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At least 685 records · Page 38Linked to original sources
PubMed1998

Bioengineering in the millennium.

This symposium identified the major challenges in biomedical research that will benefit from bioengineering applications. Attention was focused on the important role that bioengineers will play in future advances in biomedical research. There was considerable discussion about how to integrate bioengineering with biological research in meeting the challenges of the twenty-first century. Symposium presenters showcased the accomplishments of NIH-funded bioengineering researches and increased the visibility of bioengineering to NIH leaders, staff, and members of the intramural and extramural research community. Recommendations were also made for future NIH-funded research projects. Attention was also placed on how basic bioengineering research can lead to commercialization of new health care technology and therefore maintain the nation's leadership in this important area. New products, from biotechnology and novel devices for diagnosis and treatment, are marketed through interactions between universities, medical centers, small start-up firms, and larger, more established companies. In the United States the gross revenue of the bioengineering private sector industry involved in the manufacture of health care products already exceeds $40 billion. More then 750 persons attended this bioengineering symposium. Over 110 scientific posters and exhibits relating to biology and medicine were presented. They provided a forum for showcasing NIH-funded bioengineering projects and fostered future collaboration among academic investigators, industry, and members of the small business community. The contributions of Pugwash bioengineer, Maciej Natecz, a member of the Polish Academy of Sciences, was recognized by the Conference Planning Committee. He was honored for his work in nuclear disarmament. Indian medical scientists should note that this symposium provided a framework for the development of technology in biomedical sciences during the Twenty-First Century. Major concentrations in interdisciplinary research should occur at all of the premier research institutions in India.

Animals↗
PubMed1999

Development and application of a generic methodology to assess the quality of clinical guidelines.

BACKGROUND: Despite clinical guidelines penetrating every aspect of clinical practice and health policy, doubts persist over their ability to improve patient care. We have designed and tested a generic critical appraisal instrument, that assesses whether developers have minimized the biases inherent in creating guidelines, and addressed the requirements for effective implementation. DESIGN: Thirty-seven items describing suggested predictors of guideline quality were grouped into three dimensions covering the rigour of development, clarity of presentation (including the context and content) and implementation issues. The ease of use, reliability and validity of the instrument was tested on a national sample of guidelines for the management of asthma, breast cancer, depression and coronary heart disease, with 120 appraisers. A numerical score was derived to allow comparison of guidelines within and between diseases. RESULTS: The instrument has acceptable reliability (Cronbach's alpha coefficient, 0.68-0.84; intra-class correlation coefficient, (0.82-0.90)). The results provided some evidence of validity (Pearson's correlation coefficient between appraisers' dimension scores and their global assessment was 0.49 for dimension one, 0.63 for dimension two and 0.40 for dimension three). The instrument could differentiate between national and local guidelines and was easy to apply. There was variation in the performance of guidelines with most not achieving a majority of criteria in each dimension. CONCLUSIONS: Use of this instrument should encourage developers to create guidelines that reflect relevant research evidence more accurately. Potential users or groups adapting guidelines for local use could apply the instrument to help decide which one to follow. The National Health Service Executive is using the instrument to assist in deciding which guidelines to recommend to the UK National Health Service. This methodology forms the basis of a common approach to assessing guideline quality in Europe.

Evaluation Studies as Topic↗
PubMedDate not supplied

A patient-initiated system for preventive health care. A randomized trial in community-based primary care practices.

OBJECTIVE: To test the effectiveness of a patient-initiated, touch-sensitive computer system (TSCS) for improving screening rates for cancers of the breast, cervix, colon and rectum, and oral cavity. DESIGN: One-year, randomized, controlled trial with primary care practice as the unit of analysis. SETTING: Sixty primary care practices, randomly recruited from 329 nonteaching practices in a southeastern state. SUBJECTS: Random sample of the medical records of 50 male and female adult patients before intervention and 50 adult patients after intervention in each practice and a random sample of 507 TSCS users. INTERVENTIONS: Touch-sensitive computer system and a registered nurse who served as liaison to the study practices. The TSCS provided patient-specific preventive service recommendations and facilitated work flow to increase the completion of these interventions. MAIN OUTCOME MEASURE: Average change, adjusted for health maintenance examination (HME) and use of the TSCS, in the proportion of eligible patients undergoing screening mammography, clinical breast examination, digital rectal examination, fecal occult blood test, flexible sigmoidoscopy, Papanicolaou smear, and oral cavity examination. RESULTS: We observed a significant increase in the completion of screening mammography (6.6%; P < or = 0.5) and clinical breast examination (6.1%; P < or = .01) in women 50 years of age and older, particularly for those who had an HME during the study year. CONCLUSIONS: Patients who have HMEs are more likely to receive cancer screening; however, a computer-based system for preventive services can contribute to improvement in screening. Among those patients who did not have an HME, TSCS users had higher rates of breast cancer screening than nonusers.

Adult↗
PubMed1999

Computer-assisted health counselor visits: a low-cost model for comprehensive adolescent preventive services.

OBJECTIVE: To evaluate a low-cost strategy for providing preventive health services to adolescents using computerized health assessments with individualized educational videos, trained health counselors, and nurses. DESIGN: Feasibility study, cost analysis, and comparative evaluation of health problems identified, guidance delivered, and patient satisfaction. SETTING: Eleven sessions at nontraditional sites including schools, universities, shopping malls, and after-hours clinics on Oahu, Hawaii. PARTICIPANTS AND INTERVENTION: Adolescents (N=258, mean age 17 years) completed confidential computerized health assessments, received individualized feedback, and viewed automatically selected educational videos on a laptop computer. The computer additionally printed a prioritized problems list for the graduate student-level health counselor to review with the adolescent. The counselor subsequently reviewed each encounter with a nurse-educator who performed further counseling and physical examinations when indicated. RESULTS: Visit length averaged 44 minutes. Subjects spent an average of 21 minutes completing the automated health assessment and viewing interactive multimedia and 15 minutes with the health counselor. One third of subjects required further evaluation and counseling by the nurse (average, 8 minutes). A team of 2 counselors and 1 nurse provided comprehensive screening, health counseling, and physical examinations to 1 patient every 10 minutes at a salary cost of $7.46 per visit. This model identified risk behaviors at levels consistent with local behavioral data, and addressed and documented them significantly more often than do physicians in traditional settings. Subjects (71%) preferred the computer-assisted visits to standard office visits, and 92% felt the amount of time spent was acceptable. CONCLUSIONS: Computer-assisted delivery of adolescent preventive services using nonphysician health counselors is a feasible, economical, and acceptable alternative to traditional clinical practice for screening young people for health-compromising behaviors and providing individualized health education and routine physical examinations. This model would likely increase adolescents' access to needed preventive services at a very modest cost.

Adolescent↗
PubMed1990

Medical informatics. An emerging academic discipline and institutional priority.

Information management constitutes a major activity of the health care professional. Currently, a number of forces are focusing attention on this function. After many years of development of information systems to support the infrastructure of medicine, greater focus on the needs of physicians and other health care managers and professionals is occurring--to support education, decision making, communication, and many other aspects of professional activity. Medical informatics is the field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education, and research, including the information science and the technology to support these tasks. An intrinsically interdisciplinary field, medical informatics has a highly applied focus, but also addresses a number of fundamental research problems as well as planning and policy issues. Medical informatics is now emerging as a distinct academic entity. Health care institutions are considering, and a few are making, large-scale commitments to information systems and services that will affect every aspect of their organizations' function. While academic units of medical informatics are presently established at only a few medical institutions in the United States, increasing numbers of schools are considering this activity and many traditional departments are seeking and attracting individuals with medical informatics skills.

Career Choice↗