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PubMed1992

Epidemiology of pediatric brain tumors.

Brain tumor research is unlike some other areas of cancer research, in which definite causes have been identified and prevention and treatment strategies may be developed. Primary brain tumors are heterogeneous with respect to several characteristics, and brain tumor research is hampered by this fact, as well as by the small numbers of cases, by the lack of a clearly established and consistently applied histopathologic classification scheme, and by geographical variations in diagnostic capabilities and mechanisms for case reporting. The current movement toward molecular epidemiology has resulted in several changes in the ways we will be able to investigate cancer etiologies in the future, and promises to be especially fruitful in the area of brain tumor research. The search is under way for biologic markers of risk exposures for various cancers, and for laboratory methods to identify those individuals who, because of their genetic qualities, are most likely to have brain tumors. There are probably multiple causes for brain tumors, incorporating both genetic and environmental pathways. Prior research has consistently identified few risk factors for brain tumors, such as ionizing radiation. Thus, collaborative efforts among clinicians, laboratory scientists, and epidemiologists, which make use of molecular epidemiologic methods, are perhaps of greater importance in this field than for cancers arising at other sites.

Brain↗
PubMed2006

A study of nurses' spiritual intelligence: a cross-sectional questionnaire survey.

BACKGROUND: Nurse's spiritual well-being may assure a positive attitude toward spiritual care, and assist patients in overcoming spiritual distress. Spirituality is often related to one's belief system. Spirituality on the part of nurses is yet largely unheard of in a society with materialism which is one of the most destructive belief systems on the world. OBJECTIVES: The objective of the study was to explore the profile of spiritual intelligence among nurses, and to examine the effect of religions on nurses' spiritual intelligence in China. DESIGN: This is a cross-sectional descriptive and inferential designed study. SETTINGS: The study was carried out in a medical center in China. Subjects were widely distributed, throughout seven provinces, with 16 hospital settings. PARTICIPANTS: A total of 130 registered hospital nurses, who were taking part in a 3-day, national nursing quality conference held by the target medical center in China, were recruited by convenience sampling. METHODS: Wolman's (2001) four-point Likert-type Psycho-Matrix Spirituality Inventroy (PSI) was distributed collaboratively during the period of the conference. Upon receiving oral approval from nursing administrators, the author ensured that subjects' responses would remain confidential and that filling out the questionnaire was to be construed as willingness to participate in this study. RESULTS: 1. The majority of nurses (90%) tended to experience numerous instances of physical emotional pain and suffering throughout life. 2. Among the 130 subjects, only seven nurses clearly specified their religions, and religious beliefs accounted for most of the variance in the criterion variable in the study. CONCLUSIONS: Exploring nurses' spiritual profiles, especially for those who seem to be unfamiliar with spiritual matters, is a starting point on the journey to delivering spiritual care. Chinese nurses' spiritual intelligence is only to be excavated. The study draws attention to the diverse culture of the nurses' concepts of spirituality, which is fundamental to the delivery of truly holistic care of humans in a multi-faith society.

Adult↗
PubMed2002

Awareness of sources of peer-reviewed research evidence on the internet.

CONTEXT: Peer-reviewed research evidence that was once available only to clinicians is now posted on the Internet and accessible to everyone, but levels of awareness of this evidence among patients and clinicians is not known. METHODS: Cross-sectional survey, conducted from July 1998 through January 2000, of cancer patients (n = 1998), their family physicians (n = 871), and all oncologists (n = 30) and oncology nurses (n = 44) at the Hamilton Regional Cancer Centre, Hamilton, Ontario. Comparisons made between and within groups to examine use of the Internet by patients and clinicians to find health information, and their awareness of organizations using Internet-based resources to promote evidence-based decision making. RESULTS: Response rates were 72%, 44%, 97%, and 84% for patients, family physicians, oncologists, and nurses, respectively; 47% of patients, 64% of family physicians, 100% of oncologists, and 72% of nurses reported that they used the Internet. Few patients were aware of the existence of the Cochrane Collaboration (1%), MEDLINE (13%), or the Program in Evidence-Based Care of Cancer Care Ontario (3%). Oncologists had the highest reported levels of awareness of the sources of evidence on the Internet. Most family physicians had not heard of any of the sources. CONCLUSIONS: The awareness of evidence sources on the Internet varies between patients and clinicians and across groups of clinicians, and some of the most rigorously developed sources of information are still unknown.

Adult↗
PubMed1993

Joseph E. Whitley Award. The effect of preradiology clinical training on the performance of radiology residents.

RATIONALE AND OBJECTIVES: A multi-institutional study was developed to evaluate whether having preradiology clinical training has an effect on the quality of performance of radiology residents assessed both after 1 year of training and at the end of the 4-year residency. MATERIAL AND METHODS: Five faculty members from each of nine collaborating institutions that accept residents both directly from medical school and with postgraduate clinical training completed 1,015 evaluation forms on their 203 residents who had just completed their first year of radiology training or had finished training in the past 2 years. Each resident was evaluated by two senior faculty, two junior faculty, and the residency program director using a cross-institutionally validated, behavior-oriented, standardized instrument that assessed five behavioral characteristics: conscientiousness, curiosity, interpersonal skills, confidence, and recognition of limits. The differences between residents who did and did not have preradiology clinical training were evaluated by analysis of variance and by simple effects testing. RESULTS: At the conclusion of training, no significant differences in resident performance were found between residents who did and did not have postgraduate clinical training before radiology residency. Among residents who had just finished their first year of training, those who had had clinical training scored significantly higher on four of the five behavioral scales. CONCLUSIONS: Clinical training before radiology residency does not correlate with any measurable benefit in performance at the end of radiology residency. Training programs should consider elimination of this requirement.

Adult↗
PubMedDate not supplied

International collaborative workshops. A 6-year partnership between Canada and China.

Interprofessional exchanges such as workshops are common activities in international development programs. The authors describe processes used to select, implement, and evaluate six collaborative workshops held in Tianjin, China, between 1990 and 1995. These workshops targeted curricular change for a baccalaureate nursing program in Tianjin Medical University. Our experience highlights the importance of understanding the assumptive base for change, developing an institutional memory in both partner universities, introducing interactive teaching methods congruent with Chinese value systems, and using a formative evaluation strategy to foster cross-cultural dialogue and mutual understanding among project partners.

Canada↗
PubMed1996

[Recent trends of epidemiological studies on cancer in Japan--personal experience and view of an epidemiologist].

As the number of cancer deaths has increased, the number of cancer researchers including cancer epidemiologists has increased. Compared to the approaching methods of epidemiologic studies on cardiovascular diseases, those of cancer epidemiology are different. In cancer epidemiology a case-control study has been used most frequently, while in cardiovascular disease epidemiology a cross-sectional study with health examinations in a defined population has been used most frequently. In the latter study a cross-sectional study has been repeated periodically forming a cohort study in a model area. Only few large scale cohort studies on cancer had been conducted previously, but in recent years several large scale cohort studies on cancer have been conducted by several research groups. In recent years there is a trend that epidemiologists in cancer, cardiovascular diseases and other related areas collaborate in conducting a large scale cohort study. Chemoprevention studies on cancer have been initiated by cancer epidemiologists in recent years.

Case-Control Studies↗
PubMed1999

Systems change resulting from HIV/AIDS education and training. A cross-cutting evaluation of nine innovative projects.

An evaluation of nine diverse HIV/AIDS training programs assessed the degree to which the programs produced changes in the ways that health care systems deliver HIV/AIDS care. Participants were interviewed an average of 8 months following completion of training and asked for specific examples of a resulting change in their health care system. More than half of the trainees gave at least one example of a systems change. The examples included the way patient referrals are made, the manner in which agency collaborations are organized, and the way care is delivered.

Adolescent↗
PubMed2004

Management of French patients with type 2 diabetes mellitus in medical general practice: report of the Mediab observatory.

OBJECTIVES: The Mediab study was conducted to estimate the medical care in French patients with type 2 diabetes mellitus managed by general practitioners on an ambulatory basis, but consIdered as requiring new treatment implementation. METHODS: Five thousand one hundred and fourty eight diabetic patients without any treatment or treated with lifestyle measures either alone or combined with an oral antIdiabetic agent given as monotherapy were included in a cross-sectional study that was conducted on a nationwIde basis by using the ORP (R) methodology. The 4088 patients in whom HbA1c was determined with a reliable method were further classified into 3 categories according to whether HbA1c was<=6.5% (group I, n=525), ranging between 6.6 and 8% (group II, n=1699) or > 8% (group III, n=1864). RESULTS: A large proportion of patients (45.6%) exhibited HbA1c > 8%. Adherence to diet and regular physical activity were progressively decreasing while prevalence of diabetic complications was steadily increasing from group I to III, i.e. when diabetic control was worsening. The complications suffered from severe "underreporting". When complications were reported, the odds-ratio analysis showed that retinopathy is influenced by both the magnitude of glucose excess and the diabetes duration, while renal diseases and macroangiopathy depend mainly on diabetes duration. 38.1% of patients visited a diabetologist, but most of these patients were referred to the speciaList after the inclusion visit. CONCLUSIONS: Despite the development of guIdelines, a large percentage of patients remains poorly-controlled. Future actions should be based on: (i) better collaboration between general practitioners and diabetologists (ii) better detection of complications that suffer from severe "underreporting", (iii) reinforcement of lifestyle recommendations and of pharmacological treatments by shifting from mono- to multi-drug therapy, at earlier stages of the disease.

Age of Onset↗
PubMedDate not supplied

The induction of human B-cell activation, proliferation and differentiation by anti-CD3-stimulated T cells--a model of T cell/B cell collaboration.

It is clear that anti-CD3-activated T cells provide all the signals necessary for polyclonal activation, proliferation and differentiation of human B cells. B-cell activation, proliferation and differentiation are initiated by a complex series of receptor-ligand interactions, of which LFA-1-ICAM-1 ligation plays a central, but not exclusive role. In addition, the action of a number of cytokines, most prominently IL2, is essential for B-cell proliferation and differentiation. It is apparent from the results obtained using this model system that the conjugate formation that occurs as part of antigen presentation and T-cell activation is not required for the subsequent collaboration between activated T cells and B cells necessary to trigger B-cell responses. The implication of these studies is that after initial antigen recognition and T-cell activation, T cell/B cell collaboration leading to antibody production is antigen non-specific and potentially capable of inducing polyclonal B-cell responses. Conjugate formation that develops as part of antigen presentation may tend to focus the response and limit the B cells that can be induced to respond. Alternatively, T-cell recognition of antigen may deliver a signal to the B cell by cross-linking MHC molecules bearing the recognized antigenic fragment that makes it more capable of responding to the T-cell-derived antigen-non-specific signals and cytokines promoting B-cell activation, proliferation and differentiation.

Antigens, Differentiation, T-Lymphocyte↗
PubMed2006

Influence of primary care practice and provider attributes on preventive service delivery.

BACKGROUND: While visits to the doctor's office are appropriate times to advise patients on health behaviors, these opportunities are often missed. Lapses in care quality are no longer attributed solely to individuals, but are also increasingly understood to be the result of organizational factors. This research examines the influence that both practice and provider attributes have on the delivery of preventive services for health behaviors. METHODS: This study used data collected from the Prescription for Health initiative sponsored by the Robert Wood Johnson Foundation. Quantitative data on 52 primary care practices and 318 healthcare providers were gathered from September 2003 to September 2004, and were analyzed upon completion of data collection. Hierarchical linear modeling was used to examine associations between both practice and provider attributes and preventive service delivery. RESULTS: Practice staff participation in decisions regarding quality improvement, practice change, and clinical operations positively influenced the effect of work relationships and negatively influenced the effect of practice size on service delivery. Nurse practitioners and allied health professionals reported more frequent delivery of services compared to physicians. Last, use of reminder systems and patient registries were positively associated with preventive service delivery. CONCLUSIONS: This study offers preliminary support for staff participation in practice decisions as a positive aspect of teamwork and collaboration. Findings also suggest leveraging nonphysician clinical staff and organized clinical systems to improve the delivery of preventive services for health behaviors.

Adult↗
PubMed2005

Comparison of differing C-reactive protein assay methods and their impact on cardiovascular risk assessment.

A medium-sensitivity assay for C-reactive protein (CRP) was compared with a high-sensitivity, enhanced immunoturbidimetric assay in 803 angiographically studied patients. Different absolute CRP values were found by the assays, but there was a high correlation by quartile rank and similar predictive values for death and myocardial infarction. This suggests that the conclusions of previous studies performed using the medium-sensitivity assay are still valid but that cross-study comparisons should use percentile rank.

Blood Chemical Analysis↗
PubMed2005

Treatment exhaustion of highly active antiretroviral therapy (HAART) among individuals infected with HIV in the United Kingdom: multicentre cohort study.

OBJECTIVES: To investigate whether there is evidence that an increasing proportion of HIV infected patients is starting to experience increases in viral load and decreases in CD4 cell count that are consistent with exhaustion of available treatment options. DESIGN: Multicentre cohort study. SETTING: Six large HIV treatment centres in southeast England. PARTICIPANTS: All individuals seen for care between 1 January 1996 and 31 December 2002. MAIN OUTCOME MEASURES: Exposure to individual antiretroviral drugs and drug classes, CD4 count, plasma HIV RNA burden. RESULTS: Information is available on 16,593 individuals (13,378 (80.6%) male patients, 10,340 (62.3%) infected via homosexual or bisexual sex, 4426 (26.7%) infected via heterosexual sex, median age 34 years). Overall, 10,207 of the 16,593 patients (61.5%) have been exposed to any antiretroviral therapy. This proportion increased from 41.2% of patients under follow up at the end of 1996 to 71.3% of those under follow up in 2002. The median CD4 count and HIV RNA burden of patients under follow up in each year changed from 270 cells/mm3 and 4.34 log10 copies/ml in 1996 to 408 cells/mm3 and 1.89 log10 copies/ml, respectively, in 2002. By 2002, 3060 (38%) of patients who had ever been treated with antiretroviral therapy had experienced all three main classes. Of these, around one quarter had evidence of "viral load failure" with all these three classes. Patients with three class failure were more likely to have an HIV RNA burden > 2.7 log10 copies/ml and a CD4 count < 200 cells/mm3. CONCLUSIONS: The proportion of individuals with HIV infection in the United Kingdom who have been treated has increased gradually over time. A substantial proportion of these patients seem to be in danger of exhausting their options for antiretroviral treatment. New drugs with low toxicity, which are not associated with cross resistance to existing drugs, are urgently needed for such patients.

Adolescent↗
PubMedDate not supplied

Clinical grading in psychiatric clerkships.

OBJECTIVE: The clinical grade assessment is the most frequently used and heavily weighted component in the overall assessment of U.S. psychiatry clerkship students, yet the topic is understudied. The authors aimed to learn more about the nature, perceived virtues, and deficiencies of the clinical grade evaluation. METHODS: A 26-item questionnaire regarding the psychiatry clerkship clinical grading form was distributed to the clerkship directors of 129 medical schools in the U.S. and U.S. territories. The design of the document, its strengths, its weaknesses, grading outcomes, and utilization were assessed. RESULTS: Trends regarding clinical grading in psychiatry clerkships were detected. The clerkship grade form similarities, differences, desirable features, and utilization were ascertained, as were areas for improvement. CONCLUSIONS: The search for an optimal clinical grading process for the thousands of third-year medical students rotating annually is formidable. However, collaboration among psychiatry clerkship directors on development and improvement of clinical evaluation forms can clarify learning objectives and lead to better clinical evaluation tools.

Clinical Clerkship↗
PubMed2001

The superefficient company.

Most companies do a great job promoting efficiency within their own walls, streamlining internal processes wherever possible. But they have less success coordinating cross-company business interactions. When data pass between companies, inconsistencies, errors, and misunderstandings routinely arise, leading to wasted work--for instance, the same sales, order entry, and customer data may be entered repeatedly into different systems. Typically, scores of employees at each company manage these cumbersome interactions. The costs of such inefficiencies are very real and very large. In this article, Michael Hammer outlines the activities and goals used in streamlining cross-company processes. He breaks down the approach into four stages: scoping--identifying the business process for redesign and selecting a partner; organizing--establishing a joint committee to oversee the redesign and convening a design team to implement it; redesigning--taking apart and reassembling the process, with performance goals in mind; and implementing--rolling out the new process and communicating it across the collaborating companies. The author describes how several companies have streamlined their supply-chain and product development processes. Plastics compounder Geon integrated its forecasting and fulfillment processes with those of its main supplier after watching inventories, working capital, and shipping times creep up. General Mills coordinated the delivery of its yogurt with Land O'Lakes; butter and yogurt travel cost effectively in the same trucks to the same stores. Hammer says this new kind of collaboration promises to change the traditional vocabulary of corporate relationships. What if you and I sell different products to the same customer? We're not competitors, but what are we? In the past, we didn't care. Now, we should, the author says.

Commerce↗
PubMed1992

Molecular and genetic analysis of liver oncogenesis in transforming growth factor alpha transgenic mice.

Overexpression of a transforming growth factor alpha (TGF-alpha) transgene induced the development of liver tumors in 69 of 93 (74%) adult male mice. To identify factors associated with oncogenesis, liver tumors from transgenic animals were characterized at the molecular level. TGF-alpha RNA transcripts were elevated in 17 of 25 (68%) liver tumors, relative to adjacent nontumorous tissue. Expression of the endogenous c-myc and insulin-like growth factor II genes was enhanced in 7 of 19 (37%) and 12 of 16 (75%) tumors, respectively. In contrast, epidermal growth factor receptor RNA levels were unchanged or reduced in all liver tumors, and mutations were not detected in either the Ha-ras or Ki-ras genes. The occurrence of liver tumors in castrated TGF-alpha transgenic mice was reduced about 7-fold, while in ovariectomized transgenic animals the incidence was increased about 6-fold. The progeny of a cross between CD1-derived TGF-alpha transgenic (MT42) and C57BL/6 mice exhibited no reduction in tumor burden (83%); however, the incidence of tumor formation in MT42 x FVB/N offspring was substantially lower (19%). We conclude that in these transgenic mice TGF-alpha promotes tumor formation and appears to play a major role in tumor progression. Moreover, other factors that may collaborate in TGF-alpha-induced hepatocarcinogenesis include c-myc, insulin-like growth factor II, sex hormones, and the genetic background upon which the transgene operates.

Animals↗
PubMed2004

Handwashing compliance.

Undeniably, handwashing remains the single most effective and cost-efficient method for preventing and reducing the transmission of nosocomial infections. Yet the rates and outbreaks of nosocomial infections in Canadian and international healthcare institutions continue to increase. Shaikh Khalifa Medical Center developed and implemented a multidisciplinary approach to address the challenges of handwashing compliance among nurses and healthcare workers in its workplace setting. Supported by evidence-based research, the approach consisted of three components: collaboration, implementation and evaluation. The use of the alcohol-based hand rub sanitizer or "solution" was integral to the multidisciplinary approach. Ongoing education, communication and a committed leadership were essential to promote and sustain handwashing compliance.

Allied Health Personnel↗
PubMed1989

Preliminary report of cardiac study: cross-sectional multicenter study on dietary factors of cardiovascular diseases. CARDIAC Study Group.

The International cooperative 'Cardiovascular Diseases and Alimentary Comparison Study' (CARDIAC Study) was designed to study the relationship of dietary factors to blood pressure (BP) and other major cardiovascular diseases (CVD) in widely different populations of both industrialized and developing countries. The primary aim of the research was to test specific hypotheses linking the intake of certain dietary constituents, e.g., sodium (Na), potassium (K), calcium (Ca) and protein, to BP ('Core' Study); in some centers the relationship between dietary factors and mortality from CVD was also examined ('Complete' Study). The final aim of this multicenter research was to contribute to the scientific information base required to guide the formulation of dietary goals for the primary prevention of major CVD. Forty centers in 20 countries are now participating in the CARDIAC Study. From each population 100 males and 100 females aged 50-54 years were selected randomly for BP measurement by an automated system, 24-hour urine collection by aliquot cups, blood sampling etc. according to CARDIAC protocol; and all samples were analyzed by the WHO Collaborating Center (Izumo) by standardized methods. Although studies are now in progress, surveys in China, Tanzania, USSR and Japan suggest the importance of Na and protein intakes, and all data so far obtained of systolic and diastolic BP, urinary Na and K excretions, serum cholesterol levels, etc. show wide distribution in different populations, so that dietary factors of CVD will be analyzed in more detail when the analyses of total samples are completed.

Blood Pressure↗
PubMedDate not supplied

Predictors and outcomes of household food insecurity among inner city families with preschool children in Vancouver.

OBJECTIVES: The purposes of this study were to measure household food security and to determine its association with potential predictor variables related to household and community environments, as well as the relationship between household food insecurity and preschool children's nutritional status. METHODS: In this cross-sectional study, household food security was measured in a convenience sample of households (n=142) with children aged 2-5 years in Vancouver in March 2004. We assessed the association between environmental predictors and household food security status, adjusted for household income. Indicators of children's nutrition were compared between categories of household food security. RESULTS: Household food insecurity was associated with indicators of suboptimal health status in preschoolers. After controlling for household income, parents with less access to food of reasonable quality, fewer kitchen appliances and a lower rating of their cooking skills had greater odds of experiencing household food insecurity. IMPLICATIONS: Our study results support the need to test interventions involving collaborative efforts among government, social planners and public health practitioners to remove barriers to food security for families. Multiple measures, including opportunities to gain practical food skills and household resources that enable convenient preparation of nutrient-dense foods, could be examined. Our findings suggest the need for improved selection and quality at existing small stores and an increase in the number of food outlets in low-income neighbourhoods.

British Columbia↗