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PubMed2000

Getting nutrition education into medical schools: a computer-based approach.

Despite awareness of the importance of nutrition as part of medical student's education, numerous barriers exist to incorporating nutrition education into the medical school curriculum. Chief among such barriers is that most medical schools do not have faculty trained specifically in nutrition. A curriculum is needed that can deliver comprehensive nutrition information that is consistent across medical schools. One way to deliver this information is to use computer-assisted instruction (CAI). To meet the different needs of medical schools and provide a consistent base of nutrition information, we developed a series of interactive, multimedia educational programs (Nutrition in Medicine) that teach the basic principles of nutritional science and apply those principles in a case-oriented approach. Curriculum content is derived from the American Society for Clinical Nutrition consensus guidelines. These modules offer the advantages of accessibility, self-paced study, interactivity, immediate feedback, and tracking of student performance. Modules are distributed free to all US medical schools. Preliminary data from surveys gathered by our team at the University of North Carolina at Chapel Hill indicate that 73 US medical schools use, or are planning to use, these modules; more schools are currently evaluating the programs. Successful implementation of CAI requires easy program access, faculty training, adequate technical support, and faculty commitment to the programs as a valuable resource. CAI fails when the program is just placed in the library and students are told to use it when they can find the time.

Computer-Assisted Instruction↗

PubMed2004

Reaching low-income families: Focus group results provide direction for a behavioral approach to WIC services.

Supplemental Nutrition Program for Women, Infants, and Children (WIC) families were asked to identify motivators and barriers to health behavior change and preferred approaches to nutrition education in WIC. Six focus groups involved a total of 41 English-speaking WIC participants and addressed parenting, family meals, food preparation, and physical activity. The discussions were audiotaped, transcribed, and analyzed using NUD*IST software (Non-Numerical Unstructured Data Indexing, Searching, and Theorizing, version 4.0. Thousand Oaks, CA: Sage Publications Software, 1997). Key barriers to behavior change included inadequate parenting skills, lack of knowledge, unhealthy social environments, lack of time, and lack of social or financial support. Key motivators included feelings of responsibility, concern for child health and development, and positive social support. Participants identified facilitated discussions, support groups, cooking classes, and a WIC Web site as preferred methods of nutrition education. Results provided the foundation for the Healthy Habits nutrition education modules implemented in the Washington State WIC program and can be used to improve future nutrition education in WIC.

Adolescent↗

PubMed2000

Prospects for genetic therapy of cardiovascular disease.

Significant progress has been made in cardiovascular gene therapy. Further investigations are required to understand the basic science of vectors, mechanisms of gene delivery, vector-associated immunogenicity, and pathophysiology of vascular and myocardial diseases. In addition, catheter and stent devices will be required to deliver vectors to the vasculature and myocardium (Fig. 3). Despite these scientific challenges, molecular therapies for cardiovascular diseases are being implemented into clinical practice.

Animals↗

PubMed2002

Distributed structure-searchable toxicity (DSSTox) public database network: a proposal.

The ability to assess the potential genotoxicity, carcinogenicity, or other toxicity of pharmaceutical or industrial chemicals based on chemical structure information is a highly coveted and shared goal of varied academic, commercial, and government regulatory groups. These diverse interests often employ different approaches and have different criteria and use for toxicity assessments, but they share a need for unrestricted access to existing public toxicity data linked with chemical structure information. Currently, there exists no central repository of toxicity information, commercial or public, that adequately meets the data requirements for flexible analogue searching, Structure-Activity Relationship (SAR) model development, or building of chemical relational databases (CRD). The distributed structure-searchable toxicity (DSSTox) public database network is being proposed as a community-supported, web-based effort to address these shared needs of the SAR and toxicology communities. The DSSTox project has the following major elements: (1) to adopt and encourage the use of a common standard file format (structure data file (SDF)) for public toxicity databases that includes chemical structure, text and property information, and that can easily be imported into available CRD applications; (2) to implement a distributed source approach, managed by a DSSTox Central Website, that will enable decentralized, free public access to structure-toxicity data files, and that will effectively link knowledgeable toxicity data sources with potential users of these data from other disciplines (such as chemistry, modeling, and computer science); and (3) to engage public/commercial/academic/industry groups in contributing to and expanding this community-wide, public data sharing and distribution effort. The DSSTox project's overall aims are to effect the closer association of chemical structure information with existing toxicity data, and to promote and facilitate structure-based exploration of these data within a common chemistry-based framework that spans toxicological disciplines.

Carcinogens↗

PubMed2004

Designing and executing scientific workflows with a programmable integrator.

MOTIVATION: As in many other fields of science, computational methods in molecular biology need to intersperse information access and algorithm execution in a computational workflow. Users often find difficulties when transferring data between data sources and applications. In most cases there is no standard solution for workflow design and execution and tailored scripting mechanisms are implemented in a case by case basis. RESULTS: In this paper, we present a general purpose 'programmable integrator' that can access information from a variety of sources in a coordinated manner. Its usefulness in complex bioinformatics applications is claimed and supported by some application examples. AVAILABILITY: Tools are freely available to non-profit educations and research institutions. Usage by commercial organizations requires a license agreement. Software requirements: Java v1.3 (http://java.sun.com), Xerces XML Parser (http://xml.apache.org/xerces-j) and Kweelt implementation of XQuery (http://kweelt.sourceforge.net/).

Algorithms↗

PubMed1998

How best to measure implementation of school health curricula: a comparison of three measures.

The impact of school health education programs is often attenuated by inadequate teacher implementation. Using data from a school-based nutrition education program delivered in a sample of fifth graders, this study examines the discriminant and predictive validity of three measures of curriculum implementation: class-room observation of fidelity, and two measures of completeness, teacher self-report questionnaire and post-implementation interview. A fourth measure, obtained during teacher observations, that assessed student and teacher interaction and student receptivity to the curriculum (labeled Rapport) was also obtained. Predictive validity was determined by examining the association of implementation measures with three study outcomes; health knowledge, asking behaviors related to fruit and vegetables, and fruit and vegetable intake, assessed by 7-day diary. Of the 37 teachers observed, 21 were observed for two sessions and 16 were observed once. Implementation measures were moderately correlated, an indication of discriminant validity. Predictive validity analyses indicated that the observed fidelity, Rapport and interview measures were significantly correlated with post-test student knowledge. The association between health knowledge and observed fidelity (based on dual observation only), Rapport and interview measures remained significant after adjustment for pre-test knowledge values. None of the implementation variables were significantly associated with student fruit and vegetable intake or asking behaviors controlling for pre-test values. These results indicate that the teacher self-report questionnaire was not a valid measure of implementation completeness in this study. Post-implementation completeness interviews and dual observations of fidelity and Rapport appear to be more valid, and largely independent methods of implementation assessment.

Child↗

PubMedDate not supplied

A qualitative tool for critical thinking skill development.

Quantitative measures were not meeting the needs of faculty for evaluating critical thinking among Baccalaureate of Science Nursing students. The authors discuss the critical thinking self-reflection tool that was developed for teaching critical thinking and qualitatively evaluating changes over time with established interrater reliability and content validity. The tool is consistent with the concepts of critical thinking in the curriculum and was implemented systematically in all clinical nursing courses.

Education, Nursing, Baccalaureate↗

PubMedDate not supplied

The relationship between computer testing during a nursing program and NCLEX performance.

Computerized testing for the National Council Licensure Examination (NCLEX) became available in April 1994. In an effort to assist students in becoming more comfortable with taking the licensure examination by computer, faculty in the author's school of nursing initiated computer-based testing in selected nursing courses. This article reports the results from 7 years of data on the relation between computer-based testing during a Bachelor of Science in Nursing program and subsequent performance on the NCLEX examination. Student cohort pass rates on the NCLEX for the 4 years before the administration of course computer-based testing were compared with those for the 3 years after the course computer-based testing strategy was implemented. The results show no significant differences in NCLEX pass rates between the students who were exposed to computer-based testing in their nursing program and those who were not exposed. The implications of these findings are discussed.

Computers↗

PubMed1996

Improvement in lung function measurements using a flow spirometer that emphasizes computer assessment of test quality.

We compared retrospective measurements of lung function from 101 steel workers using a commercially available spirometer to prospective lung function measurements performed, on average, 1.3 years later, with a newly developed spirometer. This spirometer was designed and developed to incorporate technology that provides immediate feedback on the quantitative and qualitative aspects of each forced expiratory effort. Of the 101 workers, 82 who had spirometry performed with each spirometer had at least two acceptable curves, and 51 workers tested with each spirometer had curves that met all American Thoracic Society (ATS) criteria for spirometry. No group showed the anticipated decline in forced expiratory volume in 1 second (FEV1) over time. The results showed an increased number of curves meeting ATS acceptability and reproducibility criteria, and a statistically significant increase in the FVC in all groups, and an increase in the FEV1 in the group encompassing all workers. Use of technology that strengthens the interaction between the spirometry technician, the data available to the technician on the computer, and the participant appears to represent true underlying lung function more accurately. Such an approach to the collection of lung function data should be considered by those evaluating spirometers for implementation in the workplace or pulmonary function laboratory as well as by those planning future spirometer development.

Humans↗

PubMed2006

Evidence-based medicine.

Evidence-based medicine (EBM) has become a watchword for "the new" medical practice in the new century. Whether it represents a paradigm shift or simply a codification of the scientific method in medicine will be debated for years to come. Regardless of the place of EBM in medicine, this "movement" has served an important role in moving physician practice into the realm of becoming more scientific (albeit empirical) and transparent. There are still many problems to be addressed in the global application of the best evidence for medical practice. These include low-quality studies, delays in implementation of clear-cut improvements, outright fraud and deceit, and wariness on the part of physicians to change their practice. By working to understand the underpinnings of EBM (basic statistical concepts and critical thinking) we can advance the practice of medicine along the moral high road of science.

Delivery of Health Care↗

PubMedDate not supplied

[Cyberspace and the negotiation of meaning: the social aspects of implementing digital communications networks in public health academic institutions].

This article analyzes social aspects in the incorporation of new information and communications technologies in public health academic institutions. To demarcate the study of these processes and demonstrate the close relationship between their social and technical aspects, the study employs concepts pertaining to "intellectual technologies" and a "critical theory of technology". Theoretical and methodological elements are identified to approach the implementation dynamics of electronic networks in public health institutions, through a discourse analysis of their social actors and the various meanings they attribute to such dynamics Considering discourse as an expression of the relations created during these implementation dynamics, the study seeks a proposal for the ways by which these relations might influence the social and technical dimensions of digital networks.

Computer Communication Networks↗

PubMedDate not supplied

[International review of health educational programs for nutrition in the elderly].

Progressive increase of the elderly may well explain the interest to educational programs at this age. Different chronic conditions such as cardiovascular diseases, diabetes and osteoporosis may be controlled and prevented by proper educational campaigns. In our review, the role of nutritional educational on quality of life has been evaluated, either in healthy subjects or in those with chronic disease. Evaluation tools and outcome index have been described. It is emphasized that applying specific projects may improve nutritional attitudes and lifestyle even in older adults. Proper educational intervention should be implemented, but socio-cultural characteristics of the target population should be taken into account.

Aged↗

PubMed1989

The recruitment and retention of minority and disadvantaged allied health students.

Student recruitment and retention has been given high priority over the last several years. The School of Allied Health Sciences at the University of Texas Medical Branch at Galveston has been involved in recruitment and retention programs that have produced minority student enrollment of over 20% over the past seven years. The programs are supported by federal grants that have provided seed money to design, develop, and implement three specific recruitment and retention programs. These programs have assisted in enrolling over 575 minority students with a retention rate above 90%. Graduation, licensure, and certification rates have been at or above the majority population. These programs are adaptable at other allied health professions schools and have been used as models for several programs across the United States.

Data Collection↗

PubMed2005

Metabolomics: building on a century of biochemistry to guide human health.

Medical diagnosis and treatment efficacy will improve significantly when a more personalized system for health assessment is implemented. This system will require diagnostics that provide sufficiently detailed information about the metabolic status of individuals such that assay results will be able to guide food, drug and lifestyle choices to maintain or improve distinct aspects of health without compromising others. Achieving this goal will use the new science of metabolomics - comprehensive metabolic profiling of individuals linked to the biological understanding of human integrative metabolism. Candidate technologies to accomplish this goal are largely available, yet they have not been brought into practice for this purpose. Metabolomic technologies must be sufficiently rapid, accurate and affordable to be routinely accessible to both healthy and acutely ill individuals. The use of metabolomic data to predict the health trajectories of individuals will require bioinformatic tools and quantitative reference databases. These databases containing metabolite profiles from the population must be built, stored and indexed according to metabolic and health status. Building and annotating these databases with the knowledge to predict how a specific metabolic pattern from an individual can be adjusted with diet, drugs and lifestyle to improve health represents a logical application of the biochemistry knowledge that the life sciences have produced over the past 100 years.

Journal Article↗

PubMed1993

A DYNAMO application of microcomputer-based simulation in health sciences teaching.

This paper presents a concrete application of microcomputer-based simulation in health sciences education. It shows a pharmacological system dynamics model representing graphics and numerical behaviour and relations between variables, which in addition allows interaction with students for experimentation. The work also illustrates a strategy for introducing this kind of model in the classroom, as well as the suitability of their implementation, in educational environments, using professional tools such as DYNAMO and DYNEX. Subsequent evaluation of the results and comments given by the students revealed more positive attitudes towards the discipline.

Computer Simulation↗

PubMed2001

Evaluating informatics applications--some alternative approaches: theory, social interactionism, and call for methodological pluralism.

A review of evaluation literature concerning CDSSs indicates that randomized controlled clinical trials (RCTs) are the 'gold standard' for evaluation. While this approach is excellent for studying system or clinical performance, it is not well suited to answering questions concerning whether systems will be used or how they will be used. Because lack of use of CDSS has been of concern for some years, other evaluation research designs are needed to address those issues. This paper critiques RCT and experimental evaluation approaches and presents alternative approaches to evaluation that address questions outside the scope of the usual RCT and experimental designs. A wide range of literature is summarized to illustrate the value of evaluations that take into account social, organizational, professional, and other contextual considerations. Many of these studies go beyond the usual measures of systems performance or physicians' behavior by focusing on 'fit' of the system with other aspects of professional and organizational life. Because there is little explicit theory that informs many evaluations, the paper then reviews CDSS evaluations informed by social science theories. Lastly, it proposes a theoretical social science base of social interactionism. An example of such an approach is given. It involves a CDSS in psychiatry and is based on Kaplan's 4Cs, which focus on communication, control, care, and context. Although the example is a CDSS, the evaluation approach also is useful for clinical guideline implementation and other medical informatics applications. Similarly, although the discussion is about social interactionism, the more important point is the need to broaden evaluation through a variety of methods and approaches that investigate social, cultural, organizational, cognitive, and other contextual concerns. Methodological pluralism and a variety of research questions can increase understanding of many influences concerning informatics applications development and deployment.

Attitude↗

PubMed1994

The problems with rule-based rationing.

Centralized, democratic rules are often asserted as a superior basis for rationing than individualized physician discretion. This article counters this prevailing wisdom by exploring the deficiencies of rule-based rationing. Rules are too imprecise to accurately reflect all the nuances of physical and mental impairment and the complexity of medical science, particularly considering the widely varying personal values that different patients attach to medical risk and benefit. Rule-based rationing also suffers from the biasing effects of interest group pressure on political processes and the tendency to absolve physicians from any moral responsibility for the rationing decisions they implement. Internalizing cost constraints is a more socially and professionally acceptable means of rationing and, in any event, it is inevitable since even a preponderance of rule-based rationing will leave considerable areas of discretion for physician judgment in the implementation and interpretation of the rules. As a consequence, despite the flaws of bedside rationing, it is foolhardy to dispense with it entirely in favor of an exclusively rule-based system.

Cultural Diversity↗

PubMed2006

Issues in weaning from mechanical ventilation: literature review.

AIM: The aim of this paper is to raise questions on the effect of skill mix and organizational structure on weaning from mechanical ventilation. BACKGROUND: Mechanical ventilation is an essential life-saving technology. There are, however, numerous associated complications that influence the morbidity and mortality of patients receiving intensive care. Therefore, it was essential to use the safest and most effective form of ventilation for the shortest possible duration. Because of the potential complications and costs of mechanical ventilation, research to date have focused on accurate weaning readiness assessment, methods and organizational aspects that influence the weaning process. METHOD: In early 2005, the literature was reviewed from 1986 to 2004 by accessing the following databases: Medline, Proquest, Science Direct, CINAHL, and Blackwell Science. The keywords mechanical ventilation, weaning, protocols, critical care, nursing role, decision-making and weaning readiness were used separately and combinations. DISCUSSION: Controversy exists in weaning practices about appropriate and efficacious weaning readiness assessment indicators, the best method of weaning and the use of weaning protocols. Arguably, the implementation of weaning protocols may have little effect in an environment that favours collaboration between nursing and medical staff, autonomous nursing decision-making in relation to weaning practices, and high numbers of nurses qualified at postgraduate level. CONCLUSION: Further research is required that better quantifies critical care nurses' role in weaning practices and the contextual issues that influence both the nursing role and the process of weaning from mechanical ventilation.

Australasia↗