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At least 1,189 records · Page 66Linked to original sources
PubMed2006

Evidence into practice: combining the art and science of injury prevention.

OBJECTIVES: To bring together scientific evidence of what works in injury prevention with the knowledge and experience of practitioners, using a case study of smoke alarm installation from England. DESIGN: There is good evidence of strategies to reduce injuries but less is known about the art of translating those strategies to implementation in real-world settings. England's Health Development Agency developed a structured process applicable to many public health fields, which integrates practitioner knowledge into the evidence base and reflects local contexts. The multistep process includes convening structured field meetings with local practitioners and policy makers, which focus on a mapping exercise of strategies, policies, targets, and funding streams related to childhood injury prevention, and barriers and facilitators relating to implementation of specific interventions. SETTING: Meetings were held in six venues across England with 98 participants from a range of professional backgrounds and sectors. RESULTS: The collective knowledge of participants provided many local insights unlikely to emerge in conventional research. Discussion topics covered key partners and sectors to include when planning a program; national policies and programs that could be used to drive the agenda; potential sources of funding; the importance of providing and installing appropriate smoke alarms; targeting of programs; and suggestions for gaining access to hard-to-reach populations. CONCLUSION: This methodology represents an efficient way of gaining insight necessary for successful implementation of evidence based programs. It may be particularly useful in lower and middle income countries, serving to translate evidence into the local contexts and circumstances within which practitioners operate.

Accident Prevention↗
PubMedDate not supplied

Computer-based physician order entry: the state of the art.

Direct computer-based physician order entry has been the subject of debate for over 20 years. Many sites have implemented systems successfully. Others have failed outright or flirted with disaster, incurring substantial delays, cost overruns, and threatened work actions. The rationale for physician order entry includes process improvement, support of cost-conscious decision making, clinical decision support, and optimization of physicians' time. Barriers to physician order entry result from the changes required in practice patterns, roles within the care team, teaching patterns, and institutional policies. Key ingredients for successful implementation include: the system must be fast and easy to use, the user interface must behave consistently in all situations, the institution must have broad and committed involvement and direction by clinicians prior to implementation, the top leadership of the organization must be committed to the project, and a group of problem solvers and users must meet regularly to work out procedural issues. This article reviews the peer-reviewed scientific literature to present the current state of the art of computer-based physician order entry.

Computer User Training↗
PubMed1999

Funduscopy: a forgotten art?

Funduscopy is an integral part of the physical examination, especially in older patients in whom visual problems and systemic diseases affecting the fundi (e.g., diabetes mellitus) are more common. We have assessed the views of hospital doctors to funduscopy via a questionnaire survey, reviewed the case notes to see whether or not funduscopy is carried out on older patients, and assessed the views of older patients on vision via a questionnaire survey. Review of the case notes showed only three of 100 patients had had funduscopy. Most patients reported a visual problem on specific enquiry. Whilst most hospital doctors believed funduscopy was important, many felt they had insufficient training in this procedure and felt their skills could be improved. We conclude that older patients are missing out on routine funduscopy. Hospital doctors should be aware that not all patients complain of visual problems and specific enquiry should be made. The issue of training and encouragement to perform funduscopy needs to be addressed before funduscopy becomes a forgotten art.

Diabetic Retinopathy↗
PubMed1985

Art, science and mathematics: new approaches to animal health problems in the agricultural industry.

This article is about change; particularly the prospect for change in veterinary research during the last decade and a half of the 20th century. The title encapsulates the idea that veterinary medicine, if it is to be effective, periodically has to change its approach to solving animal health problems; that over the last century we have witnessed one major change, that from veterinary medicine as an art to veterinary medicine as a science, and that we are probably on the brink of another change, moving from a scientific or more correctly an experimental approach to a mathematical or observational approach.

Agriculture↗
PubMed1997

Pharmacoeconomics: state of the art in 1997.

Economic evaluation of pharmaceutical products, or pharmacoeconomics, is a rapidly growing area of research. Pharmacoeconomic evaluation is important in helping clinicians and managers make choices about new pharmaceutical products and in helping patients obtain access to new medications. Over the last few years, the scientific rigor of this field has increased greatly. At the same time, new types of analysis, based on prospective data collection, have been developed. This article reviews the basic concept of pharmacoeconomics, the types of data available for economic evaluation, and the "state of the art" in pharmacoeconomics as reported in the medical literature.

Cost-Benefit Analysis↗
PubMed1996

State of the art in emission tomography equipment.

The current state of the art in single photon emission computed tomography (SPECT) and positron emission tomography (PET) equipment is based on developments over the last 35 years, including those items necessary to make the devices clinically useful. In SPECT, most of the development has involved rotating gamma cameras, since this device could also be used for conventional planar imaging. Recent advances involve the use of multiheaded SPECT cameras and have led to a substantial increase in image quality with these devices. Historically, attenuation correction in SPECT has been applied only to brain and abdominal studies. Currently, the application of nonuniform attenuation correction for cardiac studies, which typically requires acquisition of a transmission scan, has been investigated. Over the past 10 years, greater interest in the clinical application of PET has led to design changes in the equipment used for chemistry and scanning. Modern cyclotrons are typically smaller, self-shielded, and less complicated to run than older models. PET scanners can now image multiple planes over an extended axial field of view with approximately equal spatial resolution in all directions. Advancements in emission tomography have made these technologies more accessible for clinical application.

Brain↗
PubMed2003

Acupuncture Randomized Trials (ART) in patients with migraine or tension-type headache--design and protocols.

BACKGROUND AND OBJECTIVE: We report the design and essentials of the protocols of two Acupuncture Randomized Trials (ART) investigating whether acupuncture is more efficacious than no treatment and minimal acupuncture in the interval treatment of migraine and tension-type headache. DESIGN: Randomized controlled multicenter trials with three treatment arms and a total observation period of 28 weeks. SETTING: 30 practitioners and outpatient units in Germany specialized in acupuncture treatment. PATIENTS: Per study 300 patients with migraine and episodic or chronic tension-type headache, respectively (diagnosis according to the criteria of the International Headache Society). INTERVENTIONS: Patients are randomly assigned to receive either (1) semi-standardized acupuncture (150 patients), (2) standardized minimal acupuncture (75 patients), or (3) no interval treatment for 12 weeks followed by semi-standardized acupuncture (75 patients, waiting list control). Acupuncture treatment consists of 12 sessions per patient over a period of 8 weeks. MAIN OUTCOME MEASURE: Main outcome measure in the migraine trial is the difference between the number of days with headache of moderate or severe intensity during the 4 weeks before randomization and weeks 9 to 12 after randomization. In the study on tension-type headache the main outcome measure is similar to that described above, but for the number of headache days regardless of intensity. OUTLOOK: The results of these two studies (available in 2004) will provide health care providers and policy makers with the information needed to make scientifically sound assessments of acupuncture therapy.

Acupuncture Therapy↗
PubMed2003

Acupuncture Randomized Trials (ART) in patients with chronic low back pain and osteoarthritis of the knee - design and protocols.

BACKGROUND: We report on the study design and protocols of two randomized controlled trials (Acupuncture Randomized Trials = ART) that investigate the efficacy of acupuncture in the treatment of chronic low back pain and osteoarthritis of the knee, respectively. OBJECTIVE: To investigate whether acupuncture is more efficacious than (a) no treatment or (b) minimal acupuncture in the treatment of low back pain and osteoarthritis. DESIGN: Two randomized, controlled, multicenter trials with three treatment arms and a total follow-up time of 52 weeks. SETTING: 30 practitioners and outpatient units in Germany specialized in acupuncture treatment. PATIENTS: 300 patients will be included in each study. In the low back pain trial, patients will be included according to clinical diagnosis. In the osteoarthritis pain trial, patients will be included according to the American College of Rheumatology criteria. INTERVENTIONS: Patients are randomly assigned to receive either (1) semi-standardized acupuncture (150 patients), (2) minimal acupuncture at non-acupuncture points (75 patients), or (3) no treatment for two months followed by semi-standardized acupuncture (75 patients, waiting list control). Acupuncture treatment consists of 12 sessions per patient over a period of 8 weeks. MAIN OUTCOME MEASURE: The main outcome measure is the difference between baseline and the end of the 8-week treatment period in the following parameters: pain intensity as measured by a visual analogue scale (VAS; 0-100 mm) in the low back pain trial and by the Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC) in the osteoarthritis trial. OUTLOOK: The results of these two studies (available in 2004) will provide health care providers and policy makers with the information needed to make scientifically sound assessments of acupuncture therapy.

Acupuncture Therapy↗
PubMed2003

The metaphysical art of Giorgio de Chirico. Migraine or epilepsy?

It has been suggested that the great Italian painter Giorgio de Chirico (1888-1978), who developed the unique style of 'metaphysical art', suffered from migraine and used some of his morbid manifestations as a source of inspiration for his paintings. Yet, whereas many of the symptoms that de Chirico described are rare in migraine, they are frequently encountered in patients with temporal lobe epilepsy. Here we rediscuss de Chirico's symptoms critically and suggest that, if his symptoms were of neurological origin, they rather relate to temporal lobe epilepsy than migraine.

Diagnosis, Differential↗
PubMed1990

Treatment of acid-related disorders with gastric acid inhibitors: the state of the art.

Since their introduction in 1976, and until recently, the H2-receptor antagonists have been the 'state-of-the-art' gastric acid inhibitors, but the advent of omeprazole, the acid pump inhibitor, has necessitated a reassessment of therapy for acid-related diseases. In making this reassessment, the following therapeutic goals should be considered: rapid and reliable therapeutic effect, safety, simple treatment regimen, resolution of recurrence, and cost-effectiveness. Extensive clinical evidence indicates that omeprazole offers an advance over the H2-receptor antagonists in achieving these goals. A series of meta-analyses shows that omeprazole gives more rapid symptom relief and more reliable healing than H2-receptor antagonist, ranitidine, in uncomplicated duodenal ulcer (DU), in uncomplicated gastric ulcer (GU) and in reflux oesophagitis (RO). By contrast with the H2-receptor antagonists, refractoriness leading to failure to heal is virtually unknown with omeprazole. Omeprazole also fulfils the goal of therapeutic safety, and this has been documented in extensive short- and long-term clinical and laboratory studies. Omeprazole has a simple treatment regimen: 20 mg once daily is recommended in the routine treatment of DU, GU and RO. As a result of its high therapeutic success rate, omeprazole is also cost-effective. Taking all these factors into account, it is concluded that omeprazole approaches the therapeutic targets set for the treatment of acid-related disorders.

Gastric Acid↗
PubMed1997

Economics of urinary tract cancers: state of the art.

The guiding principles of the predominant methods of economic evaluation, cost-effectiveness analysis and cost-utility analysis, are briefly outlined, stressing the usefulness of the methods as a systematic approach to a structured and consistent analysis of decision problems, e.g. involving choices between treatment alternatives. The paper continues with an assessment of state of the art of economic evaluations of urinary tract cancers, based on a comprehensive survey of the available publications, which are limited to bladder cancer and advanced prostate cancer. Following a description of the methods employed in the relatively few existing studies and their results, it is concluded that they are of very dubious value in providing reliable guidance on the relative costs and benefits of treatment alternatives, as they are very rudimentary and usually based on data of low quality. Considering the high and growing incidence of both prostate and bladder cancer, there is an urgent need for economic assessment of a high methodological standard and based on data of a good quality.

Cost of Illness↗
PubMed2001

Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients: insights from the Arterial Revascularization Therapy Study (ARTS) trial.

BACKGROUND: Our aims were to compare coronary artery bypass grafting (CABG) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study (ARTS) trial and to determine the costs of these 2 treatment strategies. METHODS AND RESULTS: Patients (n=1205) were randomly assigned to stent implantation (n=600; diabetic, 112) or CABG (n=605; diabetic, 96). Costs per patient were calculated as the product of each patient's use of resources and the corresponding unit costs. Baseline characteristics were similar between the groups. At 1 year, diabetic patients treated with stenting had the lowest event-free survival rate (63.4%) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG (84.4%, P<0.001) and nondiabetic patients treated with stents (76.2%, P=0.04). Conversely, diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG (84.4% and 88.4%). The total 1-year costs for stenting and CABG in diabetic patients were $12 855 and $16 585 (P<0.001) and in the nondiabetic groups, $10 164 for stenting and $13 082 for surgery. CONCLUSIONS: Multivessel diabetic patients treated with stenting had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting. The strategy of stenting was less costly than CABG, however, regardless of diabetic status.

Cerebrovascular Disorders↗
PubMed2001

Incidence, predictors, and significance of abnormal cardiac enzyme rise in patients treated with bypass surgery in the arterial revascularization therapies study (ARTS).

BACKGROUND: Although it has been suggested that elevation of CK-MB after percutaneous coronary intervention is associated with adverse clinical outcomes, limited data are available in the setting of coronary bypass grafting. The aim of the present study was to determine the incidence, predictors, and prognostic significance of CK-MB elevation following multivessel coronary bypass grafting (CABG). METHODS AND RESULTS: The population comprises 496 patients with multivessel coronary disease assigned to CABG in the Arterial Revascularization Therapies Study (ARTS). CK-MB was prospectively measured at 6, 12, and 18 hours after the procedure. Thirty-day and 1-year clinical follow-up were performed. Abnormal CK-MB elevation occurred in 61.9% of the patients. Patients with increased cardiac-enzyme levels after CABG were at increased risk of both death and repeat myocardial infarction within the first 30 days (P=0.001). CK-MB elevation was also independently related to late adverse outcome (P=0.009, OR=0.64). CONCLUSIONS: Increased concentrations of CK-MB, which are often dismissed as inconsequential in the setting of multivessel CABG, appear to occur very frequently and are associated with a significant increase in both repeat myocardial infarction and death beyond the immediate perioperative period.

Biomarkers↗
PubMed2001

"Professionalization" and "confessionalization": the place of physics, philosophy, and arts instruction at Central European academic institutions during the Reformation era.

During the sixteenth and early seventeenth centuries, physics was regularly taught as part of instruction in philosophy and the arts at Central European schools and universities. However, physics did not have a special or privileged status within that instruction. Three general indicators of this lack of special status are suggested in this article. First, teachers of physics usually were paid less than teachers of most other university-level subject-matters. Second, very few Central European academics during this period appear to have made a career out of teaching physics. And third, Reformation Era schools and universities in Central Europe emphasized language instruction; such instruction not only was instrumental in promoting the confessional--i.e., Calvinist, Lutheran, and Roman Catholic--agendas of those same schools and universities, but also helped to prepare students for service in nascent but growing state governments.

Europe↗
PubMed1982

Partial hospitalization: state of the art.

While partial hospitalization as a treatment modality has existed since the 1930s it has been only recently begun to gain widespread attention. The attempts at defining partial hospitalization are traced to the current standards and guidelines. The authors review studies of efficacy and cost-effectiveness and find that partial hospitalization almost invariably compares favorably with inpatient treatment. There are a number of factors militating against increased use of the modality, including haziness in the definitions of goals and target populations, prejudice among clinicians and patients, institutions' resistance to relinquishing beds, and difficulty in establishing third-party reimbursement. The state of the art in partial hospitalization is an attempt to translate face-value validity into an acceptable and fundable alternative to inpatient treatment. The authors conclude that, despite the relatively small growth of programs nationwide and the reluctance of third-party payers to reimburse for the modality, partial hospitalization has an enduring role as a treatment modality.

Ambulatory Care↗
PubMedDate not supplied

1984 Santa Barbara state-of-the-art symposium on otosclerosis. Results, conclusions, consensus.

A state-of-the-art symposium on otosclerosis convened in Santa Barbara, California on Jan 6, 1984. The panel included some of the most distinguished and experienced otosclerosis surgeons in the world, with a collective experience of over 100,000 stapes operations. The purpose of the symposium was to develop guidelines for safe management of otosclerosis and to identify the at-risk patient for surgery. Topics included techniques developed by these surgeons through avoidance, recognition, and correction of technical problems; complications; and errors that lead to poor results. Discussed in order were patient evaluation, performance of surgery, and postoperative care.

Anesthesia, Local↗
PubMedDate not supplied

The art and science of successful teaching (continuing education credit).

Many health care professionals don't teach because they were never taught how to organize and present teaching material. To do this effectively requires knowledge of how to assess learner needs, develop a teaching plan, conduct a class, and evaluate both learner progress and program effectiveness. Equally as important are the interpersonal skills, attitudes, and techniques used by the teacher to capture student interest and facilitate learning. This paper describes both the art and science of teaching effectiveness to help the health care provider who was not born a good teacher to become one.

Allied Health Personnel↗
PubMedDate not supplied

Renal and retinal complications in insulin-dependent diabetes mellitus: the art of changing the outcome.

Over the past decade much has been learned about the relationship between good glycemic control and the alteration or prevention of long-term renal and retinal complications of insulin-dependent diabetes mellitus. The challenge for diabetes health professionals is to translate knowledge into improved patient care. A model program, using a multidisciplinary team approach, is presented to show how the art of changing the outcome can be incorporated into each patient encounter through screening, education, and counseling.

Diabetes Mellitus, Type 1↗