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Pharmacogenomics makes use of genetic and genomic principles to facilitate drug discovery and development, and to improve drug therapy. Its goal is to attain optimal therapy for the individual patient. This article analyzes current trends in pharmacogenomics and asks how this new science affects drug development in the pharmaceutical industry and the clinical use of drugs.
The University of Iowa Teaching Scholars Program was initiated in 1999 at the University of Iowa Carver College of Medicine (CCOM) with the overall goal of promoting leadership in faculty development related to teaching skills. Specific goals of this program are (1) to promote the development of a cadre of faculty members who have the skills to implement faculty development within their departments and the CCOM; (2) to increase departmental involvement in faculty development efforts; (3) to increase resources available for dissemination of college-wide faculty development efforts; and (4) to acknowledge the extra effort faculty put into developing their skills and knowledge in medical education and in providing continuing education to their faculty colleagues. All clinical and basic science departments in the CCOM are given the opportunity to have a faculty member participate in the program. Unlike other programs reported in the literature, competitive decisions for program participation are made at the departmental level. The three-year program combines monthly meetings and other activities to train faculty to provide faculty development in teaching skills. Each scholar develops and implements a project to address departmental faculty development needs as well as needs of other departments in the CCOM. To date (2006), 50 faculty members from 19 different departments have participated in the program with an average of 12 scholars per class. The program has resulted in a substantial increase in departmental and college-wide faculty development programming and has had a positive impact on individual scholars' teaching skills and leadership roles.
Evidence-Based Dental Practice (EBDP) is the most appropriate and best patient-centered care because it uses the evidence derived from interdisciplinary resources. These resources include the integration of the clinical and basic science researcher, clinician, and patient in the clinical decision-making process. Best evidence has different meanings to each of the interdisciplinary decision makers and, thus, defines their individual roles accordingly. Implementing EBDP requires an organizational structure and process that involve evidence-based dentistry databases in centralized repositories that are shared nationally and internationally. Facilitating the inclusive and reciprocal transfer of information from all resources requires use of information technology and computerized decision-making support programs. However, the potential lack of financial resources and incentives will diminish the universal adoption of EBDP.
This article reports experimental investigations on the use of RF resonators for continuous-wave electron paramagnetic resonance (cw-EPR) and proton nuclear magnetic resonance (NMR) imaging. We developed a composite resonator system with multi-coil parallel-gap resonators for co-registration EPR/NMR imaging. The resonance frequencies of each resonator were 21.8MHz for NMR and 670MHz for EPR. A smaller resonator (22mm in diameter) for use in EPR was placed coaxially in a larger resonator (40mm in diameter) for use in NMR. RF magnetic fields in the composite resonator system were visualized by measuring a homogeneous 4-hydroxy-2,2,6,6-tetramethyl-piperidinooxy (4-hydroxy-TEMPO) solution in a test tube. A phantom of five tubes containing distilled water and 4-hydroxy-TEMPO solution was also measured to demonstrate the potential usefulness of this composite resonator system in biomedical science. An image of unpaired electrons was obtained for 4-hydroxy-TEMPO in three tubes, and was successfully mapped on the proton image for five tubes. Technical problems in the implementation of a composite resonator system are discussed with regard to co-registration EPR/NMR imaging for animal experiments.
The importance of prevention teaching is increasingly recognized in medical education, but its implementation in medical school curricula is hampered by its cross-specialty nature, lack of curricular time, and perception as a topic of less importance than the traditional basic and clinical sciences. The Case-Based Series in Population-Oriented Prevention (C-POP) was developed to address national objectives for prevention education in a format that recognizes the students' abilities and preferences for case-based learning. This series uses small-group discussion cases that can be adapted to a variety of settings and instructor capabilities. These cases guide the learners from a specific clinical problem to the broader clinical and population-based prevention issues for the topic. The cases were developed with the use of local health department scenarios and data and have been taught and refined in a number of settings. As part of the curriculum development project, evaluation tools that examined prevention skills and orientation were developed and tested. With its emphasis on small-group learning, clinical relevance, and adaptability to a variety of learner and instructor needs, the C-POP project effectively integrates prevention concepts into medical education.
Great progress has been made in cancer chemoprevention during the past 2 decades. Nevertheless, the field could benefit from the experiences of investigators studying the prevention of cardiovascular disease. During the past 50 years, prevention of cardiovascular disease has gone from a dream to a reality, with major clinical impact. The trend during the last 30 years has been impressive and sustained. From 1987 to 1994, there was a sustained major decrease in age-adjusted mortality from coronary heart disease in both men (from 3.1 to 2.2 per thousand persons) and women (from 1.1 to 0.9 per thousand persons). This trend is believed to have resulted from improvements in the treatment of myocardial infarction and, more substantively, from improvements in secondary prevention. This explanation is consistent with earlier computer simulations of trends in cardiovascular mortality during the 1980s, which estimated that 25% of the declines were attributable to primary prevention and 70% were caused by reductions in risk factors or treatment. The greatest effect of primary prevention had previously been noted in the late 1960s and 1970s. Most of these important findings occurred before cholesterol-lowering drugs became widely available, so further improvements are expected. Researchers in cancer prevention should follow in the footsteps of their cardiovascular colleagues. The tools are now available to make prevention of cancer a clinical reality. As the science of prevention improves, it must be remembered that effective and efficient preventive services do not help if they are not used. It is difficult to motivate practitioners and patients to implement preventive services. Also, preventive services are often considered a luxury. Persons without health insurance and those covered by Medicaid are much more likely to be diagnosed with late-stage cancer; therefore, they are key cohorts to target for effective preventive approaches. Finally, the most effective cancer prevention program will probably use both rational drug therapy targeting specific risk factors and public health efforts to promote healthy lifestyle choices in the population at large.
INTRODUCTION: The policy goal of shifting nonurgent visits from the emergency department to nonemergency health care settings is commonly devised, planned, and implemented without considering patients' perspectives. The purpose of this study was to gain an understanding of the context in which patients choose to seek health care in an emergency department. Human science provided the framework for this exploratory descriptive research study. METHODS: This study was conducted at an urban, university emergency department in Denver, Colo. Uninsured adult patients triaged as nonurgent who were being discharged home were eligible to participate. Eligible patients from 15 randomly selected shifts were asked to participate. Following their ED visit, open-ended interviews began with the question, "Can you tell me the story, or the chain of events, that led to your coming to the emergency department today?" Each interview was audiotaped. Transcripts were analyzed to identify common themes. Patients also rated their severity of illness from 1 (not severe) to 5 (life-threatening), and they rated their satisfaction with the health care they received from 1 (not satisfied) to 5 (extremely satisfied). RESULTS: The 30 study participants ranged in age from 17 to 60 years; 22 participants (73%) were women. Most patients (73%) rated their severity of illness as 3 or less and their satisfaction with the health care they received as 4 or more (83%). Five themes for seeking care were identified: (1) toughing it out, (2) symptoms overwhelming self-care measures, (3) calling a friend, (4) nowhere else to go, and (5) convenience. Despite the fact that the patients had nonurgent medical problems, their stories revealed that distress in their lives had influenced their need for emergency care. CONCLUSIONS: Access was prominent in the minds of uninsured patients seeking ED care for nonurgent medical diagnoses. Typically, patients did not perceive themselves as having an urgent problem, had been unsuccessful in gaining access to alternative non-ED health care settings, and found the emergency department to be a convenient and quality source of health care. The patients' stories relayed a context for ED visits that goes beyond medical diagnoses. This perspective has important implications for quality care delivery and for including patients in planning ways to access emergency health care.
Recent research suggests some alarming substance abuse trends among Hispanic/Latino adolescents. Children in this age group are at a particularly vulnerable juncture in their lives, and early prevention efforts are warranted. For a national anti-drug campaign targeting this young Hispanic/Latino audience and their parents, the White House Office of National Drug Control Policy and the Partnership for a Drug-Free America are incorporating culturally appropriate messages based on behavioral science research and theories. The purpose of this article is to provide information and recommendations on relevant factors and influences in the Hispanic/Latino culture that should be addressed in designing and implementing this campaign.
As part of a Spotlight series on grant writing by members of the Center for Clinical Investigation of the Wound Ostomy and Continence Nursing (WOCN) Society, this article completes an explanation about writing the Methods section of a grant proposal. The aim of this series is to enhance the skills of WOC nurses to increase submissions of high-quality grants related to WOC nursing science and success in garnering funding, particularly from foundation grants, such as that of the WOCN. In this article, writing about the sample and setting, power analysis, sampling and recruitment procedures, implementation and data collection procedures, statistical analysis plan, and ethical considerations are described.
Pharmaceutical companies exist today in a hostile legal and regulatory environment. The threat of product liability in the pharmaceutical industry has risen to the point where it stifles research and development, especially for contraceptive and psychotropic drugs. Regulatory sanctions against the industry are more likely now than in the past since the Food and Drug Administration (FDA) has placed significant emphasis on regulatory inspection and enforcement. Industrial pathologists play a critical role in defending their company in product liability litigation and from regulatory sanctions. In-house and contract pathologists should be prepared to give expert testimony in court and ensure that an effective document retention policy is implemented. Pathologists should know the limits of the FDA's inspection authority and be aware of the "pitfalls" of the FDA's new Fraud Policy. In addition to keeping abreast of science, industrial pathologists today can best serve the pharmaceutical industry if they maintain an awareness of legal issues that pose a threat to the future success of the industry.
Pyrosequencing AB develops, manufactures and sells research products that enable life sciences researchers to add utility to the massive amount of genomic information available, with the goal of improving human health. As more genomic information becomes available, research efforts are shifting toward implementing practical applications of this genetic information. Pyrosequencing has developed comprehensive genotyping solutions that provide researchers with rapid and accurate technology for assessing individual genetic variation. Genotypic information is anticipated to play an important role in the emerging field of applied genomics and as a result, significant opportunities may be derived from analyzing genetic variation in individuals and across populations. These data will be key to understanding how genetic differences may be used to determine an individual's predisposition to disease, detect and monitor disease progression, and select the most appropriate therapy and dose and to avoid adverse events. This is pharmacogenomics, an area in which Pyrosequencing technology is being applied and will no doubt continue to enable researchers to ultimately improve human health.
A culturally diverse nursing workforce is essential to meet the health needs of an increasingly diverse Canadian population. The recruitment and retention of nursing students representing diverse backgrounds are vital to the building of this diversified work force. Studies have shown that diversity within the student body benefits everyone. For example, students who study and work within a diverse environment are better able to understand and consider multiple perspectives and to appreciate the benefits inherent in diversity. This paper describes one school of nursing's project on the Recruitment and Retention of Black students into their Bachelor of Science Nursing (BScN) Program. The project goals are to increase diversity, foster student learning, and ultimately improve health care for the Black community. Presented in this paper are the project background, implementation process, challenges and outcomes. This may provide learned lessons and future directions for similar initiatives in other institutions.
The paper discusses the possibility and necessity for establishing a postmodern individualized medicine in terms of hierarchic emergence, a basic concept of contemporary system science. Through analysis of the strong and weak points of modern individualized medicine, personalized medicine and genomic medicine, the author found that Chinese traditional individualized medicine has its strong points in implementing whole (holistic) emergence and weak points in lower hierarchic emergence compared with the other three modern medical disciplines. Thus the author concluded that there are possibility and necessity to integrate the strong points of these medical systems for establishing a holistic and deepgoing patient-centered postmodern individualized medicine.
Neural networks have demonstrated their research potential in bio-medical sciences. The literature is filled with experiments that evidence the value of neural networks for the solution of diagnostic and predictive problems. The next step is to direct research efforts toward implementation of these neural networks into the clinical information environments where their diagnostic and predictive capabilities can be truly utilized. To accomplish this goal, it is necessary to create a new generation of neural network tools that ease the transition of experimental results to a production state. This paper describes the architecture of such a system.
The widespread use of effective, science-based interventions to motivate and sustain behavior change provides an important approach to reducing the spread of HIV. The process of disseminating information about effective interventions and building capacity for implementing them in field settings must be improved, however. Starting with a review of diffusion of innovations and technology transfer literature, we offer a technology transfer model for HIV interventions. We identify participants and activities directed toward the use of effective interventions by prevention services providers (e.g., health departments and community-based organizations) in each phase of technology transfer: preimplementation, implementation, and maintenance and evolution. Preimplementation activities focus on selecting an intervention and preparing for implementation. Implementation activities include initial implementation and process evaluation. Maintenance and evolution are ongoing with continued support for and evaluation of the intervention. This article takes the perspective of providers. Other perspectives are presented elsewhere in this issue.
Throughout the century, based on the precedent set by Flexner in the United States, almost every subsequent report on the reform of medical education has pointed out the need for more prevention-oriented teaching in the curriculum. This has been particularly so in countries like Korea where the basic public health services have been so important for the improvement of health of the people. And, in fact, preventive medicine and public health have contributed a great deal to the prevention of communicable diseases and prolongation of life expectancy. Recently, however, along with the educational reform that emphasizing the interdisciplinary teaching, integration of basic science and clinical education, and centralization of responsibility for the medical education curriculum, concerns are being voiced by preventive medicine educators. These concerns are primarily centered around the fear that the implementation of interdisciplinary, centrally administered courses would result in a weakening of content and teaching expertise as well as a loss of departmental power and control. This paper foresees that preventive medicine and public health will be more important in Korea in the future and proposes that preventive medicine educators will have to step forward and turn the challenges of curricula restructuring into opportunities to expand the role of preventive medicine in the curricula of their institutions.
OBJECTIVE: This article explores the development and implementation of the Medical Library Association (MLA) Benchmarking Network from the initial idea and test survey, to the implementation of a national survey in 2002, to the establishment of a continuing program in 2004. Started as a program for hospital libraries, it has expanded to include other nonacademic health sciences libraries. METHODS: The activities and timelines of MLA's Benchmarking Network task forces and editorial board from 1998 to 2004 are described. RESULTS: The Benchmarking Network task forces successfully developed an extensive questionnaire with parameters of size and measures of library activity and published a report of the data collected by September 2002. The data were available to all MLA members in the form of aggregate tables. Utilization of Web-based technologies proved feasible for data intake and interactive display. A companion article analyzes and presents some of the data. MLA has continued to develop the Benchmarking Network with the completion of a second survey in 2004. CONCLUSIONS: The Benchmarking Network has provided many small libraries with comparative data to present to their administrators. It is a challenge for the future to convince all MLA members to participate in this valuable program.
This review provides a synthesis of published public health and social science literature to determine how process evaluation has been used to examine community participation and its intermediary role in health and social change outcomes. Community participation is defined, and its relationship to other community-development principles and evaluation and research methods is described. Then, case studies and research initiatives help answer questions such as who participates and why? What are the benefits and challenges of community participation? What qualitative and quantitative methods are used in process evaluations to measure community participation? What measures are used to help define the influence of community participation in community-based interventions? A better understanding of these issues is needed to ensure that community participation is valued and used effectively to plan and implement health-promotion initiatives and evaluate their processes and outcomes.