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PubMedDate not supplied

Science and policy implications of defining environmental justice.

Although 'environmental justice' is an increasingly important issue for policy makers and researchers, it remains for many a vague and abstract notion that is hard to define in practical, real-world terms. Part of the problem is that environmental justice is a complex, multidimensional construct that cannot easily be defined. Our aim in this article is to identify fundamental dimensions of environmental justice and highlight the resulting questions that are an inherent part of putting principles into practice. We argue that to have a constructive and informed debate about this emotionally charged topic, it is necessary to have a clear and workable definition of environmental justice. We do not propose our own definition, but instead point out that there are many possible legitimate definitions depending on one's beliefs, opinions, and values. The central point is not that a particular definition is right or wrong, but rather than choosing a definition has distinct implications for the formulation, implementation, and evaluation of both policy and science. These critical choices should be made explicit so that public dialogue can focus on the substance of this important policy issue.

Environmental Health↗

PubMed1995

Emerging trends in the application of the social sciences to health and medicine.

Tensions are inevitable between funders seeking to solve specific health care issues within existing frameworks and many social scientists who see health and health care as reflections of societal stratification and processes of power and control. Many current and impending issues require deep scrutiny of values and meaning systems as they relate to class, gender, ethnicity and other forms of social differentiation. Interdisciplinary efforts provide social scientists important problem-solving opportunities but also occasions to refine disciplinary theories and methods. In recent years such efforts have resulted in increased sensitivity to demographic imperatives, prospective investigations, social experimentation, a growing appreciation of the complexity of life trajectories, development of more complex models of causation and remediation, and a revival of interest in meaning systems and their effects on ultimate outcomes. Social scientists have come to play a variety of roles in health services and policy research that contribute to a fruitful interplay of theory and practice. Major roles include helping to frame issues and how they are attacked; anticipating emerging trends, issues and problems; monitoring health and the provision of health services; evaluation and assessment; and implementation processes. The contributions of the social sciences to understanding complex organizational arrangements, structures, cultures, managerial approaches, financial arrangements and regulatory processes are increasingly evident and part of a culture of informed thinking.

Delivery of Health Care↗

PubMed1999

Reassessing the role of epidemiology in public health.

This commentary examines the scope of epidemiology and delineates the role of epidemiology in relation to public health. Epidemiology is a science; public health is a mission that is implemented through societal action. The implications of this difference are considered, and the sufficiency of epidemiology for guiding public health is evaluated in relation to other scientific disciplines and nonscientific considerations. The authors conclude that epidemiology is not the basic science of public health but one of many contributors to guiding action. The need for public health decisions despite scientific uncertainty and the potential for epidemiologic certainty's failing to provide clear guidance to public health action emphasize the distinctiveness of these endeavors. Criticisms that epidemiology fails to solve major public health problems, such as tobacco use; that it overemphasizes methods; that it fails to meet the needs of public health practitioners; and that it isolates itself from public health ethics are unwarranted. However, epidemiology should focus on addressing issues that directly affect public health decisions and should clearly communicate information about such issues to public health workers. Public health is far more complex than merely applying epidemiology.

Epidemiology↗

PubMed1996

A successful university-school-district partnership to help San Francisco's K-12 students learn about science and medicine.

The Science and Health Education Partnership (SEP) is a program at the University of California, San Francisco, established in 1987 to support the San Francisco School District ("the District") in its efforts to improve science education in grades K-12. A large cadre of active biomedical scientists and health professionals and a core program staff provide support to 90-95% of the District's schools. The District's students are from a variety of racial and ethnic groups, including a large percentage from underrepresented minorities (URMs). The SEP program has numerous components, some designed to help teachers (e.g., a clinician or scientist forms an ongoing partnership with a teacher to enrich classroom instruction) and some involving direct work with students (e.g., a contest where teams of students design and present lessons on science or health to their peers; activities related specifically to the encouragement of URM students). The SEP's perspective has evolved from an emphasis on assisting individual teachers and students to one of supporting systemic change throughout the District (e.g., supporting full implementation of hands-on, inquiry-based science instruction throughout the District via professional development). During this evolution, the kinds of issues facing program staff have changed and a great deal has been learned about fostering successful partnership activities. For example, (1) having a coordinator is crucial to make such a program work well; (2) it is easier to find start-up funding than to find continuing funding for ongoing activities that are working; and (3) it is important to work with the volunteering scientists and the teachers to help them understand what each has to offer the partnership and to encourage explicit dialogue about roles and expectations. The author concludes with advice for starting a new partnership: think big but start small, and work toward a long-term association based on communication and trust.

Adolescent↗

PubMed1993

Interactive videodisc and compact disc-interactive for ophthalmic basic science and continuing medical education.

BACKGROUND: The authors designed and implemented a complete curriculum in ophthalmic pathology using IBM- and Macintosh-based interactive videodisc (IVD) technology. They also redesigned a portion of this curriculum for a new television-based platform, compact disc-interactive (CD-I). METHODS: The following issues were addressed: curriculum design, instructional design, the assembly of illustrations and the ownership of such materials, the generation of computer-based medical art and animation, and programming. The issue of academic credit for faculty participating in this effort also was considered. RESULTS: The computer-based IVD program provides the following features: (1) rapid access to thousands of high-quality illustrations with the option of superimposing graphic labels and text directly over pictures; (2) the ability to view enlargements of photographs; (3) an online glossary to view definition of terms coupled with high-quality photographs; and (4) a dynamic introduction to pathophysiology using interactive animation sequences. The authors were able to incorporate the same interactive features into the CD-I version. High-quality medical illustrations can be used effectively on the CD-I platform. CONCLUSIONS: Computer-based multimedia workstations are relatively expensive for personal use but may be useful if the equipment can be shared in a learning center or library. Compared with interactive computer-based solutions, consumer-oriented television-based technology such as CD-I is a relatively inexpensive vehicle for providing continuing medical education programs intended for use in the individual practitioner's office or home.

Compact Disks↗

PubMed2001

Problem-based learning in a new Canadian curriculum.

Problem-based learning (PBL) is a method of group learning that uses true-to-life problems as a stimulus for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences. This article documents the design and implementation of PBL in a second year course in the new curriculum of the University of Ottawa School of Nursing's Generic Program. The learning and teaching experiences of students and facilitators in this PBL course are described. As a way to determine students' perception of their learning using PBL, they were asked to respond to four questions. The most frequently described thinking processes were problem solving, nursing process and group process. When asked to describe the learning they derived from PBL, as differentiated from other instructional methods, students identified group process and problem solving most often. The most frequently identified factors that influenced performance and learning in PBL were positive attitude and group effort. The factors that affected the facilitators' performance of their role were large group size, insufficient practice of facilitator skills and PBL preparation. To enhance group process, facilitators modelled and shared roles. They fostered student motivation and development through formative evaluation. PBL produced clear benefits for students, such as increased autonomous learning, critical thinking, problem solving and communication. For facilitators, PBL was a liberation from the traditional role of 'content expert and super consultant'.

Communication↗

PubMedDate not supplied

The CSAT methamphetamine treatment program: research design accommodations for "real world" application.

The Methamphetamine Treatment Program (MTP), funded by the Center for Substance Abuse Treatment, has the objectives of implementing the Matrix outpatient model and evaluating that model in comparison to the existing community "treatments as usual." Seven organizations in three western states (California, Montana, and Hawaii) were selected to participate in this randomized, controlled, multisite project in what constitutes the largest trial to date of treatment for methamphetamine (MA) dependence. One hundred fifty MA-dependent patients recruited at each site are randomly assigned to receive either the Matrix model, a manualized program of intensive outpatient treatment, or the site's standard treatment, "treatment as usual." Participants are evaluated at admission, weekly during treatment, at the time of scheduled discharge, and at six and 12 months after admission. Dependent measures assess changes in drug use, HIV risk behaviors, quality of life, and patient satisfaction. Cost analyses to quantify treatment costs and determine the association between costs and clinical outcomes will be conducted. A number of adjustments in the original study design have been necessitated by the realities of community sites' strengths and limitations. Experiences from this multisite project will also provide a model for other efforts to transfer research-based treatments into community settings. This article describes the main aims of the project, the background and rationale for the study design, a brief description of the research plan, and methods implemented to protect the integrity of the science.

Central Nervous System Stimulants↗

PubMed1997

The influence of accreditation on educational change in U.S. medical schools.

The authors examined the influence of accreditation on educational change and reform in U.S. medical schools in the past decade, by reviewing the survey databases and site visit reports of 90 schools that had comprehensive accreditation surveys by the Liaison Committee on Medical Education (LCME) between July 1992 and June 1997. In this study, substantive change was defined as centralizing the design and management of the curriculum, as well as one or more of the following reforms: integrating basic and clinical science instruction and/or conversion to interdisciplinary courses; implementing methods of active, small-group, independent, and hypothesis-based learning; and substantially increasing students' exposure to ambulatory and primary care. Accreditation reports were reviewed to determine the extent to which the LCME previously had admonished schools for shortcomings in their educational programs and advised curricular changes. Notice was taken of grant support by national foundations promoting educational reform, in relation both to the correction of accreditation deficiencies and to curricular reform undertaken by schools on their own initiative. The study also scrutinized the evolution of accreditation standards promoting educational reform, and the LCME's support of initiatives for shortening the period of medical education and promoting performance-based teaching and the assessment of clinical skills. On entering the 1990s, the LCME toughened the standards for design and management of the medical curriculum and for the evaluation of educational program effectiveness that schools must conduct. The greater assessment rigor identified educational shortcomings in 61 of 90 medical schools coming up for accreditation surveys during 1992-1997. On those occasions, 34 of the 61 schools had instituted reforms or were on the verge of doing so. Twenty-five of the schools carrying out reforms (73%) had received major foundation grants, compared with ten of the 27 schools (37%) that had accomplished little. Fifteen schools that had not been reproached earlier were found on the 1992-1997 surveys to have undertaken substantial innovation on their own initiative, five with the help of major foundation awards. The study also shows that a number of schools implemented parts of more sweeping reforms with the help of smaller foundation grants for more discrete purposes. In some instances, it has not been possible to differentiate the influence of the LCME as a force for educational reform from the incentives for change created by national foundations. Overall, the LCME, through its standards and assessment practices, and in synergy with schools and kindred agencies promoting change, is now on the leading edge of improved education and evaluation in the nation's medical schools.

Accreditation↗

PubMed2001

Admissibility of scientific evidence post-Daubert.

Proof of medical causation is the key element in cases involving alleged radiation injury. Until 1993, the use of scientific testimony in the courtroom was governed by the Frye doctrine requiring that a theory be "generally accepted" before it can be the basis of an expert's opinion. Applying that rule trial courts adopted a "let it all in" approach resulting in a near overdose of pseudoscience presented to juries. With its decision in Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S. Ct. 2786 (1993), the U.S. Supreme Court announced a new five-factor, non-exclusive test for federal district courts to consider when assessing the opinion of scientific experts. The Court further directed that the trial courts, acting as a gatekeeper for expert evidence, must evaluate whether there is an adequate "fit" between the expert's data and the opinion offered. This article examines how the Daubert standard has been implemented in federal court to combat junk science. Examples from recent case law dealing with operational health physics issues are presented as an illustration of the use of the five-factor test to challenge questionable testimony on causation. Guidance is offered to prospective expert witnesses in radiation-related litigation to insure that proposed testimony will be admissible in district court.

Causality↗

PubMedDate not supplied

Reorganization of a burn unit in response to underutilization: a critical assessment.

The incidence of burn injury in the United States has declined over the past few years, resulting in a dramatic decrease in the number of admissions to burn centers. This decrease has generated considerable concern, leading to a variety of proposals to modify burn units to control the cost of inpatient care. In 1986 Albany Medical Center Hospital, a 654-bed regional academic health sciences center, closed its burn unit and implemented a program to manage thermally injured patients in the intensive and progressive care areas of the medical center. A retrospective study was performed to compare patient outcomes and length of stay for the dedicated burn unit and the integrated burn program. Between the year before and the year after this change there was no significant difference in mortality rate, length of stay, or number of positive blood cultures. The relationship between burn severity and length of stay was unaltered by the burn program change. A comparison of data collected just after the change to those collected 2 years later again showed no difference, except that the annual census had dropped more than 50%. The results suggest that burn units can be converted to integrated burn programs without compromising patient care outcomes, although the lack of a cohesive burn team and the unavailability of beds designated for patients with burns ultimately resulted in a deemphasis of the burn program and consequent marked reduction in the number of patients with burns seen in the institution.

Burn Units↗

PubMed2001

Sleep loss and fatigue in medical training.

The effects of sleep loss and fatigue in the context of medical training is a topic that has generated considerable interest, as well as controversy, over the past two decades. The sleep deprived state in medical trainees potentially impacts on a variety of domains relevant to medical care, including performance on neurobehavioral and work-related tasks, mood and affect, learning, risk for and commission of medical errors, and the health and well-being of medical students and residents. The following review provides a summary of research conducted on this topic in the past decade, including the relation of sleep loss and fatigue to medical errors and the quality of patient care. Those few studies that have analyzed the use of operational alertness management strategies, countermeasures, and educational interventions to address and mitigate the effects of sleep loss and fatigue are also reviewed. There is clearly a need for additional research to further explore the complex interaction between sleep and fatigue and medical care, and to support the development and implementation of regulatory policies based on sound science.

Clinical Competence↗

PubMed2002

Clinical data retrieval: 25 years of temporal query management at the University of Vienna Medical School.

OBJECTIVES: Today, many clinical information systems include analysis components which allow clinicians to apply a selection of predefined statistical functions that satisfy typical cases. They are mostly to inflexible to handle complex, non-standard problems, however. The focus of this paper, therefore, is to present an approach that enables clinicians to autonomously create ad hoc queries including temporal relations in an interactive environment. METHODS: We developed the query language AMAS, which was specifically customized for users from the medical domain to flexibly retrieve and interpret temporal, clinical data. AMAS provides for a significant temporal expressiveness in data retrieval using time-stamped clinical databases and relies on an operator-operand concept for the specification of a query. RESULTS: Within the last 25 years, four different clinical retrieval systems have been implemented at the Department of Medical Computer Sciences, based on the AMAS query language. Currently, these systems allow access to the medical records of more than 2 million patients. Physicians of 46 different departments at the University of Vienna and Graz Medical Schools have made extensive use of these systems in the course of clinical research and patient care, executing more than 10,000 queries per year. CONCLUSIONS: We discuss a list of 20 issues that represent the most essential lessons we have learned in the development of the four systems mentioned above. Amongst others, our experiences indicate that the operator-operand concept allows on intuitive specification of complex, temporal queries. Further, customization to different user classes, based on their statistical background, is essential.

Austria↗

PubMedDate not supplied

[The development, transfer and use of medical technology as a special subject of research].

Regardless of the real exposion of scientific findings and information concerning medical sciences, research in the field, especially fundamental one, has rather insignificant influence on the development of new technologies, applicable in everyday medical practice (pull technologies). Far greater significance has been put on research in other fields, usually initiated with other purposes. "Side product" of that research is the development of these technologies which are best applicable in medicine (push-technologies). This is not the only reason why, as a rule, there is no direct connection between researchers and those supposed to apply and use new technologies. Initiation of evaluational research in the field of medical technologies will be the only way to establish the relationship between the two groups of actors: researchers and implementators.

Medical Laboratory Science↗

PubMed1991

Providing access to blacks and Hispanics in dietetics education.

To increase the number of blacks and Hispanics in dietetics and three other health professions, the Health Sciences Recruitment and Retention Program was developed and implemented in 1985 by the College of Health at Florida International University in Miami. The coordinated undergraduate program assisted in a federal grant to accomplish the objectives of recruiting and retaining minority students. High school and community college students were recruited using a slide/tape presentation featuring black and Hispanic professionals. In addition, the college offered a summer course entitled "Perspectives of the Health Sciences Professions" to students entering their senior year in high school. In this course, students learned how dietitians, medical laboratory scientists, and physical and occupational therapists treat various disease states. Field trips and site visits provided additional exposure to the professions. A summer orientation and tutorial program was established to retain minority students enrolled in the coordinated undergraduate program. We recommend that this program be considered as a model for dietetics educators to use in developing other programs to increase the number of minorities in the profession.

Black or African American↗

PubMed1997

Social science and the public agenda: reflections on the relation of knowledge to policy in the United States and abroad.

It is tempting to oversell the practical value of applied research. A hard look at the effects of U.S. social science on public policy in areas such as active labor market policies (training, job creation, placement, etc.), crime prevention, fiscal policy, poverty reduction, and health care reform suggests an inverse relationship between social science consensus and policy and budgetary decisions. Fragmented and decentralized political economies (e.g., the United States) foster policy segmentation and isolated, short-run single-issue research--often politicized and misleading. More corporatist democracies (such as Sweden, Norway, Austria, and Germany) evidence a tighter relation between knowledge and power in which a wider range of issues is connected, longer-range effects are sometimes considered, and research is more often actually used for planning and implementation. Even in less hospitable societies, however, social science does make its way in the long run. Favorable conditions and examples are discussed.

Cross-Cultural Comparison↗

PubMed1979

The LeMoyne-Owen College--UTCHS cooperative educational program: a model for minority recruitment.

A program of cooperative education between LeMoyne-Owen College and the University of Tennessee Center for the Health Sciences (UTCHS) was designed to attract students from the undergraduate institution to the various health professional schools at UTCHS. The program was initiated by a black faculty member at UTCHS. It involved a faculty exchange between the two institutions and the implementation of several changes in the pre-health science curriculum at the undergraduate institution. Other components of the program included: the gift of equipment and supplies to LeMoyne-Owen College by UTCHS; counseling of LeMoyne-Owen students by UTCHS faculty members; the generation of private funds by the faculty and staff at UTCHS for the support of LeMoyne-Owen students participating in the cooperative education program; and broad exposure of LeMoyne-Owen students to the laboratories and clinical facilities at UTCHS.

Black or African American↗

PubMed1985

A proposed expert system for nursing practice. A springboard to nursing science.

The knowledge on which nursing practice is based comes largely from traditional sources, expert nurses passing on the wisdom of their experience to novices. Nursing research, although increasing, is usually parallel to nursing practice, and its findings, at best, are implemented only after long delays. Consequently, the most effective nursing responses to a particular client problem may be undiscovered or unknown. Nursing information systems reflect the nature and usage of nursing knowledge. They offer standard care plans, but the knowledge and decision structures for individualizing care remain exclusively in the mind of the nurse. Nurses may have great freedom to enter information into the information system, but the information is rarely retrievable in a form suitable for evaluation or research. Nursing practice, and the knowledge on which it is based, could be enhanced through the use of a novel expert system. This paper describes how such a system could be developed, with examples from the authors' prototype programs. Taxonomies of data, diagnoses, objectives, and interventions would make it possible to compare patients and to determine the relative effectiveness of nursing interventions. A built-in evaluation component would provide feedback and correction. Everyday nursing practice would become a field for research, and the knowledge gained from research would immediately be fed back into practice. In its development and in its implementation, this kind of system would help to build nursing science.

Computers↗

PubMedDate not supplied

Quantitative methods for quality improvement.

Measuring clinical and financial outcomes in health care is a science in the early stages of development and implementation. Many tools and techniques are derived from industry models of continuous quality improvement and epidemiology. Epidemiologic (enumerative) and statistical process control (analytic) methods are effective alternatives to traditional quality assurance methods of evaluating patient care that encompass clinical and financial outcomes. Their use has resulted in significant improvement of clinical outcomes and financial performance, and has increased physician involvement in the process. Although cost will be the driving force of health care reform for the next few years, demonstration of high-quality care by providers through outcomes measurement will differentiate long-term from short-term winners in an environment of managed competition. This fact will make the science of outcomes management increasingly more important.

Chicago↗