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PubMed2003

Context-dependent transcription: all politics is local.

An organism ultimately reflects the coordinate expression of its genome. The misexpression of a gene can have catastrophic consequences for an organism, yet the mechanics of transcription is a local phenomenon within the cell nucleus. Chromosomal and nuclear position often dictate the activity of a specific gene. Transcription occurs in territories and in discrete localized foci within these territories. The proximity of a gene or trans-acting factor to heterochromatin can have profound functional significance. The organization of heterochromatin changes with cell development, thus conferring temporal changes on gene activity. The protein-protein interactions that engage the trans-acting factor also contribute to context-dependent transcription. Multi-protein assemblages known as enhanceosomes govern gene expression by local committee thus dictating regional transcription factor function. Local DNA architecture can prescribe enhancesome membership. The local bending of the double helix, typically mediated by architectural transcription factors, is often critical for stabilizing enhanceosomes formed from trans-acting proteins separated over small and large distances. The recognition element to which a transcription factor binds is of functional significance because DNA may act as an allosteric ligand influencing the conformation and thus the activity of the transactivation domain of the binding protein, as well as the recruitment of other proteins to the enhanceosome. Here, we review and attempt to integrate these local determinants of gene expression.

Animals↗
PubMedDate not supplied

A standardized method for assessment of elbow function. Research Committee, American Shoulder and Elbow Surgeons.

The American Shoulder and Elbow Surgeons have adopted a standardized form for assessment of the elbow. This form was developed by the Research Committee of the American Shoulder and Elbow Surgeons and subsequently adopted by the membership. The patient self-evaluation section contains visual analog scales for pain and a series of questions relating to function of the extremity. The responses to the questions are scored on a 4-point ordinal scale. The physician assessment section has 4 parts: motion, stability, strength, and physical findings. It is hoped that adoption of this method of data collection will stimulate multicenter studies and improve communication between professionals who assess and treat patients with elbow disorders.

Activities of Daily Living↗
PubMedDate not supplied

Building and maintaining a stronger workforce: CLMA tackles the clinical laboratory staffing shortage.

During the mid- to late 1990s, CLMA heard frequent comments and requests for help from its membership related to the problem of staffing their laboratories. As this information was collected and addressed on an individual basis, CLMA's leadership quickly realized the potential impact such staffing shortages would have on both its membership and the clinical laboratory industry. As this issue has eclipsed our health-care horizon, CLMA has developed and participated in a variety of activities to address the staffing shortage, from coalitions and committees to surveys and seminars. This article highlights some ways in which our association has created strategies and sources to help its membership and the industry at large avoid the crisis.

Bioterrorism↗
PubMed2004

Toxicogenomics in risk assessment: an overview of an HESI collaborative research program.

The value of genomic approaches in hypothesis generation is being realized as a tool for understanding toxicity and consequently contributing to an assessment of drug and chemical safety. In 1999 the membership of the International Life Sciences Institute Health and Environmental Sciences Institute formed a committee to develop a collaborative scientific program to address issues, challenges, and opportunities afforded by the emerging field of toxicogenomics. Experts and advisors from academia and government laboratories participate on the committee, along with approximately 30 corporate member organizations from the pharmaceutical, agrochemical, chemical, and consumer products industries. The committee has designed, conducted, and analyzed numerous toxicogenomic experiments within the broad fields of hepatotoxicity, nephrotoxicity, and genotoxicity. The considerable body of data generated by these programs has been instrumental in increasing understanding of sources of biological and technical variability in the alignment of toxicant-induced transcription changes with the accepted mechanism of action of these agents and the challenges in the consistent analysis and sharing of the voluminous data sets generated by these approaches. Recognizing the importance of standardized microarray data formats and public repository databases as the mechanism by which microarray data can be compared and interpreted by the scientific community, the committee has partnered with the European Bioinformatics Institute to develop a database to house the data generated by its collaborative research.

Gene Expression Profiling↗
PubMed2000

Pacific Health Research Council: health research by and for Pacificans.

The inaugural meeting of the Pacific Health Research Council (PHRC) was held at Sonaisali, Fiji 12-14 Oct 1998. It was attended by representatives of eight Pacific Island countries and five Pacific Island institutions. The organisation is designed to provide three levels of membership: Pacific Island countries; Pacific Island institutions; and individual Pacific Island researchers. An executive committee was appointed and given the task with the special objectives: to promote and strengthen health research by Pacific people and; to develop Pacific people capacity to exert more control and ownership of data generated through research. In the past Pacific health research has often been driven by external agendas and there is a need to increase the capacity among Pacific Island people to conduct action oriented research. An initial collaborative project for the PHRC is in the area of injury prevention and control. Implementing tasks of the PHRC will require the use of distant consulting and co-ordination to provide ongoing technical assistance, to manage multi-centre activities, and to share ideas and concerns etc. Hence, PHCR will be interested in participating in evolving telehealth networks in order to adequately address these tasks. In the spirit of cooperation and co-ordination, the PHRC can be expected to become actively involved in these emerging developments.

Health Services Research↗
PubMed2003

[Surgical techniques used for the treatment of varicose veins: survey of practice in France].

UNLABELLED: This survey was undertaken in 2001 among surgeons of the French speaking Vascular Surgery Society (SCV-Société de Chirurgie Vasculaire de Langue Française) and SCV non-members with a heavy caseload in varicose vein surgery. AIM OF THE STUDY: To identify --the various surgical procedures used for treating chronic venous disease and in particular varicose veins; --the current use of preoperative investigation with duplex ultrasound; --the type of anesthesia used; --the postoperative treatment prescribed, and specifically compression therapy. MATERIAL AND METHODS: This survey was conducted by mail through a "half open" questionnaire including 17 questions and a patient form (see appendices I and II). 675 surgeons were questioned (501 were SCV members and 174 non members). RESULTS: Two-hundred and eighty surgeons answered (41.5%). The level of replies for French surgeons was 45.3%. A scientific committee assessed these replies. The surgeons were classified into different groups according to their membership of the SCV, own practice, and caseload. The 2 most performed procedures were respectively high ligation + saphenous trunk stripping + tributaries stab avulsion (71.9%) and high ligation + saphenous trunk stripping (17.3%). Isolated phlebectomy was 5.6%, high ligation + tributaries stab avulsion + saphenous trunk preservation 2.8%, isolated high ligation 2.2%, and ambulatory hemodynamic and conservative treatment of venous insufficiency (CHIVA) 0.3% ). The various procedures used (total number, average and percentage) inside the different groups are displayed in, and. Concerning trunk stripping modality the 2 most frequently used techniques were invagination and Babcock techniques. Both were evaluated respectively for the great saphenous vein (invagination 78.1%, Babcock technique 44.2%) and the small saphenous vein (invagination 77.1%, Babcock technique 31.8%). Complete resection of the saphenous trunk was more frequently performed than partial stripping. Pre-operative duplex scanning was systematically undertaken by 85.4% of surgeons without a statistical difference between the different groups. General anesthesia remains the most used form of anesthesia (83.9%) followed by spinal or epidural anesthesia (70.4%), and local or loco-regional (29.2%). As multiple answers were allowed, the most frequent procedures associated with general anesthesia were spinal or epidural (36.9%). Responders prescribed postoperative compression and anticoagulation in 97.1% and 55.8% respectively. Intra-group comparison was then undertaken in order to determine if their practice was different. Annual caseload was significantly (P=0.001) higher in Group I (353) than in Group II (226) and Group III (152). There was no difference in terms of the various surgical procedures used between the different groups. Group 1 favored the trunk stripping modality invagination for avulsion of the great saphenous vein and small saphenous vein. Concerning anesthesia, local and loco-regional anesthesia was used more by Group I than by the other groups as was anticoagulation. Responders perform perforator ligation and deep venous reconstructive surgery respectively in 70.3% and 22.4% without any intra group difference, however we have no information on frequency and indications for this type of surgery as these items were not included in the questionnaire. DISCUSSION: Total number of procedures recorded in this survey is in keeping with the yearly French data concerning surgical treatment of varicose veins (ie, approximately 200,000 procedures). Since the emphasis was on surgical procedures sparing the saphenous trunks in varicose vein treatment only 10.9% of the techniques used in this survey were compatible with this purpose. Invagination technique for stripping both the great and small saphenous trunk was preferentially used by the Group I. Although it is surprising that all groups favored total trunk stripping particularly for the small saphenous vein. It is not surprising that a large majority, despite very little controversy on this point, performed preoperative duplex scanning. Although postoperative compression can be only quoted as a grade C recommendation according to evidence-based medicine, it was prescribed in almost all cases. CONCLUSION: Surgery for varicose veins is one of the most frequently performed surgical procedures in France, mainly by surgeons exercising in private practice. There is no significant difference between the various groups (SCV Member or not, type of practice and annual case load) concerning the various procedures used, although through careful analysis certain different tendencies may be identified. In addition postoperative compression is systematically prescribed.

Humans↗
PubMed1991

Medical ethics committees in Hungary.

Hungarian medical ethics committees were established at the end of the 1950s. They came into being on the Communist Party's initiative. They could hardly be called "interdisciplinary" since their membership was made up of high-ranking physicians and a few head nurses. Their main task was to counter the practice of "tipping." Medical ethics and "tipping" were practically synonymous. These committees did not confront or try to resolve ethical problems concerning such issues as patient rights, informed consent, refusal of treatment, human experimentation, abortion, etc. These committees - whether it is believable or not - belonged to the Physicians Health Workers Trade Union. They were under the guidance and supervision of this social organization. The public was excluded from their meetings, and the committees' duty was to follow the health laws which were supposed to have given excellent ethical guidance. Even in a textbook on medical ethics used at one of the medical universities, written by a psychiatrist, the health laws were presented and explained back and forth. Of the 88 pages only 23 dealt with morals in general and the Hippocratic tradition. The Hungarian National Health Service as well as its medical ethics committees are similar in many respects to the Soviet and Eastern European countries' health care system and ethics committees. Since radical changes have taken place in these so-called "former" communist countries, it can only be hoped that these committees will eventually develop into groups who will deal directly with the moral questions or medicine and health care.

Communism↗
PubMed2000

Critical care bug team: a multidisciplinary team approach to reducing ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia rates in the medical-surgical intensive care unit first exceeded the 90th percentile in September 1997 and were significantly (P <.05) higher than National Nosocomial Infections Surveillance System pooled mean data. In January 1998, a multidisciplinary "Critical Care Bug Team" was developed by the Infection Control Committee to review 1997 National Nosocomial Infections Surveillance System data for four adult intensive care units in a 583-bed tertiary care hospital. METHODS: Membership included clinical nurse specialists, a dietitian, a pharmacist, a respiratory therapist, an infection control professional, a research specialist, and a physician adviser. Having the team report directly to the hospital's Infection Control and Adult Critical Care Committees maximized support for recommendations and provided a direct link from patient care to hospital administration. By identifying issues, evaluating patient care processes, performing literature searches, and monitoring compliance, the team implemented numerous interventions, including policy and procedure changes, purchasing of equipment, and implementation of various education tools. RESULTS: Each member of the Critical Care Bug Team contributed to a synergized effort that may have produced the desired outcome of decreasing ventilator-associated pneumonia rates. Except for August 1998, ventilator-associated pneumonia rates have been below the 75th percentile since May 1998. CONCLUSION: This study illustrates the effectiveness of a multidisciplinary team approach devised to reduce and stabilize ventilator-associated pneumonia rates in a medical-surgical intensive care unit.

Adult↗
PubMedDate not supplied

Guidelines for clinical engineering programs--Part III: the risk of electrical shock in hospitals; Part IV: isolated power in anesthetizing locations? History of an appeal.

This four-part series presents guidelines for: electrically isolated inputs and outputs; measuring the performance of hospital biomedical engineering programs; evaluation the risk of electric shock in hospitals; and for isolated power in anesthetizing locations. Parts I and II, covering the first two topics above, were published in the Oct.-Dec. 1980 issue of this Journal. Part III constitutes an attempt to place the risk of electric shock in hospitals in a quantitative perspective. Arguments are presented that indicate that electrical safety precautions usually take up a larger share of the hospital's biomedical equipment safety budget than is justified by the actual hazard levels. Part IV reviews the need for isolated power in anesthetizing locations. Three independently proposed revisions to the 1973 edition of NFPA Standard 56A would have significantly simplified the safety requirements for hospital anesthetizing locations (a) by reducing the area in flammable locations classified as hazardous to the internationally accepted "zone of risk," and (b) by permitting the use of conventional electrical power rather than isolated power in locations where the risk of electrical accidents can be shown to be no greater than it is in other areas of the hospital. Despite extensive technical testimony supported with substantial supporting documentation, the revisions were vetoed by the Technical Committee after they were voted into the document by a floor vote of the general membership attending the NFPA Annual Meeting in Anaheim in 1978. The chronology of the major events surrounding the subsequent appeal of this veto is traced back to 1974, and an analysis is presented of what are considered to be shortcomings in the NFPA appeals process revealed by this particular case history.

Accident Prevention↗
PubMed1996

Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association.

A set of minimum clinical guidelines for use by primary care physicians in the evaluation and management of patients with thyroid nodules or thyroid cancer was developed by consensus by an 11-member Standards of Care Committee (the authors of the article) of the American Thyroid Association, New York, NY. The participants were selected by the committee chairman and by the president of the American Thyroid Association based on their clinical experience. The committee members represented different geographic areas within the United States, to reflect different practice patterns. The guidelines were developed based on the expert opinion of the committee participants, as well as on previously published information. Each committee participant was initially assigned to write a section of the document and to submit it to the committee chairman, who revised and assembled the sections into a complete draft document, which was then circulated among all committee members for further revision. Several of the committee members further revised and refined the document, which was then submitted to the entire membership of the American Thyroid Association for written comments and suggestions, many of which were incorporated into a final draft document, which was reviewed and approved by the Executive Council of the American Thyroid Association.

Adenocarcinoma, Follicular↗
PubMed2002

Promoting early detection tests for colorectal carcinoma and adenomatous polyps: a framework for action: the strategic plan of the National Colorectal Cancer Roundtable.

BACKGROUND: The purpose of the current study was to provide health professionals, professional organizations, policy makers, and the general public with a practical blueprint for increasing the practice of screening for colorectal carcinoma (CRC) and adenomatous polyps over the next decade. The National Colorectal Cancer Roundtable (NCCRT) was founded in 1997 by the American Cancer Society and the Centers for Disease Control and Prevention to provide strategic leadership, advocacy, long-range planning, and coordination of interventions targeted at reducing the disease burden of CRC through education, early detection, and prevention. The NCCRT and its three workgroups include CRC survivors; recognized experts in primary care, gastroenterology, radiology, colorectal surgery, nursing, public policy, epidemiology, and behavioral science; patient advocates; and representatives of health plans and insurers, government, and other organizations. METHODS: The NCCRT performed a literature review of published and unpublished data related to CRC screening guidelines, compliance, and barriers to adherence, as well as test effectiveness and cost-effectiveness. Members of the three NCCRT workgroups developed summary reports regarding professional education, public education and awareness, and health policy. A drafting committee developed the final strategic plan from workgroup reports, which was reviewed by the entire NCCRT membership, amended, and subsequently approved in final form. RESULTS AND CONCLUSIONS: Although the rationale for population-wide CRC screening is well established, the majority of adults in the U.S. are not currently being screened for CRC. Thus, the nation foregoes an opportunity to reduce CRC-related mortality by an estimated >or= 50%. To increase CRC screening rates, the issues of patient and physician barriers to screening, lack of universal coverage, lack of incentives to motivate adherence, and expanded infrastructure must be addressed.

Adenomatous Polyps↗
PubMed1998

Closure of Disputes in Assessments of Climate Change in The Netherlands

/ This paper presents an analysis of the closure of visible disputes in the assessments of climate change in the Netherlands. We focus primarily on two key constituents of the assessments: the estimate of climate sensitivity and the inclusion of non-CO2 greenhouse gases in assessment studies. For the cases studied, we identify variability in the assessment reports in the Netherlands during the pre-IPCC period. In the Netherlands arena, the assessments in this period can be seen as exponents of two different lines, a Netherlands line and an international line. We seek to identify what factors were decisive in the selection processes that resulted in the closure of visible disputes (visible in or across the assessment reports) for both cases. Our analysis reveals a remarkable difference in the adoption behavior of two Dutch assessment groups despite a large overlap in membership. We provide evidence that it is not the paradigmatic predisposition of the experts in the committee that was decisive for the closure of visible disputes, but it was the context in which the experts operated and the commitments they had made in each setting.

Science for policy↗
PubMedDate not supplied

Extended evaluation of diagnostic skin testing practices in Orange County, California.

In an effort to evaluate conformity with published guidelines for diagnostic allergy skin testing in their locality, a committee of members of the Orange County (California) Society of Allergy and Clinical Immunology surveyed their membership for the number, identity, and rates of sensitization of aeroallergens in a selected patient population. Test data were analyzed on patients who were judged appropriate to undergo immunotherapy. Complete test results of 271 patients were obtained from one third of local allergy specialists. A total of 115 different aeroallergen extracts were identified. By category, tree pollen allergens (32) were followed in declining order by weed pollens (28), molds (22), environmentals (18), and grass pollen extracts (15), for the total of 115. The average number of aeroallergens used by a practice in a comprehensive evaluation was 77 (range, 47-114). When only unequivocally positive reactions were considered (3+ equivalent or greater), Bermuda grass pollen extracts elicited the highest rate, 85%, and the environmental, rat dander, was the lowest at 1.8%. At least 20% of the patients reacted strongly on skin tests to 97% of the extracts. The disparity between the recommendations of a maximum of 30 aeroallergens for a comprehensive evaluation and actual practice procedures merits efforts at resolution.

Adult↗
PubMed1981

Proposed standards for professional health sciences library services in hospitals of New York State.

Hospital libraries are considered to be the basic unit of the medical information system. A major statewide effort was begun in 1978 to introduce and support legislation in the New York State Legislature which would encourage hospitals to establish and maintain libraries that meet minimum services standards. Included in this legislation is the concept that the Commissioner of Education in consultation with the Commissioner of Health shall have the power to establish standards for hospital libraries. The Ad Hoc Committee for the Promotion of Hospital Library Services, Western New York Library Resources Council, proposes The Standards for Professional Health Sciences Library Services in Hospitals of New York State to clarify and to strengthen existing hospital library standards. These standards differ specifically from the Joint Commission on Accreditation of Hospitals standards in that they place equal and specific emphasis on eleven points: administration, qualifications of library staff, continuing education of library staff, requirement for a library advisory committee, required library services, required library resources, library space requirements, library budget, library network and consortium membership, documentation of library policy, and continued evaluation of the needs of the hospital for library service. Detailed interpretations are provided. An appendix describes the qualifications of a hospital library consultant.

Libraries, Hospital↗
PubMed1995

Presidential address. American College of Clinical Pharmacology has provided a variety of educational opportunities.

At the current time, the College is in an excellent position to support the educational needs of its growing membership. The fund balance has increased over the past few years and is continuing to increase during the current year. The unprecedented speed of changes in the health care environment in which all clinical pharmacologists are now working necessitates that the American College of Clinical Pharmacology continually examine and update its Strategic Plan and Long Range Goals to allow all of its members to keep abreast of these changes. As hospitals, medical schools, and other allied health colleges address the need for economic accountability, as educators in medical and pharmacy and other schools encounter state and federal reductions in financial assistance to students, and as new roles are developed for the clinical pharmacologists working within the professions of medicine, pharmacy and allied health specialties, the College must maintain its role as a leader for all clinical pharmacologists. The success of the College will be directly related to the effort invested by all of the committee members and chairpersons, the Board of Regents, the Officers of the College, and most of all, the membership. During the next two years, I look forward to working with the entire membership to encourage growth of the College.

Humans↗
PubMed1999

Women in medicine: still a long way to go, baby.

No doubt about it, women have come a long way in the medical profession. The average female enrollment in our nation's medical schools is 42% and growing. Women physicians are entering more non-traditional fields and are running successful practices. They're working to change attitudes and overcome obstacles that have traditionally barred them from thriving in such a demanding field. They're getting creative with options that allow them to pursue their dream while raising a family. But the bars are still up on some windows, namely the ones that peek into the halls of organized medicine. Professional organizations and medical schools are still largely run by men. The Tennessee Medical Association recognizes the discrepancy and is working to make some changes. TMA's Executive Assistant for Membership Services Phyllis Franklin says leadership is rethinking the entire structure of the Association in the light of changing demographics. "We're looking at younger physicians, minorities, female physicians, academicians, and students; we want to get them involved in organized medicine," she says. The leadership structure is one area that is slowly changing. Franklin admits while the hierarchy has been male-dominated, the Association can now claim its first female vice president, Dr. Phyllis Miller of Chattanooga. "We don't have a lot of women leaders, but it's getting better, and there are a lot more opportunities in the committee structure." TMA officials say surveys are forthcoming that will help them gauge the needs and wants of its female membership and hopefully increase further that 11% number, up from 8.9% two years ago. In the meantime, Franklin encourages women physicians to make their wishes known. "Instead of not joining the TMA because of perceived barriers or stumbling blocks, we would certainly prefer that they help us identify obstacles and give us the opportunity to do what we can to make membership more appealing," she says. "This Association is truly for all physicians."

Attitude of Health Personnel↗