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PubMed1993

Assuring access to state-of-the-art care for U.S. minority populations: the first 2 years of the Minority-Based Community Clinical Oncology Program.

BACKGROUND: The Minority-Based Community Clinical Oncology Program (MBCCOP) was initiated in September 1990 to expand the National Cancer Institute's (NCI's) clinical trials network to minority populations. Institutions, organizations, and/or physician groups that had more than 50% of new cancer patients from minority groups were eligible to participate. There has been no previous evaluation of the MBCCOP. PURPOSE: This study was designed to describe the early implementation of the MBCCOP and identify the challenges that have emerged in developing a network aimed at increasing the participation of minority populations in clinical trials. METHODS: Data were taken from primary and secondary sources, including site visits and patient log data, that described performance of 12 MBCCOP centers initially funded in September 1990. Accrual was measured by the number of credits earned per MBCCOP for patients enrolled in research protocols for cancer treatment or for prevention and control, which includes activities such as early detection, pain control, and rehabilitation. These accrual credits, assigned by the NCI, were based on the complexity of the protocol and the amount of resources expected to be required for accrual of patients by the MBCCOP. RESULTS: Data for the first 2 years of the MBCCOP showed that 344 patients were accrued to trials of treatment protocols from June 1, 1990, to May 31, 1991, and this number increased to 470 during the second accrual year, June 1, 1991, to May 31, 1992. Similarly, accrual of patients to cancer prevention and control studies increased from 256 in 1990-1991 to 423 in 1991-1992. More than 70% of the MBCCOP patients entered in studies were from minority populations. The proportion of eligible MBCCOP patients entered into treatment protocols was identical with that experienced by the initial Community Clinical Oncology Program (CCOP). Results also demonstrated that MBCCOP centers operate in an environment characterized by socio-economic decline and limited resources, both having substantial effects on the implementation of clinical trials among minorities. While minority patients are willing to participate in clinical trials, there are profound barriers involving language, logistics, and the appropriateness of available protocols. Participating physicians, nurses, and support personnel report a high level of agreement with program goals and have developed unique approaches to meeting the challenges faced in the implementation of this program. CONCLUSIONS: The MBCCOPs have demonstrated their ability to participate in clinical trials. Evaluation reveals, however, that they are emerging organizations influenced by factors endemic to the community they serve and their own structure. The MBCCOPs are confronting substantial challenges, yet they provide an important link to the overall NCI clinical trials network.

Aged↗

PubMed1987

Implementation of nursing diagnoses through integration with quality assurance.

Implementation of nursing diagnosis is both a challenging and frustrating procedure. Guidelines and published experiences are limited. Efforts of one hospital to implement nursing diagnosis demonstrated the value of using quality assurance techniques to monitor the effectiveness of the implementation. Implementation of nursing diagnosis without consideration of intervention and outcome criteria results in trial and error practice. Monitoring the quality and appropriateness of care using standards and criteria for nursing diagnosis leads to new knowledge and insights. The nursing profession now faces the test of managing and disseminating the information that comes from the implementation of nursing diagnosis.

Accidental Falls↗

PubMedDate not supplied

Program evaluation within a health promotion framework.

Program evaluation can assist in assessing the conceptualization, design, implementation and utility of health promotion action. Evaluation of health promotion, with multiple strategies combining individual, social and policy action, lends itself to an evaluation-as-politics paradigm. Consideration of the interests of all major stakeholders, use of a series of related studies, and a commitment to multiple methods and multiple perspectives characterize this paradigm. Simple, practical research that is adequate for answering relevant questions is required. The program evaluator is not a neutral, scientific observer--he/she is a participant in the political arena along with other stakeholder groups. A model of the areas of interest in evaluation of health promotion, some potential evaluation questions, and a health promotion impact evaluation model are presented to emphasize unique aspects involved in evaluation of health promotion action. The evaluator can take a proactive role and challenge problems in conception and implementation of health promotion action. He/she can advocate for health promotion.

Health Policy↗

PubMed1985

Using nursing expertise for non-nursing computer systems.

The nurse working with automated systems often uses the same practical and clinical skills used in the analysis, implementation, and evaluation of patient care. Transferring those cognitive skills from a clinical setting to a setting in which automated systems are the primary focus is practical, yet challenging. The intuitive processes of analysis, implementation, and evaluation are the same; however, the methods, procedures, and tools vary. The additional skills required to become a systems analyst, technical writer, information specialist, project officer, or consultant can be learned either formally by attending courses, seminars, workshops, or other educational programs or by on-the-job experience with the many aspects of systems implementation. Whenever possible, opportunities for learning should be sought by the nurse to develop her analytical and technical skills, depending on the nature of the role she fills in working with automated systems. Experience with non-nursing technology provides the nurse with a deeper understanding and appreciation of the applications of computer technology in a variety of settings. This kind of knowledge contributes to her ability to more accurately assess the capabilities desirable in automated health care system, with particular emphasis on nursing requirements. The combination of nursing, technical, and analytical skills places the nurse working with automated systems in a position to greatly expand her knowledge base and to identify mechanisms to transfer non-nursing technology to automation in nursing practice, education, and research. The challenge to the nursing profession will continue as automation continues to become an integral part of health care delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Competence↗

PubMed2026

Targeted Next-Generation Sequencing for Improved Clinical Outcomes in People Living With Rare Diseases in Global South: Protocol for a Systematic Review and Meta-Synthesis.

BACKGROUND: Rare diseases affect many individuals and pose major challenges in diagnosis and treatment, especially in Global South countries where health care resources are limited. Targeted next-generation sequencing (NGS) has significantly advanced diagnostic accuracy and clinical care for rare diseases globally; however, its implementation and impact within the Global South context remain insufficiently studied. OBJECTIVE: This study aims to evaluate the use, clinical benefits, challenges, and implementation outcomes of targeted NGS for diagnosing and managing rare diseases in Global South populations. Specifically, it seeks to quantify the diagnostic yield of NGS, examine its influence on subsequent clinical decision-making, and identify principal barriers to, and facilitators of, the implementation of targeted NGS approaches in these contexts. METHODS: This protocol follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We will systematically search PubMed, Scopus, and Web of Science for studies published between 2005 and 2025 that report on the use of targeted NGS in Global South population with rare diseases. Two reviewers will independently perform study selection, data extraction, quality assessment, and evaluation of risk of bias by using QUADAS-2 for diagnostic accuracy studies and the risk of bias assessment tool for nonrandomized studies. Meta-analyses will be conducted to estimate pooled outcomes for diagnostic yield, with heterogeneity assessed using random effects models. Heterogeneity will be further examined through visual inspection of forest plots and by evaluating the chi-square test and I² statistic. RESULTS: The protocol has been registered with PROSPERO (CRD420251078455). Database search or screening, data extraction, and data synthesis are planned to commence in June 2026 and conclude by September 2026. Study findings will synthesize the diagnostic yield, clinical impact, and contextual determinants influencing the implementation of targeted NGS in Global South health care settings. CONCLUSIONS: This review will provide evidence on the application, advantages, limitations, and clinical outcomes of targeted NGS for individuals affected by rare diseases in countries of the Global South. The finding will identify priorities for capacity strengthening, policy development, and future genomic research. TRIAL REGISTRATION: PROSPERO CRD420251078455; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251078455. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/85150.

Rare Diseases↗

PubMed1990

Physiologic consequences of local heart irradiation in rats.

Noninvasive methods have been used to study the long-term cardiovascular and pulmonary functional changes at rest and after exercise in adult rats following local heart irradiation with single x-ray doses of 15, 17.5 or 20 Gy, and in non-irradiated control animals. Rats that had undergone a chronic exercise program were compared with untrained cohorts. The earliest dysfunction detected was an increased respiratory rate (f) at 10 weeks after irradiation in the highest dose group. In contrast, both telemetric heart-rate (HR) and rhythm and indirect systolic blood pressure measurements performed at rest only revealed changes starting at 43 weeks after irradiation with 20 Gy, up to which point the rats showed no clinical signs of heart failure. However, the number of minutes required for the recovery of the HR to pre-exercise levels following the implementation of a standardized exercise challenge was elevated in untrained rats compared with their trained cohorts at 18 weeks after irradiation with 20 Gy. Increases in recovery times were required in the two lowest dose groups, starting at 26 weeks after irradiation. It was concluded that the reserve capacity of the cardiopulmonary system masks functional decrements at rest for many months following local heart irradiation, necessitating the use of techniques which reveal reductions in reserve capacities. Further, the influence of local irradiation to the heart and lungs deserves closer scrutiny due to mutual interactions.

Animals↗

PubMed2026

Moving Beyond Morphology to Multiplexed Molecular Imaging as the Next Frontier in Diagnostic Pathology.

Diagnostic pathology has long relied on the morphologic interpretation of hematoxylin and eosin-stained tissues to guide diagnosis and assess prognostic features. Although pathologists intuitively recognize spatial patterns and architectural organization, these assessments remain largely qualitative and difficult to quantify systematically. Immunohistochemistry and immunofluorescence have introduced molecular specificity but are limited in multiplexing capacity, whereas bulk genomic and transcriptomic assays provide high molecular depth but lose spatial context by averaging signals across heterogeneous cell populations. Recent advances in spatial proteomics-including mass spectrometry-based imaging and cyclic immunofluorescence-now enable multiplexed, single-cell protein analysis within intact tissue architecture. These technologies have revealed complex immune and stromal microenvironments, spatially organized biomarkers predictive of therapeutic response, and molecular gradients underlying disease progression. By integrating histologic and molecular information, spatial proteomics bridges traditional microscopy with high-dimensional omics, allowing quantitative, spatially resolved insights into tissue organization and disease mechanisms. This review summarizes recent developments in multiplexed spatial proteomics from both scientific and pathologic perspectives, highlighting how these technologies extend beyond morphology to quantify histologic patterns, refine biomarker discovery, and facilitate clinical translation. The review also examines translational challenges and barriers to clinical implementation, including costs, standardization requirements, and workflow integration.

Humans↗

PubMed2026

Promises and pitfalls of long-read sequencing for resolving microbial complexity.

Long-read sequencing (LRS) has driven a transition in microbial genomics, overcoming the assembly fragmentation inherent to short-read sequencing. This review elucidates the impact of LRS across isolate genomics, metagenomics, and multi-omics domains. By spanning extensive repetitive regions, LRS facilitates the reconstruction of circular chromosomes and precisely resolves mobile genetic elements (MGEs). In metagenomics, LRS enables strain-level resolution, the recovery of circular metagenome-assembled genomes, and the precise localization of MGEs within host replicons. Furthermore, the single-molecule, amplification-free properties of LRS provide enhanced resolution of native epigenetic modifications and full-length transcriptomes. Despite these advancements, widespread implementation remains constrained by multidimensional challenges, including stringent high-molecular-weight DNA requirements, depth deficits, and computational overhead. Nevertheless, LRS is increasingly becoming the method of choice for isolate genomics and metagenomics. As detection technologies and algorithms progress, LRS will further improve our ability to decipher the structural and functional diversity of microbial ecosystems.

Metagenomics↗

PubMed1994

Cleanup protocol for 226Ra-contaminated cobbly soil at UMTRA Project sites.

The nonuniform distribution of 226Ra and other radiological contamination of cobbly soil encountered on several Uranium Mill Tailings Remedial Action Project sites is presented and discussed, and the concomitant challenges to the intent and implementation of the U.S. Environmental Protection Agency's soil cleanup standards are noted. In response to technical assessments and information presented to the U.S. Nuclear Regulatory Commission by the U.S. Department of Energy, the Nuclear Regulatory Commission has recently resolved the dilemma by concluding that compliance with Environmental Protection Agency soil cleanup standards for cobby soil at Uranium Mill Tailings Remedial Action Project sites would be adequately attained using bulk radionuclide concentrations, instead of requiring that the radionuclide concentration of the finer soil fraction passing a #4 mesh sieve met the standards. A Nuclear Regulatory Commission-approved procedure developed for cobbly soil remediation is outlined and discussed. The site-specific implementation of this procedure at Uranium Mill Tailings Remedial Action Project sites containing cobbly soil is estimated to save millions of dollars.

Colorado↗

PubMed1990

Coronary artery disease in blacks.

Coronary artery disease (CAD) is the leading cause of death in black Americans, accounting for 25% of all deaths. Risk factors for CAD that have been established in white populations also have a high prevalence in black populations. Some risk factors, such as hypertension, have a greater prevalence in blacks. Risk factor reduction for this population remains as great a problem as it is for whites and other minority groups. The major challenges for nursing lie in implementing and evaluating primary and secondary prevention strategies beginning with children and extending to the elderly.

Adolescent↗

PubMed1995

Perinatal care across the continuum: early discharge and nursing home follow-up.

Efforts to control health care costs have resulted in earlier hospital discharge of both perinatal and neonatal patients. While earlier discharge may reduce hospital charges, it can increase families' burden of care, stress, and expenses and postdischarge complications may go undetected. A number of programs of home follow-up care have been developed in response to earlier hospital discharge. Nursing's challenge is to develop and implement the most effective and cost-efficient services acceptable and available to all perinatal and neonatal patients who need them.

Continuity of Patient Care↗

PubMed1990

Hemogram changes in lactating dairy cows given human recombinant granulocyte colony stimulating factor (r-MethuG-CSF).

As a prelude to mammary gland challenge experiments, this investigation was implemented to assess the hematologic changes in lactating dairy cattle induced by two dosage regimes of human recombinant colony stimulating factor (Hr-GCSF). This study documents the capability of the human recombinant colony stimulating factor to produce hematologic changes in both a time and dose dependent manner when administered to the adult lactating bovine. A screening dose of 1 microgram/kg of Hr-GCSF administered to three study subjects produced a three- to four-fold increase in peripheral blood mature neutrophil counts (P less than 0.043) by day 12 of the trial. The priming dose treatment group of four lactating cows (3 micrograms/kg of Hr-GCSF) exhibited a three- to five-fold increase in peripheral blood mature neutrophil counts (P less than 0.05) and two- to three-fold increases in white blood cell counts by day 5 of the trial. Hematologic examinations of the control group (n = 4; no Hr-GCSF administration) did not detect significant changes in their neutrophil counts over baseline values. The milk somatic cell counts did not statistically shift over baseline values in any of the control or Hr-GCSF treatment groups. When attempting to alter the course of infectious disease processes, potential applications of colony stimulating factors provide interesting speculations about new therapeutic modalities.

Animals↗

PubMed2026

Human-AI Interaction With AI-Assisted Tumor Overlays in Pediatric Whole-Body Magnetic Resonance Imaging: Exploratory Reader Study.

BACKGROUND: AI tools have the potential to enhance personalized clinical care, particularly in radiology. However, their integration into clinical workflows remains complex, especially in pediatric oncology, where early cancer detection is critical. Children with Li-Fraumeni syndrome (LFS), a rare cancer predisposition disorder, undergo regular surveillance whole-body magnetic resonance imaging (wbMRI), which presents an opportunity for AI-assisted tumor detection. OBJECTIVE: We evaluated the feasibility of an AI-assisted overlay for highlighting tumor-like regions in pediatric surveillance wbMRI and explored how access to the overlay influenced radiologist workflow, candidate-lesion marking behavior, follow-up recommendations, and perceived workload. METHODS: We developed a patch-based AI segmentation model trained on augmented 2D slices from 675 surveillance wbMRI volumes of pediatric patients with LFS. The model was designed to highlight regions with high tumor probability. A reader study was conducted with 2 radiologists who independently reviewed wbMRI cases both with and without AI assistance. We measured evaluation time, number and location of reader-marked candidate lesions, type of follow-up recommendation, and subjective feedback using structured questionnaires. RESULTS: AI assistance altered interpretation workflows for both radiologists, with mixed effects. On average, the time required to evaluate each case increased when using the AI tool for both radiologists. However, one radiologist had an increase in the number of candidate lesion locations selected with the tool, and one had a decrease in the number of candidate lesion locations selected with the tool. Subjective feedback indicated that one of the radiologists reported lower mental demand with the AI tool, while both radiologists reported lower stress with the AI tool. Interrater variability was evident, underscoring the need for personalized calibration of AI tools. CONCLUSIONS: AI-assisted wbMRI interpretation can improve tumor detection in pediatric cancer surveillance by reducing false negatives. However, its influence on workflow efficiency and interradiologist variability highlights the importance of careful implementation. Successful integration requires addressing challenges such as improving the predictive precision of AI models, offering intuitive end-user designs and instructions, and building trust in AI outputs. AI outputs can influence workflow and behavior in reader-specific ways. Clinical translation will require larger, randomized, multireader studies and model refinement to reduce false positives and quantify lesion-level reader performance. This can help ensure better patient outcomes in addition to reduced clinician burnout.

Humans↗

PubMed1992

[Some considerations on stuttering].

Stuttering implements communication with interference through challenges other than sharing information, messages and emotion. This dramatic behaviour implies a phobic origin. The therapist must reproduce the symptom in its overall economy. Attentive listening, reassurance and non-submission of the esteem to the performance of expression should lead to a veritable reassessment of the challenges of expression.

Behavior Therapy↗

PubMed1985

Laboratory animal medicine. Changes and challenges.

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

Animals↗

PubMed1993

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

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

Child↗

PubMed1993

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

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

Aminocaproic Acid↗

PubMed1992

Implementing managed care in a pediatric setting.

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

Hospitals, Pediatric↗