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PubMed1995

Community planning: a national strategy to improve HIV prevention programs.

Beginning in fiscal year (FY) 1994, the Centers for Disease Control and Prevention (CDC), in collaboration with health departments and other human immunodeficiency virus (HIV) prevention partners, set in motion a significant innovation in HIV prevention programs: HIV Prevention Community Planning. This process, implemented by all 65 health departments receiving HIV prevention funds from CDC, requires that the identification and prioritization of HIV prevention needs to be a shared responsibility between the health departments administering the funds and representatives of the affected communities for whom the services are intended. Guidance for this planning process strongly embraces the notion that high priority HIV prevention strategies and interventions must have a sound basis in behavioral and social science and that program planning must begin with an accurate assessment of the epidemiology of the current and projected future HIV epidemic. Rather than mandate a single standardized process for all of the 65 jurisdictions, CDC guidance provides flexibility for each jurisdiction to configure a planning process responsive to its own unique circumstances. However, all planning activities must be guided by 13 essential principles. This article will describe the principles and logistics of HIV Prevention Community Planning, identify the potential program benefits of this new undertaking, and describe implementation challenges.

Centers for Disease Control and Prevention, U.S.↗

PubMed2003

Evidence-based laboratory medicine as a tool for continuous professional improvement.

BACKGROUND: Evidence-based medicine (EBM), defined as "the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of patients," seems a tool (a "new paradigm") able to meet individual clinical experience with robust observations. EBM has been driven by the need to manage information overload by cost control and by public request for the best in diagnostics and treatment. METHODS: The application of EBM in laboratory medicine or evidence-based laboratory medicine (EBLM) is aimed to advance clinical diagnosis by researching and disseminating new knowledge, combining methods from clinical epidemiology, statistics, and social science with the traditional pathophysiological molecular approach. RESULTS: EBLM, by evaluating the role of diagnostic investigations in the clinical decision-making process with emphasis on measurable outcome, can help both in improving the quality of new scientific findings and in translating the results of good-quality research into everyday practice. CONCLUSIONS: Since there is a need to integrate many educational tools to focus the strategy on promoting the implementation of best practices, the STARD proposal for robust diagnostic test primary studies, the presence of systematic reviews of high quality, and the development of valid guidelines based on the best scientific evidence may be useful to promote an a evidence-based culture for appropriateness, efficiency, and effectiveness in laboratory medicine.

Evidence-Based Medicine↗

PubMed2001

Strengthening user participation through health sector reform in Colombia: a study of institutional change and social representation.

The challenge of achieving community participation as a component of health sector reform is especially great in low- and middle-income countries where there is limited experience of community participation in social policy making. This paper concentrates on the social representations of different actors at different levels of the health care system in Colombia that may hinder or enable effective implementation of the participatory policy. The study took place in Cali, Colombia and focused on two institutional mechanisms created by the state to channel citizen participation into the health sector, i.e. user associations and customer service offices. This is a case study with multiple sources of evidence using a combination of quantitative and qualitative social science methods. The analysis of respondents' representations revealed a range of practical concerns and considerable degree of scepticism among public and private sector institutions, consumer groups and individual citizens about user participation. Although participation in Colombia has been introduced on political, managerial and ethical grounds, this study has found that health care users do not yet have a meaningful seat around the table of decision-making bodies.

Attitude to Health↗

PubMed2001

The socio-organizational age of artificial intelligence in medicine.

The increasing pressure on Health Care Organizations (HCOs) to ensure efficiency and cost-effectiveness, balancing quality of care and cost containment, will drive them towards a more effective management of medical knowledge derived from research findings. The relation between science and health services has until recently been too casual. The primary job of medical research has been to understand the mechanisms of disease and produce new treatments, not to worry about the effectiveness of the new treatments or their implementation. As a result many new treatments have taken years to become part of routine practice, ineffective treatments have been widely used, and medicine has been opinion rather than evidence based. This results in suboptimal care for patients. Knowledge management technology may provide effective approaches in speeding up the diffusion of innovative medical procedures whose clinical effectiveness have been proved: the most interesting one is represented by computer-based utilization of evidence-based clinical guidelines. As researchers in Artificial Intelligence in Medicine (AIM), we are committed to foster the strategic transition from opinion to evidence-based decision making. Reviews of the effectiveness of various methods of guideline dissemination show that the most predictable impact is achieved when the guideline is made accessible through computer-based and patient specific reminders that are integrated into the clinician's workflow. However, the traditional single doctor-patient relationship is being replaced by one in which the patient is managed by a team of health care professionals, each specializing in one aspect of care. Such shared care depends critically on the ability to share patient-specific information and medical knowledge easily among them. Strategically there is a need to take a more clinical process view of health care delivery and to identify the appropriate organizational and information infrastructures to support this process. Thus, the great challenge for AIM researchers is to exploit the astonishing capabilities of new technologies to disseminate their tools to benefit HCOs by assuring the conditions of knowledge management and organizational learning at the fullest extent possible. To achieve such a strategic goal, a guideline can be viewed as a model of the care process. It must be combined with an organization model of the specific HCO to build patient careflow management systems. Artificial intelligence can be extensively used to design innovative tools to support all the development stages of those systems. However, exploiting the knowledge represented in a guideline to build them requires to extend today's workflow technology by solving some challenging problems.

Artificial Intelligence↗

PubMed2003

What medical students value in a population health tutor: characteristics for consideration in staff recruitment and development.

BACKGROUND: Recent moves to integrate aspects of population health into medical curricula have created new staff development challenges for many institutions. Small group teaching in population health is a relatively new initiative, often requiring recruitment of additional staff and considerable training. This analysis identifies the tutor characteristics rated most positively by medical students in a small-group course in population health and discusses their implication for staff recruitment and development. METHOD: Retrospective evaluation of tutors by students using a self-administered questionnaire. Overall tutor rating was analysed against various tutor characteristics, using univariate logistic regression methods. Optional qualitative comments were summarized by thematic methods and triangulated with findings from the quantitative analysis. RESULTS: Creating a supportive group climate was the tutor attribute most positively evaluated by students (OR=9.62, 95%CI 4.46-20.83). Perceived interest in teaching (OR=8.93, 95%CI 3.83-20.83) and the ability to give useful feedback (OR=8.40, 95%CI 4.07-17.54) were also highly rated by students as valuable qualities in their tutors. Qualitative analysis highlighted the importance of informed comment, good knowledge and expert input from tutors. CONCLUSION: Whilst a degree of content expertise in population health was desirable in a tutor, its value was secondary to good facilitation skills and an enthusiasm for teaching when student evaluation was considered. Faculties implementing small-group methods of teaching population health should consider facilitation skills and interest in teaching as priorities when recruiting and training staff. As is the case for self-directed student-led learning in basic and clinical sciences, these appear to be more influential than content expertise, from the students' perspective.

Australia↗

PubMed1997

Pseudoissues in practice evaluation: impediments to responsible practice.

This article reviews often-cited barriers to the implementation of practice evaluation activities and suggests that they are pseudoissues. Five pseudoissues in evaluation are reviewed: (1) time constraints, (2) single-system design issues, (3) gender and ethnic bias, (4) complexity of practice, and (5) incompatibility between the science of evaluation and the art of helping. These pseudoissues result from two misconceptions: First, these issues are sometimes viewed as affecting only the evaluation component of practice, but they pervade all of practice. Second, the confusion about the purpose of single-system designs leads to unwarranted concerns about design and methodology. The article argues that the incorporation of evaluation activities in practice helps practitioners become more aware of and sensitive to legitimate barriers to effective practice and paves the way for overcoming these barriers.

Adolescent↗

PubMed2003

Curricular reform of the 4th year of medical school: the colleges model.

BACKGROUND: The practice of medicine has changed dramatically over the last 3 decades. Medical education has struggled to keep up with these changes, with only limited success. The 4th year of medical school offers a tremendous opportunity for curricular innovation, but little change has occurred in the past 30 years. DESCRIPTION: This article traces the history of the 4th year, from the Flexnerian era in which the classic preclinical-clinical model for medical education was developed, through the 1970s, when virtually every medical school adopted a largely elective 4th year, to the present. Although the classic 4th-year curriculum has a number of strengths such as flexibility and relative autonomy of scheduling for students, it also has significant weaknesses. EVALUATION: A major educational initiative for the 4th year-the "College Phase"-has been implemented at the David Geffen School of Medicine at UCLA. It is designed to remedy many of the weaknesses of the 4th-year curriculum while preserving the benefits. CONCLUSION: Five colleges have been created: acute care, applied anatomy, medical science, primary care, and urban underserved. Students participate in a number of different college-specific activities that are hoped to produce a more engaging, rigorous, and enriching experience for students and faculty alike

Career Choice↗

PubMed1998

[Berlin-Brandenburg-Saxony Rehabilitation Research Group].

The principal subject of the Rehabilitation Research Network of Berlin, Brandenburg and Saxony (BBS) is "the theoretical and practical bases of the organisation and economics of rehabilitation". What is involved is a nation-wide analysis of the rehabilitation system, i.e. obtaining empirical information on the question as to what organisational forms are currently used to carry out rehabilitation and what results are achieved. This empirical stocktaking also includes economic aspects as far as possible. This study is to serve as a basis for developing, testing and implementing steps to rationalise steering mechanisms in the rehabilitation system. The first aspect to be studied is "national steering problems in institutionalised forms of rehabilitation". The focus is on projects on information management and performance and quality management in rehabilitation sciences as well as on the actual work of a number of bodies paying for rehabilitation (Bundesversicherungsanstalt für Angestellte, Landesversicherungsanstalten) as well as rehabilitation facilities (clinics etc.). The two other focuses of the study will examine "rehabilitative adjustment to remedies and technical aids/prostheses" and problems facing "family members in the context of rehabilitation". In studying these two areas, we are particularly interested in examining the interaction between institutionalised aspect of rehabilitation and informal factors both inside and outside the system. The BBS approach is supported by close co-operation with the regional pension insurance institutes (BfA, LVAs) with regard to both the data model and steps being taken. The principal instrument of co-operation is the "Gesellschaft für Rehabilitationswissenschaften e.V." (Society for Rehabilitation Sciences). In Berlin the BBS co-operates with Free University, the Technical University and the Robert Koch Institute and in Saxony with the universities in Dresden and Leipzig. Responsibility for scientific questions in the BBS lies with the Institute for Rehabilitation Sciences of Berlin's Humboldt University.

Cost-Benefit Analysis↗

PubMed1996

Nazism and nursing: a comment on relevance.

This paper suggest that it is crucial at the present time to look back and consider the role of nurses and the health-care system in the development of Nazi Germany. The paper points out that medical involvement in the Holocaust was extensive and underwritten by the subversion of science to political ends. Evidence is amassed which points to dangerous trends in the conduct of contemporary medicine and to the continuing capacity for institutionally endorsed abuses of human rights. It is suggested that nursing examine its role in the implementation of Nazi policies, so that its continuing susceptibility to political subversion can be recognised, evaluated and neutralised.

Germany↗

PubMed2005

Standards for Hospital Libraries 2002 with 2004 revisions.

The Medical Library Association's Standards for Hospital Libraries 2002 has been developed as a guide for hospital administrators, librarians, and accrediting bodies to ensure that hospitals have the resources and services to effectively meet their needs for knowledge-based information. Specific requirements for knowledge-based information include that the library be a separate department with its own budget. Knowledge-based information in the library should be directed by a qualified librarian who functions as a department head and is a member of the Academy of Health Information Professionals. The standards define the role of the medical librarian and the links between knowledge-based information and other functions such as patient care, patient education, performance improvement, and education. In addition, the standards address the development and implementation of the knowledge-based information needs assessment and plan, the promotion and publicity of the KBI services, and the physical space and staffing requirements. The role, qualifications, and functions of a hospital library consultant are outlined. The health sciences library is positioned to play a key role in the hospital. The increasing use of the Internet and new information technologies by medical, nursing, and allied health staffs, patients and the community require new strategies, strategic planning, allocation of adequate resources, and selection and evaluation of appropriate information resources and technologies. The Hospital Library Standards Committee has developed this document as a guideline to be used in facing these challenges together.

Guidelines as Topic↗

PubMed2006

[The history of medicine and pharmacy in "Kwartalnik Historii Nauki i Techniki" in the years 1956-2005].

The publications in "Kwartalnik Historii Nauki i Techniki" in the years 1956-2005 reflected the state of Polish history of medicine and pharmacy. After the thaw of 1956, a positivist (physician-oriented) current prevailed in such publications, and that tendency grew even stronger in the 1980s. Marxist attempts at writing the history of medicine never gained a dominant position, and a gradual disppearance of that convention could observed from the 1970s onwards. Since 1993, representatives of the antipositivist (humanist) current began to publish in the quarterly, encouraged by a conducive atmosphere in the Institute of the History of Science of the Polish Academy of Sciences. The history of pharmacy, which at first was present in only negligible quantities among the quarterly's publications, began to make its presence felt since the middle of the 1960s. Historians of pharmacy were never engaged in methodological discourse, implementing their own research programmes. The quarterly was held in highly esteemed by the large and institutionalized milieu of historians of medicine, even though other journals also published studies in the history of medicine and pharmacy. The Editorial Board of the quarterly always took care that the articles and materials should be based on sources and represented high standards of quality; the Board was also open to contributions by representatives of other disciplines and to new trends in the history of medicine. Although the existing restrictions have reduced the number of potential contributors to the quarterly who could meet the criteria adopted by the Editorial Board, "Kwartalnik Historii Nauki i Techniki" has, in its fifty years of existence, served as a useful platform for the exchange of scholarly views, for the emergence of new research currents and programmes, and for information on new scienticic publications and events.

History of Pharmacy↗

PubMed2002

A conceptual framework for achieving performance enhancing drug compliance in sport.

There has been, and continues to be, widespread international concern about athletes' use of banned performance enhancing drugs (PEDs). This concern culminated in the formation of the World Anti-Doping Agency (WADA) in November 1999. To date, the main focus on controlling the use of PEDs has been on testing athletes and the development of tests to detect usage. Although athletes' beliefs and values are known to influence whether or not an athlete will use drugs, little is known about athletes' beliefs and attitudes, and the limited empirical literature shows little use of behavioural science frameworks to guide research methodology, results interpretation, and intervention implications. Mindful of this in preparing its anti-doping strategy for the 2000 Olympics, the Australian Sports Drug Agency (ASDA) in 1997 commissioned a study to assess the extent to which models of attitude-behaviour change in the public health/injury prevention literature had useful implications for compliance campaigns in the sport drug area. A preliminary compliance model was developed from three behavioural science frameworks: social cognition models; threat (or fear) appeals; and instrumental and normative approaches. A subsequent review of the performance enhancing drug literature confirmed that the overall framework was consistent with known empirical data, and therefore had at least face validity if not construct validity. The overall model showed six major inputs to an athlete's attitudes and intentions with respect to performance enhancing drug usage: personality factors, threat appraisal, benefit appraisal, reference group influences, personal morality and legitimacy. The model demonstrated that a comprehensive, fully integrated programme is necessary for maximal effect, and provides anti-doping agencies with a structured framework for strategic planning and implementing interventions. Programmes can be developed in each of the six major areas, with allocation of resources to each area based on needs-assessment research with athletes and other relevant groups.

Australia↗

PubMedDate not supplied

Patient safety, elephants, chickens, and mosquitoes.

Five years after the landmark report by the Institute of Medicine, To Err is Human (2000), many of us still grapple with making care safer for patients. This article broadly describes how patient safety fits into the picture of quality, concepts in patient safety, and practical safety processes you can implement today.

Attitude of Health Personnel↗

PubMedDate not supplied

[Clinical nutrition training in medical schools of Mexico].

OBJECTIVE: To describe the efforts carried out to strengthen nutrition education in Mexican medical schools. Emphasis was placed on the status previous to the program implementation, the design of a new basic curriculum, and the description of the main program strategies implemented. METHODS: a) Analysis of available medical curricula; b) Application of a questionnaire to the school deans; c) Assessment of knowledge of nutrition of advanced medical students; d) Design of a basic curriculum of clinical nutrition; e) Edition of a textbook; f) Design and implementation of program strategies to strengthen nutrition education. RESULTS: Clinical nutrition was not a topic included in most curricula analyzed and, when present, it was incorporated to related clinical subjects. Usually, emphasis was placed on basic topics of nutrition while clinical and applied subjects were considered less frequently. Lack of a specialized faculty and weakness of teaching infrastructure were some problems identified. A basic curriculum adaptable to different contexts was designed, and a textbook on clinical nutrition was edited and published. Training and formation of nutrition specialists were among the key programs implemented.

Adult↗

PubMed1991

Strategic planning: a biomedical communications model.

This article describes a biomedical communications approach to strategic planning. This model produces a short-term plan that allows a department to take the competitive advantage, react to technological change, and make timely decisions on new courses of action. The model calls for self-study, involving staff in brainstorming sessions where options are identified and ideas are prioritized into possible strategies for success. The article recommends that an evaluation and monitoring schedule be implemented after decisions have been made.

Communication↗

PubMed1979

The development of consensus standards for medical devices in Canada.

The Canadian Standards Association Health Care Technology Program is a new, innovative program initiated by the Canadian Standards Association four years ago in response to the great increase in technology which has innundated our health care facilities. The goal of the program is to develop consensus standards in the medical engineering field and to help in implementing those standards across Canada through education, input to professional societies, and input to provincial or federal legislation.

Canada↗

PubMed2001

Julius Hallervorden's wartime activities: implications for science under dictatorship.

The eponym Hallervorden-Spatz syndrome recalls Julius Hallervorden's and Hugo Spatz's original description of this pediatric neurodegenerative disorder. Julius Hallervorden's important contribution to the practice of neuropathology over a long career cannot be underestimated. However, his work as a pathologist during the Third Reich put him in close proximity with the implementation of biologic solutions (i.e., euthanasia) targeting those individuals with significant intellectual or physical disabilities in chronic-care facilities. The Nazi program of active euthanasia provided a scientific opportunity to gain quick access to pathologic materials. This opportunity was recognized and used by Hallervorden to achieve personal scientific objectives and research efforts. These efforts resulted in a number of postwar scientific publications using materials obtained through the euthanasia program. The participation of distinguished academic physicians in such a program provides a cautionary tale of the potential results of ethical compromise and the effects of the abrogation of personal autonomy in the setting of a totalitarian dictatorship.

Autopsy↗

PubMed2006

NICHD research initiative in newborn screening.

Recent changes in genetics research have created new opportunities to improve the scope and quality of newborn screening services. Changes in newborn screening should be supported and directed by an organized program of research. The NICHD Research Initiative in Newborn Screening includes the development of systematic methods to identify additional conditions appropriate for newborn screening; development and testing innovative interventions and treatments to improve outcomes; education of the provider workforce; development and implementation of appropriate information and communication systems for parents and providers; and, sponsoring an ongoing program of research and research training. Future needs will include the development of a national translational research infrastructure, prevention research and research into behavioral and social sciences issues. The NICHD Research Initiative in Newborn Screening is expected to be an ongoing and vital initiative that adapts itself to new scientific findings, technological developments, changes in the public and personal health care system, and our evolving understanding of the needs of affected individuals, families and the community.

Diffusion of Innovation↗