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Results for “Implementation science”

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PubMed1999

[Nutritional education in public health services].

The purpose of this study was to discuss the implementation of nutritional education in public health services from the perspective of health professionals (physicians and nurses) working in them. The study was conducted in the Municipality of Campinas, São Paulo State, Brazil, from October 1993 to July 1995, using action-based research methodology. The results describe the construction of nutritional knowledge in training and professional institutions; behavior towards food-related problems in daily professional experience as compared to personal life; the contradiction between the apparently trivial act of eating and the complexity of dietary problems; the interface between the acceptance of this work and the incorporation of nutritional education activities and their actual institutionalization; and health professionals' opinions concerning situations permeating the implementation of activities. The paper concludes by referring to the need to implement nutritional education activities, difficulties experienced by physicians and nurses in approaching nutritional problems, and the importance of including nutrition in the curricula of health courses.

Attitude of Health Personnel↗

PubMedDate not supplied

Telemedicine: experience at SGPGIMS, Lucknow.

Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) located in Lucknow, capital of Uttar Pradesh, a state in Northern India, is a tertiary level referral academic medical center involved in teaching and training of super specialist medical professionals with 22 academic departments. It is the first tertiary care hospital in public healthcare sector in India to adopt Information Technology (IT) for healthcare delivery. The Hospital Information System (HIS) was implemented in 1998 to record, store, process and retrieve health data of all the patients. This software was developed in-house in collaboration with Center for Development of Advanced Computing (C- DAC), Pune. Later in the year 1999, telemedicine activities were initiated in the form of testing the concept and technology. The first research grant was availed of in the year 2001, which helped in creating an infrastructure for telemedicine. Regular tele-healthcare and tele-educational services were introduced for the postgraduate students of medical colleges of Orissa. These services have now been extended to educate the doctors of other medical colleges and community centers in other states. Besides, the Institute is associated with organizational activities and in policy initiatives of the government. All the activities are in project mode and are being financially supported by government agencies such as Indian Space Research Organisation (ISRO) and Department of Information Technology. Looking at the need of skilled manpower in the field of telemedicine and e-health, a school of telemedicine is coming up in the campus, which will also provide core infrastructure for research and development.

Academic Medical Centers↗

PubMedDate not supplied

Use of genetic algorithms to solve biomedical problems.

Many problems in the biomedical sciences can be formulated as searches in some appropriate space. The genetic algorithm offers a domain-independent approach to searching that is often able to provide good answers to questions with difficult search spaces. This paper discusses when to use this genetically inspired approach, how to model problems as searches, how to define appropriate spaces, representations, and fitness functions, and how to implement a program using a genetic algorithm.

Algorithms↗

PubMed1995

Think globally, act locally: an approach to implementation of clinical practice guidelines.

BACKGROUND: In an environment of concern about the rising costs of medical care, the Vermont Program for Quality in Health Care (VPQHC; the program) was incorporated in 1988 as a nonprofit organization and in 1989 was made a peer review organization by the state legislature. The program acts a resource center for health care in Vermont, coordinating three functions: implementation and maintenance of a statewide database for healthcare quality; training for health care providers in continuous quality improvement (CQI) methods and support for their CQI projects; and focusing clinical study group work on specific diagnoses or procedures. METHODS: The program uses a seven-step process for implementing CQI: pick a process (modify a nationally developed guideline or develop a new guideline); select a team of people involved in doing the work; establish goals and key quality factors; document the clinical process; determine what and how to measure; measure and analyze data; and modify the process to improve. GUIDELINE: This article describes the implementation of a guideline from the American College of Obstetricians and Gynecologists (ACOG) on cesarean section (C-section). Except for a few specific contraindications, the ACOG paper states that it is reasonable to encourage vaginal birth after C-section. A related set of criteria from ACOG states that the benchmark for emergency C-section should be 30 minutes from the decision to proceed with an emergency C-section until the baby is born. CASE STUDY: State C-section rates from 1985-1990 showed wide variation by hospital. Such wide variation is based as much on practice style as on sound science. C-section rates (primary and repeated) were measured, plotted, and shared with Vermont hospitals. Successful vaginal birth after C-section (VBAC) rates from the statewide data-base also were shared. Based on these data, one hospital, Hospital A, developed a plan to lower its repeated C-section rate and improve its VBAC rate. Hospital A collected and reviewed local data, which showed interesting variations. The time from decision to birth became the focus of the overall project; Hospital A designed its project to study events during the time from decision to birth. RESULTS: Most recent data (1992-1993) from Hospital A shows improvement in three areas. First, 89% of patients having emergency C-sections met the goal of a 30-minute time frame from decision to incision. Second, the VBAC success rate for the same time period increased to 85.7% from 69% in the previous year, and from a mere 7% before the implementation of the project. Third, the percentage of total C-sections that were repeat C-sections fell to 36% from a high of 51%. In a follow-up evaluation, one-third of the C-section performed from October 1, 1993, to July 31, 1994 were performed because of patient refusal to attempt VBAC, suggesting that there is a communitywide culture that influences behavior. A major effort at patient education on VBAC is underway. CONCLUSIONS: Think globally, act locally, might be the motto for the program. Implementing guidelines starts with obtaining national guidelines and literature but needs the use of local data to sharpen the focus on narrow areas to address. Specifically, it is unrealistic to tackle the entire problem at once. Success comes from finding specific opportunities for improvement.

Cesarean Section↗

PubMed1993

Quantities and units in medical science: a plea for standardization.

The paper puts forward the idea that a relative lack of interest in the quantitative aspects of pathophysiological processes has made medical practice as well as medical research vulnerable to misconceptions carried into the field by technical innovations. More attention to these matters may not only prevent much dangerous confusion but may also deepen the insight in pathophysiological relationships. This is elucidated with the help of the description of three instances-the confusion on the definition of oxygen saturation of haemoglobin, the resistance against the implementation of SI-units, and the standardization of haemoglobinometry-bearing on different aspects of the problem. It is concluded that international agreement on the definitions of concepts, quantities and units may provide a valuable aid in the development of the quantitative side of scientific medicine.

Hematology↗

PubMed2005

Preliminary results of neural networks and zernike polynomials for classification of videokeratography maps.

PURPOSE: Our main goal in this work was to develop an artificial neural network (NN) that could classify specific types of corneal shapes using Zernike coefficients as input. Other authors have implemented successful NN systems in the past and have demonstrated their efficiency using different parameters. Our claim is that, given the increasing popularity of Zernike polynomials among the eye care community, this may be an interesting choice to add complementing value and precision to existing methods. By using a simple and well-documented corneal surface representation scheme, which relies on corneal elevation information, one can generate simple NN input parameters that are independent of curvature definition and that are also efficient. METHODS: We have used the Matlab Neural Network Toolbox (MathWorks, Natick, MA) to implement a three-layer feed-forward NN with 15 inputs and 5 outputs. A database from an EyeSys System 2000 (EyeSys Vision, Houston, TX) videokeratograph installed at the Escola Paulista de Medicina-Sao Paulo was used. This database contained an unknown number of corneal types. From this database, two specialists selected 80 corneas that could be clearly classified into five distinct categories: (1) normal, (2) with-the-rule astigmatism, (3) against-the-rule astigmatism, (4) keratoconus, and (5) post-laser-assisted in situ keratomileusis. The corneal height (SAG) information of the 80 data files was fit with the first 15 Vision Science and it Applications (VSIA) standard Zernike coefficients, which were individually used to feed the 15 neurons of the input layer. The five output neurons were associated with the five typical corneal shapes. A group of 40 cases was randomly selected from the larger group of 80 corneas and used as the training set. RESULTS: The NN responses were statistically analyzed in terms of sensitivity [true positive/(true positive + false negative)], specificity [true negative/(true negative + false positive)], and precision [(true positive + true negative)/total number of cases]. The mean values for these parameters were, respectively, 78.75, 97.81, and 94%. CONCLUSION: Although we have used a relatively small training and testing set, results presented here should be considered promising. They are certainly an indication of the potential of Zernike polynomials as reliable parameters, at least in the cases presented here, as input data for artificial intelligence automation of the diagnosis process of videokeratography examinations. This technique should facilitate the implementation and add value to the classification methods already available. We also discuss briefly certain special properties of Zernike polynomials that are what we think make them suitable as NN inputs for this type of application.

Artificial Intelligence↗

PubMed2005

[Responsibilities of the Public Health Service in psychiatric care].

Almost unnoticed by the general public, but also to some extent by public health professionals, psychiatric care in Germany has recently undergone considerable change. This development could be considered as more revolutionary than changes seen in somatic medicine. These changes can also be found in progress in "psychiatry as a science"in areas as diverse as prevention, diagnosis and treatment of those with mental illness, and their rehabilitation, recovery and after-care. Public health professionals have long witnessed these changes which have fluctuated in intention and intensity. This paper reviews the development of present-day responsibilities of the Public Health Service in psychiatric care and underlines the need for reform presenting an implementation plan and an outline of possible structural changes.

Community Mental Health Services↗

PubMed2006

Clinical trials in pediatrics: The drug delivery dimension.

The medical and drug delivery devices needs of children are quite different and unique when compared to that of adults. The practice of off label use and modification of adult devices for pediatric use is widespread. Attendant risk and adverse effects of such practices are poorly documented. Lack of pediatric age appropriate drug formulations constitutes a major impediment to pediatric drug labeling. While novel drug delivery system can help circumvent some of the pediatric formulations issues, the inherent high cost of development, the small size of the pediatric market, and the ethical dilemma of enrolling children in non-therapeutic clinical trials continue to militate against pediatric drug labeling as well medical devices development. Over the past four decades, major breakthroughs and achievements in basic biomedical science have supplied unprecedented potential information for improving human health. The need for properly designed and conducted pediatric clinical trials along with new drug delivery devices has never been greater. However major issues, like slow transition of promising basic scientific discovery into clinical applications, heavy regulatory burden, limited pediatric pharmacology research infrastructure, spiraling costs of health care, disproportionate governmental funding of basic science research over clinical research, conflicts of interest, and shortage of properly trained clinical investigators and willing study subjects continue to constitute major impediments to pediatric clinical trials clinical trials. This paper will seek to review among other things, the current state of affairs and the structure of the pediatric academic research enterprise along with their relationship with the pharmaceutical industry. Impediments to successful implementation of clinical trials in the academic setting will also be closely examined.

Child↗

PubMed2006

Effect of an integrated functional stability program on injury rates in an international netball squad.

The cost-effectiveness and efficacy of athlete profiling and injury prevention programs is influenced by procedural specificity, philosophy of athlete development within the sporting body and the dynamics within the multidisciplinary team (MDT). This article reports on the implementation of a multidisciplinary approach to injury reduction and performance development in an international netball squad. Problems with player compliance, training anxiety and injury rates sparked a decision to seek an alternative training approach. A reactive sports medicine system, poor player self-responsibility and inadequate player understanding of the anatomy and biomechanics of sound training, inadequate screening procedures and perceived conflict between sports science and sports medicine personnel were identified as causative factors. A new program was designed where common objectives were identified, and individual roles delineated. A functional profiling session was performed as a team activity and comprised player self-evaluation and netball specific movement analysis. Mechanisms of injury, training anxieties and modification of the overall program to ensure continued progression rather than a false plateau were illustrated through this process. From the above findings a strategy was outlined and comprised a foundation programme, a transitional phase, specific prophylactic programs, and sport specific sessions. A consistent approach was formulated across all disciplines in order to maximise transference of the new training program (TP). Training compliance was increased and interdisciplinary conflict prevented when dealing with different levels of training tolerance. Rate of injury in all vulnerable areas was markedly reduced. No training or overuse related injuries were sustained. Addressing fundamental functional problems and working openly and cooperatively towards a common goal, the members of the MDT were able to prevent injury, make significant gains in physiological performance and improve players' confidence and commitment to training over the defined period.

Adult↗

PubMed1998

Interpreting the notion that technology is value-neutral.

Value-freedom or value-neutrality is a well-known topic in the philosophy of science. But what about the value-neutrality of technology, medical or other? Is it too far-fetched to imagine technology as in some sense value-neutral--in view of its intimate connection with purposeful human action? No; unexpected perhaps, but less far-fetched than expected. If we try to conceive of technology as a cognitive possibility abstracted from each and every specific social context, we shall find (at least) three senses in which it may be regarded as value-neutral: (1) neutral vis-à-vis different possible uses and ends; (2) neutral before action; (3) neutral qua cognitive object, analogous to the cognitive core of science. The further meanings and implications of these three senses of value-neutrality are discussed. What is this exercise good for? The nature of technology is indeed worth pondering in its own right, not least from this rather unusual angle. But beyond that: as the possible meanings of value-neutrality are tried out, the radical nature of human responsibility for the social implementation of technology will be highlighted.

Diffusion of Innovation↗

PubMed2005

An update on master's degrees in medical education.

Planning and implementing educational programs in medicine optimally requires a background in educational theory and practice. An avenue of training open to such practitioners is a master's degree in medical education. A single 1998 report lists the programs known at that time and information about them remains scarce. The authors have re-examined all current programs offering master's degrees in medical or health sciences education in the English-speaking world, including the Netherlands. The authors contacted the programs identified in the 1998 report to establish how many were still in operation. The search was extended using Pubmed and other search engines. A further verification targeted a selected sample of 10 prominent US medical schools. Twenty-one currently operating programs were identified: six in the US, eight in the UK, three in Canada, three in Australia and one in Holland. Seven of nine original master's programs were still in existence. URLs, website and other logistical information about each program are tabled. A master's degree in medical or health sciences education is the most specific method for medical faculty to obtain a credentialed grounding in educational theory and practice. The authors provide up-to-date contact information for current programs and summarize other related essential logistical data.

Curriculum↗

PubMed2006

Policy Interpretation Network on Children's Health and Environment.

AIM: The main objective of PINCHE is to provide policy recommendations aiming at protecting children's health and environment based on completed scientific research. The project focused on four themes: indoor and outdoor air pollutants, carcinogens, neurotoxicants, and noise. The data were evaluated in workpackages on exposure assessment, epidemiology, toxicology, and risk and health impact assessment. The data were analysed according to a framework of questions. The workpackage on socioeconomic factors studied the influence of socioeconomic status on exposures and on health effects. In the workpackage on science-policy interface, recommendations on how to improve children's environmental health were formulated. RESULTS: The policy recommendations resulting from the analysis were grouped according to relevant policy levels: European Commission or the European Parliament, member states and other stakeholders at regional or local level. These recommendations are general guidelines for taking action. Regional differences and variation must be reflected when policy is actually implemented. In addition, recommendations related to education and personal behaviour are presented in the reports. CONCLUSIONS: The policy recommendations are important input for policy advisers, policy makers and public health authorities at all policy levels. The recommendations are also of direct relevance to interest groups, such as environmental NGOs including child health and advocacy groups. The policy recommendations for each policy level were prioritized. High priorities were given to reduce exposure to environmental tobacco smoke, transport related air pollution, indoor air and mercury.

Advisory Committees↗

PubMed1996

The administration's responsibility to the consumer.

Biotechnology offers the promise of good jobs that produce products fulfilling the public's need for food, fiber and pharmaceuticals. It could provide a growing market for American products abroad, and it also offers the potential of environmentally sound solutions to some current problems. Government is therefore accountable for implementing policies to protect the public health, while at the same time promoting the growth and development of the industry. Such policies should stimulate research, ensure the safety of new products, protect the environment, encourage business to innovate and invest and lead to a literate public capable of holding those high technology jobs. Stewardship of the federal government's $70 billion annual investment in science and technology entails the following: 1) setting an overall policy framework and managing the effort efficiently within that framework; 2) supporting the conduct of fundamental science critical to achieving the stated goals; and 3) providing an environment that encourages private investment in innovation and technology development.

Biotechnology↗

PubMed2025

A Systematic Review of Spatial Epidemiological Modeling Approaches Applied During the COVID-19 Pandemic.

BACKGROUND: A wide range of epidemiological modeling approaches have been applied to the SARS-CoV-2 pandemic, which presents an opportunity to assess common approaches applied to specific research questions. Spatial models interrogate how heterogeneities and host movement dynamics influence local and regional patterns of disease, issues that were of great interest for understanding and controlling SARS-CoV-2. OBJECTIVE: Here we present a systematic review of spatial epidemiological modeling approaches of SARS-CoV-2. We describe common themes and highlight unique strategies, providing a foundation for researchers to devise spatial models most appropriate for future pathogens and epidemics. Our review also categorizes the research questions that were addressed with spatial models, highlights parameter estimation techniques, and describes the cyber infrastructure used for model development. METHODS: We conducted a systematic review using Web of Science and a standardized set of keywords, followed by thorough examination of abstracts and full texts to determine which studies met our inclusion criteria. To guide our description and comparisons of models, we developed a Geography, Population, Movement (GPM) framework that conceptualizes the interactions between three distinct subcomponents of any spatial model. The geographic model represents the physical arena in which the model is implemented, the intra-population model describes the transmission and disease processes that occur within distinct spatial units of the geography, and the movement model describes the algorithms that dictate how hosts move among spatial units within the geography. RESULTS: The search identified a total of 193 articles, of which 109 were included in our review. The most abundant intra-population modeling methods were agent-based (47.7%) and compartmental modeling (29.4%) approaches. Movement models ranged in complexity, with the most complex models implementing commuter movement among many points of interest in the geographic arena, which were sometimes parameterized by fine-scale mobility data. Geographic models ranged from describing microcosms, such as single classrooms, all the way up to multi-country models. Of the 63.3% of models studies that specified the programming language used, we detected ten different languages, with Matlab and Python being the most frequent, although only 30.6% of studies provided open-access code for their models. We also described eight specialized software systems that were used to construct agent-based or compartment models of COVID-19. CONCLUSIONS: Our review identified and characterized a variety of spatial modeling strategies and software that were usefully employed to address many relevant epidemiological questions for COVID-19. Future research is needed to quantitatively assess which modeling approaches are most appropriate in specific situations, to answer specific questions, or to apply to certain disease systems. Moreover, future cyberinfrastructure could help to modularize and standardize modeling approaches, which would increase transparency and reproducibility, and which would facilitate a detailed examination of which model attributes relate to model performance in a variety of contexts.

COVID-19↗

PubMed1995

Fate, transport, and interactions of heavy metals.

Mishandling of hazardous wastes, like their unauthorized disposal in abandoned dump yards or sites, in river beds, estuaries or in the sea, causes substantial damage to the environment and its resources and, given the persistence and toxicity of these pollutants, they can seriously damage human health and quality of life. The importance of controlling management, transport, and disposal of toxic and hazardous substances in the years to come will be a crucial issue in the design and implementation of public policies. This is especially true for residents of such areas as the border between the United States and Mexico, where historically hazardous wastes have been a public health and environmental problem. The aim of this Conference on the Fate, Transport, and Interactions of Metals, A Joint United States-Mexico Conference, co-sponsored by the National Institute of Environmental Health Sciences, Superfund Basic Research Program, the National University of Mexico, Program for the Environment and the Pan American Health Organization, and hosted by the University of Arizona Center for Toxicology, College of Pharmacy, is to begin a joint effort by the United States and Mexico to better understand the complex problems related to heavy metals as hazardous wastes.

Environmental Health↗

PubMed2003

Implementing PDA technology in a medical library: experiences in a hospital library and an academic medical center library.

Personal digital assistants (PDAs) have grown from being a novelty in the late 1990s to an essential tool for healthcare professionals in the 2000s. This paper describes the experiences of a librarian who implemented PDA technology first in a hospital library, and then at an academic medical center library. It focuses on the role of the library in supporting PDA technology and resources. Included are programmatic issues such as training for library staff and clinicians, and technical issues such as Palm and Windows operating systems. This model could be used in either a hospital or academic health sciences library.

Academic Medical Centers↗

PubMed2004

[But what future for our students?].

Since June 1, 2002, only those dental practitioners holding a specific professional title are entitled to independent practice. Those practitioners are the General Dentists, the Orthodontists and the Periodontists who have had additional vocational training of one, four, or three years respectively, after completion of their study programme leading to a Licentiate in Dental Sciences (Transition measures allowed practising dentists and students who were enrolled in a training program prior to June 1, 2002 to obtain one of these titles). This regulation includes provisions to limit access to the profession for graduates holding a degree delivered by a university in the Flemish community (84 per year) or the French Community (56 per year). In the French Community, the implementation of a Numerus Clausus (limitation of numbers admitted) at the end of the first study cycle allowed for a limitation of the number of students admitted to the second cycle, and as a consequence it limited the number of candidates enrolling in vocational training in order to obtain a specific professional title. The non-compliance with - and later the cancellation of - this limitation resulted in the number of candidates seeking a specific professional title to be larger than the numbers in the quotas imposed by the Federal State.

Belgium↗

PubMedDate not supplied

Chronobiology: a frontier in biology and medicine.

On the occasion of Franz Halberg's 70th birthday, some of his many achievements are reviewed. We provide a historical background to the development of chronobiology; offer insight into the current state of this new science; and sketch the promise of this discipline for health care and cure. As a tribute to Franz Halberg, in an era of fast-growing technology, an attempt is made to describe his perspective of tomorrow's medicine and biology. The many students he trained throughout his productive career face the challenge of deserving the trust he placed in them and of further implementing his vision. A leader in social pediatrics put it aptly: it will take several generations of researchers to study and master his life's work.

Animals↗