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PubMedDate not supplied

Communicable diseases in complex emergencies: impact and challenges.

Communicable diseases, alone or in combination with malnutrition, account for most deaths in complex emergencies. Factors promoting disease transmission interact synergistically leading to high incidence rates of diarrhoea, respiratory infection, malaria, and measles. This excess morbidity and mortality is avoidable as effective interventions are available. Adequate shelter, water, food, and sanitation linked to effective case management, immunisation, health education, and disease surveillance are crucial. However, delivery mechanisms are often compromised by loss of health staff, damage to infrastructure, insecurity, and poor co-ordination. Although progress has been made in the control of specific communicable diseases in camp settings, complex emergencies affecting large geographical areas or entire countries pose a greater challenge. Available interventions need to be implemented more systematically in complex emergencies with higher levels of coordination between governments, UN agencies, and non-governmental organisations. In addition, further research is needed to adapt and simplify interventions, and to explore novel diagnostics, vaccines, and therapies.

Africa↗
PubMed2003

Primary prevention of hepatitis C virus infection.

Viral hepatitis type C is a worldwide public health problem of major concern. Waiting for a safe and effective vaccine able to confer protection to susceptible individuals, public health challenges for controlling hepatitis C require implementation of primary prevention measures that reduce risks of acquiring/transmitting HCV infection. Screening for safe blood and blood products, use of disposable syringes and needles and of universal precautions have dramatically reduced risk of infection in medical setting. Health education, counselling and testing of individuals at risk provide opportunities for controlling HCV infection.

Global Health↗
PubMed2006

Improving diabetes care and outcomes in a rural primary care clinic.

BACKGROUND: Data have shown that despite the availability of a wide variety of treatment approaches to normalize plasma glucose, the great majority of diabetic patients remain poorly controlled. The goal of a small, rural health care organization that included a critical access hospital and a 25-provider physician group was to improve glycated hemoglobin (A1C) outcomes among patients with Type 2 diabetes and to improve frequency of testing (A1C) levels. IMPLEMENTING THE IMPROVEMENT INITIATIVE: Academic detailing in practice guidelines with algorithms for care and a diabetes self-management education program were the first key activities in the improvement initiative. A variety of performance improvement activities were implemented. A diabetes care flow sheet was used to monitor and report process and outcome measurements. A diabetes registry to enter process and outcome data was introduced; data can be displayed by specific provider, by the organization as a whole, by patients whose A1C is > 7, and by patients who have not had an A1C in the last six months. The diabetes care team includes the patient, the primary care provider who provides medical management, and the diabetes educators (pharmacist and dietitian). RESULTS: As of December 2005, hemoglobin A1C levels averaged 6.7 for the 566 patients in the registry. DISCUSSION: The greatest barrier to implementing the initiative lies in the challenge of trying to provide chronic care in an acute care medical model.

Ambulatory Care Facilities↗
PubMedDate not supplied

Utilizing narrative inquiry to evaluate a nursing doctorate program professional residency.

Because the University of Colorado (CU) School of Nursing Nursing Doctorate (ND) Program initiated an innovative nursing educational reform, emerging program evaluation challenges were addressed to ensure successful implementation and program quality. The study's purpose was to evaluate the effectiveness of the ND professional clinical residency (fourth and final year) from the students' perspectives. Therefore, this evaluation was exploratory and inductive to focus on the primary questions: "How does one become an ND nurse during the residency?" (process) and "What is an ND nurse?" (outcome). Additionally, an explanation of how interactive processes affected residency experiences was addressed. The narrative inquiry framework made available a special access to the human experiences of time, order, and change during the residency process. Ten students in the first CU ND Program residency participated. Narrative data for qualitative analysis were obtained from students' monthly written vignettes and verbal sharing of their clinical experiences during conferences. Vignette formats directed students to describe significant residency experiences and share reflections on the events. One finding suggested that students' formative progression through the residency occurred in four phases similar to cognitive development theories. Additional findings confirmed students' growth toward and summative attainment of ND outcome behaviors, including holistic clinical proficiency, client advocacy, and promotion of professional growth for colleagues.

Adult↗
PubMed2003

The Mpowerment Project: community-building with young gay and bisexual men to prevent HIV1.

The Mpowerment Project is a community-level HIV prevention intervention for young gay and bisexual men ages 18-27. The program seeks to build a strong, supportive young gay and bisexual men's community where young gay and bisexual men nurture and protect each other, particularly with regard to HIV prevention. The program's theoretical framework draws from the areas of diffusion of innovations, community organizing, peer influence, and personal empowerment. The Mpowerment Project promotes a norm for safer sex through a variety of social, outreach and small group activities. The project is run by a "Core Group" of 12-15 young gay and bisexual men who, with volunteers, design and carry out all project activities. Implemented in 4 communities (Eugene, OR; Santa Barbara, CA; Albuquerque, NM; Austin, TX), the Mpowerment Project has proven to be effective in reducing high risk sex. This paper discusses the development and implementation of the program and various challenges encountered.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Sex education as health promotion: what does it take?

Health promotion should be evidence-based, needs driven, subject to evaluation, and ecological in perspective. How can this be achieved in the context of school-based sex education? Adopting new behaviors and giving up old habits involves common decision-making, planning, motivational control, and goal prioritization processes. Consequently, despite the particular nature of sexual behavior, models of cognitive change applied to other health-related behaviors also apply to the promotion of safer sex practice. Young people are less likely to have unprotected sexual intercourse if they have acquired a variety of social skills relevant to dealing with romantic and sexual relationships. Many of these social skills and the methods employed to facilitate their development are also important to the promotion of other health behaviors. However, teaching social skills relevant to sexual behavior in classroom settings requires specialist expertise both in program design and in delivery by teachers or facilitators. Theory- and evidence-based programs designed to promote such skills and modified on the basis of effectiveness evaluations are most likely to have an impact on the rate of pregnancies and sexually transmitted infections among young people. Yet, such programs may not be used in schools because of policy and cultural constraints. When this is the case, optimally effective health promotion cannot be delivered. Health promoters should acknowledge these challenges and facilitate the adoption and implementation of effective sexual health promotion programs by targeting communities and legislators.

Adolescent↗
PubMed2003

Pathways to obesity prevention: report of a National Institutes of Health workshop.

There is an extensive research base on obesity treatment and on the health benefits of weight loss, but relatively little research has focused on obesity prevention. This article summarizes results of a workshop conducted by investigators funded under a National Institutes of Health initiative designed to stimulate novel research for obesity prevention. The 20 pilot studies funded under this initiative involved study populations that were diverse with respect to life stage and ethnicity, were conducted in a variety of natural and research settings, and involved a mix of interventions, including face-to-face group and individual counseling, as well as mail, telephone, and internet-based approaches. The workshop, which occurred approximately halfway through the 3-year funding period, emphasized concepts and experiences related to initiating and conducting obesity prevention studies. Investigators discussed theoretical perspectives as well as various challenges encountered, for example, in study implementation in different clinical and community settings, in working with children and families, and in studying pregnant and postpartum women. Other topics discussed included the difficulty of motivating individuals for prevention of weight gain, relevant cultural and racial/ethnic considerations, and the particular need for valid and practical measures of energy balance, body composition, and physical fitness in obesity prevention research. A key conclusion was that using obesity treatment as the primary paradigm may be a limiting perspective for considering obesity prevention issues. Further insights derived from the workshop deliberations are reflected in a detailed list of recommendations for future obesity prevention research.

Humans↗
PubMed2000

The effects of a seamless model of management on the quality of care for emergency department patients.

The aim of this study was to examine the effectiveness of the seamless model of management on the quality of care for emergency department (ED) patients. This was a pre- and postintervention study of comparing post intervention data with the baseline on several variables of interest. The intervention was the seamless model of ED management, designed and implemented as a response to the challenge of increasing work load at the ED. Information on patients' waiting times, critical care performance, patients' satisfaction and staff morale was collected at baseline and postintervention for comparison. The results indicated significant improvements on all outcome measures were found postintervention. The average waiting time reduced by 40%, from 92.1 to 55.3 min, as well as the time to craniotomy from 120 to 45 min for more severe patients. Complaints from patients were reduced by 80% and staff morale had improved with a 48% reduction in sick days and a 80% reduction in staff resignations. Ambulatory patients presenting to the department saw a 20% improvement in their waiting time. We report a successful restructuring process that used routinely collected clinical and administrative data to highlight problems. Using these data and through a systematic planning process, appropriate strategies for restructuring were developed by emergency staff in partnership with the hospital executive. Significant improvements in waiting time and patient care were clearly demonstrated.

Attitude of Health Personnel↗
PubMed2002

The use of vaccines in the prevention and treatment of cervical cancer.

The close association between high risk HPV infection and cervical carcinoma has provided the impetus for the development of prophylactic and therapeutic vaccination schedules. An effective prophylactic vaccine would obviate the need for population-based cervical screening programmes, while therapeutic vaccination might provide an effective adjunct to or replacement for conventional treatment for benign and malignant cervical disease. While the challenges associated with the design and implemention of immunotherapies are numerous, optimism remains high and it is expected that the next few decades will witness a revolutionary change in the way we treat cervical cancer and its premalignant lesions. A papillomavirus vaccine that prevented HPV infection on the one hand and acted against established disease on the other, would have a profound impact on one of the major cancers affecting women globally.

Animals↗
PubMedDate not supplied

Problem-based learning for nursing: integrating lessons from other disciplines with nursing experiences.

Problem-based learning (PBL) is a philosophy and teaching method that structures knowledge in clinical contexts, strengthens motivation to learn, develops clinical reasoning skills, and enhances self-directed and life-long learning. During the past 30 years, PBL has been implemented in schools of medicine worldwide, including 100 of the 126 schools in the United States. This article reviews the international PBL literature and focuses on the key aspects of this paradigm in educating health professionals: recent history and worldwide diffusion, basic characteristics and rationale, typical case presentation, student and tutor roles, and data-based outcomes. Conclusions from selected meta-analytic studies of assessment are described and discussed. The potential of PBL for nursing education is examined. Key implementation issues are identified, including the challenge to persuade faculty to move from efficient teaching to effective learning.

Clinical Competence↗
PubMed2001

Restoration of tetraplegic hand function by use of the neurocontrol freehand system.

Nine tetraplegic patients with C5 or C6 level spinal cord lesions had the Freehand System, an eight channel Functional Electrical Stimulation device, implanted to allow of hand opening and grasp. This paper describes the surgical implementation of the system and the challenges encountered. Seven of the subjects are currently daily users of the device. One subject is unable to use the system due to disruption of bowel function when the system is used. A second subject suffered a lesion of the posterior interosseous nerve, but this was not thought to be related to system use. Additionally, one subject exhibited symptoms of autonomic dysreflexia, which were alleviated by reduction of the strength of the stimulus. Despite such problems, the Freehand system can significantly improve the functional ability of C5 and C6 lesion tetraplegics.

Activities of Daily Living↗
PubMed2002

Controlling tuberculosis in India.

BACKGROUND: Tuberculosis kills nearly 500,000 people in India each year. Until recently, less than half of patients with tuberculosis received an accurate diagnosis, and less than half of those received effective treatment. METHODS: We analyzed the effects of new policies introduced in 1993 that have resulted in increased resources, improved laboratory-based diagnosis, direct observation of treatment, and the use of standardized antituberculosis regimens and reporting methods. RESULTS: By September 2001, more than 200,000 health workers had been trained, and 436 million people (more than 40 percent of the entire population) had access to services. About 3.4 million patients had been evaluated for tuberculosis, and nearly 800,000 had received treatment, with a success rate greater than 80 percent. More than half of all those treated in the past 8 years were treated in the past 12 months. CONCLUSIONS: India's tuberculosis-control program has been successful in improving access to care, the quality of diagnosis, and the likelihood of successful treatment. We estimate that the improved program has prevented 200,000 deaths, with indirect savings of more than $400 million--more than eight times the cost of implementation. It will be a substantial challenge to sustain and expand the program, given the country's level of economic development, limited primary health care system, and large and mostly unregulated private health care system, as well as the dual threats of the human immunodeficiency virus and multidrug-resistant tuberculosis.

Communicable Disease Control↗
PubMedDate not supplied

Comparison of VA intentional and unintentional deaths.

This retrospective clinical study contrasts 22 unintentional ('accidental') deaths with 31 intentional (suicide) deaths of patients obtaining psychiatric care in a mid-sized VA Health Care system during 1993-1998. Unintended deaths were more frequently associated with addicting agents, particularly opioids. The number of such incidents increased from 1993-1998, a phenomenon that appeared to be associated with the implementation of managed care. These findings challenge rapidly changing psychiatric care systems to generate more effective treatment methods for dangerous addiction pathology despite decreasing numbers of substance abuse personnel per patient.

Accidents↗
PubMed2005

Interprofessional care review with medical residents: lessons learned, tensions aired--a pilot study.

Integrated interprofessional care teams are the focus of Canadian and American recommendations about the future of health care. Keeping with this, a family medicine teaching site developed an educational initiative to expose trainees to interprofessional care processes and learning (Interprofessional Care Review; IPC). A formative evaluation pilot study was completed using one-on-one interviews and a focus group (n = 6) with family medicine residents. A semi-structured guide was utilized regarding: knowledge, skills and attitudes related to interprofessional care; their experience of the processes utilized in IPC. Data were analyzed using content analysis. Residents' perspectives on their learning revolved around four themes: changes to understanding and practice of interprofessional care; personal impact of IPC; learning about other health professionals; tension and challenges of IPC learning and clinical implementation. Residents valued the educational experience, but identified that faculty supervisors provided "mixed messages" in the value of collaborating with other health professionals. Implications regarding future educational and research opportunities are discussed.

Attitude of Health Personnel↗
PubMed2026

Pesci: fast and user-friendly software to compare single-cell gene expression across species.

SUMMARY: Recent technological advances have propelled comparative functional genomics into the single-cell era, spurring a rapid development of methods to analyse these complex datasets. However, comparing single-cell gene expression across species to quantify expression similarity and ultimately identify homologous cell types remains an open problem. The ICC algorithm (Iterative Correlation of Coexpression) has been recently proposed as an attractive approach to tackle this challenge, but, to date, no software implementation is available. Here, we introduce Pesci (Pretty Easy Single-cell Comparisons using ICC), an efficient and user-friendly implementation of the ICC algorithm applied to pairwise comparisons of single-cell gene expression atlases across species. AVAILABILITY: Pesci is implemented in Python 3 (≥3.7). It is available for download on Linux, macOS and Windows via pip, conda and GitHub at https://github.com/eparey/pesci. The source code is permanently archived on Zenodo (https://doi.org/10.5281/zenodo.21477543).

Software↗
PubMed2006

Monitoring the toxicity of antiretroviral therapy in resource limited settings: a prospective clinical trial cohort in Thailand.

BACKGROUND: One of the many challenges which come together with the implementation of antiretroviral therapy (ART) in settings with limited resources is the monitoring of toxicity. This monitoring increases costs of ART and strains resources. We therefore investigated the necessity for laboratory toxicity monitoring of ART in Thailand. DESIGN, METHODS AND PARTICIPANTS: A prospective Thai cohort of 417 HIV-infected patients were enrolled in randomized clinical trials investigating ART. Time-dependent occurrence of grade III/IV abnormal laboratory values as defined by the AIDS Clinical Trial Group was analysed. RESULTS: During a median observation period of 3.7 years (2.4-4.3) 142 grade III/IV toxicities occurred in 101 (24.2%) patients. Hepatic toxicity (n = 33, 7.9%), hypercholesterolaemia (n = 57, 13.7%), hypertriglyceridaemia (n = 26, 6.2%), anaemia (n = 16, 3.8%) and low platelet counts (n = 8, 1.9%) were frequently observed. Anaemia and low platelets occurred early and during the first 2 years of ART. Hepatic toxicity was seen early and throughout the observation period. Hypertriglyceridaemia and hypercholesterolaemia occurred throughout the observation period, and increased over time. Hypercreatininaemia and hyperglycaemia occurred once after 120 and 132 weeks. ART was changed or interrupted for grade III/IV hepatic toxicity, anaemia and hyperglycaemia only. The incidence rate for grade III/IV toxicity was between 5.56 (95% CI, 6.76-18.02) for low platelet counts and 41.18 (31.77-53.39) per 1000 patient years for hypercholesterolaemia. Antiretrovirals used were zidovudine, stavudine, lamivudine, zalcitabine, didanosine, efavirenz, saquinavir, ritonavir and indinavir. CONCLUSIONS: Grade III/IV toxicity is frequently observed in Thai patients treated with ART. The simple and inexpensive monitoring of ALT and haemoglobin could prevent most serious short-term toxicity. Long-term toxicity can be addressed with a yearly monitoring of triglycerides, cholesterol, glucose and creatinine if nephrotoxic drugs are used.

Adult↗
PubMed2025

OpenSpliceAI: An efficient, modular implementation of SpliceAI enabling easy retraining on non-human species.

The SpliceAI deep learning system is currently one of the most accurate methods for identifying splicing signals directly from DNA sequences. However, its utility is limited by its reliance on older software frameworks and human-centric training data. Here we introduce OpenSpliceAI, a trainable, open-source version of SpliceAI implemented in PyTorch to address these challenges. OpenSpliceAI supports both training from scratch and transfer learning, enabling seamless retraining on species-specific datasets and mitigating human-centric biases. Our experiments show that it achieves faster processing speeds and lower memory usage than the original SpliceAI code, allowing large-scale analyses of extensive genomic regions on a single GPU. Additionally, OpenSpliceAI's flexible architecture makes for easier integration with established machine learning ecosystems, simplifying the development of custom splicing models for different species and applications. We demonstrate that OpenSpliceAI's output is highly concordant with SpliceAI. In silico mutagenesis (ISM) analyses confirm that both models rely on similar sequence features, and calibration experiments demonstrate similar score probability estimates.

Journal Article↗