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PubMed2005

Aspects on priority settings in cancer treatment and care.

The widening gap between available resources and increasing possibilities to diagnose and treat different medical conditions has resulted in new attention to priority setting. The issue is complicated and harbours several obstacles because of different valuations concerning the needs of patient groups, the true results (patient benefit) of medical actions, and also important ethical considerations. Earlier attempts have been unsuccessful in introducing a prioritization milieu into the medical profession, probably due to vague requests for an open and sharp prioritization process. With a sharpened competition of allocating resources for different medical actions, the medical profession of the cancer sector needs to have a tool for explaining consequences for the different cancer patient groups and what is achieved by the cancer treatments and the care. A model for ranking lists consisting of pairs of patient conditions and medical actions is presented, and the principle for using these lists for priority setting in medical society is discussed.

Decision Making↗
PubMed2006

Virtual and physical toys: open-ended features for non-formal learning.

This paper examines the integrated toy--both physical and virtual--as an essential resource for collaborative learning. This learning incorporates rehabilitation, training, and education. The data derived from two different cases. Pedagogical issues related to non-formal learning and open-ended features of design are discussed. Findings suggest that social, material, and expressive affordances constitute a base for an alterative interface to encourage children's play and learning.

Child↗
PubMed1994

The ethics of allocation of scarce health care resources: a view from the centre.

Resource allocation is a central part of the decision-making process in any health care system. Resources have always been finite, thus the ethical issues raised are not new. The debate is now more open, and there is greater public awareness of the issues. It is increasingly recognised that it is the technology which determines resources. The ethical issues involved are often conflicting and relate to issues of individual rights and community benefits. One central feature of resource allocation is the basing of decisions on the outcomes of health care and on their subsequent economic evaluation. The knowledge base is therefore of great importance as is the audit of results of clinical treatment. Public involvement is seen as an integral part of this process. For all parts of the process, better methodologies are required.

Biomedical Research↗
PubMed1995

The inhumanity of fairness: rationing resources for reconstructive breast surgery.

The Dr. William Logie Medical Ethics Essay Contest is open to undergraduate medical students studying at Canadian universities. The contest, named in honour of Canada's first medical graduate, is sponsored by CMAJ. In the following essay, which won second price in the 1994 competition, Dr. Agnes Wong examines how the state of Oregon reviewed the services it would insure under Medicaid, and why it determined that reconstructive breast surgery following mastectomy would not qualify.

Adult↗
PubMed2004

Sharing genomes: an integrated approach to funding, managing and distributing genomic clone resources.

National biological resource centres have a vital role in archiving and distributing biological reagents that result from large-scale genome programmes. These reagents are invaluable to the research community as they enable independent validation of results disclosed in peer review and provide tools that facilitate the next steps in discovery science. Here we address the crucial issues of open access, quality of materials, integration with public databases and sustainability of resources.

Biological Specimen Banks↗
PubMed2002

One hundred consecutive living kidney donors: modern issues and outcomes.

In order to define current issues and outcomes of living kidney donation, 100 consecutive living donors operated on between July 1996 and March 2001 were evaluated. The 64 women and 36 men ranged in age from 19 to 72 yr (mean 42.5 yr), and 65 were related to the recipient while 35 were unrelated donors. Hospital admission the morning of surgery and use of a minimal open approach to the donor kidney were standard, as were post-operative epidural pain control and plans for short hospital stay. The 100 donors were hospitalized for 2 (25), 3 (48), 4 (18), 5 (8), or 6 (1) days, with an average length of stay of 3.12 d (range 2-6 d). The mean charge for kidney donor hospitalization was 14,470 dollars (range 9671-22,808 dollars). There were no major intra or immediate post-operative complications. Six rehospitalizations occurred for post-donation nausea, vomiting, dehydration (n = 2); spinal headache; pneumonia and wound haematoma; and late wound reexploration (one hernia and one nerve entrapment). All donors returned to pre-operative functional status within 6 d to 6 wk of donation. All kidneys functioned immediately in the 100 recipients (50 women, 50 men) who averaged 46.6 yr of age (range 17-69 yr); recipient length of stay averaged 3.81 d (range 2-15 d). All donors survived in excellent health; recipient graft and patient survival, respectively, are 87 and 90% through the entire 5-yr period. Excellent long-term outcomes for living kidney donors may be accomplished using minimal open surgical technique, post-operative epidural pain control and plans for a brief hospitalization. Expansion of living donor resources in renal transplant programs may grow as unrelated kidney donation and non-directed donation as well as minimally invasive (open and laparoscopic) techniques evolve.

Adult↗
PubMed2006

Coming out, visibility, and creating change: empowering lesbian, gay, and bisexual people in a rural university community.

Personal and professional challenges faced in encouraging the development of a gay community in a rural university setting are described. Community psychologists who are lesbian, gay, or bisexual (LGB) must assess their willingness to be open and the roles they can play in developing helping resources. These issues concern how to encourage the empowerment of others while maintaining a collaborative role in a situation of major personal investment. Two specific challenges-developing informal helping resources for local LGB people and fostering institutional and policy changes to make the university a safer place for LGB faculty, staff, and students-are described. Community psychologists must consider personal risk when they become involved in empowerment efforts with this population.

Adult↗
PubMed2005

Basic science faculty in surgical departments: advantages, disadvantages and opportunities.

The number of Ph.D. faculty in clinical departments now exceeds the number of Ph.D. faculty in basic science departments. Given the escalating pressures on academic surgeons to produce in the clinical arena, the recruitment and retention of high-quality Ph.D.s will become critical to the success of an academic surgical department. This success will be as dependent on the surgical faculty understanding the importance of the partnership as the success of the Ph.D. investigator. Tighter alignment among the various clinical and research programs and between surgeons and basic scientists will facilitate the generation of new knowledge that can be translated into useful products and services (thus improving care). To capitalize on what Ph.D.s bring to the table, surgery departments may need to establish a more formal research infrastructure that encourages the ongoing exchange of ideas and resources. Physically removing barriers between the research groups, encouraging the open exchange of techniques and observations and sharing core laboratories is characteristic of successful research teams. These strategies can meaningfully contribute to developing successful training program grants, program projects and bringing greater research recognition to the department of surgery.

Faculty, Medical↗
PubMed2006

Linking implicit and explicit memory: common encoding factors and shared representations.

Dissociations between implicit and explicit memory have featured prominently in theories of human memory. However, similarities between the two forms of memory have been less studied. One open question concerns whether implicit and explicit memory share encoding resources. To explore this question, we employed a subsequent memory design in which several novel scenes were repeated once during an fMRI session and explicit memory for the scenes was unexpectedly tested afterward. Subsequently remembered scenes produced more behavioral priming and neural attenuation-two conventional measures of implicit memory-than did subsequently forgotten scenes. Moreover, brain-behavior correlations between these two implicit measures were mediated by subsequent memory. Finally, tonic activity, possibly reflecting the natural time course of attention, was predictive of subsequent memory. These results suggest that implicit and explicit memory are subject to the same encoding factors and can rely on similar perceptual processes and representations.

Adolescent↗
PubMed2005

Time-efficient strategies to ensure vaccine risk/benefit communication.

Vaccine risk/benefit communication is a mandatory requirement set forth by the National Childhood Vaccine Injury Act and is essential in enabling parents to make an informed decision about having their children vaccinated. This article is designed to improve vaccine risk/benefit communication in pediatric primary care. Current research related to previous efforts used to educate parents about vaccine safety are reviewed. Time-efficient strategies to improve vaccine risk/benefit communication are recommended. An example of an open communication letter and a list of reputable vaccine information resources are also provided.

Attitude to Health↗
PubMed2000

[Go to the health center or go to the drug store? Pharmacy offices as a primary care resource].

OBJECTIVE: To find what the pharmacy office represents socially to the population that uses it most. DESIGN: Qualitative study. Analysis of the contents of two discussion groups. PARTICIPANTS: Women from 30 to 60 years old, urban residents of the Community of Madrid. MEASUREMENTS AND MAIN RESULTS: The pharmacy offices were identified by the user as a primary care resource which was accessible--both because of its closeness and opening hours--and trustworthy. They provided health care support for treating minor ailments ("assisted self-medication") and also advised on medical technicalities and use of medication. Users with potentially serious clinical pictures were referred from the pharmacy to the doctor. The images associated with "going to the doctor" lacked the nearness and familiarity of "dropping round to the pharmacy". CONCLUSIONS: Integrating pharmacy office pharmacists into a general primary care framework would improve the health of the general population.

Adult↗
PubMed1999

A comparison of field-only electronic portal imaging hard copies with double exposure port films in radiation therapy treatment setup confirmation to determine its clinical application in a radiotherapy center.

PURPOSE: To determine in which treatment sites field-only hard copy electronic portal images (EPI) captured during a treatment exposure could replace traditional double exposed port films in a busy radiation oncology department. METHODS AND MATERIALS: The three linear accelerators in the William Buckland Radiotherapy Centre (WBRC) at the Alfred Hospital in Melbourne are each equipped with an electronic portal imaging device (EPID). These devices can be used daily on all patients where the treatment fields are within the size constraint of the cassette, for example, less than 25 x 25 cm. Port films using radiographic film in hard cassettes were previously considered the standard method of field placement verification. After the radiation therapists were trained in all program aspects of capturing, enhancing, and producing hard copies of EPIs, a study was developed to evaluate the possibility of replacing port films with EPI hard copies within the established departmental procedures. Comparison of EPI hard copy with the simulator film and the port film of the same field was carried out by the radiation oncologist specialists. Seventy-eight comparison sets were generated and grouped into seven anatomical regions for evaluation by the radiation oncologist specialist responsible for each particular region. The outcome decision was the preferred imaging option. Where no preference was stated, EPI became the modality of choice, as it increased the efficiency of work practice. RESULTS: The results indicate that field-only EPI can be considered to be at least as clinically useful for treatment verification in the following sites: breast, chest, hip, spine, and large pelvic fields. Port films using a standard, double exposure technique were considered necessary for partial brain fields, small pelvis fields, extremities, and radical head and neck fields. CONCLUSION: The quality of field-only images captured using an EPID has been favorably assessed to be equivalent to, or an improvement on, the traditional double exposed port films for some treatment areas. Departmental policy has been altered to incorporate this new imaging modality as a practical alternative to port films, resulting in a direct benefit in terms of resource management and patient care. Continuing research is currently evaluating open area exposed EPI hard copies as a potential alternative to port films.

Feasibility Studies↗
PubMedDate not supplied

ChemSem: an extensible and scalable RSS-based seminar alerting system for scientific collaboration.

A seminar announcement system based on the extensive use of XML-based data structures, CML/MathML for carrying more domain-specific molecular content, and open source software components is described. The output is a resource description framework (RDF) site summary (RSS) feed, which potentially carries many advantages over conventional announcement mechanisms, including the ability to aggregate and then sort multiple and diverse RSS feeds on the basis of declared metadata and to feed into RDF-based mechanisms for establishing links between different subject areas.

Journal Article↗
PubMed2002

Living with breast cancer - a challenge to expansive and creative forces.

The aim of this qualitative case study is to obtain a deeper and more profound understanding of the life world of women living with breast cancer focusing particularly on changes in life perspective. The study is based on a series of interviews carried out within the space of one year and involving four women with breast cancer; each woman was interviewed four times. The participants were between 42 and 54 years of age; three of the four interviewed were in an advanced stage, with metastasis or recurrent breast cancer. There was an increased awareness of the relationship between life and death, which constituted a disclosure rather than an actual change in life perspective. The four women were 'opening up' to the beauty and the essentials in life and experienced an increased desire to live their life in accordance with their own values. Their revitalized view of life increased their desire for authenticity. When it proved impossible to live in accordance with new insights the women were particularly frustrated. From a caring perspective our findings suggest that an awareness of patients' increased openness to their own needs and desires is an important resource in the healing and rehabilitative process of breast cancer patients. The paradoxes and the struggles involved disguise a hidden potential for health.

Adaptation, Psychological↗
PubMed2000

HIV prevention with young men who have sex with men: what young men themselves say is needed. Medical College of Wisconsin CITY Project Research Team.

Young men who have sex with men (YMSM), and particularly ethnic minority YMSM, experience high incidence HIV infection due to continued patterns of high-risk sexual behaviour. The intent of this research was to systematically solicit input and recommendations from YMSM themselves concerning the kinds of HIV prevention programmes that would best meet their needs and would address risk issues they believed are critical. In-depth qualitative interviews were conducted with a sample of 72 purposively selected YMSM to identify necessary components of HIV prevention targeting YMSM. Respondents noted a need for comprehensive HIV prevention programmes that addressed issues related to dating and intimacy, sexuality and arousal, drugs and alcohol, self-esteem and self-worth, abuse and coercion, and sexual identity. Respondents emphasized the importance of keeping programmes confidential, fun, comfortable, accepting and open to all YMSM regardless of sexual identity. Identified community resource needs included safe havens for youth, more peer educators and older MSM mentors, increased school-based sexuality education, and greater support from the society at large as well as from churches, the gay community and communities of Color. Implications of these findings for HIV prevention are discussed.

Adolescent↗
PubMed2003

The coping responses of the adolescent siblings of children with severe disabilities.

PURPOSE: There is a paucity of literature conducted on adolescents' perceptions of their siblings with severe disabilities. The period of adolescence is characterized by personal and emotional conflicts resulting from teenagers' search towards self-identity and autonomy and exploration of the boundaries of parental support. The study attempts to describe the coping responses of these adolescent siblings in their adjustment to the family stressor of having a sibling with a disability; and the adolescents' available coping resources. METHOD: This study is qualitative in nature and open-ended, structured interviews were conducted with 19 adolescents between the ages of 12 and 15 years who had a sibling with severe disabilities. The interviews were then analysed according to categories using an editing analysis style. RESULTS: The results indicated that the subjects reported limited family interaction and were often reticent in expressing their feelings about their sibling with a disability. In addition, they expressed guilt feelings regarding their siblings with disabilities. Furthermore, siblings of children with severe disabilities received limited information and guidance regarding their sibling's disability. CONCLUSION: The need for professional support to facilitate adolescents' coping with the disability and its consequences as well as the establishment of strong support networks for these adolescents became evident.

Adaptation, Psychological↗