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PubMed2006

Good governance for nutrition in the Philippines: elements, experiences, and lessons learned.

Malnutrition is a multifactorial problem that needs a multisectoral solution. This article reviews the role of good governance in nutrition programs, citing the Philippines as an example. In the Philippines, these efforts are reflected in the partnership between the public and private sectors in the establishment of the country's capability in research, policy-making, and program implementation. The establishment of the different public institutions engaged in research and policy-making is discussed, highlighting the role of political will through legislation. The evolving tasks of the nutrition program are discussed by citing the tasks in two eras. In the 1970s, the challenges were limited national nutrition data, man-power, tools, and health infrastructure. The public and private institutions were able to respond by legislating national nutrition surveys and dedicated nutrition workers in each village. The challenges in the current era are improved implementation of health programs, given the devolution of health services, and the gathering of an evidence base to further strengthen and refine the strategies of supplementation, fortification, breastfeeding, and food security. In responding to these challenges, multisectoral solutions and collaboration are critical in providing an evidence base to formulate policy. The role of the private sector, with the Nutrition Center of the Philippines used as an example, is that of a supportive and collaborative partner in good governance. Finally, the lessons learned from the past decades of implementing a national nutrition program, given changes in political and economic circumstances, are summarized.

Developing Countries↗
PubMed1999

Robotics and systems technology for advanced endoscopic procedures: experiences in general surgery.

The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in the field of cardiac surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. To relief the surgeon from fatigue we developed a new chair dedicated to the functional needs of endoscopic surgery. The foot pedals for high frequency, suction and irrigation are integrated into the basis of the chair. The chair is driven by electric motors controlled with an additional foot pedal joystick to achieve the desired position in the OR. A major enhancement for endoscopic technology is the introduction of robotic technology to design assisting devices for solo-surgery and manipulators for microsurgical instrumentation. A further step in the employment of robotic technology is the design of 'master-slave manipulators' to provide the surgeon with additional degrees of freedom of instrumentation. In 1996 a first prototype of an endoscopic manipulator system. named ARTEMIS, could be used in experimental applications. The system consists of a user station (master) and an instrument station (slave). The surgeon sits at a console which integrates endoscopic monitors, communication facilities and two master devices to control the two slave arms which are mounted to the operating table. Clinical use of the system, however, will require further development in the area of slave mechanics and the control system. Finally the implementation of telecommunication technology in combination with robotic instruments will open new frontiers, such as teleconsulting, teleassistance and telemanipulation.

Equipment Design↗
PubMed2001

Introduction of problem-based learning in a traditional medical curriculum in Singapore--students' and tutors' perspectives.

OBJECTIVES: The Faculty of Medicine at the National University of Singapore was founded in 1905 and has trained many generations of medical practitioners. Teaching has been based on a traditional British-style curriculum with 2 years of training in the basic clinical sciences and 3 years in the clinical disciplines. Starting in the academic year 1999-2000, a more integrated curriculum was introduced. In conjunction with this, approximately one-fifth of the curriculum time was dedicated to problem-based learning (PBL). This will be the first time that PBL is being implemented in the medical school and both staff and students will be new at it. Thus, the objective of this study was to gather information on the reactions of both staff and students after the actual implementation. MATERIALS AND METHODS: A questionnaire was designed to assess the following: (1) What are tutors' and students' opinions on the relative benefits on students' learning process and participation of PBL versus traditional lectures? (2) What is the level of satisfaction with various aspects of their PBL experience? (3) What were the difficulties that were encountered? RESULTS: Several positive and negative aspects of the tutors' and students' experiences were revealed. Most reported fairly high levels of satisfaction with their PBL experience. CONCLUSIONS: Overall, the experiences have been positive and both groups are willing to "struggle" with this new way of learning.

Education, Medical↗
PubMed2004

[School-based education strategies to promote fruit and vegetable consumption: the Pro Children Project].

Available population data suggest that a high proportion of European children and young people eat less fruit and vegetables than desirable. School based health promotion strategies fostering healthy eating practices and regular physical activity has the potential for a major impact on health and wellbeing during childhood and later stages in life. The aim of Pro-Children project is to estimate the consumption of fruit and vegetables as well as its main determinants among 11 year old European children and their families. It also aims to develop and assess the effectiveness of a school-based intervention program to promote adequate consumption levels of fruit and vegetables among school children. In the first phase of the project, cross-sectional studies were carried out on random population samples in nine European countries. The study protocol included assessment of fruit and vegetable consumption and a questionnaire to ascertain key determinants. A school-based intervention program was designed based on the Attitude, Social Influence and Self-Efficacy model (ASE). Theoretically similar but culturally relevant interventions were designed to be tested in Norway, The Netherlands and Spain during two school years. Each intervention site follows-up 10 intervention schools implementing the program and 10 control schools. Intervention planning and design followed an intervention mapping procedure. Key behaviours and determinants to be addressed through the intervention were identified in order to develop a matrix of educational objectives. The provision of fruit and vegetables in the school is an outstanding element. Program activities include guided classroom activities, computer tailored messages for children, activities to be completed at home with the family and family targeted specific actions. Additionally, optional components for community reinforcement include mass media, school health services participation and implication of grocery stores in the project. Despite cultural and social diversity, common school-based strategies to increase fruit and vegetable consumption among children are feasible across Europe. Understanding specific situations will enhance implementation and gain support.

Child↗
PubMed2004

Preventing disability from occupational musculoskeletal injuries in an urban, acute and tertiary care hospital: results from a prevention and early active return-to-work safely program.

OBJECTIVE: Healthcare workers are at high risk for musculoskeletal injuries. A program was developed to decrease the incidence of musculoskeletal injuries and the duration of associated time loss. METHODS: A program combining primary prevention and on-site early intervention was implemented at a large, urban hospital. Incidence rates were compared using Poisson regression. Cox regression was used to analyze the time to return to regular duties. RESULTS: Although there was no reduction in incidence, the program was effective in returning injured employees to work more promptly for registered nurses and health science professionals (therapists, technicians), although not for facility support staff. CONCLUSIONS: Overall savings in time loss and compensation payments were realized. However, better integration of prevention and follow-up efforts are needed, and greater attention to the sociopolitical environment is required to improve outcomes for facility support staff.

Absenteeism↗
PubMed2006

The state of the art in the reduction of medical errors.

The IOM report, To Err is Human, Building a Better Health System, galvanized public and political attention to the prevalence of medical errors in the Unites States. The IOM set a clear goal, "given the current knowledge about the magnitude of the problem, the committee believes it would be irresponsible to expect anything less than a 50 percent reduction over five years." As part of the IOM's four-part strategy was a recommendation that error reporting systems be established. No one denies that errors that occur in medicine can not be reduced if they cannot be defined. To achieve this goal of reducing errors, we have established a definition of a "medical error", described the current taxonomies that have been created over the last five years for their classification, and suggested a conceptual model for designing and testing a medical error reporting system. A system that facilitates identification, relies on health professionals and electronic repositories of clinical information to report events, and tracks and monitors medical errors, reliably, efficiently, and accurately is the objective of our design. Our next step is to implement, test, and evaluate this system based on our research.

Classification↗
PubMed1991

Nutrition components and assessment procedures of a university employee wellness program: a case study.

This article describes the various nutrition components and data collection tools developed and implemented within the Montana State University Employee Wellness Program. Nutrition components included a variety of classes, seminars, follow-up support groups, and individual consultations. Tools included surveys and computerized data input cards. It is important for dietetic professionals to initiate the development and implementation of a quality nutrition component within university employee wellness programs.

Data Collection↗
PubMed1995

Role of a central laboratory in implementing national cholesterol education panel guidelines in rural practices: model system for managed care.

We describe the use of a central laboratory to identify patients who may be candidates for a hypercholesterolemia treatment program and to direct their referral into this program. The laboratory, providing service for 16 medical practices in a rural area of upstate New York, served as the entry point to the treatment program for those patients with serum cholesterol > or = 5.18 mmol/L. This treatment program, designed to follow the National Cholesterol Education Program Adult Treatment Panel Guidelines, was provided by the lipid referral center staff, including a registered dietitian and a lipid specialist. After introduction of this program, 52% of eligible patients received nutritional counseling for hypercholesterolemia, compared with only 29% in usual care settings. This program represents an enhanced role for laboratories in the implementation of treatment protocols typical of those adopted by managed care networks.

Counseling↗
PubMed1994

Introducing new technology: confusion or order?

A model is explained for assessing the components and potential relationships which should be considered before introduction of a new or updated piece of equipment, improved supplies or a new process in nursing care. Some principles are offered to direct the weighting of various factors involved in selecting and implementing the introduction of new technology. Use of such a model can reduce staff frustration and improve quality of patient care.

Diffusion of Innovation↗
PubMed1998

Validation of capillary electrophoresis for analysis of the X-Y homologous amelogenin gene.

Capillary electrophoresis (CE) is a versatile technology with tremendous potential applications in forensic science. A refinement of the traditional slab-gel, separation occurs in a liquid polymer contained within a capillary. The capillary electrophoresis unit is computer-driven, semi-automating the loading and analysis of samples. As with any new technology, a full performance assessment is required before it may be implemented with confidence. This paper focuses on validation of CE technology for analysis of a portion of the X-Y homologous amelogenin gene used in gender determination. Typical Y/X ratios of peak heights for male samples were determined. Instrument linearity, sample resolution and reproducibility were examined. Samples subjected to contamination, extreme environmental conditions or extracted from a variety of substrates were also tested by CE. All samples typed correctly. Genetic material from a number of common non-primate animals was amplified with amelogenin primers. Some species yielded no product. Products derived from the animal samples that did amplify produced peaks on CE analysis readily distinguishable from those of human origin.

Amelogenin↗
PubMed1998

Tunnel vision information: a paradox of ethics, economics, politics and science.

BACKGROUND: Improvement in vision with spinal manipulation was first observed in the early 1970s. Reports of the phenomenon appeared in the 1980s in the popular press and at scientific meetings, but it was not until the mid-1990s that general discussion of the potential value of this knowledge occurred. Considering the far-reaching implications of the possible ability to improve brain function by spinal manipulation, the delay in consideration and implementation of this concept is a paradox in general terms and a total mystery in the case of the chiropractic profession. OBJECTIVE: To provide explanations for the delay in scientific assessment of the discovery that vision improves, in appropriate patients, when the spine is manipulated and to discuss the implications of this finding. This discovery is now called the "tunnel vision information." DISCUSSION: A schema of pathological hierarchy is depicted in which the level of intervention of spinal manipulation outranks other forms of treatment. The significance of this precedence is portrayed. Possible reasons for the failure to address this hierarchy in light of the tunnel vision information are discussed with reference to established protocols, medical politics, the presentation of the data, the failure of scientific editorship and the illogical aspects of the illness itself. CONCLUSION: In the future, the delay from the initial observation of the tunnel vision discovery to its free discussion in scientific literature may seem incongruous, particularly if the health benefits which it augurs are realized.

Chiropractic↗
PubMed1982

Innovation, ideology and innocence.

Innovative solutions are required to deal with the inadequacies of existing medical education programmes, in both the developed and developing countries, if we are to promote the evolution of more acceptable, more efficient and more effective health care. The newly formed Network of Community-oriented Educational Institutions for Health Sciences is attempting to promote a series of educational and organisational innovations, aimed at the preparation of health professionals who will be better equipped and better motivated to meet the real health needs of the populations they are to serve. Such innovations encounter many obstacles, of which ideologically-based inflexibility of thought is the most important. Ideologies are here defined, in Barnett's words, as "patterns of belief ... quasi-conceptual, quasi-affective sets assumed to be true", having the power to prohibit "rigorous or experimental examination of novel experience." Such systems of thought have 'negative, restrictive and pathological effects' on the development of innovative solutions to complex problems. A particularly destructive and inhibiting stereotype has flowed from an ideological commitment to the achievement of 'international excellence'. A state of what in this paper is called 'innocence' is regarded as mandatory for the implementation of studies based on a commitment to the empirical approach, to the null hypothesis and above all to the evaluation of the process and outcome of educational and other interventions in the health care system.

Communication↗
PubMed2004

In silico experiments of existing and hypothetical cytokine-directed clinical trials using agent-based modeling.

OBJECTIVES: To introduce a form of mathematical modeling, agent-based modeling (ABM), and demonstrate its potential uses in the evaluation of the dynamics of the innate immune response (IIR) and the development of possible treatments for systemic inflammatory response syndrome (SIRS)/multiple organ failure (MOF). RATIONALE: The IIR can be categorized as a complex system that responds to interventions in a nonintuitive fashion, leading to difficulty in translating basic science knowledge into effective treatments for SIRS/MOF. It is proposed that ABM is particularly well suited to examining the complex interactions of the IIR and its disordered states of SIRS/MOF. STUDY DESIGN: Computer simulation and mathematical modeling. DATA SOURCE: Review articles on components and mechanisms involved in the IIR. Published results from phase III anticytokine/mediator trials. Published results from smaller clinical trials and animal studies. MAIN RESULTS: An abstract ABM of the IIR was created. The model reproduces the general behavior of the IIR with respect to outcome and cause of system "death." Patterns of levels of individual cytokines matched patterns of measured cytokines reported in the existing literature. Clinical trials of anticytokine therapy were simulated and produced outcomes qualitatively similar to those reported in the literature. A series of hypothetical treatment regimes (variation of dose and length of treatment [anti-tumor necrosis factor and anti-interleukin-1], anti-CD-18, and multiple-drug regimes [combination of anti-tumor necrosis factor, anti-interleukin-1, and anti-CD-18]) were formulated and implemented in the ABM. None of the simulated therapies showed a statistically significant improvement in system mortality. CONCLUSIONS: Presented herein is an abstracted ABM of the IIR. This model is intended primarily as an introduction to and demonstration of this technique. However, even this relatively simple model demonstrates counterintuitive system responses and the difficulty of effectively manipulating a complex system like the IIR. ABM may provide a synthetic, analytical platform to integrate basic science data on the IIR, thus eventually aiding in formulating and testing future mediator-directed therapies for SIRS/MOF before clinical trials, and it may provide insights into directions of future research.

Clinical Trials as Topic↗
PubMed2004

Planning, implementation and optimization of future space missions using an immersive visualization environment (IVE) machine.

Beginning in 1995, a team of 3-D engineering visualization experts assembled at the Lockheed Martin Space Systems Company and began to develop innovative virtual prototyping simulation tools for performing ground processing and real-time visualization of design and planning of aerospace missions. At the University of Colorado, a team of 3-D visualization experts also began developing the science of 3-D visualization and immersive visualization at the newly founded British Petroleum (BP) Center for visualization, which began operations in October, 2001. BP acquired ARCO in the year 2000 and awarded the 3-D flexible IVE developed by ARCO (beginning in 1990) to the University of Colorado, CU, the winner in a competition among 6 Universities. CU then hired Dr. G. Dorn, the leader of the ARCO team as Center Director, and the other experts to apply 3-D immersive visualization to aerospace and to other University Research fields, while continuing research on surface interpretation of seismic data and 3-D volumes. This paper recounts further progress and outlines plans in Aerospace applications at Lockheed Martin and CU.

Astronauts↗
PubMed2000

[Handling small relative risks in science and management: the third-generation pill].

Small relative risks (a twofold or lesser increase in disease frequency) become scientifically acceptable with (a) repeated consistent findings from studies that (b) address the most important forms of bias and confounding, and (c) when there is a plausible biologic mechanism. The third-generation oral contraceptive controversy is an example of such a relevant but small relative risk and demonstrates the problem of interpretation and implementation into medical practice guidelines.

Confounding Factors, Epidemiologic↗
PubMed2001

ICCVAM evaluation of the murine local lymph node assay. The ICCVAM review process.

New test methods are being developed to improve the prediction of human and environmental risks and to benefit animal welfare by reducing, refining, and replacing animal use. Regulatory adoption of new test methods is often a complex and protracted process, requiring test method validation, regulatory acceptance, and implementation. Assessments of new test methods have not always been uniform within or among regulatory agencies. Thus, there have been increased pressures for a harmonized approach to test method evaluation and acceptance. In 1997, in response to these pressures and to U.S. Public Law 103-43, the National Institute of Environmental Health Sciences (NIEHS) established the Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM) to coordinate interagency consideration of new and revised test methods. This article describes the validation and acceptance criteria and process used for the first test method evaluated by ICCVAM, the murine local lymph node assay (LLNA). Based on ICCVAM's conclusions and recommendations, the LLNA has been accepted by U.S. regulatory agencies as a stand-alone assay for allergic contact dermatitis. Two related articles in this series of three present the results of the independent peer review evaluation of the LLNA and summarize the performance characteristics of the database substantiating the validity of the LLNA.

Animal Welfare↗
PubMed2006

Disseminating evidence-based practices in substance abuse treatment: a review with suggestions.

Although substance abuse professionals are generally open to new and better therapeutic methods, most evidence-based treatments do not easily find their way into practice. Natural diffusion processes for innovations in substance abuse treatments are relatively informal and have yielded a widely acknowledged gap between science and community practice. This review focuses on methods for effectively disseminating new treatment methods into practice. Therapist manuals and one-time workshops are in themselves relatively ineffective in helping practitioners gain proficiency in new clinical approaches. Individual performance feedback and coaching improve the acquisition of clinical skills. Specific incentives for implementation may also be needed to encourage treatment providers, programs, and systems to adopt new approaches.

Behavior Therapy↗