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A report on methods to reduce, refine and replace animal testing in industrial toxicology laboratories.

The Committee to Promote Principles of Reduction, Refinement and Replacement of Animal Testing in Industrial Toxicology Laboratories was established in 1987 to work toward industrywide improvements in laboratory animal testing methods. The committee's goals are to gather information about effective nonanimal testing techniques and other methods of conserving and improving the care of laboratory animals, to work toward the systematic validation of nonanimal alternatives, and to disseminate useful information about progressive programs and policies throughout the industrial toxicology community. This is the first in a continuing series of reports the committee plans to produce as part of an ongoing program to promote communication among industrial toxicologists about successful methods of reducing, refining and replacing animal testing. Here are some of the report's major findings: (1) Animal care and use committees charged with the oversight of laboratory animal use are a universal practice at the companies surveyed. (2) Significant reductions in the number of animals used for acute toxicity testing have taken place at all the companies during the last 5- to 10-year period. (3) Structure-activity relationships (predicting a test compound's properties based on the known properties of familiar chemicals with similar structures) are widely used to minimize, but not replace, the use of animals. (4) Tissue and organ culture systems are being used with increasing frequency for screening and mechanistic studies, but are not completely replacing animal evaluations as a final step. (5) There is a pressing need for the systematic and scientifically sound validation of nonanimal alternative techniques to reduce the use of animals in toxicology testing while satisfying requirements for the protection of public safety.

Advisory Committees↗

Nucleotide signaling in nervous system development.

The development of the nervous system requires complex series of cellular programming and intercellular communication events that lead from the early neural induction to the formation of a highly structured central and peripheral nervous system. Neurogenesis continuously takes place also in select regions of the adult mammalian brain. During the past years, a multiplicity of cellular control mechanisms has been identified, ranging from differential transcriptional mediators to inducers or inhibitors of cell specification or neurite outgrowth. While the identification of transcription factors typical for the stage-specific progression has been a topic of key interest for many years, less is known concerning the potential multiplicity of relevant intercellular signaling pathways and the fine tuning of epigenetic gene regulation. Nucleotide receptors can induce a multiplicity of cellular signaling pathways and are involved in multiple molecular interactions, thus opening the possibility of cross talk between several signaling pathways, including growth factors, cytokines, and extracellular matrix components. An increasing number of studies provides evidence for a role of nucleotide signaling in nervous system development. This includes progenitor cell proliferation, cell migration, neuronal and glial cellular interaction and differentiation, and synaptic network formation.

Adenosine Triphosphate↗

Buoyant density and molecular weight calculations on an Apple II microcomputer from equilibrium banding experiment on analytical ultracentrifuge.

Buoyant density is one of the non-destructive measurements of viruses, nucleic acids etc. which help in characterizing these entities in terms of their chemical composition and physical conformation. In recent years equilibrium sedimentation in CsCl buoyant density gradient has been proved to be a powerful tool for genome characterization. The method enables one to obtain information such as the absolute and the relative buoyant density of the material and its molecular weight. This communication describes a program in BASIC which calculates these parameters from the raw data obtained directly from the experiment. The program is fully interactive, user-oriented, and written keeping in view biologists and biochemists as the main users. The program has a built-in option to calculate either the absolute or the relative buoyant density and the molecular weight.

Algorithms↗

[Evaluation of pediatric advise asked by telephone in emergency units].

BACKGROUND: Telephone calls for advice are common in pediatric emergency departments. This study was conducted to determine the nature of these calls and the answers provided. METHODS: From 24 April through 24 July 1994, all telephone calls requesting pediatric advice in the emergency department of the Poissy Hospital were independently analysed by two pediatricians from forms prospectively filled in for each call by the resident or the attending people who answered the call. RESULTS: Of the 239 registered calls, 186 could be analysed. They represented, in number, 15.25% of the children seen at the same emergency department during the study period. Weekend and holiday calls accounted for 35.5% of calls. 7.8% of calls were received from 0.01 am to 8.00 am, 28.7% from 8.01 am to 4.00 pm, and 63.5% from 4.01 pm to 12.00 pm. Thirty-seven percent concerned children under one year of age. The caller was one of the parents in 93% of cases. The four most frequent complaints were fever (26.5%), requests for information (17.2%), rash (12.3%), and vomiting (10.2%). The review of calls by two pediatricians determined that 67% of children did not need to be seen by a physician within six hours; 28% needed to be seen within 6 hours, and 5% needed to be seen within one hour. The advice given was followed in 88% of cases; 96% of callers were satisfied with their calls management. CONCLUSIONS: Telephone advice constitutes an important part of the activity in the pediatric emergency department. Instructional programs in telephone management are necessary for physicians. These programs should include communication skills and familiarization with protocols concerning the most frequent complaints, especially those regarding children under one year of age.

Adolescent↗

A method for implementation of nutritional therapy in hospitals.

BACKGROUND AND AIMS: Many barriers make implementation of nutritional therapy difficult in hospitals. In this study we investigated whether, a targeted plan made by the staff in different departments could improve nutritional treatment within selected quality goals based on the ESPEN screening guidelines. METHODS: The project was carried out as a continuous quality improvement project. Four different specialities participated in the study with a nutrition team of both doctors, nurses, and a dietician, and included the following methods: (1) Pre-measurement: assessment of quality goals prior to study including the use of screening of nutritional risk (NRS-2002), whether a nutrition plan was made, and monitoring was documented in the records. (2) INTERVENTION: multidisciplinary meeting for the ward staff using a PC-based meeting system for detecting barriers in the department concerning nutrition, elaboration of an action plan and implementation of the plan. (3) Re-measurement: as in (1) based on information from records and patient interviews, and an evaluation based on focus group interview with the staff. Patients who gave informed consent to participate in the study (>14 years) were included consecutively. Mann-Whitney and Kruskal-Wallis test was used for ordinal data, and Pearson chi(2) test for nominative data. P values <0.05 were considered significant. The study was performed in accordance with the Research Ethics Committee. RESULTS: In this study 141/122 patients were included before/after the implementation period with a mean weight loss within the last 3 months of 6.2 and 5.2 kg, respectively. Before the study we found that BMI was not measured. More than half of the patients had a weight loss within the last 3 months, and 40% had a weight loss during hospitalization, and this was not documented in the records. About 75% had a food intake less than normal within the last week, and nearly one-third were at a severe nutritional risk, and only 33% of these had a nutrition plan, and 18% a plan for monitoring. Barriers concerning nutrition included low priority, no focus, no routine or established procedures, and insufficient knowledge, lack of quality and choice of menus, and lack of support from general manager of the hospital. The staff introduced individually targeted procedures including assigning of responsibility, a nutrition record, electronic calculator of energy intake, upgrading of the dieticians and special diets, communication, and educational programs. A great consistency existed between barriers for targeted nutrition effort and ideas for improvement of the quality goals between the different departments. Quality assessment after study showed an overall significant improvement of the selected quality goals. CONCLUSION: The introduction of a new method for implementation of nutritional therapy according to ESPEN screening guidelines seems to improve nutritional therapy in hospitals. The method included assessment of quality goals, identification of barriers and individual targeted plans for each department followed by an evaluation process. The model has to be refined further with relevant clinical endpoints.

Aged↗

Recruiting seniors with chronic low back pain for a randomized controlled trial of a self-management program.

OBJECTIVE: To identify recruitment challenges and elucidate specific strategies that enabled recruitment of seniors for a randomized trial on low back pain comparing the Chronic Disease Self-management Program of the Stanford University to a 6-month wait-list control group. DESIGN: Recruitment for a randomized controlled trial. SETTING: Community-based program offered at 12 locations. PARTICIPANTS: Community-dwelling seniors 60 years and older with chronic low back pain of mechanical origin. METHODS: Passive recruitment strategies included advertisement in local and senior newspapers, in senior e-mail newsletters and listservs, in local community centers and businesses. Active strategies included meeting seniors at health fairs, lectures to the public and organizational meetings, and the help of trusted professionals in the community. RESULTS: A total of 100 white and 20 African American seniors were recruited. The program seemed to have the most appeal to white, middle-class older adults, educated through high school level. Advertisement failed to attract any participants to the program. Successful strategies included interaction with seniors at health fairs and lectures on health care, especially when the program was endorsed by a trusted community professional. CONCLUSION: Generating interest in the self-management program required keen communication skills because the idea of "self-management" was met with a myriad of responses, ranging from disinterest to disbelief. Generating interest also required active participation within the communities. Initial contacts had to be established with trusted professionals, whose endorsement enabled the project managers to present the concept of self-management to the seniors. More complex recruitment strategies were required for this study involving the self-management approach to back pain than for studies involving treatment.

Aged↗

Science, politics and animal health policy: epidemiology in action.

Public policy decisions underlie society's response to current animal health issues ranging from emerging diseases and public health threats to food safety concerns and sustainable animal agriculture strategies. Despite strong calls for "science-based" decisions, animal health policy most commonly emerges at the interface of science and politics. Too often scientists' disdain for politics limits their involvement in formulating policy. By contrast, epidemiologists are ideally qualified to bring scientific skills to complex policy issues through analytical, macro-epidemiological approaches that consider the economic, legal, and cultural context of policy issues as well as the biological and medical aspects. Risk analysis provides a systematic approach to evaluating animal health issues and comparing policy options. Capturing these opportunities for applied epidemiology requires an understanding of the policy-making process as well as the basic principles of epidemiology. Furthermore, epidemiology training programs must incorporate communications skill building and experiential learning opportunities in a team environment.

Animals↗

The efficacy of a compact psychoeducational group training program for married couples.

There is a lack of psychoeducational programs for married couples who, although subjectively concerned about their marriages, do not seek marital therapy. In this study, the efficacy of a cognitive-behavioral program delivered on a weekend by 2 trainers for groups of 4 couples was investigated. Couples (n = 67) were recruited by newspaper announcements, then randomly assigned to the intervention program or a waiting-list control group. The program consisted of communication and problem-solving training, couples' discussions to clarify their relationship expectations, and exercises to enhance their sensual or sexual relationship. At postassessment, intervention couples emitted more positive verbal and nonverbal communication behaviors during a conflict discussion task than did control couples, who reported significantly more relationship problem areas and displayed more negative communication behaviors. At the 1-year follow-up, intervention couples reported fewer problem areas in comparison with preassessment.

Adult↗

Maintenance and rehabilitation of independence in old age: an intervention program for staff.

Research has attested to the prevalence of a "dependency-support" and "independence-ignore" script characterizing the interactions between staff and elderly residents in long-term care institutions. To examine whether the scripts could be modified, a staff training program (focusing on communication skills, knowledge about aging, and basic behavior principles) was implemented in 3 different institutions. Observational data on staff-resident interactions in the context of self-care were collected pre- and postintervention. Findings revealed significant changes for the experimental group. Specifically, a decrease in dependence-supportive behavior of staff and an increase in their independence-supportive behavior, an increase in independent behavior of residents, and an increase in independence-related interaction patterns were demonstrated.

Adult↗

Effects of alternative modeling strategies on outcomes of interpersonal-skills training.

The effects of two alternative modeling strategies-using multiple scenarios and combining negative and positive model displays-on outcomes of a behavior modeling training program were explored. Trainees (N = 72) participated in a program on assertive communication structured to allow for a controlled experimental design that crossed scenario variability (one vs. multiple scenarios) with model display variability (positive model displays vs. positive and negative model displays). Outcomes assessed included trainee reactions, learning, and retention and behavioral measures of reproduction and generalization. The effects of multiple scenarios were negligible, but the positive and negative combination of model displays had a significant positive effect on trainee generalization and a significant negative effect on reproduction. Implications for future modeling research and practice are discussed.

Adult↗

A virtual educational strategy on telemedicine and medical simulation.

Medical services in Columbia are scarce in many regions, not only because of accessibility problems and costs, but also because of difficulties in access to medical knowledge. We envision a long-term strategy for virtual education programs, based upon communication technologies that could be developed by private and government institutions. The diffusion of telemedicine concepts, applications, and technologies are critical for propagating medical knowledge. This paper describes the virtual education experiences at the Pontificia Universidad Javeriana.

Colombia↗

Timed-event sequential analysis of agitation in nursing home residents during personal care interactions with nursing assistants.

Computer-assisted behavioral observation data were collected from 66 nursing home residents while they received assistance during personal care routines from a certified nursing assistant (CNA). Data were collected both before and after a comprehensive behavior-management and communication-skills training program was delivered to the nursing staff. A total of 30 residents showed 6 or more episodes of disruptive vocalization or other forms of agitation during baseline observations, and timed-event sequential analysis methods were used to test whether certain CNA behaviors either elicited or prevented onsets of agitation in these 30 residents. Simple verbal prompts used by CNAs during personal care routines before staff training were found to elicit agitation onset ( p =.03), whereas positive statements to the resident were found to reduce the likelihood of agitation onset (p =.02). In a previous analysis of the effects of staff training, we found that rates of resident agitation were significantly lower after training compared with baseline and that CNAs increased their rates of positive statements to residents. In the present study, timed-event sequential analyses indicated that the verbal prompts used by CNAs during personal care routines were no longer associated with an increased rate of resident agitation after staff training among the 20 residents who showed 6 or more episodes of agitation both before and after staff training. These findings suggest that the staff training program improved the quality of CNA verbal prompts. The sequential analysis of observational data provides an important method for studying interpersonal interactions, including those of nursing home residents and the nursing staff who care for them.

Activities of Daily Living↗

Post-stroke inpatient rehabilitation. I. Predicting length of stay.

This study was undertaken to identify factors predicting stroke inpatient rehabilitation length of stay in an acute inpatient rehabilitation program, including occupational therapy, physical therapy, and speech therapy. A cohort of 152 patients suffering from stroke (76 women and 76 men) voluntarily participated in this study. They were recruited from a general hospital in which they had received physical rehabilitation. The functional status of patients was observed by a physiotherapist, using the Functional Independence Measure(SM). The functional status was observed on patient admission to rehabilitation and at 1 wk from admission. Post-stroke biologic characteristics, including physical, neuropsychological, and clinical characteristics, as well as sociodemographic characteristics were also collected. A path analysis, using successive multiple linear regressions, was adopted to predict length of stay in rehabilitation. Significant predictors of length of stay were age, functional status at 1 wk post-rehabilitation admission, perceptual status, and balance status. These predictors accounted for 43.6% of the total variance in the rehabilitation length of stay. Indirect predictors of length of stay were identified as the following: functional status at admission, rehabilitation program, motor status, communication problems, and medical complications. Functional, biologic, and sociodemographic characteristics should be considered simultaneously in the prediction of length of stay as well as for the better understanding of the stroke rehabilitation process.

Adult↗

Institutionally shared trauma rotations are viable solutions to deficiencies in trauma training.

Numerous national trauma leaders have expressed concern about the lack of uniformity of trauma training in this country. In 1984 we instituted a trauma rotation between the University of Louisville (U.L.), with a large trauma volume, and Loyola University (L.U.) in the planning stages of trauma center development. Third year L.U. residents rotated at U.L. in 3-month blocks with an increased level of responsibility monthly, culminating in major decision-making roles and operative treatment under the chief resident's direction. The L.U. residents functioned as full members of the team and not as passive observers. Fifteen L.U. residents and 12 U.L. residents rotated during this period. Yearly major trauma visits, helicopter flights, and trauma service admissions average 1,908, 700, and 1,520, respectively. U.L. chief residents averaged 136 major operative trauma cases and 115 nonoperative trauma cases each were managed during this time period (RRC records greater than 85th percentile for all U.L. residents). L.U. residents performed an average of 30 major operative cases, nine as teaching assistant, in 3 months. Each managed more than 75 nonoperative cases. Several elements are critical in such a multi-institutional rotation: 1) active communication among the program directors, 2) commitment to one sharing arrangement only, 3) financing and malpractice for off-site residents, 4) housing, and 5) the ability to assimilate off-site residents as true trauma team members. The resident-to-resident interplay is crucial and has succeeded because both residency staffs have had excellent early training.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗

The final phase of rehabilitation: work hardening.

In addition to an individual's academic or educational preparation for a specific job or vocation, the importance of physical readiness has been recognized in the past decade. Physical readiness is particularly needed for individuals injured on the job. Work conditioning and work hardening programs have been developed by the health care community in response to this need. An understanding of the characteristics basic to work conditioning and hardening includes awareness of programmatic and philosophical differences between work programs, knowledge of the interdisciplinary team approach, the powerful rehabilitative tool of communication used by work programs particularly for goal formation, and awareness of each team member's role.

Humans↗

Patient-safety and quality initiatives in the intensive-care unit.

PURPOSE OF REVIEW: Patient safety has become the primary focus of health-care improvement in the last few years as an increasing body of evidence emphasizes the magnitude of harm posed to patients by medical errors. The intensive-care unit, by virtue of the high technology aggressive level of care the unit provides, has been identified as a significant source of patient harm. Consequently, the intensive-care unit also represents a tremendous opportunity to study and implement patient-safety initiatives, as significant improvements can be realized in this environment. RECENT FINDINGS: Several broad areas of successful patient-safety initiatives have been reported over the recent past including implementation of Comprehensive Unit-based Safety Programs, introduction of communication tools (for example daily goal sheets), application of care bundles (that is mechanical ventilation or sepsis), as well as team approaches that can eradicate catheter-related bloodstream infections. Specific interventions are gaining supportive evidence and widespread acceptance for their ability to reduce harm including tight glucose control and ultrasonography for reducing central-line placement complications. Recent data also demonstrate the value of an intensivist as the team leader for the critically ill within the intensive-care unit and potentially with rapid-response teams. SUMMARY: Many patient safety and quality-of-care initiatives that have broad application to all areas of medical care have been successfully developed in the intensive-care unit. The intensive-care unit appears to be a fertile ground for the development of safety initiatives.

Blood Glucose↗

Making the business case for health and productivity management.

Health and productivity management (HPM) is an important innovation for businesses concerned with rising health care costs. Like any innovation, however, it will not be adopted rapidly unless it is tailored to the needs of employers. For the last 6 years the Institute for Health and Productivity Management has studied the needs of American employers and sponsored employer driven case studies of health care and productivity. From these studies and the work of academic experts we have fashioned a set of programs to effectively communicate the advantages of health and productivity measurement and management. To make the business case for health and productivity management, researchers need to (1) demonstrate the relative advantage of HPM, (2) keep the evidence simple, (3) show that HPM is compatible with employer practices, and (4) communicate the results within and across corporate departments.

Diffusion of Innovation↗