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PubMed2003

Genomics and medicine: distraction, incremental progress, or the dawn of a new age?

The technology of molecular genetics has profoundly altered the conduct of biomedical research. An entire universe of problems that in the past had been addressed only through conjecture, including whole genome analysis, can now be studied directly. The rapidity and scope of these changes in research capacity have in turn led to speculation that medicine will be radically altered by the application of genomics to everyday practice. To date, gene therapy and several new tests for genetic susceptibility have been successfully implemented, although their impact on medicine as a whole remains very limited and their future contribution is hotly contested. The potential of molecular genetics, like all technology, must be evaluated on the basis of established principles of clinical and epidemiologic research. The rhetoric of some enthusiasts focuses instead on an optimistic best-case scenario of the future of DNA science, and many of their most far-reaching claims cannot be substantiated on the basis of what is currently known. The tension between the long-term goal of public health and medicine to identify and remove the causes of ill health, in contrast to the development of technological innovations that can cure disease or identify individual susceptibility, emerges as a major theme in this debate.

Culture↗

PubMed2001

Point-of-care testing. Cost issues and impact on hospital operations.

Advancing technology has allowed for the migration of laboratory testing from the central laboratory to the near-patient setting, leading ideally to a shorter therapeutic turnaround time. This potential benefit, however, comes with a price tag. Assessing the cost-benefit ratio on a per test basis cannot effectively be done in a generalized manner, because each hospital must evaluate this with respect to its own unique circumstances. There are, however, certain outcomes, such as decreased LOS and decreased blood-product usage that, if achieved, far outweigh the cost of POCT, justifying its use. Any hospital attempting to implement POCT must also realize that hospital operations are affected by such use and that adjustments and careful laboratory oversight are required.

Costs and Cost Analysis↗

PubMed2004

[Role of the State Sanitary Inspection in supervision over nosocomial infections].

Suitably conducted monitoring of nosocomial infections in Polish health care centers would be a proof of the quality of medical services for the Polish society. However, because of some organizational and financial negligence from previous years, the Ministry of Health services are implementing practical and scientific rules of the nosocomial infections monitoring, through the implementation of systemic solutions, recommendations and suitable procedures. The State Sanitary Inspection has prepared a modern amendment of the act of communicable diseases and infections, which will help with proper enforcement of reliable reports and registers conducted by professional groups and existing committees for nosocomial infection control. We can expect that suitably conducted, hospital antibiotic policy, the use of medical science in the above-mentioned scope, reliable comparing analyses, as well as drug resistance monitoring will bring clearly defined effects, such as: reduction of expenditures on health care, as well as lessening of hospitalization duration.

Cross Infection↗

PubMed1998

Utilization of intensive care unit technology.

Technology utilization in acute and critical care holds great promise for improving the management and outcome of patients. However, before this promise can be realized, technology has to be properly evaluated for appropriateness of use. This evaluation must include both the clinical impact on patient outcomes as well as the economic impact. Following this initial evaluation, for technologies deemed appropriate for use, careful preparation of clinicians in the use of the technology is necessary. Education must prioritize how the technology is to be used as well as provide incentives for the clinicians to change their current practice. If these three key steps are followed, technology can achieve the promise of improving patient management and outcome. Unfortunately, evidence exists which suggests that these three steps are not followed in many, if not most, hospitals in the United States. In this article, a method of implementing these three steps is presented. However, it is essential that national organizations and societies become active in this process, lest widespread variation in technology utilization continue.

Attitude of Health Personnel↗

PubMed1993

Probing the effects of individual components in multiple component prevention programs.

Assessing the contributions of individual components in multi-component interventions poses complex challenges for prevention researchers. We review the strengths and weaknesses of designs and analyses that may be useful in answering three questions: (1) Is each of the individual components contributing to the outcome? (2) Is the program optimal? and (3), Through what processes are the components of the program achieving their effects? Factorial and fractional factorial designs in which a systematically selected portion of all possible treatment combinations is implemented are used to address question 1. Response surface designs in which each component is quantitatively scaled are explored in relation to question 2. Mediational analysis, a hybrid of experimental and correlational approaches, is considered in relation to question 3. Design enhancements are offered that may further strengthen some of these techniques. These techniques offer promise of enhancing both the basic science and applied science contributions of prevention research.

Combined Modality Therapy↗

PubMed2001

Fast Algorithm for X-ray Cone-beam Microtomography.

Cone-beam X-ray microtomography attracts increasing attention due to its applications in biomedical sciences, material engineering, and industrial nondestructive evaluation. Rapid volumetric image reconstruction is highly desirable in all these areas for prompt visualization and analysis of complex structures of interest. In this article, we reformulate a generalized Feldkamp cone-beam image reconstruction algorithm, utilize curved voxels and mapping tables, improve the reconstruction efficiency by an order of magnitude relative to a direct implementation of the standard algorithm, and demonstrate the feasibility with numerical simulation and experiments using a prototype cone-beam X-ray microtomographic system. Our fast algorithm reconstructs a 256-voxel cube from 100 projections within 2 min on an Intel Pentium II(R) 233 MHz personal computer, produces satisfactory image quality, and can be further accelerated using special hardware and/or parallel processing techniques.

Journal Article↗

PubMedDate not supplied

An integrated instrument control and informatics system for combinatorial materials research.

The use of high-throughput synthesis and characterization techniques is increasingly prevalent in materials science research. We describe the London University Search Instrument, a research apparatus designed for the high-throughput synthesis and characterization of thick-film sample libraries of ceramic compounds. The instrument is constructed largely from commodity components, which pose particular engineering challenges for achieving the automated operation required for efficient high-throughput experimentation. This paper describes the architecture and implementation of the software system that provides integrated instrument control and data management functions.

Journal Article↗

PubMed2002

Quantitative X-ray projection microscopy: phase-contrast and multi-spectral imaging.

We outline a new approach to X-ray projection microscopy in a scanning electron microscope (SEM), which exploits phase contrast to boost the quality and information content of images. These developments have been made possible by the combination of a high-brightness field-emission gun (FEG)-based SEM, direct detection CCD technology and new phase retrieval algorithms. Using this approach we have been able to obtain spatial resolution of < 0.2 micro m and have demonstrated novel features such as: (i) phase-contrast enhanced visibility of high spatial frequency image features (e.g. edges and boundaries) over a wide energy range; (ii) energy-resolved imaging to simultaneously produce multiple quasi-monochromatic images using broad-band polychromatic illumination; (iii) easy implementation of microtomography; (iv) rapid and robust phase/amplitude-retrieval algorithms to enable new real-time and quantitative modes of microscopic imaging. These algorithms can also be applied successfully to recover object-plane information from intermediate-field images, unlocking the potentially greater contrast and resolution of the intermediate-field regime. Widespread applications are envisaged for fields such as materials science, biological and biomedical research and microelectronics device inspection. Some illustrative examples are presented. The quantitative methods described here are also very relevant to projection microscopy using other sources of radiation, such as visible light and electrons.

Journal Article↗

PubMed1991

Assessment of hybrid speckle reduction algorithms.

A consequence of employing coherent detection methods in medical ultrasound imaging systems is the occurrence of interference effects in the received echo field, which produce the speckle artefact. Speckle can severely degrade the information content of the image, and its efficient removal from ultrasound pulse-echo images is the focus of a number of research projects. Traditionally, the approach towards speckle reduction in pulse-echo images has been based on two classes of technique, either employing some form of spatial/frequency compounding or a data (image) filter. Both approaches have inherent shortcomings, and two alternative techniques are suggested here: 'local frequency diversity' and 'frequency differencing'. These algorithms deterministically identify where speckle occurs, and correct for speckle only within short, localized, corrupted segments of the A-line. This provides the potential for real-time implementation. Simulated and clinical in vivo images have been obtained, and the capabilities of the alternative speckle reduction algorithms are assessed against the more conventional approaches.

Algorithms↗

PubMedDate not supplied

Telehealth as a tool for enhancing care for patients with cardiovascular disease.

Telehealth refers to the use of telecommunication technology to remove time and distance barriers in the delivery of healthcare services. Telehealth can help nurses provide education and counseling, social support, disease monitoring, and disease management reminders to cardiovascular patients in their homes. As a result, patients gain more flexibility in scheduling healthcare visits, have easier and more convenient access to healthcare, may have fewer time-demanding clinic visits, receive care in a location that does not require the burden of transportation, and in an environment that is less threatening than a clinic or emergency department. Cardiovascular healthcare may be enhanced through diverse telehealth applications, including sensor technology and wearable monitoring systems, Internet-based peripheral monitoring devices, videophones, interactive voice response systems, and nanotechnology. Although telehealth enhances care, legal, human, and environmental factors need to be considered before implementing a telehealth program. Additionally, more evidence that is obtained through large multicenter controlled trials about the potential benefits and cost effectiveness of telecardiovascular health is needed.

Cardiovascular Diseases↗

PubMed1980

Problems in implementing a good food and nutrition policy in Britain.

There is no co-ordinated food and nutrition policy in Britain, primarily because it is still not recognized that diet has an important role to play in the development of many diseases of affluence. The demand for absolute proof of the dietary component of disease on a population level ignores both the innate biological susceptibility in only a portion of the population to a particular nutrient as well as the increasing evidence from studies on non-human primates that diet plays a key role in several conditions including heart disease. Government remains unsure of how to implement its own current recommendations and the traditional paternalistic and conservative approach delays action. Vested interests, seeking only short-term gains, are not confined to industrial concerns. Marketing Boards are allowed almost unfettered freedom to promote nutritionally undesirable eating habits. Health education in schools remains inadequate with most of the involved teachers still promoting incorrect concepts. The medical profession is still unwilling to take a physician maintaining treatment programmes for marginal effects on a public health problem. General practitioners are better able to start practising preventive medicine but they need to be helped by community physicians who should begin on their main task of implementing policies for preventing disease rather than limiting themselves to their current preoccupation with systems analyses and operational research.

Adult↗

PubMed2006

[Problem-posing as a nutritional education strategy with obese teenagers].

Obesity is a public health issue with relevant social determinants in its etiology and where interventions with teenagers encounter complex biopsychological conditions. This study evaluated intervention in nutritional education through a problem-posing approach with 22 obese teenagers, treated collectively and individually for eight months. Speech acts were collected through the use of word cards, observer recording, and tape-recording. The study adopted a qualitative methodology, and the approach involved content analysis. Problem-posing facilitated changes in eating behavior, triggering reflections on nutritional practices, family circumstances, social stigma, interaction with health professionals, and religion. Teenagers under individual care posed problems more effectively in relation to eating, while those under collective care posed problems in relation to family and psychological issues, with effective qualitative eating changes in both groups. The intervention helped teenagers understand their life history and determinants of eating behaviors, spontaneously implementing eating changes and making them aware of possibilities for maintaining the new practices and autonomously exercising their role as protagonists in their own health care.

Adolescent↗

PubMed2003

Refinements in the care and use of animals in toxicology studies-regulation, validation, and progress.

During the past decade, important advances have been made in the humane care and use of laboratory animals used in toxicology studies, and there is strong international interest by the pharmaceutical sector in continuing with this progress. Because of the potential influence on human health, safety studies are highly regulated, and implementing refinements in laboratory animal care and use may require an initial validation study to demonstrate a lack of effect on study outcome. This paper provides an overview of issues surrounding implementation of animal care refinements in toxicology laboratory settings, including regulatory constraints, conducting validation studies, current progress in refinements, and areas for future consideration.

Animal Care Committees↗

PubMed1987

Using cooperative learning strategies to teach nutrition.

There are three ways in which student-student interaction may be organized for nutrition education. Of the three, cooperation is the only instructional strategy congruent with the goals of nutrition education. The essential elements of cooperative learning and the specific actions teachers need to take to implement it are presented. When cooperative learning is implemented effectively, long-term modifications of nutrition knowledge, attitudes and behavior result. Nutrition education classes will more successfully fulfill their purposes when cooperative learning is primarily used.

Adolescent↗

PubMedDate not supplied

Microprocessors in intensive care medicine.

Three specific applications of microprocessors to intensive care instrumentation are presented. Automatic feedback control of mechanical ventilation is achieved using end-tidal carbon dioxide concentration, oxygen consumption, and carbon dioxide production as the input control parameters. Closed-loop control of fluid infusion is used for resuscitating burn patients; intravenous infusion rate is microprocessor controlled to maintain a desired urine output. Metabolic rate is measured by indirect calorimetry using a microprocessor to compute the results and control the measuring instrumentation. These examples show how microprocessor technology has been used to expand instrumentation capability and implement feedback control. These systems use multiple-input feedback control, user guidance, automatic calibration, self-diagnostics, and intelligent alarms.

Computers↗

PubMed1996

How to evaluate and implement new technologies in an era of managed care and cost containment.

New technologies often enable clinical laboratorians to overcome the challenges we face. These technologies sometimes become available with amazing punctuality, addressing recent problems and keeping the physician-customer satisfied for another day. Traditionally, developments such as a new cancer marker have been implemented into routine use with little circumspection because the benefits diagnostically and financially were perceived to far outweigh the risk that the new test or technology was not as effective as described. The notion of subsequently removing older tests inferior to the new one has hardly been considered. The challenges confronting clinical laboratorians today, however, are affecting that typical pattern dramatically. Four of the most pervasive challenges are comprehensively examined in the 1995 Clinical Chemistry Forum. One of these key areas--the proper implementation of modern technology in the form of new tests or new approaches to producing clinical laboratory results--is the main topic of this review.

Chemistry, Clinical↗

PubMed1998

Balancing ethical quandaries with scientific rigor: Part 2.

Traditional ethical concerns in research tend to focus on serious misconduct such as fabricating data and gross violations of informed consent. In this two-part article, we focused on some of the less serious and more subtle ethical quandaries, inherent and common in most social science research. It is our thesis that these issues are important and warrant more attention and careful thought than they have been accorded in the scientific literature and, perhaps, by investigators at large. In Part 2, we provided examples of how we, and others, dealt with some of these issues in actual studies. However, we also must emphasize the individual and reflective nature of confronting ethical issues in research. We found many benefits in using a team approach to address ethical dilemmas during implementation of our studies. Doing so kept everyone honest with themselves and each other, shared the burden of responsibility among team members for the decisions made, maximized the use of team members' strengths, and led to much better resolutions of the issues from both a scientific and an ethical perspective. Maintaining scientific rigor while balancing and deliberating about the ethical implications of decisions is a challenge for all research teams. It requires learning how to be vigilant and responsive when faced with the many subtle, but ever-present, scientific and ethical quandaries encountered when doing what is often assumed to be nonthreatening social research. There are no fixed, prescriptive rules for what to do in every study. Rather, a reflective process, considering the specific issues of each unique study, is required.

Adult↗

PubMed2006

Maslow's hierarchy of needs: a framework for achieving human potential in hospice.

Although the widespread implementation of hospice in the United States has led to tremendous advances in the care of the dying, there has been no widely accepted psychological theory to drive needs assessment and intervention design for the patient and family. The humanistic psychology of Abraham Maslow, especially his theory of motivation and the hierarchy of needs, has been widely applied in business and social science, but only sparsely discussed in the palliative care literature. In this article we review Maslow's original hierarchy, adapt it to hospice and palliative care, apply the adaptation to a case example, and then discuss its implications for patient care, education, and research. The five levels of the hierarchy of needs as adapted to palliative care are: (1) distressing symptoms, such as pain or dyspnea; (2) fears for physical safety, of dying or abandonment; (3) affection, love and acceptance in the face of devastating illness; (4) esteem, respect, and appreciation for the person; (5) selfactualization and transcendence. Maslow's modified hierarchy of palliative care needs could be utilized to provide a comprehensive approach for the assessment of patients' needs and the design of interventions to achieve goals that start with comfort and potentially extend to the experience of transcendence.

Hospices↗