Biosensors: where do we go from here?

In the 1980s, researchers predicted that biosensors would dominate hospital POC, POL, and home testing. While that hasn't quite come to pass, here's what biosensors have accomplished and a look at their future.     

Teaching evidence-based management: where do we go from here?

Recently we talked with executive directors of healthcare organizations about the sources of information they use when conducting research. The responses were very similar. They preferred "googling," reading trusted trade journals, and reading more generic business literature such as Harvard Business Review. When asked if they ever read and used healthcare management research, they said the articles were often inaccessible. First, as CEOs faced with the responsibility for their organization's performance, they want to know whether there is anything in the research that will help them run their organizations better. Unfortunately, as observed by Gary Mecklenburg in this issue, the focus in healthcare research is too frequently on research implications, not on what a CEO wants and needs to know. As a result, the research is not always relevant. Further, by the time the research is conducted and published (it is not infrequent for more than a year to elapse from submission to actual publication in a journal, and by then the data may be two or more years old), executives have moved on to other decisions. As one of the CEOs observed, there is a gap between what she needs to know and what the health management literature has to say. Second, managers have limited time, and information needs to be succinct and to the point if it is to be useful. Research articles are very time consuming to read, and as the CEOs commented, time is a precious resource. Research articles frequently devote considerable space to conceptual development and methods, and even when managerial implications are addressed, managers     

Where do we go from here?

In the past two and a half years since the Senate Committee began its study of the Canadian healthcare system, an abundance of reports on healthcare, at both the provincial and federal levels, have been issued that have provided the public and policy-makers with a comprehensive overview of the key issues and the main options for change. We have clearly reached a point where action of some sort can no longer be deferred on the grounds that further study is necessary. It is now a question of finding the political will to move forward with reform.     

Dietary fibre and colon cancer: where do we go from here?

The relationship between intake of dietary fibre and risk of colon cancer has been studied for 30 years and still the data are inconclusive. There are many possible reasons for this outcome, and they include a failure to consider exposure to dietary fibre separately by source, or colon cancers separately by subsite. These potential confounders have been known for at least 20 years. However, the disease is normally considered by epidemiologists as a single entity. More recently, it has become clear that colon cancer can arise via various histological pathways, and by various genetic pathways. There is no reason at all for assuming that risk factors for these possible pathways are the same. There is a need, therefore, for a more detailed approach to the study of diet and colon cancer, with fibre source and cancer subsite, genetic pathway and histological pathway taken into account.     

Statins and cancer risk: what do we know and where do we go from here?

The relationship between statin use and cancer risk has been evaluated in numerous observational studies and as a secondary outcome in randomized controlled trials evaluating the effects of statins on cardiovascular outcomes. Although there are plausible biologic mechanisms to suggest that statins could inhibit cellular proliferation, the epidemiologic data do not show a consistent reduction in cancer risk among statin users. Despite the current lack of evidence for a chemopreventive effect, there are several methodologic considerations in the studies reported to date that prevent a definitive conclusion that statins do not reduce cancer risk. Given the widespread use of statins, continued monitoring of their risks and benefits is warranted.     

Medical sociology and the biological body: where are we now and where do we go from here?

In this article I pose the question, 'where is the biological body in medical sociology today?' The first part of the article provides a selective corporeal balance sheet of where we are now in medical sociology, with particular reference to social constructionist and phenomenological approaches and their respective stances or takes on the (biological) body. The subsequent section considers where we might profitably be going in the future in terms of bringing the biological body (back) in, and the broader issues this raises for the sociological enterprise as a whole. Various problems associated with this evolving project and merits of other recent approaches, such as the sociology of translation, are considered. The article concludes with some further thoughts and reflections on these matters, including a revisiting of relations between the sociology of the body and medical sociology in the light of these debates.     

The treatment of epilepsy in developing countries: where do we go from here?

Epilepsy is the most common serious neurological disorder and is one of the world's most prevalent noncommunicable diseases. As the understanding of its physical and social burden has increased it has moved higher up the world health agenda. Over four-fifths of the 50 million people with epilepsy are thought to be in developing countries; much of this condition results from preventable causes. Around 90% of people with epilepsy in developing countries are not receiving appropriate treatment. Consequently, people with epilepsy continue to be stigmatized and have a lower quality of life than people with other chronic illnesses. However, bridging the treatment gap and reducing the burden of epilepsy is not straightforward and faces many constraints. Cultural attitudes, a lack of prioritization, poor health system infrastructure, and inadequate supplies of antiepileptic drugs all conspire to hinder appropriate treatment. Nevertheless, there have been successful attempts to provide treatment, which have shown the importance of community-based approaches and also indicate that provision for sustained intervention over the long term is necessary in any treatment programme. Approaches being adopted in the demonstration projects of the Global Campaign Against Epilepsy--implemented by the International League Against Epilepsy, the International Bureau for Epilepsy, and the World Health Organization--may provide further advances. Much remains to be done but it is hoped that current efforts will lead to better treatment of people with epilepsy in developing countries.     

The developmental origins of health and disease: where do we go from here?

A large number of studies have shown associations between birth weight and later adult disease, and these studies have ignited an interest in the developmental origins of disease and health. A paper in this volume of Epidemiology finds an overall U-shaped association between birth weight and all-cause mortality in a large Danish cohort. In this commentary, I discuss some of the issues that are important to epidemiologic studies concerned with the developmental origins of disease and health. These include considerations of causality and the public health/clinical relevance of the developmental origins of disease. I suggest that this area of research needs to move away from simply describing the association of birth weight with disease/health outcomes. Instead, we must aim to understand whether there are modifiable risk factors during the developmental period that are importantly causally related to later disease outcomes in ways that mean public health interventions should be aimed at the developmental period.     

Neighborhoods and health: where are we and were do we go from here?

In recent years there has been an explosion of interest in neighborhood health effects. Most existing work has relied on secondary data analyses and has used administrative areas and aggregate census data to characterize neighborhoods. Important questions remain regarding whether the associations reported by these studies reflect causal processes. This paper reviews the major limitations of existing work and discusses areas for future development including: (1) definition and measurement of area or ecologic attributes; (2) consideration of spatial scale; (3) cumulative exposures and lagged effects; (4) the complementary nature of observational, quasi-experimental, and experimental evidence. As is usually the case with complex research questions, consensus regarding the presence and magnitude of neighborhood health effects will emerge from the work of multiple disciplines, often with diverse methodological approaches, each with its strengths and its limitations. Partnership across disciplines, as well as among health researchers, communities, urban planners, and policy experts will be key.     

Back to the future for many hospital-physician relationships: where do we go from here?

Many hospitals, health systems, and large physician group practices have experienced the rise and fall of "managed care," over the past decade or so. The impact has been large and has included the rapid growth and acquisition of physician practices, followed by huge financial losses, and subsequent re-organization, divestiture, and bankruptcies. Regardless, physicians, hospitals, and health systems still face the burden of a rising demand for patient care services. Hospital-physician relationships are still crucial to the health care system. Suggestions with regard to how to analyze your local market and move forward from here to rebuild hospital-physician relationships and care systems are presented and discussed.