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PubMed1997

Using PICOS workshops to identify and eliminate waste.

"Any human activity that absorbs resources but creates no value," says Maureen Bisognano of the Institute for Healthcare Improvement, "is waste." At war with waste--in healthcare as well as in the automobile industry--is General Motors Corp. The battle plan is an accelerated change process known as PICOS. In a four-step, three-and-one-half-day workshop, GM facilitators work with teams from the healthcare organization to identify waste and plan ways to get rid of it. See if you can identify, within your organization, the seven types of waste they attack--then read about systems that have used PICOS successfully in battle.

Cost Control↗
PubMed1983

Teaching health economics: some guidelines arising from a WHO workshop.

This paper provides some guidelines for the teaching of health economics particularly but not exclusively to non-economist personnel in the health care sector. It arose from a workshop, sponsored by WHO (Regional Office for Europe) in Copenhagen in 1982, for training a few health service personnel from various European countries in the economics of health care. The material in the guidelines is organised under eight topic headings, each followed by the main themes of each topic and some possible teaching/learning problems. Organised in this way, it would be possible to use the outline as an eight-day course on health economics or eight weekly sessions in a traditional university undergraduate or postgraduate course. The eight topics covered include: (i) What is economics? (ii) Health measurement and valuation; (iii) The patient as demander; (iv) Supply and financing of health care; (v) Setting health priorities; (vi) Assessing the costs and benefits of alternatives; (vii) Strategies for efficiency in health care; and (viii) Equity in health and health care. At a time when there is an increasing demand for economic skills and trained economists with a knowledge of the health care sector, the article emphasises that it would be unfortunate if the view were to become widespread that economics is something that only economists do. Many decision-makers in health care make decisions every day to which the principles of economics can, and should be, applied. It is with a view to introducing more of these decision-makers to the principles of economic analysis that the authors have written this article. However, while some may gain directly, the article aims to stimulate and assist those who might contribute to this process by providing ideas on how economics of health care might be taught.

Cost-Benefit Analysis↗
PubMed1999

Chromosome Workshop: chromosomes 11, 14, and 15.

This report describes linkage data presented at the Workshop on Chromosomes 11, 14, and 15 at the Sixth World Congress of Psychiatric Genetics in Bonn, Germany, together with relevant linkage data submitted to the chair and co-chair, and it is presented in the context of the previous literature concerning these chromosomes. We have attempted to collate current linkage data to provide a guide to potentially interesting findings on chromosomes 11, 14, and 15 for the phenotypes of bipolar disorder, schizophrenia, alcoholism, autism, and spelling and reading disability. We discuss methodological limitations and provide chromosome ideograms and tables summarizing findings to date. The most promising region currently appears to be 15q13-q15 in the region of the alpha 7 nicotinic receptor for the phenotype of schizophrenia (and, perhaps, more generally for functional psychosis). Additionally, 15q11-q13 in the region of GABRB3 holds interest as a potential site of a susceptibility gene for autism. Two regions on chromosome 11, 11p15 in the region of tyrosine hydroxylase gene and 11q22-q23 in the region of DRD2, continue to retain some interest for functional psychosis.

Alcoholism↗
PubMed1999

Sixth World Congress of Psychiatric Genetics X Chromosome Workshop.

At the X chromosome workshop of the Sixth World Congress on Psychiatric Genetics, new data regarding psychiatric phenotypes and the X chromosome were presented. In the last year a number of groups have published linkage results for the X chromosome in schizophrenia, which provide no significant evidence for linkage. Presentations by groups from Cardiff, Oxford, State University of New York (SUNY), and Finland provide weak nonsignificant evidence for linkage of markers on the Xp11.4-p11.3, Xq21, and Xq26 with schizophrenia. However, the presence of a male-specific transmission ratio distorter (DMS1) that maps to Xp11.4-21.2 [Naumova et al., 1998: Am. J. Hum. Genet. 62:1493-1499] makes the interpretation of linkage findings in brother-brother pairs difficult in this region. Regarding bipolar affective disorder, little new data were reported, but previous reports provide evidence for linkage to Xq25-q26. Summary tables of linkage results for schizophrenia and bipolar disorder can be obtained from http://www.camh.net/ research/x-chromosome/. No linkage or transmission disequilibrium of polymorphisms of MAOA and MAOB in attention deficit hyperactivity disorder was seen. Negative results for transmission disequilibrium of polymorphisms of HTR2C and MAOA with autism were provided from German and Austrian families.

Alcoholism↗
PubMed1999

Eighth International Workshop on Ataxia-Telangiectasia (ATW8).

ATW8 was a unique opportunity to review the complex and growing field of ataxia-telangiectasia (A-T) research and to cross-fertilize ideas for new experimental designs. A-T biology now encompasses human and mouse neurology, neurobiology, immunology, radiobiology, cell signalling, cell cycle checkpoints, gametogenesis, and oncogenesis, as well as radiotherapy, cancer epidemiology, premature aging, cytogenetics, and DNA repair mechanisms. By an as yet undetermined mechanism, the ATM protein appears to sense double strand breaks (DSB) during meiosis or mitosis, or breaks consequent to the damage of free radicals which are generated during the metabolism of food. As a protein kinase, ATM then directly phosphorylates p53 and interacts with many other molecules involved in homologous and nonhomologous DSB repair, as well as in cell signalling. Some of these molecule targets include: c-abl, ATR, chk-1, chk-2, RPA, BRCA1, BRCA2, NFkappaB/IkappaB alpha, beta-adaptin, and perhaps ATM itself. Thus, ATM is a "hierarchical kinase," initiating many pathways simultaneously. Parallel sessions or longer meetings will clearly be necessary for future A-T workshops.

Animals↗
PubMed1999

1998 International Meeting on the Arylamine N-Acetyltransferases: synopsis of the workshop on nomenclature, biochemistry, molecular biology, interspecies comparisons, and role in human disease risk.

On October 22-24, 1998, a workshop was held at Kuranda, Queensland, Australia. The purpose of the meeting was to provide a forum for discussion of a number of diverse research areas of the biochemistry and molecular biology of arylamine N-acetyltransferases and to foster collaboration among several major groups of investigators around the world. In addition, participants were asked to consider how the nomenclature system for arylamine N-acetyltransferases could be strengthened to cope with the burgeoning number of new alleles discovered in the last 3 years. The full text of all meeting abstracts can be viewed at.

Arylamine N-Acetyltransferase↗
PubMed1975

Habilitation of severe craniofacial anomalies--the challenge of new surgical procedures: an NIDR workshop.

Three NIDR-sponsored workshops were conducted with the goal of identifying research needs in treatment and basic sciences relating to a group of severe craniofacial anomalies that are now correctable by new radical surgical procedures. Experts in the fields of developmental biology, neurosurgery and reconstructive craniofacial surgery discussed areas of investigation dealing with etiology, prevention and treatment that are most likely to result in clincally-useful information. In addition the establishment of craniofacial anomalies centers for data collection, treatment and research was examined.

Acrocephalosyndactylia↗
PubMed1999

United States-Japan workshop on New Rodent Models for the Analysis and Prevention of Carcinogenesis.

In assessing the present status of rodent models for the analysis and prevention of carcinogenesis, the discussion emphasized that models exist for very few of the major cancers occurring in the United States and Japan. Almost without exception, those that do exist were invented for etiological and mechanistic studies of chemical and physical carcinogenesis. Applicability to cancer chemoprevention was not a primary objective in their development. However, they have been adapted and used for identifying and characterizing chemopreventive agents out of necessity. It is therefore not surprising that they generally fail to fulfill most or all of the requisites of "ideal" models enumerated above, and consequently, the validity of data produced through their use has been questioned. Evolution of future mechanistic models may similarly lead to their eventual adaptation to chemoprevention, but advances will be fragmentary, and the rate of progress seems likely to be slow. Animal models discussed at this workshop were designed specifically for this purpose and promise to expedite the accumulation of valuable new information. Nonetheless, recurrent discussion identified the urgent need for institution of a major, dedicated research initiative with the expressed objective of developing rodent models for organ-specific chemoprevention based on current understanding of underlying genetic and cellular processes. No concerted programs with this objective presently exist either in the United States or Japan. In addition to research specifically designed to meet this need, efforts should be made to involve investigators developing mechanistic animal models in the validation of their models through modulating cancer development by chemopreventive agents. Support for such research initiatives will be essential to continued progress toward the overall objective of identifying safe and effective cancer chemopreventive agents.

Animals↗
PubMedDate not supplied

Developing an educational workshop on teen depression and suicide: a proactive community intervention.

Eight years into the YES emergency services collaboration, a comprehensive Youth Emergency Services model has emerged, one that incorporates a proactive approach to clinical and prevention strategies. In addition to direct service provision, these strategies include: (1) workshop training of school and community professionals so that they can identify young persons at highest risk for suicidal thoughts, threats, and attempts; (2) prevention education for both adolescents and parents about suicide, risk factors, and interventions; (3) a partnership with the local hotline to facilitate community screening and referral to appropriate crisis services for families and youths; (4) collaboration with a large primary care provider network to streamline the after-hours crisis referral process, using the hotline; and (5) the use of a website to inform individuals about services and resources. It is proposed that this is a contemporary model that can meet the present primary and secondary intervention needs for children, adolescents, and their families.

Adolescent↗
PubMed2000

[Proceeding of the workshop "What an ideal clinical microbiological laboratory should be". The 33rd in-service training course for medical technologists of university hospitals in 1999].

In the workshop of the 33rd in-service training course for University Hospital Medical Technologists in 1999(sponsorship: the ministry of Education), all groups of participants were charged with discussing an ideal clinical microbiology laboratory. In conclusion, the successful operation of the ideal system of clinical microbiology should require a high level of competence in every staff member of the hospital. It must not be focused solely on the sophistication of laboratory methods. We must modify our behavior effectively and establish a good collaborative partnership with physicians and other health care professionals.

Clinical Laboratory Techniques↗
PubMed2000

Multiple gestation pregnancy. The ESHRE Capri Workshop Group.

Multiple gestation pregnancy rates are high in assisted reproductive treatment cycles because of the perceived need to stimulate excess follicles and transfer excess embryos in order to achieve reasonable pregnancy rates. Perinatal mortality rates are, however, 4-fold higher for twins and 6-fold higher for triplets than for singletons. Since the goal of infertility therapy is a healthy child, and multiple gestation puts that goal at risk, multiple pregnancy must be regarded as a serious complication of assisted reproductive treatment cycles. The 1999 ESHRE Capri Workshop addressed the psychological, medical, social and financial implications of multiple pregnancy and discussed how it might be prevented. Multiple gestations are high risk pregnancies which may be complicated by prematurity, low birthweight, pre-eclampsia, anaemia, postpartum haemorrhage, intrauterine growth restriction, neonatal morbidity and high neonatal and infant mortality. Multiple gestation children may suffer long-term consequences of perinatal complications, including cerebral palsy and learning disabilities. Even when the babies are healthy they must share their parents' attention and may experience slow language development and behavioural problems. Current data indicate that the average hospital cost per multiple gestation delivery is greater than the average cost of in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles. Prevention is the most important means of decreasing multiple gestation rates. Multiple gestation rates in ovulation induction and superovulation cycles can be reduced by using lower dosage gonadotrophin regimens. If there are more than three mature follicles, the cycle should be converted to an IVF cycle, or it should be cancelled and intercourse should be avoided. In IVF cycles two embryos can be transferred without reducing birth rates in most circumstances. Embryo reduction involves extremely difficult decisions for infertile couples and should be used only as a last resort. Assisted reproductive treatment centres and registries should express cycle results as the proportion of singleton live births; twin and triplet rates should be reported separately as complications of the procedures. Reducing the multiple gestation pregnancy rate should be a high priority for assisted reproductive treatment programmes, despite the pressure from some patients to transfer more embryos in order to improve success. If nothing is done, public concern may lead to legislation in many countries, a step that would be unnecessary if assisted reproductive treatment programmes and registries took suitable steps to reduce multiple pregnancy rates.

Female↗
PubMedDate not supplied

Hepatitis C infection: its sequelae and outcomes--State-of-the-Art Workshop, September 24 to 25, 1998. Canadian Association for the Study of the Liver.

This report summarizes a state-of-the-art workshop held in September 1998 on the "Natural History and Outcome of Hepatitis C Infection". Sixteen Canadian and two internationally renowned hepatologists were invited. A practical classification of HCV infection served as a framework for the meeting. The concepts of modelling of chronic disease, the epidemiology of HCV infection before the introduction of anti-HCV testing, and the outcome of various forms of chronic hepatitis C in adults and children were presented. Lectures on the outcome of HCV cirrhosis, hepatocellular carcinoma, the role of liver transplantation, the influence of host factors on outcome, iron overload in chronic hepatitis C and possible modification of the natural history by antiviral therapy were followed by discussion and consensus statements pertaining to each presentation. "The European Experience in Assessing Chronic Hepatitis C" was presented by Prof G Dusheiko from the United Kingdom, and Prof Leonard Seeff from the National Institutes of Health (United States) presented "The Epidemiology and Outcome of Hepatitis C Infection in the United States and the World".

Adult↗
PubMed2000

On the difficulties of establishing a consensus on the definition of and diagnostic investigations for reactive arthritis. Results and discussion of a questionnaire prepared for the 4th International Workshop on Reactive Arthritis, Berlin, Germany, July 3-6, 1999.

OBJECTIVE: There is no agreement on how to classify and diagnose reactive arthritis (ReA) and it is also unclear what kind of specific clinical and laboratory investigations are appropriate. We define relevant points of agreement and identify points of disagreement among an international group of experts in the field. METHODS: Prior to the 4th International Workshop on Reactive Arthritis, Berlin, July 1999, we sent questionnaires to 42 experts identified by personal knowledge and recent publications. RESULTS: The response rate was 81% (n = 34). There was agreement on the nomenclature and recommendation to use the term "reactive arthritis" only if the clinical picture and the microbes involved are HLA-B27 and spondyloarthropathy (SpA) associated, whereas the term "infection related arthritis" is used for all other arthritides related to or associated with infections. A differentiation between acute and chronic ReA with a cutoff of 6 months is recommended. The history of a preceding symptomatic infection is thought to be most relevant for a diagnosis of ReA. The minimal interval between preceding symptoms and arthritis is proposed to be 1-7 days, maximally 4 weeks. The joint pattern in ReA is asymmetrical, with predominance of the lower limbs. SpA related symptoms may contribute to the diagnosis. A search for chlamydia in urine/urethra/cervix is recommended, while in the case of diarrhea enterobacteria should be searched for in stool and antibodies against them in serum. There were also areas of disagreement, such as: Is arthritis essential for the diagnosis of ReA?, Is it oligoarthritis or any arthritis?, What are the role and value of polymerase chain reaction investigation?, The role and value of serology?, Is the diagnostic sensitivity of microbiological tests for ReA increased by HLA-B27 determination? CONCLUSION: The points of agreement will support better communication in this area, and clarification of the disagreements will lead to further studies and discussion.

Arthritis, Reactive↗
PubMedDate not supplied

An orthopaedic workshop and skills laboratory.

Planning and implementing care for patients with musculoskeletal disorders can be intimidating for nursing students. Moreover, changes in health care delivery often limit the opportunities students will have to learn skills and participate in the care of a patient in need of these services. This article describes the development of an orthopaedic workshop and skills laboratory which provides hands-on learning experience in a nonthreatening environment. The teaching strategy uses the collaborative resources of health care providers, allowing the student to be introduced to the care of orthopaedic patients from admission to discharge.

Attitude of Health Personnel↗
PubMed2000

Workshop report: physical activity and cancer prevention.

A workshop to evaluate the evidence for the role of physical activity in cancer prevention and to identify priorities for action, particularly in relation to the primary prevention of cancer, was held by Cancer Care Ontario in March 2000. A review of the scientific evidence was commissioned and an expert panel convened to consider the review report and to make recommendations for public health, research and intervention. The panel concluded that evidence was convincing for the role of physical activity in preventing colon cancer; probable for breast cancer; possible for prostate cancer and insufficient for other sites. It is recommended that physical activity messages promoting at least 30 45 minutes of moderate to vigorous activity on most days of the week be included in primary prevention interventions for cancer. The panel recommended that future research on physical activity incorporate comprehensive assessments, including measures of the multiple dimensions and types of physical activity; biological mechanisms; and behavioural and population factors. Cancer Care Ontario will incorporate physical activity messages in its primary prevention programming around nutrition and health body weight.

Canada↗
PubMed1995

Workshop on pediatric AIDS rehabilitation: a summary.

The workshop offered the following recommendations for research on pediatric AIDS: (1) investigating cross-cutting issues such as pain and/or QOL; (2) identifying effective service delivery and associated cultural considerations; (3) promoting data sharing and standardized instruments; and (4) examining affected body systems.

Acquired Immunodeficiency Syndrome↗
PubMed2001

[Report on the ICCVAM workshop on in vitro methods for assessing acute systemic toxicity].

It was suggested in the ICCVAM workshop that the Register of Cytotoxicity (RC), using in vitro cytotoxicity data to predict the in vivo starting doses, should be implemented into acute toxicity testing as soon as possible. The validity of the in vitro cytotoxicity data to establish appropriate starting doses for acute toxicity testing will be assessed experimentally. Secondly, in order to replace the use of animals in acute lethality testing a formal validation will be conducted in which the ability to predict rodent LD50 values and toxicity classes from cytotoxicity data will be evaluated.

Animal Testing Alternatives↗