institutes and Centers support a broad portfolio of prevention research. This paper will provide an overview of NIH support, the functional relationships of prevention research within NIH, and background information that can be useful to those interested in research.

Health Education↗

PubMed1996

Ultraperspective and endophysics.

Ultraperspective is the capability of human beings to step into the shoes of another person. Endophysics is the science of those physical properties of the world which exist not from the outside but only form the inside. Both have in common the adoption of an 'exterior' position. In the one case, the exteriority is 'horizontal', in the other, 'vertical'. Ultraperspective is a macroscopic concept, endophysics a microscopic one. Both can be implemented in computer models. Novel experiments can be set up in either domain: animals acquiring the status of human persons, and objective features of the physical world acquiring the status of an observer-specific mirage. Mead an Levinas, and Einstein and Bohr, are the protagonists. In the age of computer-assisted enlightenment, a new look at the ethical roots of science appears justified.

Ethics↗