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Vascular mechanics in the clinic.

The bioengineer has more to contribute to medicine than he/she ever has in the past. The successful contribution must be based on such experiences as described by Donald McDonald in his collaboration with John Womersley. Clinician and engineer must come to know the other's problems, their weaknesses and their strengths. They must be prepared to compromise, but to know where compromise is warranted, and where it is not. The clinician must be prepared to change if he/she is to gain help from the engineer. Blind acceptance of old concepts (of "hypertension", and of cuff sphygmomanometric accuracy, etc.) needs enlightenment, while acceptance of physiological reality such as wave reflection needs emerge. The clinician's vocabulary will need to change. This chapter opens with a discussion of a time where knowledge of engineering, physics, physiology and medicine was meagre. These disciplines were small, but they did interconnect through the work of renaissance (and later) scientists. With increase in knowledge, the disciplines enlarged, and grew apart from each other. The challenge of today is to bring these closer together so that there may be some connection, some overlap, and so that the crevices between the disciplines are not so deep, and not such a deterrent to those who wish to engage in interdisciplinary activity.

Animals↗

Treatment and the process of care in musculoskeletal conditions. A multidisciplinary perspective and integration.

Chronic musculoskeletal pain for which there is not an obvious underlying physical cause is one of the most common reasons for long-term disability. There is a need to develop better ways of managing these problems. Improving the understanding of the basis for decision making, the processes of care, and the beliefs and expectations of patients and health care professionals seems as fundamental as basic laboratory science is to understanding inflammatory arthopathies. Little is known about the beliefs and expectations of patients and health care professionals, nor the multitude of factors such as traditions within professional groups, education, and language that professionals use in decision making. When better understanding of these factors and the mismatch between professionals and patients is achieved, then theoretical frameworks, treatment approaches, and the education of professionals in appropriate management will be improved.

Attitude of Health Personnel↗

Introducing integrated product and process development into the education of science and engineering undergraduates: a lecture course with an accompanying case-study programme at the ETH chemistry department.

Increased quality requirements in the development of chemical products and a growing awareness within society of the activities of chemical companies present a new challenge to the education of young scientists. Nowadays, the teaching of chemists, chemical engineers and environmental scientists at universities has to go beyond the traditional, discipline-orientated knowledge acquisition. The students also have to learn to work and communicate in interdisciplinary teams, to solve application-oriented tasks and to integrate scientific, economical, ecological and social aspects into their work. For this reason, a case-study programme was launched at the chemistry department of the Swiss Federal Institute of Technology. In this paper, we describe the organisational aspects of the programme, its inclusion into academic and industrial environments and summarise some of the scientific methodologies applied. One of the seven case-studies, an assessment of a modern insecticide, is presented in more detail. Finally, we discuss how far the case-study programme is suitable for introducing a new mode of knowledge production to universities.

Agriculture↗

Psychosocial and ethical issues of AIDS health care programs.

The psychiatric, psychosocial, and ethical considerations in the design and evaluation of health care programs for AIDS patients and others with HIV infection are described in this article. The responsibilities of health care providers are considered in the context of the history and epidemiology of AIDS, previous responses of the health care delivery system, and the concerns of the general public. General guidelines for program development are set forth; these guidelines embody ethical principles, the role of education in altering the behavior and attitudes of patients and health care workers, the optimal levels of and precautions for infection control, and the evaluation of a patient's competency and judgement. Several examples of the use of these guidelines to resolve difficult policy issues arising in the treatment of patients with AIDS or HIV infection are also provided.

Acquired Immunodeficiency Syndrome↗

An account of the usefulness of a pilot clinical ethics program at a community hospital.

This article describes the development and implementation of a six-month pilot clinical ethics program at Saint Thomas Hospital (Nashville, Tenn). To assess the impact of this program, baseline data were gathered from a self-selected sample of critical and special care unit nurses and physicians about the "most troublesome" ethical dilemmas in their practices. Nurses and physicians reported facing similar dilemmas in practice. Nurses believed that chaplains and peers were most "beneficial" in resolving their "most troublesome" cases; physicians did not deem one particular individual or service to be of any greater benefit than any other in dilemma resolution. Nurses and physicians indicated that in many cases patients and families did not appear involved in the process. In a posttest survey following the pilot program, nurses rated the beneficial role of chaplains somewhat lower and agreed that the clinical ethics service was beneficial. As with the pretest sample, the posttest nurses evaluated the role of the attending physician as "detrimental" to resolving their ethical conflicts. In the posttest, physicians ranked the role of the clinical ethicist as comparable to that of chaplains and social workers.

Attitude of Health Personnel↗

Comprehensive medication therapy management: identifying and resolving drug-related issues in a community pharmacy.

OBJECTIVE: The aim of this study was to characterize comprehensive medication therapy management (MTM) involving a community pharmacy and local physicians by describing the drug-related issues encountered, identifying which medication types were associated with these issues, and listing the actions taken by physicians and pharmacists to address them. METHODS: In the MTM program studied, community pharmacists and physicians worked together to manage the drug therapy of ambulatory Iowa Medicaid recipients dispensed > or =4 medications for chronic conditions by a community pharmacy. After initial assessment, pharmacists made written recommendations to the patient's physician, and the physicians subsequently responded. Data were extracted from pharmacy records for patients who made > or =1 visit during the first 2 years of the program. Collected data included patient demographics, number of chronic conditions and medications at enrollment, type and number of drug-related issues, medication category, pharmacist recommendations, and physician acceptance of recommendations. RESULTS: Data were gathered for 150 patients. The mean (SD) age was 54.4 (19.4) years and 74.0% were female. They were taking a mean (SD) of 9.3 (4.6) medications and had a mean (SD) of 6.1 (3.1) medical conditions at enrollment. A total of 886 drug-related issues were classified into 7 categories: inappropriate adherence (25.9%), needs additional therapy (22.0%), wrong drug (13.2%), unnecessary drug therapy (12.9%), adverse drug reaction (11.1%), dose too low (9.7%), and dose too high (5.3%). Overall, physicians accepted 313 (47.4%) of the 659 recommendations to alter drug therapy made by pharmacists, with the highest rates of agreement to stop or change a medication (50.3% and 50.0%, respectively) and the lowest rate of agreement to start a new medication (41.7%). CONCLUSION: The MTM program showed that drug therapy for ambulatory patients taking multiple medications to treat chronic conditions can be improved through collaboration between physicians and community pharmacists.

Adolescent↗

The philosophy of chemistry.

Although chemistry is by far the largest scientific discipline according to any quantitative measure, it had, until recently, been virtually ignored by professional philosophers of science. They left both a vacuum and a one-sided picture of science tailored to physics. Since the early 1990s, the situation has changed drastically, such that philosophy of chemistry is now one of the most flourishing fields in the philosophy of science, like the philosophy of biology that emerged in the 1970s. This article narrates the development and provides a survey of the main topics and trends.

Chemistry↗

Neural connections that compute.

The UK's Foresight Cognitive Systems Project brings together researchers in the life sciences and physical sciences to see where they can learn from one another and to debate, and plan, the future of research in cognitive systems. The project, a part of the UK government's Foresight initiative, sets out to identify potential opportunities for the economy or society from new science and technology. Through a series of research reviews, the project has created 'snap shots' of research in cognitive systems. A major conference in Bristol in September will consider series of research manifestos created by interdisciplinary groups.

Cognition↗

Needed: models of biotechnology intellectual property.

Although never uncontroversial, intellectual property rights in biotechnological innovation are once more the focus of intense debate. The debate has yet to reach any result, largely because of several important errors in the way that various disciplines approach it. These errors include making assumptions without empirical basis and conflating various intellectual property regimes. What is needed is a transdisciplinary integrated method to correct these errors. Such a method can be implemented through the construction of alternative models of intellectual property protection designed to balance the various social, ethical and economic constraints that affect biotechnology.

Biotechnology↗