A number of primary care research networks were set up throughout England in 1998 in order to (1) improve the quality of primary care research (2) increase the research capacity of primary care, and (3) change the culture of primary care towards reflective inquiring practice (NHSE, 2000b). It is not clear how best to operate a network to achieve these diverse aims. This paper describes the first 30 months of a network that adopted a whole system approach in the belief that this would offer the best chance of simultaneously achieving the three aims. A cycle of activity was designed to facilitate the formation of multidisciplinary coalitions of interest for research with complementary 'top down' and 'bottom up' programmes of work co-existing. At least 330 people participated in the generation of research questions of whom one third (33%) were general practitioners, 16% community nurses, 6% practice managers and other primary care practitioners. Over two fifths (43%) were 'key allies' - academics, health authority staff, community workers and project workers. One fifth (110) of all practices (500) in the WeLReN area have collaborated in at least one research project. The ratio of doctor:nurse participation in the 24 research project teams was markedly different in the supported coalitions (2:1) compared to projects devised and led by more experienced researchers (6:1). The evidence suggests that it is possible to operate a primary care research network in a way that develops coalitions of interest from different parts of the health care system as well as both 'top down' and 'bottom up' led projects. It is too early to tell if the approach will be able to achieve its aims in the long-term but the activity data are encouraging. There is a need for more research on the theoretical basis of network operation. 相似文献
The concept of personalised medicine for cancer is not new. It arguably began with the attempts by Salmon and Hamburger to produce a viable cellular chemosensitivity assay in the 1970s, and continues to this day. While clonogenic assays soon fell out of favour due to their high failure rate, other cellular assays fared better and although they have not entered widespread clinical practice, they have proved to be very useful research tools. For instance, the ATP-based chemosensitivity assay was developed in the early 1990s and is highly standardised. It has proved useful for evaluating new drugs and combinations, and in recent years has been used to understand the molecular basis of drug resistance and sensitivity to anti-cancer drugs. 相似文献
Medication mishaps are a common cause of morbidity and mortality both within and outside of hospitals. While the use of a variety of technologies and techniques have promised to improve these statistics, instead of eliminating errors, new ones have appeared as quickly as old ones have been improved. To truly improve safety across the entire enterprise, we must ensure that we create a culture that is willing to accept that errors occur in normal course of operation to the best of people. Focus must not be on punishment and shame, but rather building a fault tolerant system that maintains safety of both staff and patients. 相似文献
Initial resistance to antibiotics is the main reason for the failure of Helicobacter pylori (H. pylori) eradication in children.
Objectives:
As we commonly face high antibiotic resistance rates in children, we aimed to determine the susceptibility of H. pylori to common antibiotics.
Patients and Methods:
In this cross-sectional in vitro study, 169 children younger than 14 years with clinical diagnosis of peptic ulcer underwent upper gastrointestinal endoscopy. Biopsy specimens from stomach and duodenum were cultured. In isolated colonies, tests of catalase, urease, and oxidase as well as gram staining were performed. After confirming the colonies as H. pylori, the antibiogram was obtained using disk diffusion method.
Results:
Culture for H. pylori was positive in 12.3% of the specimens, urease test in 21.3%, serological test in 18.9% and stool antigen test was positive in 21.9%. We could show high specificity but moderate sensitivity of both histological and H. pylori stool antigen tests to detect H. pylori. The overall susceptibility to metronidazole was 42.9%, amoxicillin 95.2%, clarithromycin 85.7%, furazolidone 61.9%, azithromycin 81.0%, and tetracycline 76.2% with the highest resistance to metronidazole and the lowest to clarithromycin.
Conclusions:
In our region, there is high resistance of H. pylori to some antibiotics including metronidazole and furazolidone among affected children. To reduce the prevalence of this antibiotic resistance, more controlled use of antibiotics should be considered in children. 相似文献
to test a theoretical model based on the Parent-Based Expansion of the Theory of
Planned Behavior examining relation between selected parental, teenager and
cultural variables and Latino teenagers'' intentions to engage in sexual behavior.
METHOD:
a cross-sectional correlational design based on a secondary data analysis of 130
Latino parent and teenager dyads.
RESULTS:
regression and path analysis procedures were used to test seven hypotheses and
the results demonstrated partial support for the model. Parent familism and
knowledge about sex were significantly associated with parents'' attitudes toward
sexual communication with their teenagers. Parent Latino acculturation was
negatively associated with parents'' self-efficacy toward sexual communication with
their teenagers and positevely associated with parents'' subjective norms toward
sexual communication with their teenagers. Teenager knowledge about sex was
significantly associated with higher levels of teenagers'' attitudes and subjective
norms about sexual communication with parents. Only the predictor of teenagers''
attitudes toward having sex in the next 3 months was significantly associated with
teenagers'' intentions to have sex in the next 3 months.
CONCLUSION:
the results of this study provide important information to guide future research
that can inform development of interventions to prevent risky teenager sexual
behavior among Latinos. 相似文献
Purpose: Problem-based learning (PBL) is an educational method that fosters self-directed study in small groups. The purpose of this study was to describe the Tel Aviv University’s occupational therapy (OT) program and the challenges implementing such program. In addition, the study compared the PBL grades obtained by students who are native Hebrew speakers with those students who are native Arabic speakers; and, assessed the correlation between the grades in the PBL course and the grades in the clinical fieldwork studies.
Method: 166-second year OT undergraduate students participated. All completed three PBL courses and seven weeks of clinical fieldwork studies. Data collection included students’ grades in PBL course (based on PBL evaluation forms) and in clinical fieldwork studies (based on preceptor’s evaluation and a written assignment).
Results: Pearson correlations revealed significant correlations between PBL grades and clinical fieldwork studies grades. T-test analysis between students who are native Hebrew speakers and those who are native Arabic speakers revealed significant differences in PBL grades.
Conclusions: Findings imply partial congruence between students’ grades in the PBL course and their achievements in the fieldwork studies. Findings might suggest that adjustments should be made in order to assist students from minorities (challenged by language requirements) in gaining higher grades in the PBL program.
Implications for Rehabilitation
Problem-Based Learning (PBL) is an educational method, which fosters independent, self-directed study in small groups.
PBL studies have the potential to prepare students for their clinical experience during studies.
The PBL program should be adjusted for students from minorities (challenged by language requirements and different cultural backgrounds) in order to assist them in gaining more benefits from the program.
Microbial detoxification of deoxynivalenol (DON) represents a new approach to treating DON-contaminated grains. A bacterium Devosia mutans 17-2-E-8 was capable of completely transforming DON into a major product 3-epi-DON and a minor product 3-keto-DON. Evaluation of toxicities of these DON-transformation products is an important part of hazard characterization prior to commercialization of the biotransformation application. Cytotoxicities of the products were demonstrated by two assays: a MTT bioassay assessing cell viability and a BrdU assay assessing DNA synthesis. Compared with DON, the IC50 values of 3-epi-DON and 3-keto-DON were respectively 357 and 3.03 times higher in the MTT bioassay, and were respectively 1181 and 4.54 times higher in the BrdU bioassay. Toxicological effects of 14-day oral exposure of the B6C3F1 mouse to DON and 3-epi-DON were also investigated. Overall, there were no differences between the control (free of toxin) and the 25 mg/kg bw/day or 100 mg/kg bw/day 3-epi-DON treatments in body and organ weights, hematology and organ histopathology. However, in mice exposed to DON (2 mg/kg bw/day), white blood cell numbers and serum immunoglobulin levels were altered relative to controls, and lesions were observed in adrenals, thymus, stomach, spleen and colon. Taken together, in vitro and in vivo studies indicate that 3-epi-DON is substantially less toxic than DON. 相似文献
The spatial organization of the pulp cells may modify the cytodifferentiation process. The purpose of this study was to compare the two- versus three-dimensional cell culture systems for differentiation of human odontoblastic cells in vitro. Pulpal cores from freshly extracted human third molars were cultured in vitro in a perfusion device on two types of membranes: polyester membrane (two-dimensional [2D] cell culture) and nylon mesh (three-dimensional [3D] cell culture). The cells were incubated with minimum essential medium containing (a) substitute serum, (b) 10% fetal calf serum (FCS), (c) 10% fetal calf serum + 2 mM g -glycerophosphate ( g GP), and (d) 10% fetal calf serum + transforming growth factor (TGF) g 1. Immunohistochemistry was used to evaluate the expression of collagen I, osteonectin, and nestin. Small differences were observed between 2D and 3D cell culture systems. This was particularly evident in the 10% FCS group. g -Glycerophosphate in the 3D system seems to stimulate the osteogenic cell phenotype, as a considerable induction of osteonectin is observed. 相似文献