Hospital marketing: a new frontier.

Competition is now forcing hospitals to become more efficient and market-wise. This article investigates the past, present and future trends in hospital marketing. Dramatic changes are taking place at a staggering pace in the health care arena. An understanding of the necessity of hospital marketing is essential for all health care workers.     

Xenograft technology: a new frontier in medicine

The era of xenotransplantation is here and will certainly impact nursing. It is a 21st century answer to curing fatal diseases and prolonging life. Our society can no longer deny life-saving treatment to individuals simply because there are not enough human organs available. Xenotransplantation is a viable, exciting, and preferable option. The public will accept xenotransplantation better than the "presumed consent" system. Xenotransplantation may not fully replace human organs and tissue transplantation even with the recent successes of animal cloning. It can, however, serve as a back-up system for human graft donors. As nurses, we must be open to xenotransplantation as an alternative method that can eliminate the current human organ supply and demand problem.     

Nanodiagnostics: a new frontier for clinical laboratory medicine

BACKGROUND: The use of nanotechnologies for diagnostic applications shows great promise to meet the rigorous demands of the clinical laboratory for sensitivity and cost-effectiveness. New nanodiagnostic tools include quantum dots (QDs), gold nanoparticles, and cantilevers. QDs, which are the most promising nanostructures for diagnostic applications, are semiconductor nanocrystals characterized by high photostability, single-wavelength excitation, and size-tunable emission. QDs and magnetic nanoparticles can be used for barcoding of specific analytes. Gold and magnetic nanoparticles are key components of the bio-barcode assay, which has been proposed as a future alternative to the PCR. METHODS: We examined articles published over the past 10 years investigating the use of QDs, gold nanoparticles, cantilevers, and other nanotechnologies in promising diagnostic applications. RESULTS: Several nanodiagnostic assays have been developed, including a QD-based assay capable of detecting biotinylated prostate-specific antigen (PSA) at 0.38 ng/L, a bio-barcode assay capable of detecting 30 amol/L PSA in a 10-microL sample, and another able to detect 50 molecules of the Alzheimer marker amyloid beta-derived diffusible ligand in 10 microL of cerebrospinal fluid. CONCLUSIONS: Nanodiagnostics promise increased sensitivity, multiplexing capabilities, and reduced cost for many diagnostic applications as well as intracellular imaging. Further work is needed to fully optimize these diagnostic nanotechnologies for clinical laboratory setting and to address the potential health and environmental risks related to QDs.     

Molecular diagnostics: a new frontier in cancer prevention

The promise of molecular diagnostics for cancer prevention in terms of early detection rests on two premises: assays can be developed to measure proteins, DNA, RNA or metabolites that accurately and reproducibly detect incipient neoplasias; and that this early detection will eventually result in a decrease in morbidity and mortality and therefore benefit patients. Novel molecular technologies, including laser capture microdissection, time-of-flight mass spectrometry, DNA microarrays, tissue arrays, protein microarrays and antibody microarrays, are being developed to investigate the molecular differences between disease and normal cells and detect cancer-specific alterations in proteins, DNA and RNA in body fluids. Although literally hundreds of articles are published each year describing alterations in genes or proteins that are associated with cancer, very few result in useful molecular diagnostics for early cancer detection. Thus, there remains a critical need for new biomarkers for use in early detection and for assay methods that allow the translation of these biomarkers from the laboratory to the clinic.     

Clinical pharmacy travel medicine services: a new frontier

Travel to remote destinations has increased dramatically in recent years. The Clinical Pharmacy International Travel Clinic (CPITC) was established in 1991 in the Kaiser Permanente Colorado Region to provide pre-travel advice to members to decrease their risk of travel-related diseases. The CPITC is unique from other travel medicine clinics because it is a pharmacist-run telepharmacy service. The team includes an infectious diseases physician, an infectious diseases clinical pharmacy specialist, 4 clinical pharmacists, and a pharmacy technician. The clinical pharmacists provide consultations via telephone. Both patient- and trip-related information are gathered to assess the traveler's health risks. Recommendations are provided regarding food- and water-borne diseases, insect-borne diseases, sexually transmitted diseases, and diseases related to animal bites. Additionally, detailed information is provided on vaccines that may be needed to protect travelers against various diseases. The travel consult is documented electronically. A copy of the consult, along with a booklet that provides travel information, is mailed to the patient. Success of the CPITC is demonstrated in several ways. The clinic initially served Kaiser Permanente members in the Colorado Region. The service has expanded and now also provides travel consults to Kaiser Permanente members in the Northwest and Ohio Regions. Patient satisfaction is high, and significant cost-savings have been realized secondary to avoiding the use of unnecessary vaccinations and medications. The CPITC allows resources to be leveraged and provides one center where individuals trained in travel medicine provide information to members, thus improving efficiency and decreasing cost.     

Aerospace nursing: the new frontier

Since the days of Florence Nightingale and the Crimean War, nursing has been involved in shaping the environment to make it more conducive to human existence. With the emergence of the Space Age the environment has broadened to encompass not only Earth and its ionosphere, but its moon and sister planets as well. To date, nursing has been successful in developing theories that address human-environmental interactions. However, the environment of the 21st century will be vastly different from the environment of the 1980s. In the 21st century, macroutilization of space will become a reality. Such broad-based use of space will include space industrialization and manufacturing, satellite solar power generation, and space habitation. In order to achieve long-duration space flights and habitation, human needs and responses to microgravity must be addressed. This article discusses the physiological and psychological stresses that have an impact on the ability of humans to achieve space habitation and nursing's role in that endeavor. The nursing knowledge base needed to establish the discipline as a major contributor to space health science is discussed. An educational strategy for the development of this knowledge at both the master's and doctoral levels is proposed.     

Health promotion: the new frontier

In a country where many U.S. children live in poverty, do not share equally in health and access to health care, and are at risk for several adolescent problems, health promotion has become the new frontier in health care. The newer approaches to health promotion are discussed.     

Biosimilar biologic drugs: a new frontier in medical care

Physicians in training are expected to be aware of the newest developments in patient care. Biologic therapies have changed treatment of many diseases by specifically targeting key disease mediators, but patient access to these therapies can be limited. As patents for the first biologic therapies are expiring, the development and approval of products known as biosimilars is rapidly gaining momentum. A biosimilar is a biologic product that is highly similar to a reference product (a licensed biologic product), notwithstanding minor differences in clinically inactive components. Biosimilars undergo a thorough evaluation compared with the licensed biologic and need to demonstrate comparable clinical pharmacokinetics, efficacy, and safety including immunogenicity. Understanding the processes for new drug approvals, the rigorous evaluation of biosimilars, and considerations about their selection and use can help recently trained physicians to make informed treatment decisions and improve patient outcomes.     

Research translation: a new frontier for clinical laboratories.

Translational research and translational medicine (referred to hereafter as translational research) are interchangeable terms that underline the pressing need to translate into practical benefits for those affected by disease the extensive investments divested by the private and public sectors in biomedical research. For people more directly involved in clinical practice (physicians, clinical laboratory professionals and patients), translational research responds to the need to accelerate the capture of benefits of research, closing the gap between what we know and what we practice. This basically means the transfer of diagnostic and therapeutic advances proven effective in large, well-conducted trials (and, therefore, evidence-based) to daily medical practice. Translational research should be regarded as a two-way road: bench to bedside, and bedside to bench. In particular, to make possible a more effective translation process, a new road map should be implemented through interaction and cooperation between basic researchers, clinicians, laboratory professionals and manufacturers. Some examples of recent developments in clinical laboratory testing, including markers of cardiovascular diseases, clinical proteomics and recombinant allergens, may explain the importance of careful evaluation of all variables that allow the introduction of such new insights into clinical practice to assure better clinical outcomes. The vital role of laboratory medicine in the delivery of safer and more effective healthcare requires more careful evaluation not only of the analytical characteristics, but also of any other variable that may affect the clinical usefulness and diagnostic performances of laboratory tests, thus allowing more accurate interpretation and utilization of laboratory information.     

State regulation of medical discount programs: a new frontier

Over the past several years, discount medical programs have flourished as a result of double digit increases in health insurance premiums. Given the rapid growth and sometimes questionable practices of such programs, several states have taken notice and have begun to regulate discount medical programs. This article summarizes the laws of several states that have chosen to oversee these programs.     

Nursing and business: the new frontier

Understanding free market principles is important for fulfilling nursing's obligation to professional stewardship. Stewardship is the act of conserving and enhancing what we have received from those before us, then disseminating it to new generations in the hopes of creating a stronger, more vital profession. In order to do that, nursing needs an improved understanding of the marketplace. This will help nursing grow as a profession, particularly through entrepreneurial and intrapreneurial efforts.