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Theory and science in communication disorders.

The role of theory and of science for communication disorders is discussed. It is argued that communication disorders is a unique discipline, committed to the understanding and remediation of disordered communication, but that it is also fully invested in the theories and paradigms that inform all of behavioral science, and so it is inappropriate to expect it to generate its own theories. Theory contributes to research and to therapy in communication disorders, and we discuss the ways in which our discipline can make rational use of theory for both enterprises.

Behavioral Sciences↗

The use of administrative data as the first step in the continuous quality improvement process.

Billing or claims data, commonly referred to as administrative data, can be a valuable tool as the first step in a continuous quality improvement process. It is an inexpensive source of information which allows providers to identify opportunities for improvement in the process and the outcomes of health care delivery. The All Patient Refined/Diagnosis-Related Group case mix or severity-adjusted data represents one tool. The Practice Review System of Value Health Sciences is another. Comparative information is the first step, and the first step only in the quality improvement process. As such, to meet the needs of all continuous quality improvement customers, it is necessary to make this first step as reliable, yet inexpensive, as possible. Completing all the steps requires the use of a several measures over time.

Comorbidity↗

Developments in the dynamical theory of high energy electron reflection.

High energy electron reflection (HEER) is an important technique in surface science and uses the information carried by high energy electrons reflected from surfaces to study surface structures and surface electronic states. With the development of reflection high energy electron diffraction (RHEED), high energy electron microscopy (REM), and high energy electron energy loss spectroscopy (EEL) in surface science, the usefulness of HEER has been widely recognized and demonstrated. However, a stationary dynamical solution for an arbitrary surface for HEER has not been obtained yet. In this paper, some developments in understanding the dynamical theory of HEER, particularly in recent years, are reviewed: 1. The introduction of the concept of current flow for a semi-infinite crystal model has removed the confusion around the wave points in the "band gap." 2. The consistency between the Bloch wave and multislice in the Bragg case has verified the validity of the argument of current flow and led to the emergence of the BMCR method (Bloch wave + Multislice Combined for Reflection). 3. The failure of the Bloch Wave-Only solution (the BWO solution) on Au (110) surfaces in the Bragg case revealed by the BMCR method implies that previous BWO calculations in the Bragg case might be at fault. 4. The 2-D dependence of the electron wave fields and Picard iteration-like character of multislice calculation in the Bragg case has led to the emergence of an Edge Patching method in Multislice-mode-Only (the EPMO method). The new method yields an infinitely convergent stationary dynamical solution for an arbitrary surface.

Crystallization↗

Forensic sciences and medicine. The clinical or living aspects.

This presentation of information regarding the application of the forensic sciences and medicine to the evaluation of living persons and its related problems is based on the case experience of a private practitioner of forensic medicine and pathology. Lawyers, law-enforcement personnel, and fellow physicians must be educated regarding the potential role of the forensic physician in the examination of living people. Many examples of the application of forensic expertise to the solution of crimes and civil problems involving living persons are included.

Forensic Medicine↗

Nursing theory as a base for a computerized nursing information system.

This article illustrates how nursing theory can be used in a computerized nursing information system (CNIS). Before development of such a system can begin, data relationships must be specified so that: (a) the relationships are specific enough to support a computerized relational base and (b) the resultant information can support nursing science. Both goals were achieved through three interrelated processes: (a) validation of a practice model based on Orem's self-care deficit nursing theory, (b) classification of clinical data into theory-related categories, and (c) establishment of data relationships to yield meaningful information.

Databases, Factual↗

Broad issues to consider for library involvement in bioinformatics.

BACKGROUND: The information landscape in biological and medical research has grown far beyond literature to include a wide variety of databases generated by research fields such as molecular biology and genomics. The traditional role of libraries to collect, organize, and provide access to information can expand naturally to encompass these new data domains. METHODS: This paper discusses the current and potential role of libraries in bioinformatics using empirical evidence and experience from eleven years of work in user services at the National Center for Biotechnology Information. FINDINGS: Medical and science libraries over the last decade have begun to establish educational and support programs to address the challenges users face in the effective and efficient use of a plethora of molecular biology databases and retrieval and analysis tools. As more libraries begin to establish a role in this area, the issues they face include assessment of user needs and skills, identification of existing services, development of plans for new services, recruitment and training of specialized staff, and establishment of collaborations with bioinformatics centers at their institutions. CONCLUSIONS: Increasing library involvement in bioinformatics can help address information needs of a broad range of students, researchers, and clinicians and ultimately help realize the power of bioinformatics resources in making new biological discoveries.

Computational Biology↗

Interactive instruction of cellular physiology for remote learning.

The biomedical sciences are a rapidly changing discipline that have adapted to innovative technological advances. Despite these many advances, we face two major challenges: a) the number of experts in the field is vastly outnumbered by the number of students, many of whom are separated geographically or temporally and b) the teaching methods used to instruct students and learners have not changed. Today's students have adapted to technology--they use the web as a source of information and communicate via email and chat rooms. Teaching in the biomedical sciences should adopt these new information technologies (IT), but has thus far failed to capitalize on technological opportunity. Creating a "digital textbook" of the traditional learning material is not sufficient for dynamic processes such as cellular physiology. This paper describes innovative teaching techniques that incorporate familiar IT and high-quality interactive learning content with user-centric instruction design models. The Virtual Labs Project from Stanford University has created effective interactive online teaching modules in physiology (simPHYSIO) and delivered them over broadband networks to their undergraduate and medical students. Evaluation results of the modules are given as a measure of success of such innovative teaching method. This learning media strategically merges IT innovations with pedagogy to produce user-driven animations of processes and engaging interactive simulations.

Biology↗

Integrated Academic Information Management Systems (IAIMS). Part III. Implementation of integrated information services. Library/computer center partnership.

Information technologies are changing the traditional role of the library from that of a repository of information to that of an aggressive provider of information services utilizing electronic methods. In many cases, the library cannot realistically achieve this transformation independently but must work with the computer center to reach its objectives. Various models of the integration of libraries and computer centers are thus emerging. At the University of Maryland at Baltimore the Health Sciences Library and the Information Resources Management Division have developed a partnership based on functional relationships without changing the organizational structure. Strategic planning for an Integrated Academic Information Management System (IAIMS) acted as a catalyst in the process. The authors present the evolution of the partnership and discuss current projects being developed jointly by the two units.

Academic Medical Centers↗

A model of pharmacology education: the experience of Istanbul Medical Faculty.

This article describes the pharmacology education program that has been applied since 1990 at the Istanbul Medical Faculty. In Turkey, medical education lasts 6 years after 11 years of general training. Each year, approximately 350 students join the Istanbul Medical Faculty. The education is mainly in conventional form: basic sciences and elementary clinical information are given mostly as didactic lectures accompanying practical courses for small groups, with each group consisting of about 50 students during the first 3 years. In the subsequent 2 years, students have several clinical clerkships, and the last year is an internship. Pharmacology, the bridge between basic and clinical sciences, has a special place in the medical training. Accordingly, the courses were expanded to 3, 4, and 5 years, the sum of all courses being approximately 140 hours. Pharmacology education took place along with basic sciences in the first years but with clinical sciences in the later years and is based on active learning methods.

Curriculum↗

Use of the Internet by patients before and after cardiac surgery: telephone survey.

BACKGROUND: Little is known about to what extent patients who underwent medical treatment access the Internet and whether they benefit from consulting the Internet. OBJECTIVE: To understand if cardiopathic patients use the Internet for health-related information and whether they find retrieved information understandable and useful. METHODS: Telephone interviews, using a semi-structured questionnaire, were conducted with 82 patients who had undergone off-pump coronary-artery bypass grafting at the Center for Less Invasive and Robotic Heart Surgery in Buffalo, New York, USA. Study design was multidisciplinary, combining expertise of medical and communication science. Sources of medical information were identified (doctor, Internet, magazines, newspapers, television, radio, family members). Accessibility, quality, and readability of Internet medical information from the patients point of view were investigated. RESULTS: Out of 82 patients, 35 (35/82, 42.7%) were Internet users. Internet users had a significantly higher education level than Internet non-users (college education: 42.9% of users, 10.6% of non-users; P <.001). Among the Internet users, 18 (18/35, 51.4%) had used the Internet for retrieving medical information; 17 (17/35, 48.6%) had not. No statistically significant differences in demographic data were found when comparing these 2 sub-groups of patients. Family-members involvement was high (15/18, 83.3%). Internet medical information was rated helpful in most cases; readability was acceptable for only 3 patients (3/18, 16.7%). To improve on-line medical information, all patients interviewed suggested sites designed by their physicians. CONCLUSIONS: Although 1 in 5 patients in our sample has used the Internet to retrieve medical information, the majority of them experiences difficulties comprehending the information retrieved. Health-care providers should provide Internet medical information that is adequate for the non-medical public's needs.

Cardiac Care Facilities↗

Increasing the use of bicycle helmets: lessons from behavioral science.

Bicycle helmet purchase, use, consistent use, and correct use are determined by a complex set of factors. Behavioral theory suggests that they are influenced by the reciprocal association between individual characteristics such as, expectations, skills, attitudes, and beliefs; social influences such as social norms and peer pressure; and environmental factors such as availability, accessibility, and cost. These factors can be influenced through counseling and other interventions. While a review of the literature suggests that many bicycle helmet programs have not been planned using behavioral models and knowledge from the behavioral sciences, many studies include information that supports behavioral principles. This paper describes the behavioral principles and their application to the problem of increasing bicycle helmet use. Recommendations for practitioners are included.

Adolescent↗

Virtual management of radiology examinations in the virtual radiology environment using common object request broker architecture services.

In the Department of Defense (DoD), US Army Medical Command is now embarking on an extremely exciting new project--creating a virtual radiology environment (VRE) for the management of radiology examinations. The business of radiology in the military is therefore being reengineered on several fronts by the VRE Project. In the VRE Project, a set of intelligent agent algorithms determine where examinations are to routed for reading bases on a knowledge base of the entire VRE. The set of algorithms, called the Meta-Manager, is hierarchical and uses object-based communications between medical treatment facilities (MTFs) and medical centers that have digital imaging network picture archiving and communications systems (DIN-PACS) networks. The communications is based on use of common object request broker architecture (CORBA) objects and services to send patient demographics and examination images from DIN-PACS networks in the MTFs to the DIN-PACS networks at the medical centers for diagnosis. The Meta-Manager is also responsible for updating the diagnosis at the originating MTF. CORBA services are used to perform secure message communications between DIN-PACS nodes in the VRE network. The Meta-Manager has a fail-safe architecture that allows the master Meta-Manager function to float to regional Meta-Manager sites in case of server failure. A prototype of the CORBA-based Meta-Manager is being developed by the University of Arizona's Computer Engineering Research Laboratory using the unified modeling language (UML) as a design tool. The prototype will implement the main functions described in the Meta-Manager design specification. The results of this project are expected to reengineer the process of radiology in the military and have extensions to commercial radiology environments.

Algorithms↗

Genetic information and health insurance. Report of the Task Force on Genetic Information and Insurance. NIH/DOE Working Group on Ethical, Legal, and Social Implications of Human Genome Research.

One of the ironies in the current health care coverage crisis is that developing more accurate biomedical information could make things worse rather than better. In the current American health care system, information about an individual's risk of disease plays a crucial role for many people in determining access to health care coverage. This link between the likelihood of needing health care and the ability to obtain coverage for that care has the unfortunate result that those most in need may have the greatest difficulty finding affordable health care coverage. New advances in human genetics are transforming medicine by making available increasing amounts of such information about risk. Biomedical science and the delivery of health care are being reshaped by advances in our understanding of human genetics. New insights into health and disease, new diagnostic and prognostic tests and the possibility of new therapies reflect significant investments by the public and by private business and are no longer limited to the uncommon disorders traditionally labeled as "genetic diseases." Among the first products of genetic research is information useful in predicting the likelihood that an individual will develop particular diseases, opening the door both to preventive strategies that we would welcome, such as changes in diet and exercise patterns, and to the unwelcome possibility of genetic discrimination. Injecting information about genetic risks into the current health care system could result in ever more refined risk rating by insurers and ever greater difficulty in finding affordable health care coverage for large numbers of people. At a minimum, people could be discouraged from obtaining genetic information that might be useful in disease prevention and early treatment or for case planning and management because that same information could jeopardize their access to health care coverage in general, or to treatment for a condition excluded from coverage because it was "pre-existing." Under other circumstances people might be compelled to provide genetic information as a condition of obtaining affordable health care coverage. Genetic risk information carries an additional, wider burden because information about an individual's genetic health risks may also be information about the risks of children, parents, brothers, sisters, and other relatives. One suggested approach--providing special protection for genetic information--is unlikely to succeed. This special protection has been suggested because of the relevance of genetic information to family members and its implications for reproductive choices, potential discrimination and stigmatization.(ABSTRACT TRUNCATED AT 400 WORDS)

Discrimination, Psychological↗

2001: Things to come.

THIS ARTICLE DISCUSSES elements in the definition of modernity and emerging futurism in neurological surgery. In particular, it describes evolution, discovery, and paradigm shifts in the field and forces responsible for their realization. It analyzes the cyclical reinvention of the discipline experienced during the past generation and attempts to identify apertures to the near and more remote future. Subsequently, it focuses on forces and discovery in computational science, imaging, molecular science, biomedical engineering, and information processing as they relate to the theme of minimalism that is evident in the field. These areas are explained in the light of future possibilities offered by the emerging field of nanotechnology with molecular engineering.

Forecasting↗

Cardiovascular genomics.

The ongoing explosion of genomic information is revolutionizing cardiovascular science. More complete genomic maps allow easier identification of genes that cause monogenic inherited diseases. In addition, analyses of variations in gene expression in cardiovascular diseases are revealing new potential candidate genes as well as novel biomarkers for many common, multifactorial diseases. While experiments are revealing new pathophysiologic pathways, these genomic studies are also generating enormous amounts of data. Even as we learn how to sift through mountains of genomic information, new technologies in proteomics are rapidly advancing and promise to provide additional critical tools for diagnosis and for identifying new therapies.

Biomarkers↗