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PubMed1987

[Teaching of the scientific method in the basic training of the health professional].

In this article the authors explore an innovative methodological proposal for the teaching of research. They begin with an analysis of the overall critical situation, the lack of education and training in that field for health manpower, and the need to develop research as a scientific approach to the solution of problems. They also address the existing need for integrating scientific work with learning experiences in the health services setting, as a contribution to improved care and practices. On this basis, it is proposed that research should be included throughout the learning-teaching process as a dynamic methodological instrument for training people in applying the scientific method, to develop a critical and thoughtful attitude, and to conduct or participate in research projects that may help to improve the quality of life and health of the population. Under this view of professional training in the health area, they discuss some of the principles and characteristics that should be inherent in the teaching of research, which should be used as a unifying axis and be conducted from the outset of the professional training program as an ongoing, progressive, increasingly complex activity intimately bound up with the health services. This comprehensive view requires an interdisciplinary and multidisciplinary approach in the development of studies which will make an important contribution in the quest for solutions to complex problems. For the application of the proposed methodology, a few essential minimum conditions must be present, including: training of the teaching staff to be responsible for conducting the instruction and practice of integrated research at different levels and in both vertical and horizontal directions; and the assimilation of teachers into the research process through practical projects, since the teacher must not be limited to a theoretical knowledge of the subject. However, if this proves impossible when the time comes to start applying the methodology, and teachers are available who could develop this axis, they may assume responsibility, while at the same time training other teachers.

Health Education↗
PubMed1994

[Giving up tobacco and changes in biological parameters].

OBJECTIVE: To study the modifications in some biological parameters in patients who stop smoking. DESIGN: An analytic observational prospective study. SETTING: Urban Health Centre. PARTICIPANTS: 152 patients included in an intervention project against tobacco addiction. MEASUREMENTS AND MAIN RESULTS: Arterial pressure (systolic and diastolic), weight and base cardiac frequency were determined, using standard procedures at the start and end of the study year on smokers who gave up the tobacco habit and on those who continued smoking. Cessation was validated for those who gave up smoking. A non-significant reduction in arterial pressure, an average reduction of 6 beats per minute (p < 0.05) and an average weight increase of 1.5 kg (p < 0.05) were observed in the ex-smokers. CONCLUSIONS: Giving up tobacco produces a benefit not comparable to the light increase in weight observed in the ex-smokers. It would be useful to study whether proper dietary advice could minimise weight gain in recent ex-smokers.

Adolescent↗
PubMed1993

[International solutions for promoting social medicine competence in training courses--the London School of Hygiene and Tropical Medicine].

The London School of Hygiene & Tropical Medicine is an important institution for postgraduate teaching and research in public health and tropical medicine. Advanced training is provided in a wide range of disciplines leading to different qualifications. As an example the Master of Science course in Public Health Medicine is used: Training is provided by a one-year course divided in three terms. The first term starts with an orientation period and shared-core components. In the second term teaching is largely based on study units. Term three is mainly project work. A training course for membership examination of the Faculty of Public Health Medicine is also offered.

Cross-Cultural Comparison↗
PubMed1995

TennCare--health system reform for Tennessee.

TennCare, the health care system reform plan implemented in Tennessee on January 1, 1994, was developed with the dual objectives of controlling the rapidly rising cost of the state's Medicaid program and extending health insurance coverage to most Tennesseans without access to employer-sponsored or other government-sponsored health insurance. Beneficiaries enroll in competing, state-chartered managed care organizations that are responsible for providing broad preventive, inpatient, and outpatient services and are reimbursed by the state on a capitation basis at a rate based on a statewide global budget for health care. The program initially proposed to enroll up to 1,775,000 citizens and was projected to result in a cumulative cost savings to Tennessee and the federal government of $7.2 billion by the end of the 5-year demonstration period. However, major start-up problems encountered by the state and by managed care organizations and limitations imposed by the government have significantly constrained these expectations. At the end of its first year, more than 1.2 million citizens were enrolled, but the program incurred a $99 million deficit. Managed care organizations and hospitals have reported major financial problems, and constituency groups--especially those representing physicians--have attempted to block the program. Our objective is to describe the design and rationale of TennCare and discuss key issues the plan continues to face that may affect its long-term success.

Capitation Fee↗
PubMed1990

Nursing research and dermatology: where to start.

Nursing research can provide the professional growth necessary to ensure the future and credibility of dermatology nursing. This article explains common research definitions, controls, instrumentation, blinding, analysis, and where to seek help for your research project.

Data Collection↗
PubMed2005

Future costs for long-term care: cost projections for long-term care for older people in the United Kingdom.

The purpose of this paper is to analyse the future sustainability of the UK system for provision of long-term care (LTC) due to changes in demography and health status among the older people. It considers how demand for LTC will evolve and to what extent there will be sufficient supply to meet demand. For formal care, this requires an estimate of how much the public purses, and hence taxpayers, will be burdened with LTC costs. For informal care, it involves estimating whether there will be enough carers if current patterns of provision were to continue. The results show that demand for long-term care will start to take off 10 years from now, and reach a peak somewhere after 2040. The research finds that the most significant increase will be in demand for informal care, where the number of recipients are projected to increase from 2.2 million today to 3.0 million in 2050. Relative increases will be similar in all care settings, amounting to between 30 and 50% compared with the levels today; however, the most noticeable increase will be in demand for formal home care, which is projected to be 60% above current levels by 2040. Total expenditure on formal long-term care will increase from 11 billion pounds per year today to approximately 15 billion pounds per year by 2040 (in 2001 prices). Expressed in taxation terms the effective contribution rate will increase from around 1.0% of total wages today to 1.3% in 2050. Availability of informal carers is potentially a big problem, but the extent of the problem is very sensitive to the assumptions made concerning health improvements and care-giving patterns.

Adolescent↗
PubMedDate not supplied

Decision-support tool for assessing biomanufacturing strategies under uncertainty: stainless steel versus disposable equipment for clinical trial material preparation.

This paper presents the application of a decision-support tool, SIMBIOPHARMA, for assessing different manufacturing strategies under uncertainty for the production of biopharmaceuticals. SIMBIOPHARMA captures both the technical and business aspects of biopharmaceutical manufacture within a single tool that permits manufacturing alternatives to be evaluated in terms of cost, time, yield, project throughput, resource utilization, and risk. Its use for risk analysis is demonstrated through a hypothetical case study that uses the Monte Carlo simulation technique to imitate the randomness inherent in manufacturing subject to technical and market uncertainties. The case study addresses whether start-up companies should invest in a stainless steel pilot plant or use disposable equipment for the production of early phase clinical trial material. The effects of fluctuating product demands and titers on the performance of a biopharmaceutical company manufacturing clinical trial material are analyzed. The analysis highlights the impact of different manufacturing options on the range in possible outcomes for the project throughput and cost of goods and the likelihood that these metrics exceed a critical threshold. The simulation studies highlight the benefits of incorporating uncertainties when evaluating manufacturing strategies. Methods of presenting and analyzing information generated by the simulations are suggested. These are used to help determine the ranking of alternatives under different scenarios. The example illustrates the benefits to companies of using such a tool to improve management of their R&D portfolios so as to control the cost of goods.

Clinical Trials as Topic↗
PubMed2006

Mobile education in autopsy conferences of pathology: presentation of complex cases.

BACKGROUND: MeduMobile was a project to develop and evaluate learning scenarios for medical students and teachers by use of video communication and notebooks. Its core part was assigned to various medical routines, conferences or meetings such as doctor-patient bedside conversation. These were filmed by video teams and broadcasted live via the WLAN of the Charité campus to course participating students. One type of the learning arrangements was the autopsy conference as an on-call scenario. MATERIALS AND METHODS: The MeduMobile project consisted of two main compartments: the regular seminar event which took place every week or month, and the on-call event. For an on-call event the students were informed two hours before the lesson's start. A mobile video team organised the video conference via a specific MeduMobile seminar system. This software offered the students to log. The MeduMobile seminar system is based on the Windows operating system and realises an extended video communication via WLAN. Thirteen access points were implemented at the Charité Campus Virchow Klinikum and Campus Mitte. A questionnaire was developed to investigate in the response and learning effect of the mobile seminar system. RESULTS: During the MeduMobile project 42 video conferences with (cumulative) 145 participating students took place. Four autopsy conferences could be organised as on-call scenarios within this project. A prospective, not randomised follow-up study was included 25 students of the 1st - 6th clinical semester. According to the answers, professional reasoning, professional performance, sustainability, and the complexity were broadly accepted by the students. DISCUSSION: In principle, the MeduMobile realised an interdisciplinary case presentation using video conference and web page. The evaluation indicates a high acception of such complex case presentation with multidisciplinary settings. The use of the notebooks in mobile learning enables an interconnective training and promotes a complex learning.

Journal Article↗
PubMed2004

Evaluation of the UME-21 initiative at 18 medical schools between 1999 and 2001.

BACKGROUND: This study evaluated the processes of curricular change and the initial outcomes of the Undergraduate Medical Education for the 21st Century (UME-21) project at 18 schools. METHODS: Site visits were conducted at eight partner schools in 1999 and 2001. Written proposals, progress reports, and final reports of 18 schools were reviewed. Senior medical students' responses to questionnaires, including the annual Association of American Medical Colleges Graduation Questionnaire and a UME-21 supplemental graduation questionnaire, were analyzed. RESULTS: There was variation among the schools in the curriculum at baseline, in the structure of the UME-21 innovation that was introduced, and in the process of implementation. There was an increase in seniors' ratings of instruction in the newer areas of evidencebased medicine, quality assurance, and cost-effectiveness in relation to national norms between 1999 and 2001. There was less impact on the more traditional content areas of ethics, patient communications, prevention, and leadership skills. CONCLUSIONS: The circumstances of the national evaluation introduced many methodological complexities, some of which could have been avoided if planning for evaluation had started earlier. However, the evaluation revealed that even modest funding directed toward specific curricular goals can produce measurable change and can have effects that extend beyond the initial scope of the project.

Clinical Clerkship↗
PubMed1994

GAMES II Project: a general architecture for medical knowledge-based systems.

GAMES II aims at developing a comprehensive and commercially viable methodology to avoid problems ordinarily occurring in KBS development. GAMES II methodology proposes to design a KBS starting from an epistemological model of medical reasoning (the Select and Test Model). The design is viewed as a process of adding symbol level information to the epistemological model. The architectural framework provided by GAMES II integrates the use of different formalisms and techniques providing a large set of tools. The user can select the most suitable one for representing a piece of knowledge after a careful analysis of its epistemological characteristics. Special attention is devoted to the tools dealing with knowledge acquisition (both manual and automatic). A panel of practicing physicians are assessing the medical value of such a framework and its related tools by using it in a practical application.

Artificial Intelligence↗
PubMed2000

Getting started with Acedb.

Acedb is one of the more venerable pieces of Genomics software. Acedb was originally created in 1992 by Richard Durbin and Jean Thierry-Mieg to manage the data from the Caenorhabditis elegans mapping project and subsequently the C. elegans sequencing project. From beginnings as a C. elegans-specific tool, it has been continuously developed into a flexible suite of data management, display and scripting tools providing facilities for managing and annotation mapping information and DNA and peptide sequences. This paper gives a basic overview of the Acedb suite, and step-by-step guidance on how to download and install Acedb. It is intended to take an Acedb novice to stage where they can begin to experiment and explore the facilities that are available.

Animals↗
PubMed1991

Direct projective time-of-flight NMR angiography within 4s.

To enhance contrast between flow and static tissue, NMR projective angiographic methods usually require data subtraction, or alternatively the application of special data processing routines such as the "maximum intensity projection" algorithm. We have successfully developed a direct projection method which yields sufficient flow/static contrast in a single acquisition, producing angiograms in under 4 s. Direct projection angiograms of the cervical and abdominal vessels were obtained. The cervical vessels were uniformly depicted in a number of different projection views. The abdominal vessels exhibit intensity variations due to the pulsatile flow pattern. A series of abdominal angiograms were acquired, each triggered at a different starting cardiac phase. When displayed as a movie sequence the pulsatile flow pattern was seen to advance along the arteries. To more uniformly represent the abdominal vessels a 24-s average was adequate. This new technique should allow NMR angiograms to be obtained in a "fluoroscopic" mode.

Abdomen↗
PubMed1995

Measurement of the time course of bending of the back in the sagittal plane.

A simple, inexpensive method has been developed for measuring the position of the back, projected onto the sagittal plane, during flexion. Light-emitting diodes (LEDs) were attached to the skin overlying the T6, L1, L3 and L5 vertebrae. They started to flash, at a controlled frequency, at the beginning of movement from an upright to a flexed position. The positions of the markers together with the initial (upright) and final (flexed) positions of the back were recorded on a single photograph. A plumb line provided a vertical reference. Times were determined from the flashing frequency. Vertical and horizontal components of the position were measured from the photograph; their resultant represented total displacement at a given instant in time. The results were scaled so that the displacements were expressed as a fraction of their maximum value, and time was expressed as a fraction of the total movement time. The reproducibility of the technique was tested by making repeated measurements from a single healthy volunteer. At any instant, the horizontal, vertical and resultant displacements of the T6 marker could be determined to within 7% of their maximum values; the resultant displacement of the L5 marker could be determined to within 10%. The results from the other markers were less reliable.

Adult↗
PubMed1996

Quantitative assessment of radiation-induced lung changes by computerized optical densitometry of routine chest x-rays.

PURPOSE: To develop a quantitative assay of radiological lung changes after postmastectomy radiotherapy applicable for analysis of routine chest x-rays. METHODS AND MATERIALS: The assay relies on measurement of the optical density of chest x-rays by means of a standard personal computer-controlled film densitometer used for scanning dosimetry films. Density profiles were recorded at 1 mm steps along two reference lines in each lung. The crossing between the clavicula and the first rib in the x-ray projection was used as an easily identifiable anatomical landmark and was used to establish two parallel cranio-caudal reference lines separated by 20 mm. The starting point for recording optical densities was 5 mm below a line perpendicular to the reference lines and tangent to the top of the lung. Data were stored in a computer file for subsequent processing. The optical film densities in the apex of the lungs were converted into equivalent absorber thickness (EAT). To minimize the dependency on technical factors, the unirradiated lung was used as a control. Lung density changes were quantified by the relative change in EAT (REAT), which was evaluated as the difference between the summed EATs along the reference lines in the two lungs, corrected for any pretreatment difference in lung density, and taken as a percentage of the pretreatment EAT value of the lung. RESULTS: Four different test were carried out to investigate the reproducibility and validity of the proposed assay. (a) An anthropomorphic phantom was used to test the relationship between REAT and the layer of plastic absorber placed in front of one lung. A linear relationship was found with a correlation coefficient of 0.9993. (b) A series of 10 repeat measurements of the same arbitrarily chosen x-ray showed a mean REAT value of 9.8%, with a standard deviation of 0.21%. (c) Forty-three chest x-rays exposed on the same day were available from the clinical series. These were treated as double determinations of REAT values, and the standard deviation was estimated at 1.35%. (d) REAT values estimated with this assay were significantly correlated with the scores of two experienced specialists, an oncologist and a radiologist (Spearman's rank correlation coefficient being 0.605, p < 10(-8)). CONCLUSION: This assay quantifies radiation-induced lung injury from routine chest x-rays. Thus, it is possible to take advantage of the very large retrospective materials available in most oncological institutions. The assay has been validated in a phantom experiment and shown to be reproducible. Furthermore, it is technically easy to perform.

Female↗
PubMed2004

A community based programme to improve access to dental services for drug users.

In 1999 South Lancashire Health Authority published their Oral Health Improvement Plan in which they specifically identified drug users as a target group. In this paper the authors outline the development of a project, which aimed to improve access to dental services for this group. Essential to the relative success of the project was the inclusion of drug users and service providers at the outset. In addition perceived barriers, which exist between drug users and the profession have started to be broken down.

Community Dentistry↗
PubMed2000

Cost-effectiveness of strategies for primary prevention of nonsteroidal anti-inflammatory drug-induced peptic ulcer disease.

OBJECTIVE: Nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of peptic ulcer disease by 5- to 7-fold in the first 3 months of treatment. This study examined the relative cost-effectiveness of different strategies for the primary prevention of NSAID-induced ulcers in patients that are starting NSAID treatment. MEASUREMENTS AND MAIN RESULTS: A decision analysis model was developed to compare the cost-effectiveness of 6 prophylactic strategies relative to no prophylaxis for patients 65 years of age starting a 3-month course of NSAIDs: (1) testing for Helicobacter pylori infection and treating those with positive tests; (2) empiric treatment of all patients for Helicobacter pylori; (3) conventional-dose histamine2 receptor antagonists; (4) high-dose histamine2 receptor antagonists; (5) misoprostol; and (6) omeprazole. Costs were estimated from 1997 Medicare reimbursement schedules and the Drug Topics Red Book. Empiric treatment of Helicobacter pylori with bismuth, metronidazole, and tetracycline was cost-saving in the baseline analysis. Selective treatment of Helicobacter pylori, misoprostol, omeprazole, and conventional-dose or high-dose histamine2 receptor antagonists cost $23,800, $46,100, $34,400, and $15,600 or $21,500 per year of life saved, respectively, relative to prophylaxis. The results were sensitive to the probability of an ulcer, the probability and mortality of ulcer complications, and the cost of, efficacy of, and compliance with prophylaxis. The cost-effectiveness estimates did not change substantially when costs associated with antibiotic resistance of Helicobacter pylori were incorporated. CONCLUSIONS: Several strategies for primary prevention of NSAID-induced ulcers in patients starting NSAIDs were estimated to have acceptable cost-effectiveness relative to prophylaxis. Empirically treating all patients for Helicobacter pylori with bismuth, metronidazole, and tetracycline was projected to be cost-saving in older patients.

Adult↗