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PubMed2005

Geriatrics training and education for nongeriatrician faculty: the Dean's Faculty Scholars in Aging Program.

The University of South Carolina School of Medicine in Columbia implemented the Dean's Faculty Scholars in Aging (DFSA) Program in 2001 to strengthen the knowledge of geriatrics of nongeriatrician faculty members. The primary indicator of strengthening physicians' geriatrics knowledge was the development of new educational experiences by physicians in the DFSA Program. Twenty-six nongeriatrician faculty in seven departments were recruited to participate as scholars. Most scholars were in key educational positions, including assistant deans, department chairs, and clerkship and residency directors. Scholars received special training to develop geriatrics educational experiences based on their medical specialty and interests. Training encouraged cross-departmental collaboration. Scholars also had access to resources, including professional geriatric educators. Funds were available to support development of educational experiences and for a small amount of salary support. Since the program was implemented, 36 new geriatric experiences have been developed, 29 of the 36 were implemented, and 11 of the 36 were evaluated. Experiences included an elective for residents in the care of older patients in the emergency room and a required hospice rotation in the psychiatry clerkship for third-year medical students. All scholars developed a geriatrics educational experience, and most implemented one. This suggests that scholars demonstrated successful progress in geriatrics training.

Aged↗
PubMed1991

Efficacy and safety of alprazolam, imipramine and placebo in treating panic disorder. A Scandinavian multicenter study.

As part of the cross-national collaborative panic study, a double-blind comparison of alprazolam, imipramine and placebo was performed in Scandinavian outpatients with panic disorder according to DSM-III; 41 patients were randomly allocated to each drug. Doses were increased for 3 weeks to an average of about 6 mg alprazolam, 150 mg imipramine and a corresponding number of placebo capsules, which were then given for 5 weeks. No more than supportive psychotherapy was given. Key symptoms were rated weekly. The drugs were tapered for 4 or 8 weeks and the patients were followed up for 6 months. Compliance at 3 weeks was 95% for alprazolam, 83% for imipramine and 88% for placebo; at 8 weeks 95% for alprazolam, 73% for imipramine and 46% for placebo. At 3 weeks plasma determination showed that the proportion taking diazepam outside the protocol was 0% for alprazolam, 19% for imipramine and 31% for placebo; at 8 weeks the corresponding proportions were 3%, 11% and 16%. Intention-to-treat analysis showed that freedom from panic attacks was obtained for 68% with alprazolam, 61% with imipramine and 34% with placebo. Alprazolam was more effective than imipramine and placebo on anticipatory anxiety and phobic symptoms. Globally rated by physicians and patients, about 60% had complete remission with alprazolam and imipramine and 30% on placebo. At least partial remission was obtained in about 85% with alprazolam, 70% with imipramine and 40% with placebo. Alprazolam had a more rapid onset of action than imipramine on all symptoms. Side effects were generally mild, with a preponderance of drowsiness for alprazolam and anticholinergic effects for imipramine. Tapering was uneventful without significant discontinuation phenomena. During taper and follow-up, several patients in remission relapsed, leaving approximately 30% patients in complete remission in all groups. To obtain more stable improvement, either long-term drug treatment or combinations of drug treatment and psychotherapy should be evaluated.

Adolescent↗
PubMed1998

Contagious bovine pleuropneumonia. The costs of control in Central/southern Africa.

Contagious bovine pleuropneumonia (CBPP) caused by Mycoplasma mycoides subspecies mycoides small colony (M. mycoides) has been endemic in many parts of Africa for the greater part of this century. Because of an international vaccination campaign the disease was almost eliminated from the continent. With the deteriorating economic situation of many countries, vaccination programs have been allowed to slip; drought conditions have resulted in great movements of livestock and the disease has spread rapidly to the east and south. For Government Veterinary Departments, the implications of this resurgence of CBPP, are serious. The costs threaten to overwhelm completely under-funded government, services. Where cost-recovery measures are introduced, the charging for vaccines may damage rapport with communities and erode the credibility of the government services. Farmers may find the loss of cattle and the costs of vaccine severe burdens which threaten their livelihoods and social well-being (Zambia) and even, in extreme cases, their survival (Botswana). Controlling the disease today presents new possibilities which include increased cross-border collaboration (Malawi/Tanzania), increased emphasis on monitoring (N. Zambia) and the greater involvement of communities in disease control (W. Zambia).

Abattoirs↗
PubMed2004

Soft networks for bridging the gap between research and practice: illuminative evaluation of CHAIN.

OBJECTIVES: To explore the process of knowledge exchange in an informal email network for evidence based health care, to illuminate the value of the service and its critical success factors, and to identify areas for improvement. DESIGN: Illuminative evaluation. SETTING: Targeted email and networking service for UK healthcare practitioners and researchers. PARTICIPANTS: 2800 members of a networking service. MAIN OUTCOME MEASURES: Tracking of email messages, interviews with core staff, and a qualitative analysis of messages, postings from focus groups, and invited and unsolicited feedback to the service. RESULTS: The informal email network helped to bridge the gap between research and practice by serving as a rich source of information, providing access to members' experiences, suggestions, and ideas, facilitating cross boundary collaboration, and enabling participation in networking at a variety of levels. Ad hoc groupings and communities of practice emerged spontaneously as members discovered common areas of interest. CONCLUSION: This study illuminated how knowledge for evidence based health care can be targeted, personalised, and made meaningful through informal social processes. Critical success factors include a broad based membership from both the research and service communities; a loose and fluid network structure; tight targeting of messages based on members' interests; the presence of a strong network identity and culture of reciprocity; and the opportunity for new members to learn through passive participation.

Attitude to Computers↗
PubMed1995

"Healthy alliances?"--other sexual health services and their views of genitourinary medicine.

OBJECTIVE: To assess health professionals' views of genitourinary medicine (GUM) services in a large UK city and to determine potential intervention measures for change. METHODS: A postal questionnaire was sent to 205 service providers in a range of sexual health services in Glasgow, including GUM specialist doctors, nurses and health advisers. The questionnaire included structured questions about organisation and use of GUM services, assessment of profile and stigma, and asked about factors most likely to influence future service development. RESULTS: 128 questionnaires were returned from areas throughout the city. Non-GUM health professionals had poor factual knowledge about the organisation of GUM services. GUM had a poor profile compared with other sexual health services and stigma was thought to exist about the service. Most non-GUM service providers continue traditionally to regard GUM mainly as a referral centre for a few specific sexually transmitted infections and not as a centre for holistic sexual health care. Genital chlamydial infection and pelvic inflammatory disease were considered low priority for GUM referral by some groups of service providers. These views contrasted with those working in the speciality. There was generally poor professional contact between GUM and other service providers involved in sexual health. Most indicated that greater levels of information and publicity, increased professional contact, and a broader range of services within GUM were important for future service development. CONCLUSIONS: The response to the questionnaire strongly indicates that there is poor awareness of and consequently suboptimal use of the full range of services offered by GUM. Potential interventions to address this need include increased cross-speciality collaboration and targeting of specific groups of service providers involved in sexual health care. Important groups include hospital-based specialists and voluntary agencies as well as general practitioners. There is a clear need to project the broad range of sexual health services offered by GUM, and to emphasise the role of GUM in managing specific sexual health problems including several sexually transmitted infections.

Adult↗
PubMed1992

International reliability of a diagnostic intake procedure for panic disorder.

Test-retest diagnostic reliability interviews using the Upjohn version of the Structured Clinical Interview for DSM-III (SCID) were conducted with 72 patients at 13 international sites of the Cross-National Collaborative Panic Study. Agreement on the diagnosis of panic disorder was very good. For the subtypes (uncomplicated, with limited phobic avoidance, and agoraphobia), agreement was fair to good.

Adolescent↗
PubMed2001

Concurrent therapies: a model for collaboration between psychoanalysts and other therapists.

Many psychoanalysts treat individuals who are simultaneously in couples therapy or whose partners are in individual therapy. If such cases stall, some analysts may seek consultation from a colleague, though most have accepted the tacit historical prohibition against communication between therapists treating members of the same family. Experience, however, suggests that a certain form of communication between such therapists can have a powerfully enhancing effect on the concurrent therapies. After a review of the literature, the advantages, disadvantages, and impediments to collaborative cross-communication are examined. A model is then presented for use in ongoing discussion between therapists, and is illustrated with two clinical examples. The proposed model centers on the transference-countertransference configurations within the therapeutic field, and serves as an organizer highlighting areas for discussion.

Adult↗
PubMed2006

Critical health psychology, pluralism and dilemmas: the importance of being critical.

Hepworth argues for critical health psychology (CHP) to move on from binary opposition to mainstream health psychology (MHP) and to engage with other researchers in projects of common interest. In doing so, CHP can take up Murray and Campbell's earlier 'call to action' and avoid the risk of isolation. However neither action nor cross-subject collaboration are necessarily appropriate strategies for all elements of a pluralistic CHP that encompasses a diversity of epistemological positions. Conducting research on others' terms also holds risks for the development of work that remains critical. The potential contributions of a pluralistic CHP, by way of action or otherwise, might usefully be judged in relation to both the distal and proximate contexts of health issues.

Behavioral Medicine↗
PubMed2004

A Bridge Between Communities: Video-making using principles of community-based participatory research.

Health educators can play a critical role in bringing together the partners and resources to successfully make videos using principles of community-based participatory research (CBPR). This article is a "how-to" guide for making videos using community-based participatory research principles. The authors describe video-making and CBPR, then outline six steps on how to make a video using principles of CBPR: (a) engaging stakeholders, (b) soliciting funding and informed consent, (c) creation of shared ownership, (d) building cross-cultural collaborations, (e) writing the script together, and (f) pulling it all together: editing and music selection. Still photographs and key themes from the video A Bridge Between Communities are presented as a running case study to illustrate these steps. The article concludes with implications for health promotion research and practice.

Communication↗
PubMed2006

Fatal injuries while under the influence of psychoactive drugs: a cross-sectional exploratory study in England.

BACKGROUND: Studies of drug-related mortality rarely describe fatal injuries due to psychoactive drug intoxication (FIUI). The main aim of this study was to determine the nature, extent and pattern of FIUI. METHODS: This observational study covered the period January 1999 to December 2001. Data were provided by members of a study panel of coroners in England using a standard protocol. Sources of data for this study included autopsy protocols, death certificates, hospital records, police reports, toxicology reports and inquest transcripts. Inclusion criteria for this were (i) the mention of one or more psychoactive substances as contributing to fatality; and (ii) the presence of a Controlled Drug at post mortem. RESULTS: A total of 3,803 drug-related deaths of persons aged 16-64 years were reported by the study panel during the three-year period. The study panel accounted for 86% of drug-related deaths in England in this period. There were 147 FIUI cases (119 males, 28 females), giving a proportionate mortality ratio of approximately 4%. The majority of FIUI cases (84%) were aged 16-44 years, with a median age at death of 33 years (Quartile deviation = 7). Fifty-six percent of FIUI occurred in urban areas of England. The population of the study jurisdictions aged 16-64 years contributed 49,545,766 person-years (py) to the study, giving an annual crude rate of 3/1,000,000 person-years (py). Rates for male and females were 4.9 and 1.1/1,000,000 py respectively, giving a male/female rate ratio of 4.5 (95%CI = 2.9-6.8). The rates of intentional and unintentional FIUI were 2 and 1/1,000,000 py respectively. The leading mechanism for intentional FIUI was suffocation while the predominant mechanisms in unintentional FIUI were road traffic accidents and falls. There is a significant difference in the pattern of drug-specific risk between FIUI and fatal poisoning. Risks of intentional FIUI are elevated among Black and Minority Ethnic groups. CONCLUSION: There are differences in the nature, extent and pattern of intentional and unintentional FIUI that should necessitate targeted prevention strategies. Also, there is an opportunity for cross-discipline collaboration between injury prevention specialists and substance abuse/mental health specialists.

Accidents↗
PubMed2006

Identifying priorities in methodological research using ICD-9-CM and ICD-10 administrative data: report from an international consortium.

BACKGROUND: Health administrative data are frequently used for health services and population health research. Comparative research using these data has been facilitated by the use of a standard system for coding diagnoses, the International Classification of Diseases (ICD). Research using the data must deal with data quality and validity limitations which arise because the data are not created for research purposes. This paper presents a list of high-priority methodological areas for researchers using health administrative data. METHODS: A group of researchers and users of health administrative data from Canada, the United States, Switzerland, Australia, China and the United Kingdom came together in June 2005 in Banff, Canada to discuss and identify high-priority methodological research areas. The generation of ideas for research focussed not only on matters relating to the use of administrative data in health services and population health research, but also on the challenges created in transitioning from ICD-9 to ICD-10. After the brain-storming session, voting took place to rank-order the suggested projects. Participants were asked to rate the importance of each project from 1 (low priority) to 10 (high priority). Average ranks were computed to prioritise the projects. RESULTS: Thirteen potential areas of research were identified, some of which represented preparatory work rather than research per se. The three most highly ranked priorities were the documentation of data fields in each country's hospital administrative data (average score 8.4), the translation of patient safety indicators from ICD-9 to ICD-10 (average score 8.0), and the development and validation of algorithms to verify the logic and internal consistency of coding in hospital abstract data (average score 7.0). CONCLUSION: The group discussions resulted in a list of expert views on critical international priorities for future methodological research relating to health administrative data. The consortium's members welcome contacts from investigators involved in research using health administrative data, especially in cross-jurisdictional collaborative studies or in studies that illustrate the application of ICD-10.

Algorithms↗
PubMed1998

Practice styles of US compared to UK neurologists.

OBJECTIVE: This study assessed variation between neurologists in the United States and United Kingdom in their diagnostic and treatment decisions for commonly encountered neurologic presentations, and identified explanatory factors for any observed variation. METHODS: All 210 consultant neurologists in the United Kingdom and a nationally representative sample of 595 US neurologists received mailed surveys containing three detailed clinical scenarios depicting patients with (1) a single unprovoked seizure occurring 3 days previously, (2) early Parkinson's disease, and (3) dementia. The main study outcome measures were self-reported decisions regarding diagnostic test ordering and treatment, which were assessed after each scenario. Neurologists' practice characteristics, certainty about the diagnosis, and attitudes toward uncertainty were also measured. Survey response rates were 92% of US and 63% of UK neurologists. RESULTS: A higher proportion of US than UK neurologists indicated they would order additional diagnostic tests for all three scenarios (all p < 0.05); 77% of UK compared with 26% of US neurologists would manage a single unprovoked seizure without antiepileptic medication (p < 0.0001), but treatment of early Parkinson's disease was not different. Nearly all US and UK neurologists would obtain a neuroimaging study in the evaluation of dementia. International differences persisted after adjustment for differences in demographic and practice characteristics and for attitudes toward test use and clinical uncertainty. CONCLUSIONS: We identified large international variation in clinical decisions across three common neurologic conditions. Cross-country collaboration should explore these differences to develop consensus on standards of care.

Attitude of Health Personnel↗
PubMed2000

Epidemiology of inclusion body myositis in the Netherlands: a nationwide study.

Epidemiologic data on inclusion body myositis (IBM) are scarce, and possibly biased, because they are derived from larger neuromuscular centers. The present nationwide collaborative cross-sectional study, which culminated on July 1, 1999, resulted in identification of 76 patients with IBM and the establishment of a prevalence of 4.9 patients with IBM per million inhabitants in the Netherlands. Several discrepancies suggest that this may be an underestimation. The most frequently identified pitfall in diagnosing IBM was an erroneous diagnosis of polymyositis or motor neuron disease.

Adult↗
PubMed2004

Interdisciplinarity in health services research: dreams and nightmares, maladies and remedies.

Interdisciplinarity has become popular in health services research. Advocates suggest that interdisciplinary approaches may produce more accessible, applicable, exciting and realistic knowledge than traditional disciplinary approaches. To date, there has been surprisingly little analysis of the institutional and intellectual demands of interdisciplinarity as a methodology or practice. This paper (1) identifies some basic intellectual and institutional features of interdisciplinary research, (2) describes typical interdisciplinary 'dreams' and corresponding 'nightmares' that researchers might encounter in practice, (3) highlights maladies of interdisciplinary research careers and suggests practical remedies, and (4) discusses implications for health research policy. Individual researchers can avoid pitfalls of interdisciplinarity through strategies that include selective collaboration, cross-training, sustained relationships, good humour, participation in peer review, declaring the place of one's work, and balancing dissemination of research between peer and other audiences. Interdisciplinary activities span institutional boundaries and make novel demands on academic resources and allegiances. Research organizations can improve their hospitality to interdisciplinary work by encouraging straightforward communication, recognising interdisciplinary productivity, making allowances for the higher time and energy costs of interdisciplinary liaisons, and providing the necessary institutional support and stability to cultivate projects to fruition. Alongside the creation of large new interdisciplinary networks and organizations, we should invest in the highly valuable contributions of small and enduring interdisciplinary teams, modest interdisciplinary stretches and evolving interdisciplinary creatures.

Cooperative Behavior↗
PubMed2002

The state of mental health services for children and adolescents: an examination of programs, practices and policies.

This article presents an overview of the state of mental health services for children and adolescents. It provides a brief historical review of policies affecting mental health services for children and adolescents with emotional and behavioral disorders. It discusses the roles of various systems in the provision services for emotionally and behaviorally disordered children and adolescents, and the need for cross-systems collaboration and funding. A model psycho-educational day treatment program. City Lights, is highlighted as an approach to serving inner-city African American adolescents with a profile of services and of the types of youth best served by such a program.

Adolescent↗
PubMed2005

Building on leadership and social capital to create change in 2 urban communities.

There has been an appeal to reduce health inequities by increasing community involvement and social capital. Poder es Salud/Power for Health is a community-based participatory prevention research project that seeks to address health disparities in the African American and Latino communities by enhancing community-level social capital. We provide specific examples of how this intervention uses community health workers and popular education to reduce language and cultural barriers and enhance community social capital. Although the communities share fundamental challenges related to health disparities, the ways in which the Latino and African American communities identify health concerns, create solutions, and think about social capital vary. Members of the project are working together to identify opportunities for cross-cultural collaboration.

Black or African American↗
PubMed2025

Multi-omics technologies: Novel tools and methods for assessing nerve injury and regeneration.

Recently, with the rapid advancement of multi-omics technologies, including genomics, transcriptomics, proteomics, and metabolomics, new tools and approaches have been introduced for studying nerve injury and regeneration. This review highlights the application and progress of multi-omics in uncovering the mechanisms of nerve injury, guiding the development of regenerative strategies, and promoting clinical translation. By integrating multi-omics datasets, researchers can comprehensively track dynamic molecular changes following nerve injury, including abnormal gene expression, disrupted protein signaling, altered metabolic programs, and shifts in the immune microenvironment. Single-cell multi-omics technologies resolve cellular heterogeneity, revealing the distinct functions of neurons, glial cells, and immune cell subpopulations during the injury response. Spatially resolved transcriptomics maintain the spatial context of lesion and regeneration sites, enabling precise localization for targeted interventions. Multi-omics technologies not only identify key molecular players involved in nerve regeneration but also create opportunities for personalized medicine. Nonetheless, integrating multi-omics data poses technical challenges, including high dimensionality, batch effects, and algorithmic constraints, while ethical concerns related to stem cell therapy and gene editing require stringent oversight. To transition from structural reconstruction to functional remodeling, future research should emphasize artificial intelligence-driven data integration, organ-on-a-chip modeling, and cross-disciplinary collaboration to overcome existing technical barriers and accelerate the clinical application of neuroregenerative therapies.

artificial intelligence↗
PubMed1999

Designing appropriate rehabilitation technology: a mobility device for women with ambulatory disabilities in India.

Mobility is an essential requirement for personal independence and social participation. For persons with an ambulatory disability, a lack of mobility creates barriers to the realization of these goals. In developed countries, significant research and development has resulted in the technological advancement of assistive devices. Unfortunately, transfer of these technologies to developing countries has proven difficult. Consequently, effort has been directed at designing appropriate technology in these countries--most often in the form of wheelchairs and hand-driven tricycles. For activities within and around the home, however, especially in cultures where many activities are traditionally performed on the floor, wheelchairs and tricycles are often inappropriate solutions. In response to this, a novel mobility device has been designed for use by women with ambulatory disabilities living in rural and low-income areas of India. The device is intended to assist the user in performing activities of daily living which occur within and near the home, and at ground level. To this end, the device conceptually differs from traditional wheelchair designs in that it physically keeps the rider near to the floor. This paper describes the new device as well as the cross-cultural and cross-professional collaborative methodology used in its design.

Activities of Daily Living↗