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National cancer institute perspectives.

The National Cancer Institute (NCI) Perspectives this year presented information on the systemic targeted radionuclide therapy (STaRT) research projects: (1) being investigated at the NCI's Intramural Center for Cancer Research; (2) funded by NCI's Radiation Research Program and other extramural programs; and (3) the appropriate National Institutes of Health/NCI funding mechanisms applicable to researchers for obtaining funds for STaRT projects.

Antibodies, Monoclonal↗

Measurement of the costs in two mammographic screening programmes in the province of Florence, Italy.

OBJECTIVES: To estimate and to compare the cost per woman examined and per breast cancer detected in two mammographic screening programmes in the province of Florence. SETTING: Two ongoing, population based, mammographic screening programmes in the province of Florence. The first (district project) was started in the seventies in a rural area, whereas the second (city project) was started in the city at the end of 1990. METHODS: All relevant resources consumed by the programmes (costs) were listed and measured. The costs are related to 1993. The unit cost for each phase (recruitment, screening, assessment) of the screening process was estimated by dividing the total cost of the phase by the number of women examined. The cost per cancer detected was obtained by dividing the total cost of the programme by the number of cancers detected at screening. RESULTS: The costs per woman examined were $38.1 and $41.1 in the district and city programmes respectively. The cost per breast cancer detected was $7424 in the district programme and $5180 in the city programme. Staff accounted for more than 50% of the total cost. The unit cost in the screening phase was higher in the district programme, whereas it was lower in the assessment phase. CONCLUSIONS: Our results are consistent with, although slightly lower than, published estimates of the cost per woman screened. Important parameters for determining the efficiency of a mammographic screening programme are the compliance rate and the recall rate.

Breast Neoplasms↗

Top-down design of a picture archiving and communications system (PACS) by means of simulation.

The development of picture archiving and communications systems (PACS) for medical applications can be regarded as a challenging field in medical informatics. Since 1982, several projects have been started into this direction worldwide. The Dutch IMAGIS (Image Information System) project, started in 1984, is one of them. Within this project, a top-down design strategy is chosen, with the following first steps: (1) A thorough information analysis for a Radiology Department, in which both qualitative and quantitative aspects are included. Such an analysis can be used to estimate the workload on a future PACS system. (2) The construction of a flexible performance prediction tool, based on discrete even simulation. Such a tool can be used to predict the performance of a certain computer system configuration under a certain workload. Based on the information analysis, and using the performance prediction tool, a PACS system is drafted for the thorax section of the Diagnostic Radiology Department of the Leiden University Hospital. In this first design attempt, the assumption was made that current working procedures concerning images will be maintained as much as possible.

Archives↗

[Obstetric nursing in prenatal consultation].

This study consists of a report about a research project which started in August, 1997. The project involved teachers from the maternal-paediatrics department with Faculdade de Enfermagem--UERJ (Nursing Faculty with State University of Rio de Janeiro) and professionals from the municipal health center in Rio de Janeiro--SMS/RJ. The introduction of prenatal nursing consultation as a new subject in the nursing graduation course, as well as its formation, and implementation in the referred municipal health center is reported in this paper. This study also proposes a review of the current biomedical consultation model, in order to motivate reflection, break paradigms, and increase the prenatal consultation process in Rio de Janeiro.

Female↗

Studies on Schistosoma japonicum infection in the Philippines. 1. General considerations and epidemiology.

The geographical location and physical features of the island of Leyte in the Philippines, where bilharziasis is endemic and where the studies reported here were conducted, are described in the first part of this paper. An account is also given of the climate, soils, vegetation, population and rural structure, and public health of the island.The second part opens with a brief historical review of bilharziasis japonica in the Philippines up to 1953, when a control project was started. The objectives of this project, the areas selected, the census data and sampling used, and the techniques adopted are described. There follows a discussion of the prevalence of bilharziasis and its relationship to age, sex, occupation and environment; the prevalence of other common helminthic infections is also considered. In a section on the natural history and public health significance of bilharziasis, an approach to quantitative assessment of disease and disability and a method for evaluating the economic burden of bilharziasis are suggested. The incidence of disease in children of 5-9 years is reviewed in the same section. An analysis is made of possible strain differences of S. japonicum in Leyte, and the relative role of human and other animal hosts is assessed. The last section deals with the egg-laying habits of S. japonicum.

Animals↗

[Distance learning using internet in the field of bioengineering].

The Leonardo da Vinci training programme supports innovative transnational initiatives for promoting the knowledge, aptitudes and skills necessary for successful integration into working life. Biomedical engineering is an emerging interdisciplinary field that contributes to understand, define and solve problems in biomedical technology within industrial and health service contexts. Paper presents a Leonardo da Vinci pilot-project called Web-based learning and training in the field of biomedical and design engineering (WEBD). This project has started on 2001. The WEBD project proposes to use advanced learning technologies to provide education in the www. Project uses interactive 3D graphics and virtual reality tools. The WEBD distance training permits users to experience and interact with a life-like model or environment, in safety and at convenient times, while providing a degree of control over the simulation that is usually not possible in the real-life situation.

Biomedical Engineering↗

Experience with excreta-disposal programmes in rural areas of Brazil.

As part of a wide public-health programme for rural areas of Brazil, the Serviço Especial de Saúde Pública (SESP) has, since 1944, placed considerable emphasis on the problem of excreta disposal. Except in a few cities where conditions justified the construction of sewer systems, projects were started for the erection of pit privies, some 18,000 having been built up to 1952. The projects are conducted by specially trained personnel ("guardas"), who first carry out a sanitary survey of the area concerned, at the same time explaining the benefits of sanitation to the people. A general plan having been drawn up, construction is begun under the supervision of the guardas, who strive to enlist the co-operation of the house-owners as far as possible.Various types of privy have been tried, local building materials being used wherever possible. In almost all cases, however, concrete slabs have been used, covering a hole which may vary in width, but which is generally 2 m deep. Where possible, the SESP has sought the financial collaboration of the local authorities, but the earlier projects were entirely financed by the SESP.Surveys carried out before the projects were started and 3-4 years later show that in certain areas the fall in the percentage of the examined population found positive for Ancylostoma was from 37.6 to 25.4 and all severe infestations (over 500 eggs per g of faeces) had disappeared. This result, though appreciable, would probably have been greater had all the inhabitants used the privies and had they been better maintained.

Brazil↗

[Employees without pension arrangements].

Old age pensions in modern western industrial countries rest on three pillars: public, collective and individual-private arrangements. The flat-rate public system and the collective systems, domain of industrial relations, prevail in Holland. Since the early seventies the public old age pension (AOW) has been raised to the net minimum wage level. In the meantime the importance of the collective systems has been increasing. The pension levels of these systems are, however, not prescribed by law. In order to measure the present state of the collective systems the Dutch Chamber of Pensions has started a research project to investigate how many workers lack such an arrangement and why they lack it. The results of the project have recently been reported: in 1985 18% (650,000) of the workers (25-65 years) lacked an arrangement. The vast majority of them (87%) was found in the sector of services, especially the commercial services. A second research project has been started to find out the quality of the existing pension arrangements. The results of the two projects together are meant to answer the question whether or not some sort of collective pensions must be enforced by law. The improvement of collective pension schemes, however, should not lead automatically to decreasing public schemes. For most people the public pension system is the most important source of income.

Adult↗

Why German medical students abandon dissertations.

In Germany, conducting a research project followed by writing a thesis is necessary to receive the title "Doctor" but is not necessary to work as a physician. To determine the reasons that students abandon their dissertations, we conducted and analyzed a survey among 160 fifth and sixth-year medical students at the University of Wuerzburg. Fifteen of 160 respondents (9%) reported to have stopped working on their original project before starting their current replacement thesis research project. Among these 15, the major reasons for abandoning the original research project were: seven (47%) reported lack of supervision, three (20%) reported no recognizable progress, and another three (20%) reported an unacceptable burden of work. Unfamiliarity with experimental methods led two students (13%) to stop working on their original research project. Close supervision and a thorough training remain necessary to prevent students from abandoning medical dissertations and thus should be an essential part of every research project in which medical students are involved.

Journal Article↗

Organize for success: seven steps to a successful building project.

Intended for ambulatory care administrators considering a building project, the article discusses seven key steps to a successful project: Avoid common pitfalls: allow enough time, avoid over-delegation, focus staff on issues rather than egos, require staff "buy-ins" to project concepts and design, and understand the realties of construction. Select the right team: how to interview, assess qualifications, and make a sound decision. Understand all the project costs; construction cost is only one of many. Understand the various construction methods and pricing alternatives; become a sophisticated consumer. Understand the nature and scope of the risks inherent in building projects. Understand all the management issues. Start your project off right through producing. Identify strategic goals and needs, then quantify and qualify your project's intent, scope, and basic financial assumptions.

Ambulatory Care Facilities↗

Health promotion in the Finnish shipping industry.

In autumn 1997 a pilot project was started in Finland to develop methods for promoting the health of sailors. Four Finnish shipping companies, (4 cargo ships and 2 passenger-cruise ferries), with altogether 730 sailors participated in the project. Special attention was paid to individuals with health problems and those who generally did not take care of their own health or fitness. Three-quarters of the respondents saw their health as good and one fifth as fair. Thirty-four persons responded that their working capacity was poor. 154 sailors were selected into further physical fitness evaluations. The main task of the project team was to activate sailors to take care of their own health and well-being. The health-promoting activities were directed especially at those persons who needed it. Information lectures concerning healthier eating habits and meals were given. Anti-smoking and anti-alcohol drinking information was given. On board one cruise ferry a project was started on how to react as early as possible to alcohol abuse among seafarers. Courses on shore for sailors were arranged to improve their physical fitness and to increase their resting benefit between working periods at sea. The intervention time was one year. Information about smoking and alcohol led to reduced alcohol consumption. The sailors had started to exercise more often both on board ship and on shore. Those who had increased their physical exercise during free time more often found their own health and working ability to have improved than those who had not changed their exercise habits. It appeared that health intervention projects are really needed especially by older sailors. The results also showed that positive effects could be achieved in the fitness of sailors. Better fitness was good for their health and also increased the work safety.

Accidents, Occupational↗

Daycare tonsillectomy and/or adenoidectomy at the British Columbia Children's Hospital.

The fact that tonsillectomy (T), or tonsillectomy with adenoidectomy (T & A) or adenoidectomy (A) can be performed safely in selected children on a daycare or outpatient basis is well proven. This article illustrates the approach that the British Columbia Children's Hospital (B.C.C.H.) took to confirm that the procedures were safe locally. A pilot project was started in June of 1984 to perform daycare adenoidectomies only, using two full-time pediatric otolaryngologists. When this proved successful, other otolaryngologists were encouraged to use the program. In June of 1988, a second pilot project was started for daycare tonsillectomies (or tonsillectomy and adenoidectomy). Criteria were established for patient selection, preparation, anesthesia, post-anesthetic recovery (PAR), Daycare Unit (DCU) nursing, and discharge. Follow-up information was obtained. Daycare tonsillectomy with or without adenoidectomy and daycare adenoidectomy are now routine procedures at B.C.C.H.

Adenoidectomy↗

A comparison of motor performance of preschoolers enrolled in mental health programs and non-mental health programs.

Recognizing that the etiologies of some major mental illnesses may be in the physical domain, this study described and compared the motor performance of 27 preschool children enrolled in mental health programs with 27 children enrolled in Project Head Start, a non-mental health program. The two groups were matched for age, race, and sex. The Gross and Fine Motor scales of the Peabody Developmental Motor Scales were administered to all subjects. On both measures the children enrolled in mental health programs scored significantly lower than the children enrolled in Project Head Start. In addition their scores were more variable. The results of this study support other findings suggesting that developmental delays may be characteristic of children with emotional disturbances.

Child, Preschool↗

In the eye of the beholder: problems of perception in designing a strategy to promote evidence-based clinical policy.

Independent qualitative evaluation of a project designed to ensure that clinical policy in specific areas of care in three obstetric units within one English health district was based on authoritative evidence. Data from nonparticipant observation, interviews, questionnaires and documents were combined to generate a description of what the project involved and analyses from the perspectives of two key groups of stakeholders: the project proponents and the unit staff whose policies the project was intended to address. Key aspects of the project are examined from these perspectives to elucidate the assumptions of those involved in the project design and assess the adequacy of their attempts to facilitate success. Attempts were made to meet many of the accepted criteria for effective implementation. Nevertheless, the majority of unit staff retained significant doubts about the validity of the project's starting point and the approach adopted. The project process was followed as anticipated. After one year the intended work programme had been completed. The proponents saw the project as quite successful; they were unaware of the extent of the reservations still held by unit staff. The proponents focused on potential barriers that 'made sense' in the light of their own values and priorities. Failure to recognize the actual causes of concern was due to not hearing or listening to unit staff. Intended strengths of the project design were viewed quite differently by staff because they did not share the proponents' basic premises. Approaches to promoting evidence-based practice which take account of the views of all parties regarding problems and solutions are more likely to succeed.

Evidence-Based Medicine↗

[Overview on the millennium genome project].

Millennium genome project had started 2000 April as a national research project. In this project, analysis of single nucleotide polymorphism of human genome and application of its information on prevention, diagnosis and treatment of major diseases, and on drug development, regenerative medicine, and analysis of rice genome are included. This project is scheduled to complete by 2004. Since large amount of research money and research power is going to be poured to this project, fruitful results are a national expectation.

Forecasting↗

[Health care priorities].

This article describes the STAKES (National Research and Development Centre for Welfare and Health) Priorisation Project which started at the beginning of 1993. The project surveys ethical problems related to welfare and health care resource allocation. It searches for principles which could be applied in setting priorities whether they are aimed at service systems or individuals. A public debate has been instigated on choices, their justification and values which influence them. A conflict arises when medical advances have improved treatment possibilities and the needs have increased, but health care resources have remained on the same level or diminished. The role of nursing is to safeguard the rights of the patients. Now it is more important than ever to base nursing practice on ethical principles.

Consumer Advocacy↗

Adverse event monitoring in clinical trials of felodipine and omeprazole.

Although most clinical trials encompass aspects of safety, methods for assessing the safety of a drug by recording adverse events have been poorly studied. It has been suggested that adverse events rather than adverse drug reactions should be monitored, since a reliable determination of which events were caused by the drug and which were not is only possible after analysing data from a substantial number of clinical trials. In the present study adverse events were monitored to see the extent to which events recorded on the case record forms were reported as adverse events. Data from omeprazole and felodipine programmes were used, comprising altogether 143 clinical trials from eight different projects, and encompassing 12,069 patients in whom 11,812 events were recorded. The first project was started in 1982 and the last in 1988. Overall, 74% of recorded events were entered on a special adverse event form used in the trials, and 26% were not. Initially, about 35% of adverse events were not reported as such, as opposed to 13% towards the end of the study period. Serious adverse events were reported less frequently than non-serious events, but in the most recent project all serious adverse events were reported. Adverse events in women were reported more often than adverse events in men, and reporting was more complete for the middle-aged than for the oldest and the youngest persons. Certain types of adverse events were reported more completely than others. In conclusion, the transition from registering adverse reactions to registering adverse events has been a gradual one in spite of intensive educational efforts when the projects were started.(ABSTRACT TRUNCATED AT 250 WORDS)

Adverse Drug Reaction Reporting Systems↗