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PubMed1989

Old challenges and new areas for international co-operation in population.

Taking stock of accomplishments in the field of population reveals that significant progress has been made since the late 1960s but that much remains to be done. Important challenges in population for 1990 and beyond include the implementation of more effective family planning programs, greater accessibility to better family planning services at the local level, a wider range of choices in contraceptive methods, and better training and supervision of family planning delivery personnel. Another major challenge is to give attention to the various aspects of the role of women--beyond mere acknowledgement and to the actual implementation of programs. Further, policies need to be formulated and implemented across several sectors to deal with the complex interaction between population, resources, and the environment. To devise such policies, knowledge of the interrelationships needs to be clarified and refined. Finally, still greater emphasis will have to be placed on improving the integration of population and development. Accomplishing that will require wider awareness, enhanced coordination and adequate resources--an increase of at least $100 million per year from now to the end of the century over the annual current level of some $550 million for all external assistance for population.

Conservation of Natural Resources↗

PubMed2005

Protecting the blood supply from emerging pathogens: the role of pathogen inactivation.

Although the risk of infection by blood transfusion is relatively low, breakthrough infections still occur, Transfusion-related fatalities caused by infections continue to be reported, and blood is not tested for many potentially dangerous pathogens. The current paradigm for increasing the safety of the blood supply is the development and implementation of laboratory screening methods and restrictive donor criteria. When considering the large number of known pathogens and the fact that pathogens continue to emerge, it is clear that the utility of new tests and donor restrictions will continue to be a challenge when considering the cost of developing and implementing new screening assays, the loss of potential donors, and the risk of testing errors. Despite improving the safety of blood components, testing remains a reactive approach to blood safety. The contaminating organisms must be identified before sensitive tests can be developed. In contrast, pathogen inactivation is a proactive strategy designed to inactivate a pathogen before it enters the blood supply. Almost all pathogen inactivation technologies target nucleic acids, allowing for the inactivation of a variety of nucleic acid-containing pathogens within plasma, platelets, or red blood cells thus providing the potential to reduce transfusion-transmitted diseases. However, widespread use of a pathogen inactivation technology can only be realized when proven safe and efficacious and not cost-prohibitive.

Anti-Infective Agents↗

PubMed1994

Toward effectiveness assessment of health management education in Canada.

A growing theme in the management education literature is that of effectiveness assessment. Integrated effectiveness assessment systems represent an important challenge in health management education in Canada. This article examines the service effectiveness paradigm that evolved from comprehensive auditing developments in the public domain. It presents an integrated model of effectiveness assessment systems and the barriers that currently impede its full development and implementation in Canada. Finally, the evolving effectiveness assessment challenge--which will fundamentally change health management education in Canada--is examined.

Canada↗

PubMedDate not supplied

Effects of reorganization on laboratory quality: preliminary findings and lessons learned.

Reorganization and downsizing are common challenges for managers. This case study describes the implementation of a major restructuring of a clinical laboratory within a large, integrated medical-delivery organization. Economic trends prompted us to evaluate the effects of a major laboratory reorganization, with a significant shift from clinical laboratory scientists to lower waged, nonlicensed technical staff, on the analytic quality and other indicators of laboratory performance. Although a laboratory reorganization may be implemented slowly, this reorganization effort was completed quickly. Data were collected during both the pre- and post-reorganization period. Postimplementation performance indicators show no reductions in analytic quality. Effectively dealing with the human side of significant change appears to be the biggest challenge for managers, both in the short term and well after the reorganization. These results and qualitative information and insights might be of value to laboratory management contemplating a laboratory reorganization.

California↗

PubMed2004

Implementation of bioavailability in standard setting and risk assessment: suggestions based on a workshop with emphasis on metals.

Bioavailability is increasingly recognised as the key issue linking increased levels of toxicants with actually occurring adverse effects in ecosystems, whilst taking the modifying effects of the abiotic components of the environment into account. Various factors may affect bioavailability in the field, and often these factors are time- and space-dependent. This is one of the main reasons why legislators have been reluctant in implementing bioavailability in risk assessment procedures. Over the last few years, however, considerable scientific progress has been made with regard to better understanding of chemical and ecological mechanisms responsible for rendering chemicals available for uptake and toxicity. As a consequence, legislators face the challenge to anticipate the scientific progress and to implement bioavailability in legislation. This paper discusses the possibilities of implementing various methodologies within a maximum period of time of three years.

Adaptation, Biological↗

PubMed2006

The argument for integrating vector control with multiple drug administration campaigns to ensure elimination of lymphatic filariasis.

BACKGROUND: There is a danger that mass drug administration campaigns may fail to maintain adequate treatment coverage to achieve lymphatic filariasis elimination. Hence, additional measures to suppress transmission might be needed to ensure the success of the Global Program for the Elimination of Lymphatic Filariasis. DISCUSSION: Vector control successfully eliminated lymphatic filariasis when implemented alone or with mass drug administration. Challenges to lymphatic filariasis elimination include uncertainty of the exact level and duration of microfilarial suppression required for elimination, the mobility of infected individuals, consistent non-participation of some infected individuals with mass drug administration, the possible development of anti-filarial drug resistance and treatment strategies in areas co-endemic with loasis. Integration of vector control with mass drug administration can address some of these challenges. The potential benefits of vector control would include: (1) the ability to suppress filariasis transmission without the need to identify all individual 'foci of infection'; (2) minimizing the risk of reestablishment of transmission from imported microfilaria positive individuals; and (3) decreasing the risk of dengue or malaria transmission where, respectively, Aedes or Anopheles are lymphatic filariasis vectors. SUMMARY: With adequate sustained treatment coverage, mass drug administration should meet the criteria for elimination of lymphatic filariasis. However, it may be difficult to sustain sufficiently high mass drug administration coverage to achieve lymphatic filariasis elimination in some areas, particularly, where Aedes species are the vectors. Since vector control was effective in controlling and even eliminating lymphatic filariasis transmission, integration of vector control with mass drug administration will ensure the sustainability of transmission suppression and thereby better ensure the success of national filariasis elimination programs. Although trials of some vector control interventions are needed, proven vector control strategies are ready for immediate integration with mass drug administration for many important vectors. Vector control is the only presently available additional lymphatic filariasis control measure with the potential for immediate implementation.

Journal Article↗

PubMedDate not supplied

[Perception of health managers regarding collective health care].

This study aims at identifying the perception of managers and administrators of health care services, concerning the health care provided by the public health sector within SUS in the Federal District. This is a qualitative research in which the data was obtained through semi-structured interviews with health management professionals. It was concluded that the implementation of guidelines developed by the SUS still represents a challenge for the community and health care workers alike. In short, these two entities must coordinate their efforts in order to implement strategies designed at improving the health service provided to population.

Attitude of Health Personnel↗

PubMed2006

Problems and solutions for fitting amplification to patients with Ménière's disease.

Fitting amplification to a patient with Ménière's disease (MD) can present several challenges to the dispensing audiologist. These challenges include the presence of fluctuating hearing loss, a rising audiometric configuration, unilateral or asymmetrical hearing loss, reduced dynamic range, and reduced word-recognition scores. The presence of any one of these characteristics could create obstacles for a successful hearing aid fit. The presence of most if not all of these characteristics in a single patient can readily challenge the skills of even the most experienced dispensing audiologist. In addition to the audiometric challenges, this patient population has the added psychological problems associated with feeling ill due to the nausea secondary to vertiginous attacks and the anxiety associated with the unpredictable nature of the course of these attacks. This paper summarizes numerous strategies and technologies that could be implemented by the audiologist to address these unique challenges and provide a greater opportunity for a successful hearing aid fit. These suggestions include (1) advantages offered by digital signal processing; (2) using directional microphones and assistive listening devices to improve speech recognition in noise; (3) using wireless hearing aids as well as the bone anchored hearing aid; (4) counseling patients on the realistic expectations from amplification in noisy listening situations and for those with poor speech recognition; (5) using multiple programs for patients with fluctuating hearing loss; and (6) offering suggestions on programming the frequency-gain/output response for a rising configuration.

Equipment Design↗

PubMedDate not supplied

Nutrition therapy for the hospitalized patient with diabetes.

OBJECTIVE: To summarize recommendations for medical nutrition therapy (MNT), including how to implement it to achieve glycemic control targets for hospitalized patients with diabetes. METHODS: The MNT goals for hospitalized patients with diabetics are reviewed, and suggestions are made for attaining these goals. Emphasis is placed on the importance of proper screening and referral of inpatients to MNT service and on the process of providing MNT in the hospital setting. RESULTS: Implementing MNT in the hospital can be challenging because of the differences in nutrient and medication requirements compared with the home setting. Individualization of MNT during hospitalization, along with intensive medical management, generally is required if patients with diabetes are to achieve blood glucose targets. Barriers that may impact an individual's nutrition status and subsequently affect glycemic control include poor appetite, inability to eat, increased nutrient and calorie needs due to catabolic stress, variation in diabetes medications, and the possible need for enteral or parenteral nutrition support. There is limited evidence on what constitutes the optimal diet for hospitalized patients with diabetes. The consistent carbohydrate meal-planning system has been recommended because carbohydrate intake is the primary nutritional influence on blood glucose; this system focuses on the total grams of carbohydrate as the key strategy to achieve blood glucose control. Introduction of the consistent carbohydrate system requires that all healthcare disciplines understand the rationale of the system; and for the system to be effective, coordination must exist between nursing and nutrition services. Established guidelines for integration of diabetes medications with meals, snacks, or nutrition support, developed by a multidisciplinary healthcare team, will help ensure that the nutrition care plan works together with the medical treatment plan. The key areas of focus to improve inpatient glycemic control are: establishing screening criteria for appropriate referral to a registered dietitian; identifying nutrition-related issues in clinical pathways and patient care plans; implementing and maintaining standardized diet orders such as consistent carbohydrate menus; integrating blood glucose monitoring results with nutrition care plans; using standing orders for diabetes education and diabetes MNT as appropriate; and standardizing discharge follow-up orders for MNT and diabetes education post-discharge when necessary.

Diabetes Mellitus↗

PubMedDate not supplied

The 360 degrees nature of change implementation and the essential three Ds for successful and sustainable change.

The challenge and real key to future success is to be more than just receptive to change. Lasting success will come to those that encourage innovation and create change. But most of our organizations have not been successful at implementing change initiatives, let alone sustaining them. We fail to recognize that change is a process that requires definition, decisiveness, and leadership to deliver the success and sustainability we so badly need. Successful and sustainable change can happen with the "3 Ds": define, decide, and deliver. Making sure that change is successful is every stakeholder's responsibility, and making change sustainable is something that must be driven by leadership.

Laboratories↗

PubMed1997

Interstitial implantation of gynecologic malignancies.

Interstitial implantation is invaluable in the management of patients with extensive or large volume gynecologic malignancies, significant anatomical distortion, or recurrent disease. Such techniques are necessary components of the brachytherapy services available to patients with gynecologic malignancies giving superior results in terms of local tumor control and survival compared to those achieved with external beam alone or inadequate intracavitary applications. Local tumor control with an acceptable risk of complications can be achieved for these challenging disease presentations if these techniques are implemented skillfully through the joint efforts of the radiation oncologist and gynecologic surgeon.

Anesthesia, Epidural↗

PubMed2005

The future of treatment research in anorexia nervosa.

In spite of much being written on the treatment of anorexia nervosa (AN), and the well-documented long-term morbidity of this illness, treatment effects have been little investigated. The current article considers the prospects for treatment research, taking note of the formidable challenges that lie ahead for the design, implementation, and interpretation of controlled clinical trials, and highlighting opportunities for effectiveness studies. In the light of increasing evidence of the role played by biologic susceptibility factors in AN, the potential future contribution to treatment research of advances in pharmacogenetics and molecular neuroscience also receives comment.

Anorexia Nervosa↗

PubMed2006

Ethical, social and legal implications of genetic testing in liver disease.

Advances in molecular genetics challenge the hepatology community to understand and implement genetic knowledge. Despite excitement about the potential benefits of new genetic information, concerns have been raised about the inappropriate use of genetic testing, clinicians' incorrect ordering and misinterpretation of test results, and discrimination in employment and insurability based on tests results. Among the public there is fear and mistrust, in part based on horrifying historical events that were gross violations of medical ethical standards. Clinicians, scientists, patient advocacy groups, and government agencies worldwide are debating the optimal legal protections to prevent abuse. In addition, these groups are developing clinical guidelines for optimal use. Traditional ethical and legal standards of confidentiality between physicians and their patients are under scrutiny. A new principle, "the duty to warn," is emerging that has applications specific to genetic testing and may conflict with the duty to maintain patient confidentiality. Emerging ethical, legal, and social issues involve the appropriate use and protection of confidential data in tissue and serum banks. Education of the profession and the public at many levels will increase the likelihood that the unraveling of the human genome will maximally benefit society. If fear of genetic testing can be alleviated, selection bias in research could be reduced. Professional and lay organizations concerned with liver disease should consider a more active role in the public and professional debate, and foster education at all levels.

Attitude of Health Personnel↗

PubMed1998

High-dose-rate brachytherapy for medically inoperable stage I endometrial cancer.

PURPOSE: The objective of this study was to determine the efficacy of high-dose-rate (HDR) brachytherapy in 36 medically inoperable patients with stage I endometrial cancer. METHODS AND MATERIALS: From October 1989 to August 1997, 36 patients presented with clinical stage I inoperable endometrial cancer. Surgery was precluded because of obesity and/or poor cardio-pulmonary reserve. Obesity was assessed using the body mass index (BMI) scale (kg/m2). Patients received 5 weekly HDR outpatient brachytherapy applications while under intravenous conscious sedation. Three-year clinical endpoints were calculated using the Kaplan and Meier method. Grade 3 and above complications were scored using the Radiation Therapy Oncology Group system. RESULTS: The median age, Karnofsky performance status, BMI, and weight were 65 years old, 80%, 47 kg/m2, and 268 lbs, respectively. Nineteen patients were inoperable due to morbid obesity (median weight and BMI: 316 lbs and 56 kg/m2) while the remaining patients had other significant medical problems. Two patients died from acute cardiovascular events within 30 days of the last insertion. With a median follow-up of 32 months the 3-year uterine control, disease-free survival, survival, and complications were 88, 85, 65, and 21%, respectively. CONCLUSION: Excellent uterine control rates (88%) were achieved using HDR brachytherapy for patients with medically inoperable endometrial cancer, but with significant acute and late morbidities. These toxicities were observed in a previous interim analysis that resulted in major modifications of the HDR program. No severe complications have developed since these changes were implemented. The current approach used for these challenging inoperable patients is a viable alternative to observation or hormonal therapy.

Adult↗

PubMed1999

[Filmless documentation and image distribution to referring physicians exemplified by a radiologic community practice].

In healthcare, cost effectiveness as well as the quality of examinations and procedures are subjected to quickly increasing expectations and demands: we like to demonstrate how the resulting challenges and problems can be met with implementation of modern information technology. Analysing the respective demands (pattern of quantities) and choosing the adequate technical solution/technical approach, we found filmless reading and the usage of digital image distribution to communicate with referring physicians to be cost effective as well as of higher quality. Special attention should be paid to the rigorous maintenance of data security and access. Today's information technology allows individual adjustment to the respective size and requirements of a radiological department or practice for filmless reading and digital image distribution. Working with the systems as a matter of routine and using all of the expanding technological possibilities, an important improvement of service and quality can be achieved. Amortisation will be obtained despite high investments, due to the subsequent savings in personal- and enterprise costs.

Computer Security↗

PubMed2025

Optimising parent selection in plant breeding: comparing metaheuristic algorithms for genotype building.

Stacking desirable haplotypes across the genome to develop superior genotypes has been implemented in several crop species. A major challenge in Optimal Haplotype Selection is identifying a set of parents that collectively contain all desirable haplotypes, a complex combinatorial problem with countless possibilities. In this study, we evaluated the performance of metaheuristic search algorithms (MSAs)-genetic algorithm (GA), differential evolution (DE), particle swarm optimisation (PSO), and simulated annealing (SA) for optimising parent selection under two genotype building (GB) objectives: Optimal Haplotype Selection (OHS) and Optimal Population Value (OPV). Using a diverse wheat population of 583 lines genotyped for 29,972 SNPs, forming 7645 haplotype blocks and phenotyped for stripe rust scores, we assessed each algorithm's performance across fitness optimisation, convergence speed, and computational efficiency. GA consistently achieved high fitness and rapid convergence, while DE showed robustness but required longer runtime and careful tuning. PSO performed well under the OHS criterion but was less effective for OPV. SA, although computationally lighter, was less consistent in finding optimal solutions. Simulation over 100 breeding cycles showed that OHS outperformed both OPV and GEBV-based selection in long-term genetic gain and diversity retention. OHS maintained heterozygosity and additive variance, which are key for sustainable improvement, while GEBV selection led to early allele fixation. Our findings underscore the potential of GB strategies that prioritise the collective performance of parent sets rather than individual ranking to enhance selection outcomes in genomic-assisted breeding programmes.

Plant Breeding↗

PubMed2006

Organic thin-film transistors as transducers for (bio)analytical applications.

The use of organic thin-film transistors (OTFTs) in sensorics is relatively new. Although electronic noses, electronic textiles and disposable biochemical sensors appear to be viable applications for this type of devices, the benefits of the technology still have to be proven. This paper aims to provide a review of the recent advances in the area of chemically sensitive field-effect devices based on organic thin-film transistors (OTFTs), with emphasis on bioanalytical applications. Detection principle, device configuration, materials and fabrication processes as well as sensor performances will be discussed, with emphasis on the potential for implementation in real applications and the important challenges ahead.

Biosensing Techniques↗

PubMed2005

Pediatric high-grade glioma: molecular genetic clues for innovative therapeutic approaches.

High grade glioma remains the most intractable childhood tumor of the central nervous system. The molecular genetics of childhood high grade glioma remain largely unknown in comparison to that of their adult counterparts. In an era of molecularly targeted therapies, this dearth of knowledge will present particular challenges to those who must design and implement the next generation of therapeutic trials with these new agents. In this review, we discuss the current understanding of the molecular genetics of childhood high grade glioma and compare/contrast it to that of the adult tumors bearing the same classification for the purpose of beginning to identify the most promising therapeutic targets.

Age Factors↗