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At least 1,009 records · Page 56Linked to original sources
PubMed1998

Integration of palliative medicine at the Medical College of Wisconsin 1990-1996.

Palliative medicine is an emerging world-wide discipline. This article describes efforts at the Medical College of Wisconsin (MCW) to develop programs to enhance palliative medicine education and clinical care. New courses, seminars and clinical programs have been developed. Education and clinical care activities since 1990 have included a required course for second-year medical students, clinical electives for third- and fourth-year medical students, a clinical palliative care consultation service, a palliative care seminar series designed for housestaff, and a nurse preceptorship program. Palliative medicine activities have included both the academic medical center and community health agencies. MCW has integrated palliative medicine into its academic environment so that trainees at all education levels now have opportunities for didactic and clinical end-of-life care education.

Education, Medical, Graduate↗
PubMed2001

Modeling and simulation for space medicine operations: preliminary requirements considered.

The NASA Space Medicine program is now developing plans for more extensive use of high-fidelity medical simulation systems. The use of simulation is seen as means to more effectively use the limited time available for astronaut medical training. Training systems should be adaptable for use in a variety of training environments, including classrooms or laboratories, space vehicle mockups, analog environments, and in microgravity. Modeling and simulation can also provide the space medicine development program a mechanism for evaluation of other medical technologies under operationally realistic conditions. Systems and procedures need preflight verification with ground-based testing. Traditionally, component testing has been accomplished, but practical means for "human in the loop" verification of patient care systems have been lacking. Medical modeling and simulation technology offer potential means to accomplish such validation work. Initial considerations in the development of functional requirements and design standards for simulation systems for space medicine are discussed.

Aerospace Medicine↗
PubMed1995

Palliative medicine education at the Medical College of Wisconsin.

Palliative medicine is an emerging worldwide discipline. This article describes efforts at the Medical College of Wisconsin to develop programs to enhance palliative care education and clinical care. New courses, seminars, and clinical programs have been developed with assistance from various medical school departments and affiliated hospitals. Education and clinical care activities since 1990 have included a new 6-week course for 2nd-year medical students; a hospice volunteer experience for preclinical students; clinical electives for 3rd- and 4th-year medical students; a clinical palliative care consultation service; a palliative care seminar series designed for housestaff; a nurse preceptorship program; and an allied health observership program. Palliative care activities include both the academic medical center and community health agencies. The MCW has integrated palliative care into its academic environment so that trainees at all education levels now have opportunities for didactic and clinical palliative care education.

Education, Medical, Undergraduate↗
PubMed2005

The role of in vitro ADME assays in antimalarial drug discovery and development.

The high level of attrition of drugs in clinical development has led pharmaceutical companies to increase the efficiency of their lead identification and development through techniques such as combinatorial chemistry and high-throughput (HTP) screening. Since the major reasons for clinical drug candidate failure other than efficacy are pharmacokinetics and toxicity, attention has been focused on assessing properties such as metabolic stability, drug-drug interactions (DDI), and absorption earlier in the drug discovery process. Animal studies are simply too labor-intensive and expensive to use for evaluating every hit, so it has been necessary to develop and implement higher throughput in vitro ADME screens to manage the large number of compounds of interest. The antimalarial drug development program at the Walter Reed Army Institute of Research, Division of Experimental Therapeutics (WRAIR/ET) has adopted this paradigm in its search for a long-term prophylactic for the prevention of malaria. The overarching goal of this program is to develop new, long half-life, orally bioavailable compounds with potent intrinsic activity against liver- and blood-stage parasites. From the WRAIR HTP antimalarial screen, numerous compounds are regularly identified with potent activity. These hits are now immediately evaluated using a panel of in vitro ADME screens to identify and predict compounds that will meet our specific treatment criteria. In this review, the WRAIR ADME screening program for antimalarial drugs is described as well as how we have implemented it to predict the ADME properties of small molecule for the identification of promising drug candidates.

Animals↗
PubMed2006

The role of modern biology and medicine in drug development in academia and industry.

This symposium addresses careers in drug development in industry; the performance of translational research by academia, industry, and both; and numerous factors pertinent to alliances essential to drug discovery and development. Drug development is a complex process that regularly involves effective collaborations between academic and physician scientists and industry. There are specific occupational factors affecting recruitment of scientists and physicians in drug development programs in industry; ideal backgrounds for successful applicants for positions in industry in drug development; ethical and regulatory considerations particularly germane to the performance of scientists and physicians in drug development programs in industry and at universities; and particular gratifications available to scientists in industry working on drug development. Both similarities and differences characterize the performance of translational research in industry compared with academia. In industry, logistic, operational, and scientific oversight is complex, especially because it often involves relationships with clinical enterprises outside of the corporation. The process is long and arduous from formulation of a good idea in discovery to acceptance of a novel drug in the marketplace. Collaborations and partnerships by industry often involving academia and confrontation of multiple issues are pivotal.

Academic Medical Centers↗
PubMed2005

World Federation of Haemophilia programs in developing countries.

The World Federation of Haemophilia (WFH) is a global not-for-profit organization devoted to furthering the treatment of hemophilia and related disorders. Founded in Montreal in 1963, it has grown tremendously during the last 40 years and now has 107 National Member Organizations and has been recognized by the World Health Organization. The mission of the WFH is to introduce, improve, and maintain care for patients with hemophilia and related disorders. Several specific programs may be used as tools to achieve these goals. The WFH organizes regular educational workshops on key aspects of hemophilia care. Fellowships are offered to approximately 30 healthcare professionals each year that provide funding for a period of study of up to 8 weeks at an International Hemophilia Training Center of their choice. The WFH twinning program helps emerging hemophilia treatment centers develop partnerships with well-established centers. Although the ultimate goal of the WFH is to promote sustainable hemophilia treatment in developing countries, donations of concentrate are regularly made through the Humanitarian Aid program. The WHF launched the Global Alliance for Progress in its 40th anniversary year, establishing a partnership between the WFH and other stakeholders, including the pharmaceutical industry. The aim is to focus on 30 to 40 developing countries during the next 10 years, aiming to more than double the number of patients diagnosed with hemophilia in those countries. The WFH is also involved in fostering discussion on key issues such as safety and supply of blood products.

Developing Countries↗
PubMed2003

Stage-dependent effects of oocytes and growth differentiation factor 9 on mouse granulosa cell development: advance programming and subsequent control of the transition from preantral secondary follicles to early antral tertiary follicles.

The development of an ovarian follicle requires a complex set of reciprocal interactions between the oocyte and granulosa cells in order for both types of cells to develop properly. These interactions are largely orchestrated by the oocyte via paracrine factors such as growth differentiation factor 9 (GDF9). To examine these interactions further, a study was conducted of the effects of oocytes at different stages of development on proteins synthesized by mouse granulosa cells during the transition of granulosa cells (GCs) from preantral, secondary (2 degrees ) follicles (2 degrees GCs) to mural granulosa cells (3 degrees GCs) of antral tertiary (3 degrees ) follicles. The ability of recombinant GDF9 to mimic the effects of oocytes was also determined. Effects were evaluated by high- resolution, two-dimensional protein gel electrophoresis coupled to computer-assisted, quantitative gel image analysis. Coculture of the 2 degrees GCs with growing oocytes (GOs) from 2 degrees follicles brought about many of the changes in granulosa cell phenotype associated with the 2 degrees to 3 degrees follicle transition. GDF9 likewise brought about many of these changes, but only a subset of GDF9-affected protein spots were also affected by coculture with GOs. Coculture of 2 degrees GCs with the nearly fully grown oocytes (FGOs) from 3 degrees follicles had a reduced effect on 2 degrees GC phenotype, in comparison with coculture with GOs. For some proteins, oocyte coculture or GDF9 treatment appeared to have opposite effects on 2 degrees GCs and 3 degrees GCs. Additional effects of GDF9 and oocytes were seen in cultures of 2 degrees GCs for proteins other than those that differed between untreated control 2 degrees and 3 degrees GCs. These results indicate that GOs and GDF9 can each induce 2 degrees GCs to shift their phenotype toward that of 3 degrees GCs. The ability of the oocyte to produce this effect is diminished with oocyte development. The transition in the GC phenotype promoted by oocytes appears stable because differences in 2 degrees GCs promoted by oocytes and GDF9 were observed in untreated 3 degrees GCs. We conclude that the influence of the oocyte on GCs changes with the progression of their development, and so too does the response of the GCs to the oocyte. Moreover, by acting on the 2 degrees GCs, GOs are able to influence stably the phenotype of 3 degrees GCs. Thus, at or near the 2 degrees to 3 degrees follicle transition, signals from the growing oocyte contribute to the development of the mural GC phenotype.

Animals↗
PubMed1998

Developing musculoskeletal education programs for physicians and the general public: findings from a needs assessment.

OBJECTIVE: To assess the educational needs and learning preferences of primary care physicians and the general public in receiving musculoskeletal health education. METHODS: Prospective surveys were mailed simultaneously to 2,250 primary care physicians and 2,250 members of the general public. The surveys included questions about demographics, motivation for attending programs, and preferred education program formats. RESULTS: The 68 responding physicians attend continuing medical education programs mainly based on topics, speakers, and timing. They prefer lectures and find question and answer sessions least helpful in supporting learning. The 96 responding members of the general public attend programs mainly based on topics, speakers, and fees. The general public stated that question and answer sessions best support learning in programs. A large percentage of responding physicians provide health education to their patients, but a small percentage of the general public respondents stated that they receive health education from physicians. DISCUSSION: Responses from physicians and the general public were generally not surprising but revealed interesting contrasts between learning preferences. While physicians and the general public both value speakers and topics, the physicians want to increase their knowledge about disease, whereas the general public wants practical information. Physicians and the general public also appear to take different approaches to learning. The contrast between availability and provision of health education is also striking. We cannot generalize our results with absolute confidence because the return rates for the surveys were so low. Nonetheless, we support the need to educate physicians and the general public in ways that match their preferred learning methods and educational needs.

Adult↗
PubMed1991

Easy and practical utilization of CONSAM for simulation, analysis, and optimization of complex dosing regimens.

Complex dosing regimens simulated in the literature using a universal dosing regimen were calculated with a general dosing program developed using the program CONSAM. The program provides a rapid method of calculating nonuniform dosing regimens for up to n = 3 compartments for any linear model. Subject data can also be curve fitted with the program to obtain individual subject estimates to allow for dosage optimization, which is important in a clinical setting. Examples are presented to show the use of the program in optimizing a theophylline regimen, as well as estimation of a new parameter, Cuneq(T), which is defined as the average non-steady-state drug concentration at time t for a drug with an irregular dosing interval.

Computer Simulation↗
PubMed1988

The effects of a worksite health promotion program on the wives of fire fighters.

One method of increasing the cost-effectiveness of worksite health promotion programs is to develop programs that also have an impact on risk factors of family members and friends of the employees. In this study, 41 wives of fire fighters were interviewed concerning changes the fire fighters and they had made in their health habits--exercise, weight, and consumption of fats, fruits/vegetables, and cereal/whole grain breads--in the previous year. Thirty-two were wives of fire fighters who had received a worksite health promotion program and nine were wives of fire fighters who had not yet received the program. Findings of our exploratory study strongly suggest that wives of fire fighters who received information were more aware of the program (93% vs 56%), had greater exposure to the written diet plan (72% vs 11%) and guide to high fat foods (72% vs 0%) than controls. Furthermore, the intervention led to changes in the fire fighters' health habits that were reported by the wives. No significant changes in the wives' health habits occurred as a result of the intervention, although the changes were in the predicted direction in every category; changes by the wives were, however, related to changes by fire fighters. Involvement of the fire fighters in the preparation of meals and sharing of information from the intervention program by the participant with the wife, were related to change in health habits of the wives.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Doctor-patient communications in the Aboriginal community: towards the development of educational programs.

OBJECTIVE: Aboriginal people in Canada have poorer health than the rest of the population. Reasons for health disparities are many and include problems in communication between doctor and patient. The objective of this study was to understand doctor-patient communication in Aboriginal communities in order to design educational interventions for medical students based on the needs and experiences of patients. METHODS: Experiences of good and poor communication were studied by semi-structured interviews or focus groups with 22 Aboriginal community members, 2 community health representatives and 2 Aboriginal trainee physicians. Transcribed data were coded and subjected to thematic analysis. RESULTS: Positive and negative experiences of communicating with physicians fell into three broad and interrelated themes: their histories as First Nations citizens; the extent to which the physician was trusted; time in the medical interview. CONCLUSION: Aboriginal peoples' history affects their communication with physicians; barriers may be overcome when patients feel they have a voice and the time for it to be heard. PRACTICE IMPLICATIONS: Physicians can improve communication with Aboriginal patients by learning about their history, building trust and giving time.

Adult↗
PubMed2005

Has the relation between income inequality and life expectancy disappeared? Evidence from Italy and top industrialised countries.

OBJECTIVE: To investigate the relation between income inequality and life expectancy in Italy and across wealthy nations. DESIGN AND SETTING: Measure correlation between income inequality and life expectancy at birth within Italy and across the top 21 wealthy countries. Pearson correlation coefficients were calculated to study these relations. Multivariate linear regression was used to measure the association between income inequality and life expectancy at birth adjusting for per capita income, education, and/or per capita gross domestic product. DATA SOURCES: Data on the Gini coefficient (income inequality), life expectancy at birth, per capita income, and educational attainment for Italy came from the surveys on Italian household on income and wealth 1995-2000 and the National Institute of Statistics information system. Data for industrialised nations were taken from the United Nations Development Program's human development indicators database 2003. RESULTS: In Italy, income inequality (beta = -0.433; p<0.001) and educational attainment (beta = 0.306; p<0.001) were independently associated with life expectancy, but per capita income was not (beta = 0.121; p>0.05). In cross national analyses, income inequality had a strong negative correlation with life expectancy at birth (r = -0.864; p<0.001). CONCLUSIONS: In Italy, a country where health care and education are universally available, and with a strong social safety net, income inequality had an independent and more powerful effect on life expectancy at birth than did per capita income and educational attainment. Italy had a moderately high degree of income inequality and an average life expectancy compared with other wealthy countries. The cross national analyses showed that the relation between income inequality and population health has not disappeared.

Adult↗
PubMed1977

Breeding record analysis in pig herds and its veterinary applications--1: Development of a program to monitor reproductive efficiency and weaner production.

Analyses of breeding records and herd efficiency factors are important for veterinary surgeons supervising reproductive efficiency and piglet performance in breeding herds. These data include: the number of litters produced per sow per year; the distribution of weaning to service intervals; the number of sows returning to service by 30, 60, 90 and 120 days; the percentage of sows farrowing to first service; the percentage of sows found to be not pregnant; and the percentage of sows aborting. Boar performance data, piglet mortality percentages, piglet growth rates, feed efficiency factors and the percentage of sows culled from the herd are also analysed. A computer program was developed to produce these and other data from simple breeding records.

Animals↗
PubMed2001

Developing a training program to improve supervisor-resident relationships, step 1: defining the types of issues.

BACKGROUND: By some estimates, the teacher-learner relationship explains roughly half of the variance attributed to the effectiveness of teaching. Despite this, relationships largely have been ignored in the educational literature. PURPOSE: This qualitative pilot study sought to identify factors in the supervisor-resident relationship that hinder learning among University of Toronto psychiatry residents. METHOD: Thirteen postgraduate-year residents in Years 2-5 and their supervisors were interviewed regarding interactions that either assisted or adversely affected learning. RESULTS: Qualitative analysis of the interview data led to the identification of 5 types of issues affecting the supervisory relationship: goals and individual differences, communication and feedback, power and rivalry, support and collegiality, and role modeling and expertise. Face validity was supported when typed anonymous written feedback obtained from annual supervisor evaluations also could be organized into the 5 categories. CONCLUSIONS: Recognition of the types of interpersonal interactions that assist or hinder learning may contribute to enhanced teaching effectiveness.

Canada↗
PubMed2001

Screening programs to identify children at risk for diabetes mellitus: psychological impact on children and parents.

Screening programs to identify persons atrisk for diabetes mellitus (DM), before disease onset, are considered essential to understanding the natural history of the disease and for prevention program development. However, screening programs are complicated by imprecise markers of disease risk, the absence of a known effective prevention method, the use of children, and a wide variety of psychological, social, and educational challenges. Research relevant to four issues is presented: (1) parent and child anxiety in response to at-risk notification as well as how participants cope with this news; (2) accuracy of mothers' understanding of their babies' risk status; (3) predictors of participant recruitment and retention in longitudinal studies of this type; and (4) protocol compliance in prevention trials for type 1 DM. Integration of behavioral research into screening and prevention trials would help address the ethical concerns raised by such trials and improve their scientific quality.

Anxiety↗