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PubMed1999

Feasibility and marketing studies of health sciences librarianship education programs.

The University of North Carolina at Chapel Hill evaluated five curricular models designed to improve education for health sciences librarianship. Three of the models enhanced existing degree and certificate programs, and two were new programs for working information professionals. Models were developed with input from experts and a Delphi study; the marketability of the models was tested through surveys of potential students and employers; and recommendations were made as a guide to implementation. The results demonstrated a demand for more specialized curricula and for retraining opportunities. Marketing data showed a strong interest from potential students in a specialized master's degree, and mid-career professionals indicated an interest in postmaster's programs that provided the ability to maintain employment. The study pointed to the opportunity for a center of excellence in health sciences information education to enable health sciences librarians to respond to their evolving roles.

Certification↗
PubMed1999

The art and science of a behavioural approach to care.

Behavioural psychology has much to offer residents, families and staff. Properly developed, a behavioural approach to care is at once humane, scientific and practical. In our experience, the dedication of resources and expertise to implementation of a behavioural approach to care has been truly beneficial for all concerned.

Aged↗
PubMed1992

Ethics, social forces, and politics in AIDS-related research: experience in planning and implementing a household HIV seroprevalence survey.

A controversial proposal for a survey of HIV infection in a probability sample of U.S. household residents as part of the government's surveillance of the AIDS epidemic provided a number of challenges to survey science. These were compounded by ethical concerns and social sensitivities surrounding the topic. Questions about the ability of a voluntary survey to produce an accurate national estimate of infection demanded rigorous study. In 1987, the Centers for Disease Control began planning field tests of a survey to obtain blood samples and information about respondents' sexual behavior and drug use. The authors were part of the team deployed by the National Center for Health Statistics that, with the contractor staff from Research Triangle Institute, conducted studies in Pittsburgh and Dallas, but only after much was learned about developing processes and procedures for dealing both with broad community concerns and with the interests of those gravely touched by the epidemic.

Advisory Committees↗
PubMed2000

Informatics for mutagenesis: the design of mutabase--a distributed data recording system for animal husbandry, mutagenesis, and phenotypic analysis.

The increasing use of high-throughput methods for the production of biologically important information and the increasing diversity of that information pose considerable bioinformatics challenges. These challenges will be met by implementing electronic data management systems not only to capture the data, but increasingly to provide a platform for data integration and mining as we enter the post-genomic era. We discuss the design and implementation of such a data capture system, 'Mutabase', as a model of how such electronic systems might be designed and implemented. Mutabase was created in support of a large-scale, phenotype-driven mouse mutagenesis program at MRC Mammalian Genetics Unit, Harwell, in collaboration with SmithKline Beecham Pharmaceuticals, Queen Mary and Westfield College, London, and Imperial College of Science, Technology and Medicine, London. The aim of this mutagenesis project is to make a significant contribution to the existing mouse mutant resource, closing the phenotype gap and providing many more models for fundamental research and disease modeling. Mutabase records experimental details at the 'point of generation' and provides a number of dissemination and analysis tools for the experimental data, as well as providing a means of assessing various aspects of progress of the program. Mutabase uses a hypertext-based interface to provide interaction between a number of intranet-based client workstations and a central industrial strength database. Mutabase utilizes a variety of techniques in order to implement the user interface system including Perl/CGI, Java Servlets, and an experimental CORBA server. We discuss the relative merits of these methods in the context of the need to provide sound informatics approaches for the support of systematic mutagenesis programs.

Animal Husbandry↗
PubMed2006

[The ICF classification system--a problem oriented inventory on behalf of the German Society of Rehabilitation Sciences].

With the International Classification of Functioning, Disability and Health, ICF and its adoption by the World Health Organization in May 2001, the concept of "functional health" reached a new dimension. Prepared and developed further over many years, the concept of a comprehensive and internationally consented classification system completed the shifting of paradigm in our notion of disease and disablement, bringing along far-reaching consequences for theory and practice in particular in rehabilitation. Symbolizing this paradigmatic shift, destigmatization, resource orientation, context factors, and participation are among the central notions of the concept. The ICF is a foundation for seeking international agreement across the bounds of disciplines and is amidst an intensive transfer and implementation process, also in Germany. Due to the multitude of actors and activities involved, it has become almost impossible even for those taking a strong interest in the matter to keep up with developments and fields of applications, let alone to achieve consensus in these respects. The German Society of Rehabilitation Sciences therefore initiated a problem-oriented stocktaking of the present situation. This article seeks to point out a number of important developments and trends in order to provide initial orientation and overview. The stocktaking is intended to contribute to further disseminating the ICF, at the same time however to outline several crucial fields of application and development. To be continued and deepened, this preliminary stocktaking underlines several core developments along with a number of conceptual issues still unresolved for the time being. Notwithstanding a high degree of acceptance of the concepts underlying the ICF, continued and, as far as possible, coordinated efforts toward implementation will be required at all levels.

Disability Evaluation↗
PubMedDate not supplied

External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases.

CONTEXT: Organized care management processes (CMPs) can improve health care quality for patients with chronic diseases. The Institute of Medicine of the National Academy of Sciences has called for public and private purchasers of health care to create incentives for physician organizations (POs) to use CMPs and for the government to assist POs in implementing information technology (IT) to facilitate CMP use. Research is lacking about the extent to which POs use CMPs or about the degree to which incentives, IT, or other factors are associated with their use. OBJECTIVES: To determine the extent to which POs with 20 or more physicians use CMPs and to identify key factors associated with CMP use for 4 chronic diseases (asthma, congestive heart failure, depression, and diabetes). DESIGN, SETTING, AND PARTICIPANTS: One thousand five hundred eighty-seven US POs (medical groups and independent practice associations) with 20 or more physicians were identified using 5 large databases. One thousand one hundred four of these POs (70%) agreed to participate in a telephone survey conducted between September 2000 and September 2001. Sixty-four responding POs were excluded because they did not treat any of the 4 diseases, leaving 1040 POs. MAIN OUTCOME MEASURES: Extent of use of CMPs as calculated on the basis of a summary measure, a PO care management index (POCMI; range, 0-6) and factors associated with CMP use. RESULTS: Physician organizations' mean use of CMPs was 5.1 of a possible 16; 50% used 4 or fewer. External incentives and clinical IT were most strongly associated with CMP use. Controlling for other factors, use of the 2 most strongly associated incentives-public recognition and better contracts for health care quality-was associated with use of 1.3 and 0.7 additional CMPs, respectively (P<.001 and P =.007). Each additional IT capability was associated with 0.37 additional CMPs (P<.001). However, 33% of POs reported no external incentives and 50% reported no clinical IT capability. CONCLUSIONS: The use of CMPs varies greatly among POs, but it is low on average. Government and private purchasers of health care may increase CMP use by providing external incentives for improvement of health care quality to POs and by assisting them in improving their clinical IT capability.

Asthma↗
PubMed2003

Biology, ethics, and public policy: deliberations at an unstable intersection.

Biology, ethics, and politics intersect in many public policy issues. The unique features of the meeting point in each case are affected by changes in scientific and technological knowledge, moral analysis in a pluralistic society, and political relations. No one of the three can be ignored without repercussions. This essay, however, concentrates on ethics. The ethical dimension must allow for genuine differences in fundamental moral stance, which always persist alongside scientific developments. Two scientific/medical issues with considerable ethical and political implications are discussed: (1) application of human embryonic stem cell research in regenerative medicine and (2) neuroscientific reductionism in the context of behavioral research and moral responsibility. Public advisory committees and other governmental structures for pursuing public policy should not rely merely on cost-benefit analysis to form policy, as if it were uniquely objective, but should also recognize the necessity of considering science and ethics together as two separate yet complementary foundations of policy. Minimizing the distinctness of the biological and ethical dimensions will make any conclusions unstable and their later implementation more difficult.

Animals↗
PubMed1998

Advances in nuclear medicine instrumentation: considerations in the design and selection of an imaging system.

Nuclear medicine remains a vibrant and dynamic medical specialty because it so adeptly marries advances in basic science research, technology, and medical practice in attempting to solve patients' problems. As a physicist, it is my responsibility to identify or design new instrumentation and techniques, and to implement, validate, and help apply these new approaches in the practice of nuclear medicine. At Johns Hopkins, we are currently in the process of purchasing both a single-photon/coincidence tomographic imaging system and a dedicated positron emission tomography (PET) scanner. Given the exciting advances that have been made, but the conflicting opinions of manufacturers and colleagues alike regarding "best" choices, it seemed useful to review what is new now, and what is on the horizon, to help identify all of the important considerations in the design and selection of an imaging system. It is important to note that many of the "advances" described here are in an early stage of development, and may never make it to routine clinical practice. Further, not all of the advances are of equal importance, or have the same degree of general clinical applicability. Please also note that the references contained herein are for illustrative purposes and are not all-inclusive; no implication that those chosen are "better" than others not mentioned is intended.

Diagnostic Imaging↗
PubMed2000

Societal and medical consequences of the Human Genome Project. Inter-disciplinary approaches to human genetics.

The Human Genome Project is a US-based molecular biological project, the results of which are likely to be implemented on humans. The sociopolitical dimension of this is highly neglected. The aim of the conference was to fill this gap by drawing together scientists of natural and political sciences to discuss the consequences of the Human Genome Project across the disciplines.

Ethics, Medical↗
PubMed2005

Youth violence prevention curriculum for undergraduate nursing and allied health students.

This paper presents the curriculum-development process, implementation, and relevant evaluation outcomes of the Introduction to Violence Prevention in Children and Youth (INTD 4065) course designed by the Center for Hispanic Youth Violence Prevention (CHYVP) of the University of Puerto Rico. The training curriculum was implemented in the academic year 2003-2004 as an undergraduate interdisciplinary three-credit course for nursing and allied health students at one of the schools of the Medical Sciences Campus, University of Puerto Rico. Objectives for the curriculum include developing competencies in child and youth violence prevention in undergraduate allied health and nursing students and promoting involvement of undergraduate health professionals in child and youth violence prevention efforts.

Adolescent↗
PubMedDate not supplied

Cognitive pathways and historical research.

The nursing literature is replete with articles detailing the logical reasoning processes required by the individual scientist to implement the rigors of research and theory development. Much less attention has been focused on creative and critical thinking as modes for deriving explanations, inferences, and conclusions essential to science as a product. Historical research, as a particular kind of qualitative research, is dependent on and compatible with such mental strategies as logical, creative, and critical thinking. These strategies depict an intellectual framework for the scientist examining archival data and offer a structure for such inquiry. A model for analyzing historical data delineating the cognitive pathways of logical reasoning, creative processing, and critical thinking is proposed.

Cognition↗
PubMedDate not supplied

Applying mode-of-action and pharmacokinetic considerations in contemporary cancer risk assessments: an example with trichloroethylene.

The guidelines for carcinogen risk assessment recently proposed by the U.S. Environmental Protection Agency (U.S. EPA) provide an increased opportunity for the consideration of pharmacokinetic and mechanistic data in the risk assessment process. However, the greater flexibility of the new guidelines can also make their actual implementation for a particular chemical highly problematic. To illuminate the process of performing a cancer risk assessment under the new guidelines, the rationale for a state-of-the-science risk assessment for trichloroethylene (TCE) is presented. For TCE, there is evidence of increased cell proliferation due to receptor interaction or cytotoxicity in every instance in which tumors are observed, and most tumors represent an increase in the incidence of a commonly observed, species-specific lesion. A physiologically based pharmacokinetic (PBPK) model was applied to estimate target tissue doses for the three principal animal tumors associated with TCE exposure: liver, lung, and kidney. The lowest points of departure (lower bound estimates of the exposure associated with 10% tumor incidence) for lifetime human exposure to TCE were obtained for mouse liver tumors, assuming a mode of action primarily involving the mitogenicity of the metabolite trichloroacetic acid (TCA). The associated linear unit risk estimates for mouse liver tumors are 1.5 x 10(-6) for lifetime exposure to 1 microg TCE per cubic meter in air and 0.4 x 10(-6) for lifetime exposure to 1 microg TCE per liter in drinking water. However, these risk estimates ignore the evidence that the human is likely to be much less responsive than the mouse to the carcinogenic effects of TCA in the liver and that the carcinogenic effects of TCE are unlikely to occur at low environmental exposures. Based on consideration of the most plausible carcinogenic modes of action of TCE, a margin-of-exposure (MOE) approach would appear to be more appropriate. Applying an MOE of 1000, environmental exposures below 66 microg TCE per cubic meter in air and 265 microg TCE per liter in drinking water are considered unlikely to present a carcinogenic hazard to human health.

Animals↗
PubMed1991

Matching three classifications of secondary students to differential levels of study guides.

This study examined the effectiveness of matching three classifications of secondary students (17 with learning disabilities, 18 remedial, and 47 nondisabled) to differential levels of study guides. The students, 45 males and 37 females, were enrolled in science and social studies classes in middle school and high school. In one treatment, students were assigned multilevel study guides containing different levels of referential cues, with the guides implemented through three instructional groups: teacher-directed, dyadic, and independent. In another treatment, the same students were assigned single-level study guides that did not contain referential cues, with the guides implemented as an independent activity. An equivalent time samples design was arranged, with six multilevel and six single-level treatments randomly assigned in two-session blocks. The dependent measures consisted of two types of test items, factual and interpretive. The results of group analyses indicated that multilevel study guides were more effective than single-level study guides in all classes and overall on factual questions, with individual analyses verifying that the greatest benefit occurred for the teacher-directed students. On interpretive test items, the results of group analyses favored the multilevel study guides in high school social studies and overall, with individual analyses revealing few remarkable differences for students in any instructional group. A trend analysis revealed little practice effect over time in either treatment. Several methodological and clinical issues involved in matching heterogeneous students to differential levels of textbook instruction in secondary programs are discussed.

Achievement↗
PubMed2002

The clinical significance of quality-of-life results: practical considerations for specific audiences.

This is the sixth article in a series intended to summarize the state of the science for assessing the clinical significance of quality-of-life (QOL) assessments. The previous 5 articles dealt with specific methodological issues, whereas this article addresses practical considerations in implementing the methods and presenting the results to various audiences with differing perspectives. Proposals for how to interpret the "clinical significance" or "clinical meaningfulness" of changes in QOL scores were addressed in previous articles within this series. Within this article, 4 audiences-patients and physicians, clinical researchers, health policymakers, and private- and public-sector employees who work in health-related fields-are examined because each is a unique stakeholder with a distinct vantage point and each can interpret QOL outcomes differently. A clinician may attempt to explain to a patient potential treatment alternatives for his or her QOL; a health policymaker may try to describe to elected officials the financial impact on a patient population with reduced QOL; a researcher may try to obtain the vital messages from a clinical trial that included QOL end points; and a regulatory agency and/or pharmaceutical company may try to ascertain the appropriate level of evidence required for a successful research study. For each of the 4 audiences, concrete examples and practical guidelines are offered by which changes in QOL outcomes can be interpreted meaningfully. Ultimately, both determining and disseminating the meaning of clinical significance are functions of the outlook of the audience because the perspective of the audience determines its ability to comprehend, evaluate, and convey the context within which such outcomes appear meaningful. Among the audiences described within this article, a commonality of interests exist that mandates a careful exposition of the scientific rigor involved in describing the clinical significance of QOL assessments. Collectively, this series attempts to provide methods and means for making such determinations.

Clinical Competence↗
PubMed1999

Nursing management of chronic wounds: best practices across the continuum of care.

This article highlights the nurse's role within a holistic, interdisciplinary approach to chronic wound management. Best practices for chronic wound care are discussed, drawing on evidence-based science when it is available. The fundamentals of chronic wound care, including cleansing, irrigation, débridement, infection control, and topical treatment are addressed. New devices and technologies are briefly reviewed. Implementing these best practices across the continuum of care will result in greater advances in the management of chronic wounds.

Administration, Topical↗
PubMedDate not supplied

Keeping our patients pedaling--one unit's experience.

Ask yourself, if you could take a pill to increase your energy level, muscle mass, bone strength and decrease cardiovascular risk, would you? Exercise on dialysis could be that pill. The purpose of an exercise program is to provide a holistic approach to care, enabling patients to shift their focus from sick to well, to be the best they can be. The benefits of exercise include improved quality of life, and an interruption of the downward spiral of deconditioning which leads to inactivity and disability (Painter, 1995) These benefits have been well documented by Patricia Painter, PhD, and the London Health Sciences Centre, London, Ontario (Ridley, Hoey, Ballagh-Howes, 1999). In 1999, our vision of an in-centre hemodialysis exercise program became a reality. Now, one year after implementation, keeping patients motivated and staff committed to participate in this effective program has become our latest goal.

Exercise Therapy↗
PubMed2002

[Trends in the post-genomic pharmacological research].

With the advent of post-genome era, pharmacogenomics will be a new field in pharmacological sciences. In parallel, high-throughput screening, in silico research, as well as lots of visualization techniques are emerging as novel approaches in pharmacological researches. Some progress in the implementation of aforementioned new idea and methods in pharmacodynamics and pharmacokinetics research are also introduced in this review.

Genome, Human↗