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Radiation protection requires that the so-called "on contact" (PARMA) projections be prohibited. They can be replaced by the short cone technique, which provides a sufficient enlargement to eliminate parasitic shadows on the unexamined opposite side, and is indicated for profile radiology of the TMA and profile parotid sialography examinations.
The Accreditation Board of Engineering and Technology (ABET) has declared that to achieve accredited status, 'engineering programs must demonstrate that their graduates have an understanding of professional and ethical responsibility.' Many engineering professors struggle to integrate this required ethics instruction in technical classes and projects because of the lack of a formalized ethics-in-design approach. However, one methodology developed in human-computer interaction research, the Value-Sensitive Design approach, can serve as an engineering education tool which bridges the gap between design and ethics for many engineering disciplines. The three major components of Value-Sensitive Design, conceptual, technical, and empirical, exemplified through a case study which focuses on the development of a command and control supervisory interface for a military cruise missile.
Experimental projects have demonstrated the technical feasibility of systems of accessible, affordable health care. These projects have relied extensively on non-professional community health workers. However, large-scale implementation of these schemes will require new management procedures that are both responsive to rural health needs and congruent with national institutions. This paper identifies the need to establish institutional mechanisms to mobilize essential inputs, promote acceptance by beneficiaries, maintain quality standards, recruit and retain field staff, and achieve accountability for resources. It then outlines methods for developing these institutions. It stresses the need for both formal, bureaucratic organizations and informal organizations of clients. It also identifies the need to consider administrative and institutional resources in determining the appropriateness of a health care technology.
NetWellness is a community-based, consumer-defined grant program supporting the delivery of electronic health information to rural residents of southern Ohio and urban and suburban communities in the Greater Cincinnati tri-state region. NetWellness is a collaboratively developed and publicly and privately funded demonstration project. Information is delivered via ISDN, standard dial, dedicated network connections, and the Internet. TriState Online (Greater Cincinnati's Free-Net) and other southern Ohio Free-Nets are key access points in the larger project communities. The other access points are more than forty workstations distributed at public sites throughout the project's primary geographical area. Design strengths and limitations, training initiatives, technical issues, and the project's impact on medical librarianship are examined in this paper. Also discussed are ways of determining community needs and interest, building political alliances, finding and developing funding sources, and overcoming technical obstacles. NetWellness's Internet address is: http:@www.netwellness.org.
The STRATEGY project (sustainable restoration and long-term management of contaminated rural, urban and industrial ecosystems; www.strategy-ec.org.uk) addressed the need for a holistic decision framework for the selection of optimal remediation strategies for long-term sustainable management of contaminated areas in Western Europe. The project considered both technical and social aspects of implementing restoration strategies for urban and rural environments. The importance of considering socially relevant objectives in addition to the dose reduction was emphasised. A critical evaluation was carried out on 101 selected countermeasures, (including rural waste disposal options), a model was developed to aid optimising countermeasure strategies and a method of carrying out participatory decision-making suggested. The outputs of the project are described and critically evaluated.
Surgical excellence is traditionally defined in terms of technical performance, with little regard for the importance of interpersonal communication and leadership skills. Studies in the aviation industry have stressed the role of human factors in causing error and, in an attempt to reduce the occurrence of adverse events, led to the organisation of simulation based training scenarios. Similar strategies have recently been employed for the surgical team with the development of a simulated operating theatre project. This enables technical and non-technical performance of the surgeon and circulating staff to be assessed by experts situated in an adjacent control room, and provides an opportunity for constructive feedback. The scenarios have good face validity and junior surgeons can benefit from the process of learning new technical skills in a realistic environment. The effect of external influences such as distractions, new technology, or a crisis scenario can also be defined, with the ultimate aim of reducing the number of adverse events arising in the real operating room.
Software for the personal computer dramatically changes the ease with which managers of research and development can use network planning to guide projects to completion in the academic medical center setting. A case study of the use of the Critical Path Method (CPM) and Project Evaluation and Review Technic (PERT) in planning and implementing transcutaneous pCO2 monitoring by a department of laboratory medicine illustrates the utility and efficiency of these network planning technics. By means of iterative PERT analyses, the project was kept on track, despite an overly optimistic estimate of the completion date initially and intense demand by clinicians for use of the new monitoring technic in the management of premature infants with respiratory disease. Additionally, the iterative management approach improved project participants' expertise in estimating and meeting deadlines. Network planning is fully adaptable to the IBM PC or an equivalent microcomputer. This article summarizes several excellent project management software packages that have become available recently.
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The Internet is a rich source of health information but it is not as accessible as many claim. This paper brings together three projects to illustrate technical and cost barriers and some options to overcome them. (1) A survey amongst a representative sample of 180 patients in rural Spain showed a marked age gradient in computer access. None over the age of 50 had, and less than 10% planned, access to the Internet whereas a quarter were prepared to use health centre based touchscreen kiosks. (2) Half the commonly used search engines did not include the two most relevant websites for Glasgow colorectal cancer patients in the first ten documents listed, showing the difficulty facing patients in finding relevant information. Selection of information would help patients avoid being overwhelmed with information. (3) One method to improve accessibility is to download websites to kiosks but two projects showed that considerable work is required to reformat the information. Public access computing, such as kiosks, could help make the Internet more accessible. We discuss whether Web sites which structure their information according to method of access, place and person provide a way forward.
This report reviews the activities of the "Reagents, Devices, Probes" branch of the Russian State "Human Genome" Project for six-year period (1989-1994). Data on pilot and commercial production of reagents and equipment for human genome studies along with information on the project costs and awarded grants are presented.
New concepts are needed for the still increasing number of geriatric patients who require long term institutional care and for the often difficult situation of caregiving relatives. We investigated the possibility to integrate relatives of institutionalized patients in the nursing care. 323 geriatric patients were randomly selected and the relatives contacted. Only four (1%) had no relatives or friends. Of 86% of the patients it was possible to interview 343 relatives or close friends. Of those 147 (43%) were favorably disposed towards a cooperation in the care with the ward staff. Persons willing to cooperate were characterized by female sex, middle class status, good health, not too demanding jobs, and close contacts prior to institutionalization of their next of kin. In a second part 29 of 196 relatives were willing to take part in a pilot project. Unfortunately, for technical reasons only five patients could be hospitalized on the experimental ward in the given time. The practical experience demonstrated that relatives can cooperate on a part time basis with the nursing staff in the care of institutionalized geriatric patients. It is estimated that probably 12% of the geriatric patients in institutions have relatives willing and capable to take part in the nursing or other activities on the ward. Smaller nursing facilities appear more suitable than large geriatric clinics for this type of cooperation.
There was recently a growth in the funds allocated directly to scientific programs and projects and in particular to infrastructures (buildings and large pieces of equipment). It is very likely that this investment will continue to grow as a result of the development policies of the EEC applied to its less developed members. The recent experience with the Science Program, the main factor in this evolution, has demonstrated that the bottleneck in our scientific development is at the level of the allocation of funds (management). Hence, the nonrealistic Regulations of the Program, the allocation of funds to ghost institutions and the inability to distribute the funds allocated to the Program. The Program was conceived based on problem oriented and not on research oriented strategies. In the case of medical research this choice is not supported by the recent history of research in this area or by the experience of countries such as the UK or the USA. Funding of medical research in this country should be based on the identification of a talented scientist with a good research program and on an inventory of the productivity, potentialities and needs of existing institutions. We should seek the support of foreign scientists and of Portuguese scientists living abroad for the technical evaluation of projects but they should not be asked to provide global strategies of investment in Portuguese science.
We describe a study on the quality of pharmacotherapy that included downloading electronic records in pharmacies and obtaining other information from the Public Sickness Fund in Basel, Switzerland. Legal and ethical considerations were discussed with and approved by the Internal Review Board of the university clinics through which the project was organized. Technical procedures were used to assure anonymity of the records during data collection and for the analysis. Completion of the records through links with personal data could be performed using a legally required process for quality assurance of the Public Sickness Fund.
The acquisition process for interventional equipment and the care that this equipment receives constitute a comprehensive quality improvement program. This program strives to (a) achieve the production of good image quality that meets clinical needs, (b) reduce radiation doses to the patient and personnel to their lowest possible levels, and (c) provide overall good patient care at reduced cost. Interventional imaging equipment is only as effective and efficient as its supporting facility. The acquisition process of interventional equipment and the development of its environment demand a clinical project leader who can effectively coordinate the efforts of the many professionals who must communicate and work effectively on this type of project. The clinical project leader needs to understand (a) clinical needs of the end users, (b) how to justify the cost of the project, (c) the technical needs of the imaging and all associated equipment, (d) building and construction limitations, (e) how to effectively read construction drawings, and (f) how to negotiate and contract the imaging equipment from the appropriate vendor. After the initial commissioning of the equipment, it must not be forgotten. The capabilities designed into the imaging device can be properly utilized only by well-trained operators and staff who were initially properly trained and receive ongoing training concerning the latest clinical techniques throughout the equipment's lifetime. A comprehensive, ongoing maintenance and repair program is paramount to reducing costly downtime of the imaging device. A planned periodic maintenance program can identify and eliminate problems with the imaging device before these problems negatively impact patient care.
This article stresses the importance of within-government capacity build as the optimal approach to minimizing landslide risk to the most vulnerable communities in the developing world. Landslide risk is an integrated issue that demands strong managerial leadership and multidisciplinary inclusion to develop structures that deliver sustainable improvements in the reduction of risk. The tension between projects demanding international technical and financial intervention and those capable of "within-country" solutions are examined. More particularly, the challenges of developing a management methodology capable of energizing inter-ministry collaboration to achieve community-level action is examined in the context of a recently established program of slope stability management in St. Lucia. The program, Management of Slope Stability in Communities (MoSSaiC), is shown to have successfully fostered not only extensive technical collaboration within government but also to have energized local communities in the shared mission of capacity build through their direct involvement in the management process.
/ The sedimentation of reservoirs is a serious problem throughout the tropics, yet most attempts to control sedimentation in large river basins have not been very successful. Reliable information on erosion rates and sources of sediments has been lacking. In regions where geologically unstable terrain combines with high rainfall, natural erosion rates might be so high that the effects of human activity are limited. Estimates of natural erosion in these situations often have been poor because of the episodic nature of most erosion during large storms and because mass-wasting may supply much of the sediment. The predominance of mass-wasting in some watersheds can result in an unexpectedly high ratio of bedload to suspended load, shifting sedimentation to "live" rather than "dead" storage within reservoirs. Furthermore, the inappropriate use of the Universal Soil Loss Equation to assess the effectiveness of erosion control measures has led to inaccurate estimates of the sediment reduction benefits that could accrue to watershed treatment efforts. Although reducing erosion from cultivated areas is desirable for other reasons, efforts aimed at reducing reservoir sedimentation by controlling agricultural sources of erosion may have limited benefits if the principal sources are of natural origin or are associated with construction of the dams and reservoirs and with rural roads and trails. Finally, the most appropriate locations for watershed rehabilitation depend on the magnitude of temporary storage of colluvium and alluvium within the river basin: Where storage volume is large and residence time of sediment very long, reducing agricultural erosion may have limited impacts on sedimentation within the expected life of a reservoir. Systematic development and analysis of sediment budgets for representative watersheds is needed to address these limitations and thereby improve both the planning of river basin development schemes and the allocation of resources towards reducing sedimentation. When sedimentation of reservoirs is the key issue, sediment budgets must focus especially on channel transport rates and sediment delivery from hillsides. Sediment budgets are especially critical for tropical areas where project funds and technical help are limited. Once sediment budgets are available, watershed managers will be able to direct erosion control programs towards locations where they will be most effective. KEY WORDS: Tropical watersheds; Sedimentation; Reservoirs; Erosion control
The objective of this study was to assess the capability of graduating dental students to identify the causes of undiagnostic panoramic images and to interpret anatomic landmarks on panoramic films. Seventeen dental schools were represented by 311 students. A radiology faculty member at each institution completed a questionnaire that addressed lecture time and experience provided to students in panoramic radiography. The faculty member administered a test instrument comprised of several panoramic radiographs that demonstrated one or more labeled anatomic structures, technical errors, or projection artifacts and multiple choice questions that addressed each entity. The mean percentage correct for the tested population on the entire test instrument was 72.9%. The mean percentage correct for questions addressing anatomy, error and artifact recognition, and error correction was 84.0%, 61.4% and 45.2%, respectively. Factors that significantly (p < 0.05) affected student performance were the number of lecture hours provided, whether or not students took panoramic radiographs of patients, and the method of student selection as participants. Laboratory or self-study projects and the number of panoramic radiographs (> or = 1) taken of patients did not significantly affect student performance on the test instrument.
BACKGROUND: A continuous quality improvement (CQI) project was conducted at Soroka Medical Center in Beer-Sheva, Israel, in an effort to identify and address causes of delays in thrombolytic therapy in patients arriving at a high-volume (160,000 patients per year) emergency department with acute myocardial infarction and thereby reduce the "door-to-needle time" (DTNT). The study had four phases: preintervention survey, peri-intervention process redesign, postintervention evaluation, and follow-up evaluation. CQI TEAM: The CQI team followed a seven-step protocol: problem definition, present-state screening, factors analysis, solution development, outcome evaluation, standardization, and conclusions. RESULTS: A DTNT of 45 minutes was considered acceptable for this data set, and accordingly, patients were divided into an "early" group (n = 50, DTNT < 45 minutes), and a "late" group (n = 50, DTNT > or = 45 minutes). After the CQI intervention, the mean DTNT decreased from 61.8 +/- 32.5 (mean +/- standard deviation) to 47.6 +/- 18.5 minutes (p < 0.029). The prolonged DTNT time intervals of the late versus the early groups was primarily due to extended decision-making time (36.0 +/- 22.7 versus 13.6 +/- 6.7 minutes, p < 0.003), followed by time until therapy was initiated (26.2 +/- 14.2 versus 11.1 +/- 5.8 minutes, p < 0.002). CONCLUSIONS: Results suggest that the 30-minute DTNT suggested by the American College of Cardiology/American Heart Association is appropriate for patients with a clear diagnosis and no contraindications for thrombolysis, but when the risk-benefit ratio of thrombolytic therapy raises concerns, a 45- to 60-minute DTNT may still be acceptable. Further CQI projects should address technical triage of simple cases and clinical estimation of risk-benefit ratio in complicated patients.