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PubMed2006

Preanalytical variability: the dark side of the moon in laboratory testing.

Remarkable advances in instrument technology, automation and computer science have greatly simplified many aspects of previously tedious tasks in laboratory diagnostics, creating a greater volume of routine work, and significantly improving the quality of results of laboratory testing. Following the development and successful implementation of high-quality analytical standards, analytical errors are no longer the main factor influencing the reliability and clinical utilization of laboratory diagnostics. Therefore, additional sources of variation in the entire laboratory testing process should become the focus for further and necessary quality improvements. Errors occurring within the extra-analytical phases are still the prevailing source of concern. Accordingly, lack of standardized procedures for sample collection, including patient preparation, specimen acquisition, handling and storage, account for up to 93% of the errors currently encountered within the entire diagnostic process. The profound awareness that complete elimination of laboratory testing errors is unrealistic, especially those relating to extra-analytical phases that are harder to control, highlights the importance of good laboratory practice and compliance with the new accreditation standards, which encompass the adoption of suitable strategies for error prevention, tracking and reduction, including process redesign, the use of extra-analytical specifications and improved communication among caregivers.

Clinical Laboratory Techniques↗

PubMed2002

Toxicogenomics: an opportunity to optimise drug development and safety evaluation.

'Toxicogenomics', the use of complex populations of mRNA to understand toxicity, is a relatively new field which combines the wealth of gene sequence information with advances in miniaturisation technology. In a parallel evolutionary path that the broader field of toxicology has encountered, toxicogenomics is steadily changing from descriptive to mechanistic research and will ultimately progress to a predictive science. This review focuses on the application of microarray research tools to toxicology studies in preclinical development. In particular, the 'testing funnel' approach to candidate selection in drug development is used to discuss the strategic implementation of toxicogenomics to help develop drugs that harbour less toxicity. Examples of where toxicogenomics has increased mechanistic and descriptive understanding of cellular toxicity are discussed, as are early efforts to develop molecular biomarkers that are predictive of longer-term toxicity.

Animals↗

PubMed2004

Putting science into persistence, bioaccumulation, and toxicity evaluations.

In recent decades, advances have been made in the processes used to identify substances as persistent, bioaccumulative, and toxic (PBT). Key processes have been identified, and scientifically sound assessment methods have been developed. Regulatory agencies around the world have sought practical methods for implementing policies to protect both environment and human health. In the present paper, we review the various contributions that Mackay (in collaboration with his students and colleagues) has made to the development of scientifically sound methods for the identification of PBT substances and persistent organic pollutants. These contributions include efforts to clearly define the terminology and to develop scientifically defensible assessment models and evaluation frameworks.

Environmental Monitoring↗

PubMed2006

Reengineering clinical research with informatics.

The future success of the translational research spectrum depends on the clinical research enterprise's ability to break through the barriers that constrain its productivity. As more basic science discoveries emerge, our ability to effectively translate this knowledge into improved patient care rests squarely on the manner in which we answer clinical questions. Informatics--the science of effective information use--is poised to help advance the conduct of science. However, incorporating informatics into the enterprise comes with its own set of challenges. To harness the benefits of improved information use, it is important to first establish how information flows within research. A thoughtful implementation of informatics--one that factors in social and organizational nuances--will undoubtedly lead to a more efficient and effective clinical research enterprise.

Biomedical Research↗

PubMedDate not supplied

Internet resources to improve health care for patients with diabetes.

OBJECTIVE: To review diabetes-related Web sites and online resources for health-care professionals, patients, and health-care organizations. METHODS: Diabetes-related Web sites were sought and reviewed. RESULTS: The Internet has a vast amount of diabetes-related content. Many health-care organizations make their practice guidelines available for online viewing, downloading, or both. Other resources focus on helping clinicians answer specific clinical questions at the point of care by providing extensive diabetes-related basic science, diagnostic, and therapeutic content. Some online resources can help to improve patient adherence to recommended treatment regimens and healthier lifestyles. New Web sites and online tools can help health-care professionals and organizations implement improved systems of diabetes care, focusing on evidence-based decision making, effective information systems, and meeting the needs of diverse populations. Online data can also help those wishing to purchase and implement electronic registries or electronic medical record systems (or both) to compare product characteristics. CONCLUSION: An increasing number of diabetes-related Web sites have become available to help clinicians, patients, and health-care systems obtain the information, tools, and support to address the many challenges involved in effective management of diabetes.

Diabetes Mellitus↗

PubMed2002

In-country and community-based postgraduate family practice training for Micronesian physicians--the Palau AHEC: a collaborative effort.

The U.S. Institute of Medicine in its 1998 review of the health care systems among the U.S.-Associated Pacific Islands (USAPI) identified promotion of primary health care (PHC) and training of the regional health workforce including postgraduate training for physicians as priorities. With the support of the health leadership of the USAPI and the Republic of Palau, the John A. Burns School of Medicine (JABSOM) of the University of Hawaii captured U.S. federal Area Health Education Center (AHEC) funds to implement a postgraduate program to train Family Practitioners - physician specialists in primary care for the region. The Palau AHEC has evolved into ajoint activity of JABSOM, the University of Auckland Faculty of Medicine and Health Sciences (UAFMHS), the School of Public Health & Primary Care--Fiji School of Medicine, and Palau Community College to provide Diploma-level training in Family Practice and Community Health for Micronesian physicians.

Area Health Education Centers↗

PubMed2005

Trends in academic health sciences libraries and their emergence as the "knowledge nexus" for their academic health centers.

OBJECTIVES: The objective of this study was to identify trends in academic health sciences libraries (AHSLs) as they adapt to the shift from a print knowledgebase to an increasingly digital knowledgebase. This research was funded by the 2003 David A. Kronick Traveling Fellowship. METHODS: The author spent a day and a half interviewing professional staff at each library. The questionnaire used was sent to the directors of each library in advance of the visit, and the directors picked the staff to be interviewed and set up the schedule. RESULTS: Seven significant trends were identified. These trends are part of the shift of AHSLs from being facility and print oriented with a primary focus on their role as repositories of a print-based knowledgebase to a new focus on their role as the center or "nexus" for the organization, access, and use of an increasingly digital-based knowledgebase. CONCLUSION: This paper calls for a national effort to develop a new model or structure for health sciences libraries to more effectively respond to the challenges of access and use of a digital knowledgebase, much the same way the National Library of Medicine did in the 1960s and 1970s in developing and implementing the National Network of Libraries of Medicine. The paper then concludes with some examples or ideas for research to assist in this process.

Academic Medical Centers↗

PubMed2005

Quality of life assessment in otorhinolaryngology. History, measures and methods.

The term "quality of life" was first mentioned in 1920 in economic journals and became an issue in the early 1960s in North America. Initially it became accepted in social sciences and later in medicine. The development of generic measures began in the early 1970s and continues today. Disease-specific measures were introduced in the 80th and 90th. During that time methodological studies were implemented and additional emphasis was put on analytic approaches, interpretation of scale scores and cultural including language issues. In ENT study groups began slowly with research in the 1980s and expanded during the 1990s. Today Quality of Life is an accepted part of medical research and covers a broad field of issues. Study groups in ENT work on allergy treatment, oncology and economic aspects of Quality of Life research as well as patient's perception of hearing devices. Future challenges include conceptualization and testing of theoretical models, further refinement of individualized measures for use in routine clinical practice and the inclusion of Quality of Life information in health databases. This article describes the methodological concept, the history of Quality of Life assessment in ENT and gives a detailed overview on current measures.

History, 20th Century↗

PubMed1991

Guidelines for developing and managing an environmental enrichment program for nonhuman primates.

Before implementing an environmental enrichment program for nonhuman primates, several issues should be considered. The assignment of enrichment tasks can be made to caretakers, a dedicated "enrichment technician," volunteers, students or individuals with training in behavioral science. Determining the enrichment techniques to be used must take into account personnel time available; the species, age, sex, and individual histories of the nonhuman primates; and experimental protocols for which animals are being maintained. Identifying the most beneficial way to use the available personnel time must be tailored for each institution. To meet federal regulations, records must be kept of the environmental enhancements available to each nonhuman primate. Good record-keeping will allow appropriate evaluation of the program. This evaluation should involve the animals' responses to the enrichment opportunity, cost and durability of enrichment items, human and nonhuman safety considerations, and personnel required. The well-being of captive nonhuman primates will be most improved if well-informed decisions are made in developing and managing environmental enrichment programs.

Animal Husbandry↗

PubMed2006

Knowledge and skills in community oriented medical education (COME) self-ratings of medical undergraduates in Karachi.

OBJECTIVE: To assess the satisfaction of medical students regarding community oriented knowledge and skills that are proposed to be part of the current undergraduate medical curriculum. METHODS: Competencies listed in the regulations for medical education designed by the Pakistan Medical and Dental Council (PMDC) were used to develop a self-administered questionnaire. Using the questionnaire 220 final year students of 3 public sector medical schools self-rated the knowledge and skills that should be part of the curriculum. For analysis the questions were grouped into courses of Basic, Clinical and Community Health Sciences. Students ranked their perceptions on a Likert scale of 0-4 for each question. Descriptive analysis was done to calculate the proportion of satisfied and dissatisfied students using the median of the highest possible score as the cut off. RESULTS: The analysis of knowledge gained found a greater proportion of satisfied students with the Basic (55.9%) and Clinical Sciences (50.9%) courses than the Community Health Sciences course (45.5%). Analysis of skills acquired uniformly showed a low percentage of satisfied students for Basic (39.1%), Clinical (29.7%) and Community Health Sciences (19.1%). The proportion of students dissatisfied with their knowledge and skills for different courses ranged from 38.2-85%. CONCLUSION: Students perceive that current medical school curricula are unable to meet the required standards. Proper implementation of community oriented curricula is the first step towards effective health care provision.

Clinical Competence↗

PubMed1991

Clinical medical librarian: the last unicorn?

In the information age of the 1990s, the clinical medical librarian (CML) concept, like many other personalized library services, is often criticized as being too labor-intensive and expensive; others praise its advantages. To determine the attitudes of medical school library directors and clinical department heads toward implementation and feasibility of a CML program, forty randomly selected medical schools were surveyed. A double-blind procedure was used to sample department heads in internal medicine, pediatrics, and surgery, as well as health sciences library directors identified by the Association of Academic Health Sciences Library Directors (AAHSLD) annual statistics. The survey instrument was designed to measure responses to the following attitudinal variables: acceptance and nonacceptance of a CML program; importance to patient care, education, and research; influence on information-seeking patterns of health care professionals; ethical issues; CML extension services; and costs. Seventy-nine usable questionnaires out of a total of 120 (66%) were obtained from clinical medical personnel, and 30 usable questionnaires out of a total of 40 (75%) were obtained from medical school library directors. Survey results indicated significant differences between clinical medical personnel and library personnel regarding attitudes toward CML influence on information-seeking patterns, ethics, alternative CML services, and costs. Survey results also indicated a continuing strong support for CML programs in the medical school setting; however, differences of opinion existed toward defining the role of the CML and determining responsibility for funding.

Attitude of Health Personnel↗

PubMed1984

Why aren't there more significant automated nursing information systems?

This article answers the question posed in the title. The author maintains the following factors must exist if a significant computerized nursing information system is to prove successful in clinical settings: a) a strong leader whose training includes research and computer sciences; b) a "good idea" that is practical, researchable, and will attract support; c) a data base amenable to computer manipulation; d) adequate resources, including administrative support, money, hardware, personnel, and authority; and e) successful implementation of the system.

Computers↗

PubMed1993

Canadian Bacterial Diseases Network: a new approach to university-industry relationships.

Bacterial diseases are a substantial problem worldwide. Their diagnosis and therapy form the basis of a multibillion dollar industry. This industry is dynamic and is continuously revitalized by research. The Canadian Bacterial Diseases Network (CBDN) was established to capitalize on the enhanced opportunities that now exist for the rapid progression of an idea from conceptualization to implementation and, ultimately, commercialization. CBDN is one of 15 Networks of Centres of Excellence, a Federal Government initiative whose intention is to improve Canada's economic competitiveness in the global market. CBDN research involves fundamental science, is broadly-based, and encompasses all aspects of bacterial diseases. Current projects include the investigations of strategies to block Pseudomonas aeruginosa binding to epithelial cells and a novel anti-toxin approach for Escherichia coli. Also CBDN is investigating the basis for antibiotic resistance in Gram-negative bacteria, and is devising improved procedures for overcoming such resistance mechanisms. CBDN is only 28 months into its first 4-year mandate; however, considerable successes have been enjoyed to date.

Academies and Institutes↗

PubMed1999

Science, ethics, and the future of research into maternal infant transmission of HIV-1. Perinatal HIV Intervention Research in Developing Countries Workshop participants.

Effective, feasible interventions to prevent perinatal transmission of HIV-1 in developing nations are an urgent necessity. Scientific issues of concern include a need to identify other effective antiretroviral agents; to define the shortest effective course of therapy; to assess interventions other than antiretroviral agents; and to investigate interventions that may reduce HIV-1 transmission via breastfeeding. Sound scientific design is fundamental to all research studies. Ethical standards must guide such studies and include the necessity that the problem studied be a health priority in the host country; that the highest standard of care attainable in the country be assured to participants; that the health-care resources of the country not be harmed; that the informed consent of participants be obtained; and that a process of discussion ensure that a successful intervention will be considered for implementation. There are circumstances in which a no-antiretroviral comparison may be ethically justified.

Developing Countries↗

PubMed1997

Science policy reforms: the New Zealand experience.

Changes in science policy are taking place in industrialized democracies throughout the world. This paper is concerned with the implications of these changes for the content and conduct of publicly-funded science and research. We start from the view that science policy changes are related to wider changes in the role of government, and in the structure, organization and management of the public sector. New Zealand has attracted international attention in this context because of its commitment to a radical programme of public sector reforms. While this reflects similar developments and concerns elsewhere, the New Zealand experience is especially interesting because of the rigour with which policy has been implemented, the radical nature of the changes made, and the relatively short time-span involved. Thus, in focusing on New Zealand, we hope to present material of interest both there and to a wider audience.

Health Care Reform↗

PubMed1999

Core elements of developmental epidemiologically based prevention research.

In the early 1990's, important progress was documented in prevention research on mental and behavioral disorders, with recommendations for a prevention research agenda. One of the earliest implementation efforts was the workshop, "A Scientific Structure for the Emerging Field of Prevention Research," sponsored by the National Institute of Mental Health and The Johns Hopkins University Prevention Research Center, and held in Baltimore, Maryland, in December of 1994. The purpose of the workshop was to merge three perspectives from the traditionally disparate areas of epidemiology, life course development, and intervention trials technology into an integrated, interdisciplinary effort that would define a scientific structure enabling rapid advancement in prevention science. As a consequence of that workshop, the papers were written that are contained in this and the next special issue on prevention of the American Journal of Community Psychology. This first paper is a description of the salient features of developmental epidemiologically-based prevention research. Beyond the above three perspectives, we discuss the role of developmental and intervention theories; measurement of implementation, mediators, and moderators, including multi-stage sampling and measurement; the central role of multilevel growth modeling; concepts of attributable risk and prevented fraction; proximal/distal modeling and effect sizes; and partnerships between researchers and communities.

Child↗

PubMed1999

Organizational interventions: facing the limits of the natural science paradigm.

This paper reviews current challenges in the conceptualization, design, and evaluation of organizational interventions to improve occupational health. It argues that attempts to confirm cause-and-effect relationships and allow prediction (maximize internal validity) are often made at the expense of generalizability (external validity). The current, dominant experimental paradigm in the occupational health research establishment, with its emphasis on identifying causal connections, focuses attention on outcome at the expense of process. Interventions should be examined in terms of (i) conceptualization, design and implementation (macroprocesses) and (ii) the theoretical mediating mechanisms involved (microprocesses). These processes are likely to be more generalizable than outcomes. Their examination may require the use of both qualitative and quantitative methodologies. It is suggested that such an approach holds unexplored promise for the healthier design, management, and organization of future work.

Occupational Health↗

PubMed2006

Methodologic challenges in disseminating evidence-based interventions to promote physical activity.

During the past decade, numerous intervention studies have been published on the effectiveness of programs to promote active living; however, few studies have addressed the dissemination of effective physical activity interventions. Both community settings and healthcare settings are important locations for dissemination of evidence-based programs and policies. A major gap in the existing literature involves the appropriate methodologic approaches for planning, evaluating, and reporting on dissemination efforts for effective and promising interventions in these locations. To address this gap, two hypothetical dissemination studies are presented: a quasi-experimental study of local health agencies (Scenario 1) and a group-randomized trial of clinical practices (Scenario 2). These studies help to elucidate the barriers and opportunities for implementing evidence-based physical activity interventions across different settings. Based on the scenarios, the existing literature, and the authors' experience, dissemination challenges that researchers and practitioners may experience (i.e., issues of design, measures of outcomes and external validity, the balance between fidelity and adaptation to local settings, and the review and funding of dissemination science) are discussed. Researchers, practitioners, and policymakers are invited to address the issues outlined in this article in order to bridge the gap between the generation of new knowledge on efficacious physical activity interventions and widespread application of these approaches in community and clinical settings.

Community Health Services↗