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OBJECTIVES: To evaluate a national continuing professional development (CPD) scheme through the views and experiences of its participants. METHODS: A qualitative focus group methodology was used. Forty-nine career grade paediatricians were allocated to nine focus groups according to their work settings, ages and posts. All groups discussed the following: (a) ease or difficulty of achieving CPD requirements; (b) whether a personal professional development plan (PDP) enabled the planning process for CPD; (c) whether CPD participation facilitated changes in practice, and (d) their views on the CPD system in operation at the time of the study. RESULTS: Taking part in CPD had a positive effect on participants' clinical practice and broadened their professional and academic base. The main difficulties in achieving CPD were variable financial support (especially for non-consultant staff) and pressure due to extra work accumulating during study leave. The quality of internal CPD meetings was inconsistent. A professional development plan was useful for planning CPD needs, but there was a conflict between the educational and training needs of the individual and the employing NHS Trusts. The scheme's guidelines were clear but there were reservations about its layout and the system of recording points. CONCLUSION: This study enabled discovery of the views of paediatricians participating in a national CPD scheme operated by the Royal College of Paediatrics and Child Health. Consequently, changes were made to the scheme's presentation (but not content) and process of recording points. Barriers to achieving CPD requirements were identified and are being monitored. Efforts to involve non-consultant career grade paediatricians have been increased.
Health plans of 47 prefectural governments based on the Medical Law of 1985, were evaluated regarding four health planning factors: final goal, implementation plan, development of resources, and evaluation planning. Results of the evaluation showed that 8.5% of the 47 prefectures had defined future level of health based on numerical goals. On the other hand, all of the prefectures had developed numerical goals specifying the number of hospital beds in each medical district. A major component of health planning is improvement in the accomplishment of the implementation plan. There were 14 prefectures which had numerical goals for the upgrading of facilities and for manpower development to meet future health care activities. The following factors are required in the health planning to meet the needs for improving the health status of the population. 1) Including in the future health goals, in addition to the number of medical bed in regional areas, objective levels of health that should be attained. 2) Development of practical plans for evaluation of effectiveness of health planning.
The Veterans Administration Library Network (VALNET) needed an automated library system that could interface with the agency's national automation activities. The Library Special Interest Users Group was established to oversee the selection of appropriate automated systems. The Massachusetts General Hospital Utility Multi-Programming System (MUMPS) computer language and VA FILEMAN, a database management system, are being used to create new library software, which will be in the public domain.
The authors assessed the willingness of residents to pay for urban green-space conservation in Hangzhou, China, using the contingent-valuation method. The aim of the study was to provide policy makers with information that would be useful for making informed decisions in urban-development planning. The findings of the study are as follows: 1) The willingness of residents to pay for urban green-space conservation was positively correlated with their perceptions of the benefits of green spaces and negatively correlated with perceptions of the annoyances. 2) The willingness to pay a higher premium for green-space conservation is directly related to gender, income level, and residential-ownership status. Age and education level are not significantly correlated with willingness to pay. 3) A majority of respondents view the conservation of urban green spaces as a very important function of the city, and most of them are willing to pay additional taxes for this conservation. 4) The total value per year to the public of the conservation program in Hangzhou is about $15.4 million. These qualitative and quantitative findings can be used in the policy-making process for urban-development plans.
The elderly constitute a growing segment of the nation's population, but they have received a disproportionately small percentage of mental health services. To meet the mental health needs of the elderly in Milwaukee, a geropsychiatry center was opened in 1980 under the direction of the author. The center's development was based on three underlying principles: an emphasis on a biopsychosocial approach to the problems of the elderly, organization of services along a continuum of needs, and close linkages between informal support networks and the formal service system. Functional assessments on biopsychosocial and cultural factors and therapeutically oriented case management services are major thrusts of the program. The center's services, considerations in the selection of staff, funding issues, and cases seen in the first 14 months of operation are described, along with a case study illustrating the center's intervention with elderly patients.
BACKGROUND: Traditionally, nursing care has been described as performing nursing tasks and often focused on nurses carrying out doctors' orders. In many countries of the world, including Pakistan, nurses do not document care in a standardized manner. Because of this limitation many health administrators, policy makers, and consumers make inadequate assumptions about nursing work, often regarding nurses as any other 'health care technician' who can be easily replaced by more economical health care workers. PURPOSE: To overcome this problem, standardized documentation is being introduced into the Aga Khan University School of Nursing and hospital, Aga Khan Health Services, Public Health School in Karachi, and government colleges of nursing, using the International Classification for Nursing Practice (ICNP). The purpose of this paper is to highlight the process of introducing and developing standardized nursing care plans (NCP) using ICNP in Pakistan. PROCESS: The process for introducing ICNP consists of four components, including administrative planning, development, teaching and training, and testing. Subsets of the ICNP for (i) maternity: antenatal, postnatal and natal care; and (ii) cardiology were developed using standardized NCPs. The subsets were developed by nurse experts and introduced at the testing sites. The testing will be conducted as a pilot project. Findings from the pilot will be used to continue and expand standardized nursing documentation using the ICNP across Pakistan. CONCLUSION: Through this project, nurses, midwives and lady health visitors (midwives, vaccinator and health educators) will test standardization of documentation and begin to evaluate efficiency and effectiveness of clinical practice.
BACKGROUND: Six patients with histologically proven peritoneal carcinomatous pseudomyxomas were treated with radioimmunotherapy. METHODS: All the patients received a tracer dose of iodine-131 (131I) labeled B72.3 anti-TAG-72 monoclonal antibody (MoAb) to test the in vivo affinity. After informed consent was obtained the therapeutic dose (>3.7 gigabecquerels [GBq], 100 mCi) of the 131I labeled B72.3 anti-TAG-72 MoAb was infused within 60 minutes intraperitoneally using 2 catheters on both sides of the abdomen. The patients were imaged with single photon emission computed tomography (SPECT) at 3, 10, and 24 days after the therapeutic infusion. Treatment-planning software has been developed in which functional information obtained from SPECT is integrated with anatomic information obtained from computed tomography (CT). The activity distribution from SPECT images is converted to absorbed dose distributions using a point source kernel convolution dose calculation. The absorbed dose calculation requires a radionuclide specific dose kernel. The activity map is divided into equally sized source voxels from which the distribution is calculated for the target voxels that cover the patient volume. The resulting three dimensional (3D) absorbed dose distribution is viewed as isodose contours superimposed on the CT images or as 3D isodose surfaces. RESULTS: The measured activity distribution shows that the cumulated activity and biologic half-life vary in the patient's body. The developed planning system provides a method for calculating patient specific absorbed dose distributions. CONCLUSIONS: The variation of biologic clearance indicates that a 3D dose calculation method incorporating measured activity distributions is needed to quantify absorbed dose distribution.
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To assess the usefulness of proton beams for treatment of patients with rectal cancer, we have performed comparative 3D treatment planning for proton beam and x-ray beam therapy. Three common x-ray techniques (AP-PA, 3-field, and 4-field box), a proton beam only plan, and a proton boost plan were compared. The plan which would have been treated without the aid of the 3D planning system was also simulated. Dose distributions were analyzed and dose-volume histograms computed for the target volumes and critical normal tissues. Analyses of these plans demonstrate that the proton beam techniques reduce the volume of small bowel irradiated. This may allow higher doses to be delivered to the tumor, with a probable increase in local control, or a reduction in normal tissue complications probability. All the plans developed with the 3D planning system treated significantly less bowel than the one planned without it.
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BACKGROUND: The AB-180 circulatory support system is a small, durable, efficient centrifugal pump with low thrombogenic potential. The device was designed to provide a fully implantable, left ventricular assist system for short-term support to address the issues of systemic anticoagulation, thrombus formation, infection, and cost. METHODS: Extensive bench and animal studies were performed to validate the mechanical integrity of the device and its functionality as an implant. RESULTS: These studies demonstrated anticoagulation requirements, established operating guidelines, incorporated safety systems, and demonstrated safety and efficacy. CONCLUSIONS: The AB-180 fulfills the stated goals on initial evaluation. A phase I human trial is underway.
Our specialty has been a creative wonder and an outright blessing to mankind. We have honed the arts of soft-tissue reconstruction to a level never thought possible just 100 years ago. We have found solutions to wound problems long after others have given up. We have restored the destroyed features of people ravaged by disease, life circumstances, and the acts of war. We have treated the deformed child, the patient with cancer, and reversed the signs of age. But as Thomas Sowell states in his article in 1994 in Forbes Magazine on the 100th anniversary of the birth of Fredrich Hayek, the author of The Road to Serfdom, the rule of law, which Hayek saw as crucial to the economy and to the survival of freedom, is nowhere in greater danger than in the supreme court of the United States. Sowell warned of the process going on that would bring socialism to our health care delivery system. He goes on to assert that it will be paid for by "loss of freedom to make our own decisions about medical care that are literally questions of life and death. The key to the future of medicine is now in our hands. This key will open the door to every doctor's dream of having the technologies that will allow physicians to diagnose and treat all the physical ills of the human race. Or the key, on the other hand, could open the exit door through which the best and brightest will leave medicine, feeling that they no longer can take on the legal and the financial risks to themselves and their families. The road to freedom from the controlling factors noted will require a change in culture. Knowing these facts will allow the plastic surgeon in practice to accept these factors and work with them to provide better care for their patients.
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Many gene expression studies attempt to develop a predictor of pre-defined diagnostic or prognostic classes. If the classes are similar biologically, then the number of genes that are differentially expressed between the classes is likely to be small compared to the total number of genes measured. This motivates a two-step process for predictor development, a subset of differentially expressed genes is selected for use in the predictor and then the predictor constructed from these. Both these steps will introduce variability into the resulting classifier, so both must be incorporated in sample size estimation. We introduce a methodology for sample size determination for prediction in the context of high-dimensional data that captures variability in both steps of predictor development. The methodology is based on a parametric probability model, but permits sample size computations to be carried out in a practical manner without extensive requirements for preliminary data. We find that many prediction problems do not require a large training set of arrays for classifier development.