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At least 415 records · Page 23Linked to original sources
PubMed2002

From EBM to EBL: two steps forward or one step back?

The author employs his vantage point as a contributor to Evidence-based Medicine (EBM) and Evidence-based Librarianship (EBL) in the United Kingdom to anticipate obstacles to be overcome by the emerging EBL paradigm. After reviewing and synthesizing three proto-definitions of EBL, he discusses issues around the potential domains to be populated by research findings. He then briefly considers the contribution that critical appraisal skills can make to an evidence-based profession. In concluding that "evidence-based librarianship" is a self-limiting "label," he encourages health information professionals instead to promote the contribution of librarianship to evidence-based practice, a role for which they are uniquely qualified.

Databases, Bibliographic↗
PubMed1999

Mycobacteria: bugs and bugbears (two steps forward and one step back).

The use of molecular techniques to study the mycobacteria has advanced greatly since the first genomic libraries of Mycobacterium tuberculosis and M. leprae were constructed in 1985. However, there are still pitfalls for the unwary. Most of the problems associated with the use of molecular techniques to study mycobacteria can be related to one of the following problems: slow growth rate causing problems with contamination; the formation of macroscopic clumps when grown in culture; resistance to standard chemical lysis procedures; the requirement for containment facilities for pathogenic species; the lack of suitable genetic vectors; and the problems of spontaneous antibiotic resistance. Despite these problems, considerable progress has been made and standard techniques have been developed for the preparation of protein, nucleic acids (DNA and RNA) and cell wall components, chemical and transposon mutagenesis and gene replacement methods, the use of reporter genes and expression vectors, and improved detection and drug sensitivity testing.

Bacteriological Techniques↗
PubMed2001

In utero stem cell transplantation: two steps forward but one step back?

The concept of in utero stem cell transplantation has provided hope that at least some of the genetic disorders which can be diagnosed prenatally can be treated before the pathological sequelae become manifested. Our increasing knowledge of haematopoietic stem cell biology has provided further possibilities for optimising this transplant procedure. However, the relatively poor success rate achieved using this procedure has prompted some to suggest that there may be fetal rejection of donor cells via an immune mechanism. However, the prevailing evidence from both animal models and from human cases, suggest that there may be other mechanisms which are preventing successful engraftment in some disorders and these must be addressed if the procedure is to receive further attention. The ability to achieve sustained engraftment after in utero transplantation will have relevance for those seeking to use gene therapy as an alternative therapeutic stratagem.

Animals↗
PubMed1997

Multiplex PCR: critical parameters and step-by-step protocol.

By simultaneously amplifying more than one locus in the same reaction, multiplex PCR is becoming a rapid and convenient screening assay in both the clinical and the research laboratory. While numerous papers and manuals discuss in detail conditions influencing the quality of PCR in general, relatively little has been published about the important experimental factors and the common difficulties frequently encountered with multiplex PCR. We have examined various conditions of the multiplex PCR, using a large number of primer pairs. Especially important for a successful multiplex PCR assay are the relative concentrations of the primers at the various loci, the concentration of the PCR buffer, the cycling temperatures and the balance between the magnesium chloride and deoxynucleotide concentrations. Based on our experience, we propose a protocol for developing a multiplex PCR assay and suggest ways to overcome commonly encountered problems.

Buffers↗
PubMed2006

One step forward, two steps back: worker representation and health and safety in the United Kingdom.

There is now quite strong evidence for a set of preconditions that help determine the effectiveness of worker representation and consultation in improving health and safety outcomes. One of these preconditions is a regulatory framework that defines workers' rights to representation and employers' obligations to respond. Using the United Kingdom as its focus, this article explores developments at the national policy level. It shows how long-awaited legislative reforms to improve provisions for worker representation in health and safety have so far failed to materialize and, instead, government strategy has concentrated on promoting voluntary approaches. The author reviews the evidence of what makes worker representation in health and safety effective and suggests that, far from abandoning approaches to legislative reform, the U.K. agencies should be seeking to make improvements to the British provisions if they are to provide the necessary stimulus and support for worker representation in health and safety at work. Such improvements need to address long-standing weaknesses in existing provisions and their relevance to the changing world of work. The arguments presented here apply to the essential role of regulatory support for worker participation in all advanced market economies if it is to improve health and safety outcomes.

Accidents, Occupational↗
PubMed2001

Reforming Ontario's primary health care system: one step forward, two steps back?

In Ontario, one-third of the provincial budget is spent on treatment-oriented, institutionally based medical care. Urgently needed, some critics say, is a shift toward less costly, prevention-oriented, community-based care informed by a nonreductionist approach to health planning. In this regard, Community Health Centres (CHCs) have long been advocated as the most effective way to reform the province's primary health care system. At present, however, Ontario has only 56 CHCs. This article examines factors that gave rise to the implementation of CHCs during the 1970s, their slow growth across the province during the 1980s, and their relatively rapid expansion during the early 1990s. In 1995, the newly elected Progressive Conservative government decided to freeze funding for this innovative program. The author argues that the state's latest plan for "reforming" the province's primary health care system is destined to repeat the mistakes of the past.

Community Health Centers↗
PubMed2000

Dynamic contrast-enhanced MR angiography from the distal aorta to the ankle joint with a step-by-step technique.

OBJECTIVE: The aim of this study was to visualize the arteries from the distal aorta to the ankle joint and to determine the accuracy of MR angiography for detecting stenoses and occlusions. SUBJECTS AND METHODS: Twenty-four patients with peripheral arterial occlusive disease underwent digital subtraction angiography and were examined on a 1.5-T MR scanner. The transit time for contrast material was determined with a test bolus injection. A T1-weighted three-dimensional gradient-echo sequence with short TR and TE was used for a dynamic measurement at the level of the iliac arteries, the upper leg, and the lower leg arteries. For each level a single dose of gadolinium was injected into an antecubital vein with an MR power injector. Maximal-intensity-projection reconstructions were calculated after subtraction of the first measurement at each level. Two experienced MR radiologists who were unaware of the digital subtraction angiography results interactively evaluated both the MIP reconstructions and the single slices on a workstation, first independently and then in a consensus interpretation. RESULTS: With digital subtraction angiography, 80 hemodynamically significant stenoses and 39 occlusions were detected. For the stenoses and occlusions, a sensitivity of 100% was found for MR angiography. The specificity for the assessment of stenoses and occlusions was 98% and 94%, respectively, for the iliac arteries; 98% and 94%, respectively, for the upper leg arteries; and 94% and 95%, respectively, for the lower leg arteries. Most false-positive findings of occlusion were due to metal stents present in the iliac (n = 3) and upper leg (n = 4) arteries. CONCLUSION: The MR imaging technique that we used revealed the arteries from the distal aorta to the ankle and proved to be reliable at showing arterial stenoses and occlusions.

Aged↗