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PubMed2002

Finding the target: getting started with quality of care and health services research.

Choosing a research project and career goal requires planning. This article provides advice for the junior investigator on choosing a career path in health services research or quality improvement, developing and focusing project ideas, and assessing the merit of these choices. By providing specific strategies and examples, the authors highlight the importance of conceptual vision, an inquisitive perspective, and scientific rigor in both project and career development.

Attitude↗
PubMed1992

The ganglionic origins and central projections of primary sensory neurons innervating the upper and lower lips in the rat.

Retrograde and transganglionic transport of horseradish peroxidase (HRP) was used to investigate the neurons innervating the upper and the lower lips and their central projections in the rat. Both the upper and the lower lips were observed to be innervated by a very large number of trigeminal sensory neurons, with their cell bodies located in the maxillary and the mandibular parts of the trigeminal ganglion, respectively. The central projections of neurons innervating the upper lip formed a long continuous column starting rostrally at midlevels of the trigeminal main sensory nucleus (5P) and extending caudally through the C1 dorsal horn, with occasional fibers reaching the C3 segment. The heaviest projections appeared in the middle portions of 5P and nucleus interpolaris (5I), as well as in the rostral part of nucleus caudalis (5C). A small but consistent projection to the solitary tract nucleus, originating from cells in the inferior vagal ganglion, was observed in the upper-lip experiments. The central projections from neurons innervating the lower lip also appeared as a long column located dorsally or dorsomedially to the projections from the upper lip. The most prominent projections from the lower lip were located in the caudal part of 5P, the middle part of 5I, and the caudal two-thirds of 5C. Sparse projections could be traced as far caudally as C4. At 5C and cervical levels, some labeling appeared contralaterally in the same location as on the ipsilateral side.

Animals↗
PubMed1999

Automatic enrichment of the unified medical language system starting from the ADM knowledge base.

The Unified Medical Language System (UMLS) project aims to provide a repository of terms, concepts and relationships from several medical classifications. This work describes the possibility to enrich automatically with meaningful links the UMLS database by using description of diseases from another knowledge base, in our case ADM (Aide au Diagnostic Medical). In spite of the constraints and the difficulties to qualify the interconcept links, the results show that it is possible to find and create new links from a french knowledge database to the UMLS one. One of the interests of this work is that the automated learning of the connections could be used with others knowledge databases like expert system databases.

Algorithms↗
PubMed2001

Back-projection estimates of the number of dependent heroin users in Australia.

AIMS: To plan an appropriate response to heroin use in Australia, good estimates are needed of the numbers of dependent heroin users, the group who are most in need of treatment, most at risk of fatal opioid overdose and most at risk of contracting and transmitting blood-borne viruses. METHODS: Back-projection methods were used to estimate the numbers of people starting dependent heroin injecting in Australia between 1960 and 1997. Separate analyses were based on national opioid overdose deaths and numbers of new entrants to methadone treatment in New South Wales (NSW). Estimates of the rates at which dependent heroin users cease heroin use, commence methadone treatment or die from opioid overdoses were estimated from external data sources. RESULTS: Back-projection estimates derived from opioid overdose deaths indicated that there were 104 000 (lower limit of 72 000 and upper limit of 157 000) people who were heroin dependent in Australia between 1960 and 1997. Of these it was estimated that 67 000 (39 000-120 000) were still heroin dependent at the end of 1997. Back-projection estimates based on numbers of new entrants to methadone treatment in NSW indicated that there were 108 000 (82 000-141 000) heroin-dependent people in Australia between 1960 and 1997, of whom 71 000 (47 000-109 000) were estimated to be heroin dependent at the end of 1997. Both analyses indicated that the number of heroin-dependent people in Australia has increased substantially from the early 1970s onwards. CONCLUSIONS: Back-projection estimates based on analyses of treatment entries and opioid overdose deaths provide an additional method for estimating the numbers of heroin-dependent people in the population. The addition of these methods to existing methods, using different data sources and statistical methods, should improve consensus estimates of the numbers of heroin-dependent people.

Adolescent↗
PubMed2004

Advancing beyond the average: the importance of mentoring in professional achievement.

The profession of respiratory care is founded on rigorous scientific research, which in turn depends on rigorous training in research methods. Only a small part of that training is from written and audiovisual materials; the most important aspects of becoming a respiratory researcher are learned from. Becoming a thoroughly-involved respiratory care professional, then a researcher, and then a mentor is challenging but rich with the rewards of contributing to the advancement of science and, thereby, to the care and comfort of our patients. Becoming a respiratory researcher begins with. Only those with a burning desire to excel, to discover truth, and to contribute to the advancement of the profession will persevere through the setbacks and bring a research project to final fruition. The second requirement for long-term success is learning to maintain between enthusiasm and realism. It is crucial to avoid taking on more than you can realistically do, and it is necessary to devote adequate time to your family and/or non-work-related pursuits and recreation. The third aspect of becoming a contributor to respiratory care research is rigorous and ongoing education in the of respiratory care, the methods of medical research, and the basic sciences and mathematics that underlie the profession, including some calculus, engineering physics, and statistics. You must understand research design, critical analysis of research, and numerous aspects of presentation, including clear writing and concise speaking. The fourth aspect is : you must have a strong commitment to obtaining accurate, reproducible, and meaningful data. You must sustain strong attention to detail; mentors are essential because they teach the needed discipline, the required measurement skills, and how to select the appropriate equipment with which to conduct the research. is the fifth aspect. In addition to planning and using your time wisely, you must learn what are realistic expectations about how long a project will take, when to ask for help, and when to stop because you have reached your physical or mental limit and you need to rest and devote some time to your nutrition and recreation. The sixth aspect is : having achieved the basic skills and gained a fair amount of experience, your efficiency improves and you begin to achieve more in a day; you begin to start mentoring others; you can confidently and quickly handle multiple projects; if you don't know the answers you know where to find them; you are seen as an authority and people ask you for consultations and presentations and to participate in committees. The final aspect is, meaning that your practice of respiratory care reaches a level at which you meet challenges for which you feel you have no response in memory and yet you succeed.

Humans↗
PubMed2007

Major determinants of height development in Turner syndrome (TS) patients treated with GH: analysis of 987 patients from KIGS.

Little is known about factors determining height outcome during GH treatment in Turner syndrome (TS). We investigated 987 TS children within the Kabi International Growth Study (KIGS) who had reached near adult height (NAH) after >4 y GH treatment (including >1 y before puberty). Through multiple regression analysis we developed a model for NAH and total gain. Our results were as follows (median): 1) At start, age 9.7 yrs, height (HT) 118.0 cm (0.0 TS SDS), projected adult height 146.1 cm, GH dose 0.27 mg/kg wk; 2) NAH HT 151.0 cm (1.5 TS SDS); 3) Prepubertal gain 21.2 cm (1.6 TS SDS); 4) Pubertal gain 9.4 cm (0.0 TS SDS). NAH correlated (r = 0.67) with (ranked) HT at GH start (+), 1 year responsiveness to GH (+), MPH (+), age at puberty onset (+), age at GH start (-), and dose (+). The same factors explained (R = 0.90) the total HT gain. However, HT at GH start correlated negatively. Karyotype had no influence on outcome. Evidently, height at GH start (the taller, the better), age at GH start (the younger, the better), the responsiveness to GH (the higher, the better) and age at puberty (the later, the better) determine NAH.

Adolescent↗
PubMed1993

The Mediterranean Osteoporosis Study (MEDOS): theoretical and practical issues of a major international project on hip fracture epidemiology.

The Mediterranean Osteoporosis Study (MEDOS), a multicentre study on incidence, risk factors, and means of prevention of hip fracture in the Mediterranean region, started in 1986 and involved 14 centres, in Portugal, Spain, France, Italy, Greece, and Turkey. The project comprised three parts: a) a collection of existing register data on hip fracture occurrence from the 31 European ministries of health; b) a study of hip fracture incidence in the defined areas of the participating centres in the Mediterranean countries in age groups above 50 years; c) a case-control study comparing 8,185 individuals (2,816 cases and 5,369 controls; two controls per case). The structure of the project and its development is described. Methodological issues involving questions of reliability and validity are discussed. A number of measures were taken in order to obtain a high quality study, e.g., retranslations of the questionnaire of the case-control study, a separate reliability study of the interviewers' performance and uniformity, and a systematic tracing and estimation of the impact of errors in the data processing procedure. The complexity of the management process and the importance of effective communication on methodological issues are underlined.

Aged↗
PubMed1998

Introducing a quality improvement programme to primary healthcare teams.

OBJECTIVES: To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect. METHOD: Primary healthcare teams in Leicestershire (n = 147) were invited to take part in the facilitated programme. The programme comprised seven team meetings, led by a researcher, plus up to two facilitated meetings of quality improvement subgroups, appointed by each team to consider specific quality issues. OUTCOME MEASURES: To assess the effect and feasibility of the programme on improving the quality of care provided, the individual quality improvement projects undertaken by the teams were documented and opportunities for improvement were noted at each session by the facilitator. The programme's acceptability was assessed with questionnaires issued in the final session to each participant. To assess the long term impact on teams, interviews with team members were conducted 3 years after the programme ended. RESULTS: 10 of the 27 teams that initially expressed interest in the programme agreed to take part, and six started the programme. Of these, five completed their quality improvement projects and used several different quality tools, and three completed all seven sessions of the programme. The programme was assessed as appropriate and acceptable by the participants. Three years later, the changes made during the programme were still in place in three of the six teams. Four teams had decided to undertake the local quality monitoring programme, resourced and supported by the Health Authority. CONCLUSIONS: The facilitated programme was feasible, acceptable, and effective for a few primary healthcare teams. The outcomes of the programme can be sustained. Research is needed on the characteristics of teams likely to be successful in the introduction and maintenance of quality improvement programmes.

Decision Making, Organizational↗
PubMedDate not supplied

Evaluation of the midwifery pilot projects in Quebec: an overview. L'Equipe d'Evaluation des Projets-Pilotes Sages-Femmes.

In 1990, the province of Quebec adopted a law authorizing the evaluation of the practice of midwifery through eight pilot projects. The projects, which took the form of birth centres outside hospitals, started operating in 1994. The objectives of the evaluation were 1) to compare midwives' services to current physician services with regard to maternal and neonatal mortality and morbidity, the use of obstetrical intervention, individualization and continuity of care as perceived by clients, and cost; and 2) to identify the professional and organizational factors associated with the integration of midwives into the health care system. A mixed evaluative design was used: a multiple case study with each pilot project representing a case and a cohort study where 1,000 women followed by midwives in the birth centres were matched with 1,000 women followed by physicians in the usual hospital-based services. Various quantitative and qualitative data collection instruments were used. Overall, many results were favourable to midwifery practice, while some were favourable to medical care. Following the evaluation, the Government of Quebec decided to legalize the practice of midwifery.

Birthing Centers↗
PubMedDate not supplied

The PRE.DI.CA. project for radiographic lung cancer screening in cigarette smokers.

In heavy cigarette smokers and former smokers who have accumulated a high risk of lung carcinoma, a primary objective is early detection. Annual chest x-ray screening is a readily available, low cost method to detect asymptomatic lung carcinoma at an early stage (stage I) and, after radical resection, to improve the 5-year survival rate. A project of annual chest x-ray screening, named PRE.DI.CA. was started, for the early diagnosis of asymptomatic lung cancer in the high risk population of heavy cigarette smokers and former smokers, males and females, aged 45-75 years, in the province of Varese. Over a 7-year period, 4.598 heavy smokers enrolled in the PRE.DI.CA. lung project underwent 14.461 chest x-ray examinations. 45 asymptomatic lung cancers were detected and defined histologically. In the province of Varese it was possible to establish early diagnosis of lung carcinoma with annual chest x-ray screening of asymptomatic high risk smokers. 52% stage I diagnosis was achieved at the incidence screening.

Aged↗
PubMedDate not supplied

[The introduction of projects to prevent HIV infection among people using injection narcotics and women in the sex business in the city of Simferopol'].

The work on the realization of the Project on the Prevention of HIV infection, carried out by the Charity Fund "Hope and Salvation" in 1998-1999 in the Crimea is described. As shown by the analysis of the results of behavioral reactions, the forms of behavior used by drug-dependent persons contribute to the spread of HIV infection. Since November 1999 the realization of the pilot project on the reduction of HIV infection among injecting drug users has been started in Simferopol (with the financial support to the Pasteur Institute and the advisory support of the UN Representation in the Ukraine). The necessity of the development of the Project "Decrease of Spread of HIV and Sexually Transmitted Diseases among Female Sex Workers in Simferopol" is substantiated.

Female↗
PubMed2000

Mapping and identification of Mycobacterium tuberculosis proteins by two-dimensional gel electrophoresis, microsequencing and immunodetection.

Mycobacterium tuberculosis is the infectious agent giving rise to human tuberculosis. The entire genome of M. tuberculosis, comprising approximately 4000 open reading frames, has been sequenced. The huge amount of information released from this project has facilitated proteome analysis of M. tuberculosis. Two-dimensional polyacrylamide gel electrophoresis (2-D PAGE) was applied to fractions derived from M. tuberculosis culture filtrate, cell wall, and cytosol, resulting in the resolution of 376, 413, and 395 spots, respectively, in silver-stained gels. By microsequencing and immunodetection, 38 culture filtrate proteins were identified and mapped, of which 12 were identified for the first time. In the same manner, 23 cell wall proteins and 19 cytosol proteins were identified and mapped, with 9 and 10, respectively, being novel proteins. One of the novel proteins was not predicted in the genome project, and for four of the identified proteins alternative start codons were suggested. Fourteen of the culture filtrate proteins were proposed to possess signal sequences. Seven of these proteins were microsequenced and the N-terminal sequences obtained confirmed the prediction. The data presented here are an important complement to the genetic information, and the established 2-D PAGE maps (also available at: www.ssi.dk/publichealth/tbimmun) provide a basis for comparative studies of protein expression.

Amino Acid Sequence↗
PubMed2005

[Telematics and quality. Implementation of a telematic platform in Hamburg].

Since the end of the year 2000 a group of interested people has been working on the subject of quality improvement in breast cancer. Within this framework the project "improvement of breast cancer treatment by telemedicine" was started. Based on a workflow analysis and interviews with patients as well as health professionals, it turned out that there are gaps and flaws in the communication process. These problems occurred between health professionals involved in the treatment of patients and between health professionals and patients as well. As a result a telemedicine network has been developed which is based on MPLS technology. Within this network a central communication unit facilitates optimization of the workflow for the treatment of breast cancer. It will also be possible to set up groups for integrated care. Currently the system is being evaluated in specific breast centres in Hamburg. As the net is based on a positive business plan, it can be foreseen that a broad implementation will follow.

Breast Neoplasms↗
PubMed2005

Indoor air and human exposure assessment--needs and approaches.

The Commission launched on June 9, 2004 the Environment and Health Action Plan to reduce diseases caused by a polluted environment. The plan would develop an EU system integrating information on the state of the environment, the ecosystem and human health. The action plan identifies 13 actions (including an action on indoor air quality), which refer to initiatives on how to better understand the environment-health link and establish how environmental exposure leads to epidemiological effects. The ultimate goal of the proposed "Environment and Health Strategy" is to develop an environment and health "cause-effect framework" that will provide the necessary information for the development of Community policy dealing with sources and the impact pathway of health stressors. The need for policy-science interface in the EU guided in the last few years the research on indoor air pollution. In particular, the lack of information regarding human exposure to air pollutants makes it necessary, in line with the Environment and Health Action Plan, to develop targeted strategies to evaluate the impact of indoor air pollution on human health. This includes apart from specific measurements in selected confined spaces (homes, schools, public buildings, etc.), large-scale monitoring campaigns at European level, specifically designed to assess indoor and outdoor air quality and personal exposure to pollutants in combination with micro-environmental activity patterns. Information from these studies will be considered as crucial for a first evaluation of the overall situation in indoor environments and the possible sources and source strengths of pollutants to which humans are exposed during working, commuting and rest time. As a first approach to systematically evaluate the relationship between indoor air pollution and human (chronic) exposure to pollutants, we started at the end of 2003 with the AIRMEX project (Indoor Air Monitoring and Exposure Assessment Study). In the frame of AIRMEX, measuring campaigns in various cities in Southern and Central Europe were carried out to estimate indoor/outdoor relationships and personal exposure concentrations for selected volatile organic compounds (aromatics, carbonyls, terpenoids). In agreement with the overall scope of the project, the measuring objects included public buildings (town halls, guild halls), schools and kindergartens. Personal exposure measurements were conducted with employers and/or teachers working in the selected occupational environments. Preliminary results indicate that personal exposure concentrations are higher than the indoor/outdoor concentrations. In most cases they are twice as high (or even higher) as indoor concentrations and significantly higher than outdoor concentrations.

Air Pollutants↗
PubMed2003

Trace element reference values in tissues from inhabitants of the EU. XII. Development of BioReVa program for statistical treatment.

Statistical data treatment is a key point in the assessment of trace element reference values being the conclusive stage of a comprehensive and organized evaluation process of metal concentration in human body fluids. The EURO TERVIHT project (Trace Elements Reference Values in Human Tissues) was started for evaluating, checking and suggesting harmonized procedures for the establishment of trace element reference intervals in body fluids and tissues. Unfortunately, different statistical approaches are being used in this research field making data comparison difficult and in some cases impossible. Although international organizations such as International Federation of Clinical Chemistry (IFCC) or International Union of Pure and Applied Chemistry (IUPAC) have issued recommended guidelines for reference values assessment, including the statistical data treatment, a unique format and a standardized data layout is still missing. The aim of the present study is to present a software (BioReVa) running under Microsoft Windows platform suitable for calculating the reference intervals of trace elements in body matrices. The main scope for creating an ease-of-use application was to control the data distribution, to establish the reference intervals according to the accepted recommendation, on the base of the simple statistic, to get a standard presentation of experimental data and to have an application to which further need could be integrated in future. BioReVa calculates the IFCC reference intervals as well as the coverage intervals recommended by IUPAC as a supplement to the IFCC intervals. Examples of reference values and reference intervals calculated with BioReVa software concern Pb and Se in blood; Cd, In and Cr in urine, Hg and Mo in hair of different general European populations.

Databases, Factual↗
PubMed2001

From competition to community: participatory learning and action among young, debt-bonded Vietnamese sex workers in Cambodia.

Community mobilisation strategies for HIV/AIDS prevention based on recognition of social vulnerability and concepts of empowerment have emerged at the forefront of international efforts to reduce the AIDS pandemic, increasingly replacing a focus on individual risk. This paper describes the start-up phase of a participatory learning and action project to create a sense of community identity as a first step towards collective action among some 300 young, debt-bonded, brothel-based migrant sex workers from Vietnam in Phnom Penh, Cambodia. The factors that make sex workers vulnerable to HIV also pose considerable barriers to mobilising them, due to competing interests between and among brothel owners and sex workers. Discussion and visual tools--e.g. a spider diagram of causes of unsafe sex and how to overcome these--are being used in group work to analyse concerns expressed by sex workers, along with survey questionnaires and in-depth interviews. In the second phase the project will address sensitive topics such as violence and unsafe sex in more depth, in hopes of protecting the emerging solidarity among sex workers and shifting the balance towards greater co-operation.

Adult↗
PubMed1998

Combination therapy with GH and cyproterone acetate does not improve final height in boys with non-GH-deficient short stature.

BACKGROUND AND OBJECTIVE: Recently, we reported that GH therapy without gonadal suppression (GS) decreased the final height of boys with non-GH-deficient short stature by decreasing the height standard deviation score (SDS) for bone age (BA) during puberty. Combination therapy with GH and GS has been reported to suppress bone maturation and improve final height in some cases. We evaluated the effects of combination therapy with GH and GS using cyproterone acetate on the final height of boys with non-GH-deficient short stature. PATIENTS: Fifty nine boys with non-GH deficient short stature were observed retrospectively until they reached their final height. The boys were divided into 3 groups: Group A consisted of 26 boys who were not treated with GH, group B consisted of 13 boys who were treated with GH alone, and group C consisted of 20 boys who were treated with combination therapy with GH and GS using cyproterone acetate. At the start of observation, the height SDS for BA and projected height were matched among these three groups. RESULTS: The mean +/- SDS of the final height for groups A, B, and C were 162.7 +/- 5.3 cm, 155.4 +/- 4.9 cm, and 161.9 +/- 3.2 cm, respectively. GH therapy did not affect the height SDS for BA during the prepubertal period. GH therapy without GS decreased the height SDS for BA during puberty in group B. Combination therapy with GH and cyproterone acetate increased the height SDS for BA between 12 and 14 years BA in group C. However, after GS therapy was discontinued at 14 years BA, the height SDS for BA gradually decreased and eventually reached the same value as that in group A. CONCLUSIONS: GH therapy during the prepubertal period did not improve the final height of boys with non-GH-deficient short stature. GH therapy without GS decreased pubertal height gain, resulting in reduced final height. Combination therapy with GH and GS using cyproterone acetate decelerated the bone maturation during puberty which might be accelerated by GH therapy, but did not improve the final height which might have been attained without treatment.

Androgen Antagonists↗
PubMed2000

From vision to reality: how to actualize the vision of discharging patients from a hospital, with an increased focus on prevention.

Experiences in creating dialogue possibilities to stimulate interdisciplinary and intersectoral collaboration in hospital discharge and prevention are presented. Time is often a major constraint that persuades decision-makers to avoid using qualitative methodologies in research and development. Quick results are demanded of today's health-care system, not allowing ideas to be implemented or visions owned by professionals. Action-orientated research is used and recommended, despite its time-demanding methodology. A multidisciplinary management team and the authors, over a 2-year period, worked with the development and implementation of 'Preventive Discharge' in a Danish hospital clinic. The empirical starting point, developmental processes, piloting and implementation of the project are described. Earlier research from a literature review on discharge is referenced. The results show that while there are many barriers to dialogue between professions and between organizational levels, it is possible to frame such opportunities and improve interdisciplinary and intersectoral collaboration for health. External supervision may be an effective tool for stimulating dialogue. The testing phase afforded a valuable lesson when pilot-site collaborators, initially not involved in the development of the process tools, reformulated the project to suit their cultural climate while maintaining the project's original aims. Finally, a discussion is presented on actualizing the vision for 'Preventive Discharge'.

Aged↗