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Research facilities have an obligation to provide appropriate care for animals used in studies, even in the event of a disaster or emergency situation. Each facility should develop a planned response for emergency situations that affect their research animals. Appropriate resources and personnel should be identified during development of emergency management plans.
At the end of Phase II, a decision must be made as to whether or not the drug should be developed as a therapeutic agent. Such a decision may be based on many criteria in addition to the scientific data derived from the Phase II study. At this point, expert judgment is needed. One should like to assume that if the decision is made to proceed with the increasingly expensive and laborious process of further development, the drug will, barring some completely unforeseen misadventure, ultimately find its way into clinical therapeutics. Phase II studies, therefore, are the most crucial stage in the course of drug development. Planning of these studies requires great care and investigators of the highest caliber should be used for their conduct. The escalating costs of new drug development are resulting in an undesirable imbalance of efforts in the direction of studies characterized more by easily defined end points than by therapeutic needs. Industry, academia, and the FDA must all be concerned with facilitationg studies in areas of most-needed therapeutic advances.
PURPOSE: To investigate the adequacy of hospital disaster preparedness in the Osaka, Japan area. METHODS: Questionnaires were constructed to elicit information from hospital administrators, pharmacists, and safety personnel about self-sufficiency in electrical, gas, water, food, and medical supplies in the event of a disaster. Questionnaires were mailed to 553 hospitals. RESULTS: A total of 265 were completed and returned (Recovery rate; 48%). Of the respondents, 16% of hospitals that returned the completed surveys had an external disaster plan, 93% did not have back-up plans to accept casualties during a disaster if all beds were occupied, 8% had drugs and 6% had medical supplies stockpiled for disasters. In 78% of hospitals, independent electric power generating plants had been installed. However, despite a high proportion of power-plant equipment available, 57% of hospitals responding estimated that emergency power generation would not exceed six hours due to a shortage of reserve fuel. Of the hospitals responding, 71% had reserve water supply, 15% of hospitals responding had stockpiles of food for emergency use, and 83% reported that it would be impossible to provide meals for patients and staff with no main gas supply. CONCLUSIONS: No hospitals fulfilled the criteria for adequate disaster preparedness based on the categories queried. Areas of greatest concern requiring improvement were: 1) lack of an external disaster plan; and 2) self-sufficiency in back-up energy, water, and food supply. It is recommended that hospitals in Japan be required to develop plans for emergency operations in case of an external disaster. This should be linked with hospital accreditation as is done for internal disaster plans.
Few institutions have successfully implemented peer review. It is considered a hallmark of the nursing profession and in theory has positive effects by stimulating personal and professional development and challenging nurses to think critically about their practice. The key is that the change must be managed, unit readiness assessed, and an implementation plan developed. It is suggested that all members of the critical care team be involved in the review process. Characteristics of a unit that is ready to implement team review are presented and discussed.
The development of hyperthermia, the treatment of tumours with elevated temperatures in the range of 40-44 degrees C with treatment times over 30 min, greatly benefits from the development of hyperthermia treatment planning. This review briefly describes the state of the art in hyperthermia technology, followed by an overview of the developments in hyperthermia treatment planning. It particularly highlights the significant problems encountered with heating realistic tissue volumes and shows how treatment planning can help in designing better heating technology. Hyperthermia treatment planning will ultimately provide information about the actual temperature distributions obtained and thus the tumour control probabilities to be expected. This will improve our understanding of the present clinical results of thermoradiotherapy and thermochemotherapy, and will greatly help both in optimizing clinical heating technology and in designing optimal clinical trials.
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BACKGROUND: Cycling is a form of physical activity with the potential to make a significant contribution to improving public health; however, participation levels are decreasing. Primary-care trusts (PCTs) are in a position to influence local provision for cycling but the extent of their involvement in policy and practice on cycling is unknown. A survey of Directors of Public Health in PCTs was conducted to establish the level and type of PCT involvement in policies, strategies, programmes and projects on cycling. METHODS: Directors of Public Health on the Faculty of Public Health database were sent an e-mail inviting them to complete an online questionnaire that addressed key issues of PCT involvement with cycling. RESULTS: One hundred and sixty-five responses were received (49% of all PCTs). Thirty-two per cent of respondents said there was someone in the PCT with specific responsibility for cycling. Less than half of PCTs had the basic facilities to encourage staff or visitors to cycle to their premises. Around one in 10 said that cycling was included in their travel plan or local delivery plan, and 49% of respondents said that their physical activity strategy contained reference to cycling. Joint working on the local strategic partnership and community plan was common, with 94% and 82% of PCTs, respectively, saying they had worked with other agencies on these plans. Most PCTs (60%) had worked on the Local Transport Plan. Specific knowledge of cycling policy was low, and demand for additional resources high. CONCLUSION: Cycling does not seem to be high on PCTs' agendas, despite its great potential to improve public health. More could be done to ensure that cycling is given a far greater emphasis within the work of PCTs, notably PCT input into local transport plan development, and production of local physical activity strategies.
The virtual elimination of vitamin A deficiency and all its consequences is high on the political agenda as a solvable public health problem by the end of the decade. Five to six times more children in the developing world are likely to be subclinically than clinically deficient. Subclinical deficiency can be detected by newer methodological approaches. Subclinically deficient children are at increased risk of severe and fatal infections. The problem at a population level is avoidable by the appropriate selection and application of a mix of available interventions. Countries are challenged to assess, analyze and take actions to incorporate nutrition concerns into development planning to attain end-of-decade goals.
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Expensive health facilities have failed to meet most health needs. This perceived failure has been interpreted as failure of scientific medicine with subsequent alienation of health facilities. It is therefore necessary to develop primary health care (PHC) programmes shaped around the life patterns of the population it serves. This paper discusses the similarity between marketing concept and providing PHC, and as it was applied to development planning in a village of the Kingdom of Tonga. The issues, circumstances, and approaches discussed, reflect what is desirable from the villagers' viewpoint. In the absence of epidemiological data, there was greater reliance on the villagers' observations to rank priorities. The process of arriving at the final objectives used the marketing approach to provide direction and guideline for discussions for the problems. Marketing can be of assistance in the search for more acceptable and accessible health service and will help to focus on the communities' perspective of their total needs.
Describes the range of issues considered in designing a programme of education and development for NHS managers. The programme took the form of a certificate and diploma in management studies with a very work-based approach using action learning sets and applied theory and techniques. Briefly discusses the recent history and debates in management education together with the tensions caused by academic focus on critical analysis and evaluation and the workplace focus of being effective and making improvements. This programme attempts to recognize and build on the strengths of both approaches and also to add some of the best practice from trainers' experience of designing personal development plans. Discusses the emphasis on reflective learning and the use of research-based assignments instead of conventional exams. Concludes with some indications of possible future developments from this model.
Intensive case management for severely psychiatrically ill patients is a relatively new phenomenon in the private sector. The authors describe a comprehensive case management program designed at Blue Cross Blue Shield of Massachusetts to meet the needs of the most severely ill psychiatric patients in a private managed care environment. The case management program emphasizes involvement of patients in creating comprehensive treatment plans; development of a relationship between case managers, patients and their families, and providers; and clinical coordination between the public and private sectors to create individualized treatment plans. The program's case managers are able to flex the benefit limitations of a managed care or indemnity plan to integrate public and private services and can enlist providers outside a managed care network. The paper describes service utilization by the first 33 patients who participated in the program for one year.
Good management and leadership by nurses is essential for the achievement of health for all. Well-prepared nurses are required locally and nationally who can identify problems and needs, work on interdisciplinary teams to formulate development plans for human resources, improve working conditions, and raise the quality of care at reasonable cost.
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Conceptualization and development of a health services awareness campaign at the University of Kentucky followed the steps in a communication process called formative research. Preproduction surveys and subsequent testing of possible initiatives led to creation of a popular video featuring the university mascot that is being used in new-student orientation.
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The paper reviews the present state of gerontological research in South Africa and provides examples of relevant studies. So far, most of the research has focused on socioeconomic conditions, e.g, financial status, living arrangements, and intergeneration family relations. During recent years another topic has gained prominence, e.g., the subjective well-being of the elderly. Another aspect of research in this area is its inter- and multidisciplinary nature and its concern with practical relevance. Terms often used in new research on aging are "empowerment of the elderly" and "self-care strategies". In this context, the elderly are beginning to be considered as significant brokers in development planning. In the last part of the paper, the trend to qualitative methods is discussed.
Treatment planning for radiation therapy is a multi-objective optimization process. Here we present a machine intelligent scheme for treatment planning based on multi-objective decision analysis (MODA) and genetic algorithm (GA) optimization. Multi-objective ranking strategies are represented in the L(p) metric under the displaced ideal model. Goal setting, protocol satisficing and fuzzy ranking of objective importance can be incorporated into the decision scheme to assimilate clinical decision making. For distance measures in the L(p) metric, a dynamic gauge function is defined based on the state energy of the decision system, which is assumed to undergo thermodynamic cooling with iteration time. The MODA scheme interacts with a robust GA engine, which adaptively evolves in the multi-modal landscape that defines the treatment plan quality. A conventionally challenging case of stereotactic radiosurgery of a brain lesion was selected for GA optimization. The resulting dose distributions are compared to human-developed plans, which are commonly regarded as clinically relevant and empirically optimal. The GA-optimized plans achieve substantially better sparing of critical normal neuroanatomy surrounding the brain lesion while respecting the preset constraints on tumor dose uniformity. In addition, machine optimization tends to produce novel treatment strategies which complements expert knowledge. The run time for producing an optimal plan is considerably shorter than the typical planning time for human experts, thus GA can also be used to aid the human treatment planning process. In prostate brachytherapy, MODA-GA was specifically applied to non-ideal conditions in which typical surgical uncertainties in seed implant positioning occur, where noisy objectives were introduced into the optimization scheme. The noisy system is found to be manageable by MODA-GA at uncertainty levels corresponding to reasonably proficient surgery teams. In contrast, noisy objectives would be very difficult to explore by human expert planners. Potential use of noisy optimization with time series analysis is being explored for error-corrective computer guidance in the operating room for prostate seed implantation. In conclusion, the combination of MODA and GA optimization offers both a solution to practical treatment planning tasks and the potential for real time applications in radiotherapy.