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At least 1,261 records · Page 70Linked to original sources

PubMed2004

[Responsibility of the anaesthetist in preoperative risk management. Comments on the legal implications of medical publications in this field].

There is an increasing number of publications in the medical literature which address the medical and legal obligations of a specialist in a given field. These articles, mostly editorials, seek to delineate the optimal course of treatment based on the current state of the art and science of medicine. However, we believe that the unreflected adoption of these often highly theoretical ideas and suggestions carries its own dangers. For one thing, there is the threatening financial crisis in the public health system. In addition, the feasibility of implementing these suggestions in routine medical and surgical practice is questionable. Last but not least, suggestions and guidelines for preoperative risk management by, for instance, Lingnau and Strohmenger 2002 cross the well established boundaries of the various medical and surgical specialties, which obviously demands careful deliberations among the specialties involved. So far, few specialty boards have seen fit to act on these suggestions. Our article on the medical and legal responsibilities of the anaesthesiologist in perioperative risk management restates the aforementioned concerns. We attempt to point out medical and legal points of controversy. In particular, we caution against the ever present danger of a bona fide adoption of visionary guidelines as the "standard of care" by both medical and legal experts. We feel that it is imperative to carefully evaluate editorial comments and suggestions, however well meaning, in the light of established teaching and practice, lest these comments and suggestions become the basis of an unjustified determination of a physicians innocence or guilt in a court of law.

Anesthesiology↗

PubMed2005

The use of observational diaries in in-training evaluation: student perceptions.

INTRODUCTION: In health science education clinical clerkships serve the twofold purpose of guiding student learning and assessment of performance. Evidently, both formative and summative assessment procedures are needed in clerkship assessment. In-training evaluation (ITE) has the potential to serve both assessment functions. Implementation of effective ITE, however, has been shown to be problematic, partly because integration of assessment functions may have negative consequences for teaching and learning. This study investigates student perceptions of the impact of an integrated assessment approach, seeking to refine criteria for effective ITE. METHOD: In the curriculum of Maastricht Midwifery School (MMS), clerkship assessment is based on ITE serving both assessment functions. The ITE model is based on principles of extensive work sampling, and frequent documentation of performance. A focus group technique was used to explore student perceptions on the impact of the ITE approach on student learning and supervisor teaching behaviour, and on the usefulness of information for decision making. RESULTS: Results indicate that the assessment approach is effective in guidance of student learning. Furthermore, students consider the frequent performance documentation essential in clerkship grading. Acceptance and effectivity of ITE requires a learning environment which is safe and respectful. Transparency of assessment processes is the key to success. Suggestions for improvement focus on variation in evaluation formats, improvement of feedback (narrative, complete) and student involvement in assessment. CONCLUSION: ITE can fulfill both its formative and summative purposes when some crucial conditions are taken into account. Careful training of both supervisors and students in the use of ITE for student learning and performance measurement is essential.

Curriculum↗

PubMed2006

Membrane computing: brief introduction, recent results and applications.

The internal organization and functioning of living cells, as well as their cooperation in tissues and higher order structures, can be a rich source of inspiration for computer science, not fully exploited at the present date. Membrane computing is an answer to this challenge, well developed at the theoretical (mathematical and computability theory) level, already having several applications (via usual computers), but without having yet a bio-lab implementation. After briefly discussing some general issues related to natural computing, this paper provides an informal introduction to membrane computing, focused on the main ideas, the main classes of results and of applications. Then, three recent achievements, of three different types, are briefly presented, with emphasis on the usefulness of membrane computing as a framework for devising models of interest for biological and medical research.

Algorithms↗

PubMed1998

Quantitative modeling of stochastic systems in molecular biology by using stochastic Petri nets.

An integrated understanding of molecular and developmental biology must consider the large number of molecular species involved and the low concentrations of many species in vivo. Quantitative stochastic models of molecular interaction networks can be expressed as stochastic Petri nets (SPNs), a mathematical formalism developed in computer science. Existing software can be used to define molecular interaction networks as SPNs and solve such models for the probability distributions of molecular species. This approach allows biologists to focus on the content of models and their interpretation, rather than their implementation. The standardized format of SPNs also facilitates the replication, extension, and transfer of models between researchers. A simple chemical system is presented to demonstrate the link between stochastic models of molecular interactions and SPNs. The approach is illustrated with examples of models of genetic and biochemical phenomena where the ULTRASAN package is used to present results from numerical analysis and the outcome of simulations.

Animals↗

PubMed2003

caCORE: a common infrastructure for cancer informatics.

MOTIVATION: Sites with substantive bioinformatics operations are challenged to build data processing and delivery infrastructure that provides reliable access and enables data integration. Locally generated data must be processed and stored such that relationships to external data sources can be presented. Consistency and comparability across data sets requires annotation with controlled vocabularies and, further, metadata standards for data representation. Programmatic access to the processed data should be supported to ensure the maximum possible value is extracted. Confronted with these challenges at the National Cancer Institute Center for Bioinformatics, we decided to develop a robust infrastructure for data management and integration that supports advanced biomedical applications. RESULTS: We have developed an interconnected set of software and services called caCORE. Enterprise Vocabulary Services (EVS) provide controlled vocabulary, dictionary and thesaurus services. The Cancer Data Standards Repository (caDSR) provides a metadata registry for common data elements. Cancer Bioinformatics Infrastructure Objects (caBIO) implements an object-oriented model of the biomedical domain and provides Java, Simple Object Access Protocol and HTTP-XML application programming interfaces. caCORE has been used to develop scientific applications that bring together data from distinct genomic and clinical science sources. AVAILABILITY: caCORE downloads and web interfaces can be accessed from links on the caCORE web site (http://ncicb.nci.nih.gov/core). caBIO software is distributed under an open source license that permits unrestricted academic and commercial use. Vocabulary and metadata content in the EVS and caDSR, respectively, is similarly unrestricted, and is available through web applications and FTP downloads. SUPPLEMENTARY INFORMATION: http://ncicb.nci.nih.gov/core/publications contains links to the caBIO 1.0 class diagram and the caCORE 1.0 Technical Guide, which provide detailed information on the present caCORE architecture, data sources and APIs. Updated information appears on a regular basis on the caCORE web site (http://ncicb.nci.nih.gov/core).

Animals↗

PubMed1987

Teaching medical ethics symposium. Reflections from New Zealand.

The Medical Faculty of the University of Otago, New Zealand is experimenting with a new approach to the teaching of medical ethics, making it an integral part of several courses in all years of the medical curriculum. During the author's twelve-month period as a visiting professor in the faculty, trial runs in ethics have been introduced in the preclinical sciences, in behavioural science and medical-decision analysis and in every clinical attachment. Proposals for permanent course requirements will be considered by the faculty after a full evaluation of these experiments by both students and teaching staff. If such courses are to be implemented and maintained, medical facilities will need to appoint specialists in ethics, at least on a part-time basis.

Curriculum↗

PubMed1987

Radiology and the Health Policy Agenda for the American People.

Eleven radiologists appointed by the major radiological societies participated for the past 5 years in the development of the Health Policy Agenda for the American People. The Agenda is an action plan to address a wide variety of serious problems in medicine. The first phase involved establishment of 159 principles, broad value statements that were the foundation of the project. Phase 2 involved the development of policy proposals on 38 urgent issues for action in medical science; education; health resources; delivery mechanisms; evaluation, assessment, and control; and payment for services. These proposals are summarized in this report. The activities and recommendations of representatives for the field of radiology are described. The Agenda has been released, and an implementation phase has begun. It will likely be of great importance to the practice of radiology over the next decade. Important issues can be addressed by acting with the coalitions that are being formed from among the more than 150 participating organizations.

American Medical Association↗

PubMedDate not supplied

Communication of the three Rs within establishments: some problems and solutions. Report of a LASA Alternatives Section meeting. Laboratory Animal Science Association.

A meeting was organised by the Laboratory Animal Science Association (LASA) Alternatives Section to provide a forum in which ideas for strategies to raise awareness of the Three Rs could be discussed. One of the main objectives of the meeting was to identify effective strategies which could feasibly be implemented at establishments. In general, there are two main ways in which Three Rs information can be obtained and communicated. Individuals can be assigned to a role with specific responsibilities (for example, a named alternatives expert), or committees can be established, with a remit to find ways to reduce, refine and/or replace animal use (for example, an alternatives committee). The meeting involved invited speakers who are engaged in obtaining and communicating Three Rs information, and this report presents a summary of the advantages and limitations of various approaches that are being undertaken.

Animal Testing Alternatives↗

PubMed2003

Service learning in the medical curriculum: developing and evaluating an elective experience.

BACKGROUND: Medical educators are seeking ways to nurture the service commitments of their medical students while promoting interactions with the communities they serve. Service learning is a pedagogy that links community service with academic experience. DESCRIPTION: The University of Kentucky College of Medicine has developed and implemented an experiential service learning elective. The elective is based in local community agencies where small groups of students perform an asset-needs assessment and design a service project based on their findings. The elective is linked to a behavioral science course that provides accompanying biopsychosocial instruction. EVALUATION: Over the 2-year project period, we used multiple methods (i.e., surveys, interviews, reflection questionnaires, evaluations of student performance, and course evaluations) to gather information on the motivations, observations, and assessments of students, faculty preceptors, and community agency partners. CONCLUSION: Linking a service learning elective to a pre-existing course worked well, achieved its objectives, and will be continued

Community Health Planning↗

PubMed2006

Teaching and practicing pharmacogenomics: a complex matter.

This opinion is a reply to the following article: Flordellis CS: The emergence of a new paradigm of pharmacogenomics. Pharmacogenomics 6(5), 515-526 (2005). Systems biology is likely to become a leading paradigm in molecular biology in coming decades. In pharmacogenomics, complexity is rapidly increasing as more genomics and proteomics data become available. Tackling this complexity by employing a systems approach seems to be a promising strategy. The introduction of this new paradigm will reshape both professional education and clinical practice. Professionals in medicine and the life sciences must be prepared to adapt to this new approach. However, systems-based pharmacogenomics is unlikely to be ready for clinical application in near future. In order to benefit patients today, the already available options of pharmacogenomics should be carefully implemented in clinical practice as soon as possible. Teaching the current, continuously updated knowledge of pharmacogenomics should not be postponed until the new paradigm arrives.

Humans↗

PubMed1999

[Basic components in the development of research proposals in health sciences].

Any investigation in the health sciences should have a plan or proposal to answer a specific research question. This document, designed for persons preparing for or already pursuing a research project, describes the conceptual framework related with a research proposal, from the study design until its implementation. The objective of this document is to summarize different theoretical aspects that should be considered in a research project, including pertinent references that might be used to deepen the discussion. First, a series of definitions related to the scientific method are presented and then the processes to carry out a research proposal including common epidemiologic designs are illustrated. In addition, a series of research questions that can serve as a guide to perform a critical analysis of published papers are included. Finally, an interdisciplinary group integrated by health professionals with the clinical expertise and health professionals with the necessary skills in biostatistics and epidemiology to undertake a sound scientific research is recommended.

Case-Control Studies↗

PubMed2001

The South African National Non-Natural Mortality Surveillance System--rationale, pilot results and evaluation.

BACKGROUND: While individual mortuaries have recorded data for non-natural deaths in time-limited studies, there have been no systematic efforts to draw forensic-medical services and state mortuaries into a nationwide fatal injury surveillance system. Beginning in June 1998, the National Non-Natural Mortality Surveillance System (NMSS) commenced pilot operation. OBJECTIVE: To evaluate the NMSS and illustrate its utility from sample findings. DESIGN: Data entered into the system by mortuary staff were checked against a random sample of cases for which separate forms were completed by an independent researcher. Process observations and follow-up with data users were used to assess the system's acceptability, timeliness and data usefulness. SETTING: Eighteen mortuaries in six provinces representing approximately 35,000 cases per year, or around 50% of all non-natural deaths. PARTICIPANTS: The National Departments of Health; Safety and Security; and Arts, Culture, Science and Technology; national and provincial forensic medico-legal services; the South African Police Services; universities and science research councils. MAIN OUTCOME MEASURES: Surveillance system simplicity, flexibility, acceptability, sensitivity, positive predictive value, representativeness, timeliness, data usefulness and resources. RESULTS: The NMSS was established at 10 target sites. Lack of equipment, personnel resistance, and closure of some mortuaries prevented implementation in the remaining eight mortuaries. Sensitivity was internally assessed and ranged from 65% to 95% for manner of death. Positive predictive value was also internally measured, and ranged from 74% to 80% for manner of death and from 71% to 82% for mechanism of death. Timeliness was good, and basic reports covering most items were available 6 weeks after a case had been examined. While staff found the system simple, acceptability depended on the individuals involved at different mortuaries, and the system was compromised to some extent by bureaucratic barriers. End users found the data to be of great value. NMSS set-up costs totalled approximately R26,000 per mortuary, and it is estimated that maintenance costs will be R8.00 per case registered. CONCLUSIONS: With minimal resources, the NMSS uses existing investigative procedures to describe and report the epidemiology of fatal injuries. The pilot study demonstrates the feasibility of the system, and identifies the need to remove organisational constraints and individual barriers if it is to be sustained and expanded beyond the pilot sites.

Accidents↗

PubMed2001

Effects of a weaning protocol on ventilated pediatric intensive care unit (PICU) patients.

As part of a learning collaborative sponsored by the Center for the Evaluative Clinical Sciences (CECS) at Dartmouth College, a multidisciplinary pediatric intensive care unit (PICU) group began meeting in 1997 to evaluate potential performance improvement (PI) opportunities. A reduction in mechanical ventilation (MV) hours was the initial team focus. The multidisciplinary team developed and implemented protocols and physician order sets outlining care for MV weaning, neuromuscular blockade/therapeutic paralyzation, and enteral feedings. Since the initiation of our protocols in July 1997, we have significantly reduced the number of hours our PICU patients receive MV.

Algorithms↗

PubMed2003

The guideline approach to chronic obstructive pulmonary disease: how effective?

Clinical practice guidelines are systematically developed to assist health care decisions in specific clinical circumstances. They first arose to improve quality of care by decreasing unexplained practice variation, controlling health care costs, fostering evidence-based decision-making, and accelerating the application of new advances in medical science to everyday practice. Unfortunately, multiple studies demonstrate incomplete and varied effectiveness of clinical practice guidelines in altering clinician behavior and improving patient outcomes. Efforts to enhance guideline effectiveness have focused on improving the methods for guideline development, diffusion, dissemination, and implementation. Despite evidence of limited effectiveness, more than 40 clinical practice guidelines pertaining to chronic obstructive pulmonary disease have been published since 1985. The present article reviews those guidelines, evidence for their effectiveness, and approaches to improve their implementation.

Attitude of Health Personnel↗

PubMed2004

Telelearning standards and their application in medical education.

Medial education, both on the graduate and postgraduate levels, has become a real challenge nowadays. The volume of information in medical sciences grows so rapidly that many health professionals experience essential problems in keeping track of the state of the art in this domain. e-learning offers important advantages to medical education continuation due to its universal availability and opportunity for implementation of flexible patterns of training. An important trace of medical education is developing practical skills. Some examples of standardization efforts include: the CEN/ISSS Workshop on Learning Technology (WSLT), the Advanced Learning Infrastructure Consortium (ALIC), Education Network Australia (EdNA) and PROmoting Multimedia access to Education and Training in European Society (PROMETEUS). Sun Microsystems' support (Sun ONE, iPlanetTM ) for many of the above-mentioned standards is described as well. Development of a medical digital video library with recordings of invasive procedures incorporating additional information and commentary may improve the efficiency of the training process in interventional medicine. A digital video library enabling access to videos of interventional procedures performed in the area of thoracic medicine may be a valuable element for developing practical skills. The library has been filled with video resources recorded at the Department of Interventional Pulmonology; it enhances training options for pulmonologists and thoracic surgeons. The main focus was put on demonstration of bronchofiberoscopic and videothoracoscopic procedures. The opportunity to browse video recordings of procedures performed in the specific field also considerably enhances the options for training in other medical specialties. In the era of growing health consumer awareness, patients are also perceived as the target audience for medical digital libraries. As a case study of Computer-Based Training systems, the Medical Digital Video Library is presented.

Education, Distance↗

PubMedDate not supplied

Moving the New York State Research Agenda forward: the stakeholder is you!

Health care is more diverse than it has ever been. The point of care can be rural or urban, inpatient or outpatient, individual or community-focused. In this challenging, ever-changing environment, it is critical for nurses to have access to nursing research on the best way to provide care. The New York State Nursing Research Agenda was launched in 2001 as an ongoing action plan to facilitate the conduct, dissemination, and utilization of nursing research in New York. This article describes several initiatives that have been launched to implement that plan. Strategies for local and regional initiatives are outlined. Key to the success of these initiatives is the involvement of nurses at all levels of practice and in all healthcare arenas. All nurses are stakeholders because this is our science and our profession.

Credentialing↗

PubMed1981

Shaping the mental health role of family physicians.

Family physicians have an important role in mental health care delivery. The psychiatry and family practice faculty at the University of Alabama College of Community Health Sciences recently examined the principal elements of this role and the ways in which these elements might best be incorporated into the teaching/learning process of a family medicine residency. Competency based approaches to curriculum development were chosen to permit flexibility of implementation and to allow involved physicians to participate in definition of their mental health roles. Methods used to construct the curriculum included interviews with graduated residents of the first four classes of the program, literature review, and a modified delphi/nominal group technique with family medicine and psychiatry faculty. The result was a competency based psychiatric curriculum supervised cooperatively by both psychiatry and family medicine faculty. This program is begun early in the residency, is integrated longitudinally into the rest of the residents' curriculum, and utilizes seminars, clinical experience, and liaison with a mental health team in the training design.

Alabama↗

PubMed1996

The behavioral flow sheet. A tool for the primary care provider.

Behavioral flow sheets are tools that can be used outside the domain of mental health. For the knowledgeable health care provider in any setting, they render a cost-effective, noninvasive mechanism for diagnosis and management of a variety of patient problems of organic as well as behavioral natures. Though there exists an assortment of standardized formats, flow-sheet design can be tailored to address the unique circumstances of each patient. They provide an avenue for actively involving patients and families in problem assessment as well as in the planning and evaluation of treatment regimens. In addition, flow sheets provide a feedback mechanism that can enhance patient/family self-esteem and increase the likelihood of adherence to treatment recommendations. There is both an art and a science to their design and use, but the skills involved are readily acquired by any interested practitioner. The conscientious professional will become acquainted with the potential pitfalls and thus avoid irresponsible or unethical application. The authors provide guidelines for developing and implementing flow sheets and illustrate their value through the sharing of several clinical vignettes.

Behavior↗