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PubMed2004

Communicating exposure and health effects results to study subjects, the community and the public: strategies and challenges.

The Mickey Leland National Urban Air Toxics Research Center sponsored a Symposium in August 2002 that focused on the communication of health effects results from community studies involving exposure to hazardous substances in the environment. Some of the audiences identified for presentation of study results were the study subjects, the community, and the general public. Principles and approaches to communicating findings were discussed, as were the challenges that may confront researchers in developing and implementing a communication plan. The Symposium included four sessions. The first was an overview session where Timothy McDaniels (University of British Columbia) described risk communication as a decision-aiding process. In the second session, case studies were presented by Timothy Buckley (Johns Hopkins University), Jane Hoppin (National Institute of Environmental Health Sciences), and Anne-Marie Nicol (University of British Columbia). Approaches and strategies used by different stakeholders to communicate study results was the topic for a panel discussion at the third session. Panelists included: James Collins (The Dow Chemical Company), Mary White (Agency for Toxic Substances and Disease Registry), Richard Clapp (Boston University), Valerie Zartarian (Environmental Protection Agency), Pamela Williams (Chemrisk), and Tina Bahadori (American Chemistry Council). The final session was a summary presentation on lessons learned given by Rebecca Parkin of George Washington University, in which she synthesized the preceding presentations and formulated guidelines for effective risk communication in community research studies.

Communication↗

PubMed2004

Protein, programming and plumpness: is there a link?

Early-life nutrition has been suggested to influence the progression of chronic disease. In this issue of Clinical Science, Ozanne and colleagues argue that the pre- and post-natal diet can have a significant impact on the risk of becoming overweight in later life. Although an intriguing finding that warrants further investigation, it is most likely that the key to stemming the obesity pandemic will depend chiefly on the implementation of effective population-wide strategies that focus on lifestyle modification, both in childhood and in adult life.

Adult↗

PubMedDate not supplied

Detecting the edge of the tongue: a tutorial.

The goal of this paper is to provide a tutorial introduction to the topic of edge detection of the tongue from ultrasound scans for researchers in speech science and phonetics. The method introduced here is Active Contours (also called snakes), a method for searching for an edge, assuming that it is a smooth curve in the image data. The advantage of this approach is that it is robust to the noisy speckle that clouds edges. This method has been implemented in several software packages currently used for detecting the edge of the tongue in ultrasound images. The tutorial concludes with an overview of the scale-space and Kalman filter approaches, state-of-the-art developments in image processing that will likely influence work on tongue edge detection in the coming years.

Humans↗

PubMed2025

EDAmame: interactive exploratory data analyses with explainable models.

SUMMARY: Complex tabular datasets comprising many diverse features can require specific expertise to interpret, posing a barrier to researchers with minimal data science experience. EDAmame is an interactive tool that simplifies initial analysis and visualization of these datasets, providing insights into data quality and feature relationships. By leveraging open-source machine learning frameworks in R, EDAmame allows researchers to perform effective exploratory data analysis without command-line or coding requirements. AVAILABILITY AND IMPLEMENTATION: A limited online version can be accessed at https://edamame.org.au/ or can be downloaded from https://doi.org/10.5281/zenodo.15356492. The app is developed in R Shiny and implements tidyverse and tidymodels packages.

Machine Learning↗

PubMed2002

Translational medicine in the first year: integrative cores.

OBJECTIVE: The intensity of the first year leaves many students pondering the wisdom of their career choice. In creating its new curriculum, Mount Sinai School of Medicine faced this issue of burnout by devoting the last three weeks of the first year to a course that links basic science concepts introduced at the bench to the clinical care of patients. The goal of "Bench to Bedside Selectives" is to reenergize students' career choice by allowing them to experience a multidisciplinary approach to translational medicine. Students participate in an in-depth study of a selected disease entity under the direction of a faculty core leader. DESCRIPTION: In 2001, students selected either a research core (n = 57), which allowed them to expand their summer research time, or a disease-focused core (n = 48). Six diseasefocused cores were offered, each consisting of didactic sessions, exposure to basic research, diagnostic laboratory techniques, ethics, health policy, pharmacology, and clinical experiences. The cores were as follows: (1) Atherosclerotic Heart Disease: Integration of Basic Science and Clinical Medicine; (2) Translational Medicine in HIV: A Road to a Cure; (3) Gene Therapy: A Journey from Scientific Principles to Clinical Applications; (4) Solid Organ Transplantation: Defying Mother Nature; (5) The ABC's of Liver Disease; (6) The New Frontiers in Aging. Core leaders were responsible for developing and implementing their programs and recruiting faculty from many departments. All students completed an independent project tailored to their core. For example, the HIV core included modules on AIDS in Africa and needle-exchange programs, and the students' final project was a debate on whether "there will or will not be an effective HIV vaccine in the next 5 years." Students ranked their top three choices among the cores. Most (96%) were enrolled in their first or second choices, forming groups of six to eight. On the last day of core, students attended a focus group and filled out questionnaires about the strengths and weaknesses of their experience. DISCUSSION: There was overwhelming support for the core experience at the focus session. Most students commented that the program successfully overcame their end-of-first-year blues. All students felt that cores should be continued and recommended additional core selections. Weaknesses cited were inequality in the time and amount of work required for individual cores and an imbalance between excessive didactic material and insufficient clinical exposure in one core. Seventy-one percent of participants also completed the feedback questionnaires; 97% of them strongly agreed that the core successfully integrated material from previous courses; 88% strongly agreed that the clinical presentations demonstrated the relevance of content to medical practice; and 69% strongly agreed that the proportionate mix of lab, clinical, and small-group sessions was appropriate. Faculty were also enthusiastic about their experience. This program will be continued and expanded in 2002. We recommend this teaching format as an antidote to first-year burnout and a novel way to promote the development of physicians with an appreciation of the scientific basis of disease and the role ethics and health policy play in medicine.

Attitude of Health Personnel↗

PubMed1997

Nursing education in Austria, Germany, and Switzerland.

Development of nursing education in three European countries is presented in an historical context. The educational system as well as the political and economic influences in these countries are discussed. The current status of reform and academization of nursing education in Austria, Germany, and Switzerland is highlighted. In Austria, several nursing courses have been developed and implemented in the school of education at the University of Graz. In Germany, over 20 university and "Fachhochschule" programs have been established since 1990 for nurse-educators and-managers, although attempts to reform basic nursing education are being thwarted by some government officials. Swiss nurses are negotiating for a nursing science program at the University of Basel and have established new guidelines to revise the 3-year basic nursing schools.

Austria↗

PubMed2003

Explaining feast or famine in randomized field trials. Medical science and criminology compared.

A feast of randomized controlled trials (RCTs) in medical science and comparative famine in criminology can be explained in terms of cultural and structural factors. Of central importance is the context in which the evaluation of interventions is done and the difference in status of situational research in the two disciplines. Evaluation of medical interventions has traditionally been led by practitioner (clinical) academics. This is not the case in criminal justice, where theory has had higher status than intervention research. Medical science has advanced in, or closely associated with, university teaching hospitals, but links between criminology and criminal justice services are far more tenuous. The late development of situational crime prevention seems extraordinary from a medical perspective, as does the absence of university police schools in the United Kingdom and elsewhere. These structural and cultural factors explain concentration of expectation, resource, and RCT productivity in medical science. The Campbell Collaboration and the Academy of Experimental Criminology are forces which are reducing this polarization of feast and famine in RCTs. But unless scientific criminology is embedded in university schools which are responsible for the education and training of law, probation, and police practitioners, convergence in terms of RCTs and implementation of findings in practice seems unlikely.

Criminology↗

PubMed2000

Preventive care in daily practice.

Advances in medical science have led to effective preventive steps that can be used by all physicians; however, most current preventive evaluations and applications are given in primary care settings. Hence, integrating preventive care into practice has become an important challenge for all primary care physicians. This article reviews the delivery of clinical prevention including implementation, barriers, and management. It is clear that preventive care leads to healthier people and that should be the goal of all medicine.

Adult↗

PubMed2000

The new peer review.

It is widely recognized that the Internet has fundamentally changed the dynamics of publication, and in particular, it is clear that there is no effective way to control the release of any web-based publication. The scientific and lay literature is now accessible to the public with unprecedented ease Recent proposals to start a life sciences online repository of preprints highlights the trend towards "publish first, review later" that seems to be emerging. Does this mean that the peer review process is dead? It certainly suggests that there is a need for a change in how the process works. We discuss currently available technologies to enable the implementation of new, distributed peer review process benefiting multiple user communities.

Internet↗

PubMed2005

A method for predicting a student's risk for academic probation in a professional program in allied health.

Identification of students at risk for academic difficulty in a physical therapy program would provide opportunities to implement preemptive measures designed to enhance successful academic performance. The purpose of this study was to determine if a method advocated for use in evidence-based practice could be adapted for use in predicting probationary status for students in a program in allied health, specifically physical therapy. Preadmission combined math and science grade point average; cumulative grade point average (TGPA); verbal Graduate Record Examination score (VGRE), quantitative Graduate Record Examination score (QGRE), and analytic Graduate Record Examination score; and probation status were obtained for 305 students (mean age, 25.5 years; SD, 4.14) accepted into one physical therapy program from 1995 to 2000. Predictors of probation were identified using stepwise logistic regression. Likelihood ratios were calculated for three score intervals derived from receiver operating characteristic analysis. TGPA, VGRE, and QGRE were significant predictors in the regression model (p < 0.05). VGRE was the only variable that consistently showed predictive capability (likelihood ratio, 2.9; 95% confidence interval, 1.2-6.9). Quantitative preadmission data can be used in combination to improve the predictive power of estimates of probation risk. We contend that the analytic methods illustrated in this report could be used in academic programs to assist faculty with management of students who are at risk for academic difficulties.

Adult↗

PubMedDate not supplied

[Disinfectology as a forerunner of future denoxology].

Under available pollution of the environment particularly with persistent physical, chemical, and biological pathogens, it is insufficient not only to protect it, but it is necessary to implement measures for their active decontamination (denoxation) just in the environment. Environmental decontamination of biological (infective) pathogens has been both methodologically and technologically developed to the present day. The theoretical and methodical bases of disinfectology as a functioning section of a non-existing (up to now?), but necessary area of hygienic science--denoxology.

Communicable Disease Control↗

PubMed2004

State of the science: molecular classifications of breast cancer for clinical diagnostics.

Over the past few years, the study of genomics has embarked on developing gene expression-based classifications for tumors-an initiative that promises to revolutionize cancer medicine. High-throughput genomic platforms, such as microarray and SAGE, have found gene expression signatures that correlate to important clinical parameters used in current staging and are providing additional information that will improve standard of care. Although implementing a molecular taxonomy for prognosis and treatment would likely benefit cancer patients, there remain significant obstacles to using these assays within the current diagnostic framework. Since most genomic assays are being performed from fresh tissue, there is a need to either change the practice of formalin-fixing and paraffin-embedding tissue or adapting the assays for use on degraded RNA specimens. To date, even the most mature data sets, such as molecular classifications for breast cancer, still fall short of the number of patients needed to generalize the results to treating large populations. To implement these assays in large scale, there will need to be standardization of sample procurement, preparation, and analysis. Certainly, the greatest improvements in patient care will come through tailored therapies as genomics is coupled with clinical trials that randomize cohorts to different treatments. This manuscript reviews the current standards of care, presents progress that is being made in the development of genomic assays for breast cancer and discusses options for implementing these new tests into the clinical setting.

Biomarkers, Tumor↗

PubMedDate not supplied

Using a theory-driven approach to design a professional development workshop.

The objective of this study was to show how a theory- driven approach to program planning was used to design and evaluate a professional development workshop. Our method was to demonstrate modeling of theory use as a teaching strategy. The Theory of Planned Behavior was used to structure all components of a 6-hour workshop. This workshop significantly increased participants' intention to use theory in designing programs (P <.0001). Educators can apply the methods demonstrated here to systematically use theory in the development, implementation, and evaluation of their workshops, staff training, and curricular materials for professionals and consumers.

Humans↗

PubMedDate not supplied

Academia and the medical group practice interface: the 2003 Institute of Medicine quality report and medication management.

University Physicians, Inc., has been impacted by the rising cost of professional liability insurance in recent years. Our internal risk management program needed to be enhanced to heighten provider sensitivity to the challenges certain practice processes (e.g., paper medical records) posed, and to tie this information to new patient and risk management strategies. The Institute of Medicine's 2003 report Priority Areas for National Action: Transforming Health Care Quality and the Agency for Healthcare Research and Quality's 2004 report Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies were used to establish priorities and develop indicators for measurement. A case study is presented on how these reports, combined with the Joint Commission on Accreditation of Healthcare Organization's 2006 National Patient Safety Goals for ambulatory care, were used to assess the group's risk profile and to implement practice changes to minimize risk.

Academic Medical Centers↗

PubMedDate not supplied

Heart valve prostheses: who protects our patients, and from what?

Phenomenal advances in the development of cardiac valve prostheses have taken place in less than two decades. However, the currently prevailing atmosphere of consumer protectionism in existence 20 years ago probably would have made such developments impossible. Recent passage of the Medical Device Amendments of 1976 (P.L. 94-295) will not only make future development extremely difficult, but also may force the field of cardiac valve replacement back into the era of the 1950s. Regulations implementing this legislation may be even more disastrous. It is time for someone to protect patients from their so-called protectors.

Equipment and Supplies↗

PubMed1999

Breast cancer genetics and managed care. The Kaiser Permanente experience.

In 1996, with evolution of the science of cancer genetics and the advent of commercially available BRCA1 and later BRCA2 testing, Kaiser Permanente began to apply these advances in clinical practice. Recommendations for referral to genetic counseling were developed in 1997 as the Clinical Practice Guidelines for Referral for Genetic Counseling for Inherited Susceptibility for Breast and Ovarian Cancer. Implementation of these guidelines with associated protocols in Kaiser Permanente's Northern California Region has occupied the ensuing years and includes dissemination of the high-risk guidelines for breast and ovarian cancer, dissemination of patient and physician educational materials on the breast cancer guidelines, monthly classes and taped healthphone messages for patients, interactive videoconferencing for physicians, a training seminar for medical geneticists who will counsel patients at risk, publication of articles on breast cancer and genetic risk in health plan member- and physician-directed magazines, identification and training of clinical specialists and supporting clinicians to care for patients before and after counseling, individual counseling and testing of patients and families, and development of a data registry. Implementing the guidelines helped us communicate the uncertainty surrounding breast cancer testing, and we were obliged to learn more about ethical, legal, societal, and insurance controversies surrounding genetic testing. Given the lack of effective prevention for breast or ovarian cancer and the difficulty of treatment, the appropriate use of genetics in patient care is essential. In the near future, we will see the need for cancer genetics to become an integral part of practice throughout the spectrum of health care. We at Kaiser Permanente feel that the breast cancer guideline project is the first step in this process.

BRCA1 Protein↗

PubMed2003

Pain assessment in nonverbal children with severe cognitive impairments: the Individualized Numeric Rating Scale (INRS).

Children's Hospital Boston began a major pain assessment and management initiative 3 years ago: Pain assessment and management are considered one of the institution's primary standards of care. The initiative included State of the Science meetings with internationally renowned nursing pain researchers and clinicians. These meetings generated nursing staff interest in specific applications of what is known about pain; how evidence-based knowledge can be used to ask population-specific clinical questions; and how an evidence-based approach can be applied to systematically develop, implement, and assess interventions that suit a population's clinical needs. This article is an example of an evidence-based pain assessment project at Children's Hospital Boston that focused on nonverbal children with cognitive impairments. After developing a clinical question, the authors did a literature review and a benchmarking analysis of best practice. The pilot of an adapted, existing pain assessment tool is described in this article.

Child↗

PubMed2003

Medical education as a science: the quality of evidence for computer-assisted instruction.

OBJECTIVE: A marked increase in the number of computer programs for computer-assisted instruction in the medical sciences has occurred over the past 10 years. The quality of both the programs and the literature that describe these programs has varied considerably. The purposes of this study were to evaluate the published literature that described computer-assisted instruction in medical education and to assess the quality of evidence for its implementation, with particular emphasis on obstetrics and gynecology. STUDY DESIGN: Reports published between 1988 and 2000 on computer-assisted instruction in medical education were identified through a search of MEDLINE and Educational Resource Identification Center and a review of the bibliographies of the articles that were identified. Studies were selected if they included a description of computer-assisted instruction in medical education, regardless of the type of computer program. Data were extracted with a content analysis of 210 reports. The reports were categorized according to study design (comparative, prospective, descriptive, review, or editorial), type of computer-assisted instruction, medical specialty, and measures of effectiveness. RESULTS: Computer-assisted instruction programs included online technologies, CD-ROMs, video laser disks, multimedia work stations, virtual reality, and simulation testing. Studies were identified in all medical specialties, with a preponderance in internal medicine, general surgery, radiology, obstetrics and gynecology, pediatrics, and pathology. Ninety-six percent of the articles described a favorable impact of computer-assisted instruction in medical education, regardless of the quality of the evidence. Of the 210 reports that were identified, 60% were noncomparative, descriptive reports of new techniques in computer-assisted instruction, and 15% and 14% were reviews and editorials, respectively, of existing technology. Eleven percent of studies were comparative and included some form of assessment of the effectiveness of the computer program. These assessments included pre- and posttesting and questionnaires to score program quality, perceptions of the medical students and/or residents regarding the program, and impact on learning. In one half of these comparative studies, computer-assisted instruction was compared with traditional modes of teaching, such as text and lectures. Six studies compared performance before and after the computer-assisted instruction. Improvements were shown in 5 of the studies. In the remainder of the studies, computer-assisted instruction appeared to result in similar test performance. Despite study design or outcome, most articles described enthusiastic endorsement of the programs by the participants, including medical students, residents, and practicing physicians. Only 1 study included cost analysis. Thirteen of the articles were in obstetrics and gynecology. CONCLUSION: Computer-assisted instruction has assumed to have an increasing role in medical education. In spite of enthusiastic endorsement and continued improvements in software, few studies of good design clearly demonstrate improvement in medical education over traditional modalities. There are no comparative studies in obstetrics and gynecology that demonstrate a clear-cut advantage. Future studies of computer-assisted instruction that include comparisons and cost assessments to gauge their effectiveness over traditional methods may better define their precise role.

Computer-Assisted Instruction↗