Implementing academic detailing for breast cancer screening in underserved communities

Background

Canadian funding agencies are no longer content to support research that solely advances scientific knowledge, and key directives are now in place to promote research transfer to policy- and decision-makers. Therefore, it is necessary to improve our understanding of how researchers are trained and supported to facilitate knowledge translation activities. In this study, we investigated differences in health researcher characteristics and knowledge translation activities.

Methods

Our sample consisted of 240 health researchers from three Alberta universities. Respondents were classified by research domain [basic (n = 72) or applied (n = 168)] and faculty [medical school (n = 128) or other health science (n = 112)]. We examined our findings using Mode I and Mode II archetypes of knowledge production, which allowed us to consider the scholarly and social contexts of knowledge production and translation.

Results

Differences among health researcher professional characteristics were not statistically significant. There was a significant gender difference in the applied researcher faculty group, which was predominantly female (p <.05). Research domain was linked to translation activities. Applied researchers reported engaging in significantly more Mode II activities than basic researchers (p <.001), and scored higher than basic researchers regarding the perceived importance of translation activities (Mode I, p =.01; Mode II, p <.001). Main effects of faculty were limited to engaged dissemination (medical school < other faculties; p =.025) and number of publications (medical school > other faculties; p =.004). There was an interaction effect for research domain and faculty group for number of publications (p =.01), in that applied researchers in medical faculties published more than their peers in other faculty groups.

Conclusion

Our findings illustrate important differences between health researchers and provide beginning insights into their professional characteristics and engagement in Mode I and Mode II activities. A future study designed to examine these dimensions in greater detail, including potential covariates across more varied institutions, would yield richer insights and enable an examination of relative influences, needs and costs of each mode of activity.     

THE PROBLEM OF PERSONAL MEDICAL ADVERTISEMENT

It seems to be difficult or impossible for some persons to distinguish the difference between imparting useful information concerning health matters to the public, and advertising their own particular abilities. In the practice of medicine, which from its very essence must forever be impregnated with humanitarianism, self-exploitation can find no justification if one has due regard for the imperfections of medical science and for the ability of others. There is no man, no group of men, so possessed of medical knowledge that they should be blinded to a realization of their own insufficiency.     

A Prospectus for Canadian Studies in Medical Education

The need for factual information on all phases of medical education is widely recognized. In the United States the Association of American Medical Colleges has initiated an extensive program of research in medical education. No comparable program exists in Canada.On the basis of studies of medical students at the University of British Columbia and the University of Saskatchewan, a prospectus for Canadian studies in medical education is suggested. Such studies might include an annual census of Canadian medical students as well as detailed studies of specific problems. Until such studies have been undertaken in Canada, only an incomplete picture of the various problems in medical education will be available.     

An international basic science and clinical research summer program for medical students

An important part of training the next generation of physicians is ensuring that they are exposed to the integral role that research plays in improving medical treatment. However, medical students often do not have sufficient time to be trained to carry out any projects in biomedical and clinical research. Many medical students also fail to understand and grasp translational research as an important concept today. In addition, since medical training is often an international affair whereby a medical student/resident/fellow will likely train in many different countries during his/her early training years, it is important to provide a learning environment whereby a young medical student experiences the unique challenges and value of an international educational experience. This article describes a program that bridges the gap between the basic and clinical research concepts in a unique international educational experience. After completing two semester curricula at Alfaisal University in Riyadh, Kingdom of Saudi Arabia, six medical students undertook a summer program at St. Boniface Hospital Research Centre, in Winnipeg, MB, Canada. The program lasted for 2 mo and addressed advanced training in basic science research topics in medicine such as cell isolation, functional assessment, and molecular techniques of analysis and manipulation as well as sessions on the conduct of clinical research trials, ethics, and intellectual property management. Programs such as these are essential to provide a base from which medical students can decide if research is an attractive career choice for them during their clinical practice in subsequent years. An innovative international summer research course for medical students is necessary to cater to the needs of the medical students in the 21st century.     

Narrative mediation of conventional and new "mental health" paradigms: reading the stories of immigrant Iranian women

The potential of storytelling to effect change and produce new knowledge is being recognized across disciplines. Two conditions are necessary to realize these goals: first, reading of stories must be contextualized to include larger social and political landscapes; and second, how stories are read and toward what end must be closely examined. This article explores these issues with reference to the subject of the "mental health" or emotional well-being of a cohort of postrevolution Iranian women from metropolitan Vancouver, British Columbia. Reading their stories at a particular moment in time shows that well-being is essentially grounded in spaces and places where we live, work, and engage in social interactions. This commonplace knowledge, which is subdued in medical discourse, is retrieved through Iranian women's stories of life and living told at a time when their experiences, histories, and viewpoints on health are subject to erasure.     

Do Spanish Hospital Professionals Educate Their Patients About Advance Directives?

It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives (ADs). The objective of this research was to determine the frequency of hospital-based physicians’ and nurses’ engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses (77 per cent), chronic diseases (61 per cent), and elderly patients (43 per cent). Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age.     

论壮族传统文化对生物多样性的保护: 以广西靖西市为例

本文在文献研究和实地调查的基础之上, 结合目前开展的关于壮族生物多样性相关传统知识的调查、整理与编目工作, 分别从酸食文化、织染文化、地名文化和文学艺术的角度对壮族文化多样性和生物多样性之间的关系进行了初步探究, 并从自然崇拜、乡规民约和习惯法、传统生态观念以及传统医药文化等几个方面探讨了传统文化对当地生物多样性的保护作用。结果表明: (1)壮族文化多样性与生物多样性密切相关。丰富的生物多样性孕育了传统文化, 而传统文化的形成和发展又直接或间接地丰富了当地的生物多样性; (2)壮族人民在长期生产生活中创造的传统文化和传统知识促进了当地生物多样性的保护与可持续利用; 而对生物多样性的保护又进一步保障了当地传统文化的传承。本文还对传统知识和传统文化的发展现状及受威胁因素进行了讨论, 并以此为基础, 提出传承壮族传统文化、保护和可持续利用传统知识的相关建议, 即应通过加强宣传和立法, 建立传统知识数据库和发展乡村旅游等形式, 加强对传统知识与传统文化的保护。     

Hydrophobins: proteins with potential

Hydrophobins are self-assembling proteins of fungal origin. Their ability to self-assemble into an amphipathic membrane is of interest for many different applications, ranging from medical and technical coatings to the production of proteinaceous glue and cosmetics. Assembled hydrophobins can modify surface characteristics, thus controling the binding properties of the surface; for example, enzymes can be actively and non-covalently immobilized on electrode surfaces and medical coatings can be improved for biocompatibility. Over the past few years research on hydrophobins has contributed to a better understanding of the self-assembly process and is generating more handles to control and manipulate the process. This knowledge could have an immediate effect on production levels, which are not yet adequate, and provide the boost needed for hydrophobins to reach their full potential.     

El Carnival de Mitosis

Teachers as well as students often have difficulty formulating good research questions because not all questions lend themselves to scientific investigation. The following is a guide for high-school and college life-science teachers to help students define question types central to biological field studies. The mayfly nymph was selected as the example study organism because they are common in warm humid climates worldwide and are used as key indicators of water quality and stream health. Assessment of students’ work should be a logical extension field investigations. Assessment simply using traditional multiple-choice items after research investigations communicates to students that recall of specific facts (declarative knowledge) is important and investigative processes (procedural knowledge) are not important. Assessment of declarative knowledge should not be ignored, but procedural knowledge should be included. Both are important to science literacy.     

Rethinking medical ethics: a view from below

In this paper, we argue that lack of access to the fruits of modern medicine and the science that informs it is an important and neglected topic within bioethics and medical ethics. This is especially clear to those working in what are now termed 'resource-poor settings'- to those working, in plain language, among populations living in dire poverty. We draw on our experience with infectious diseases in some of the poorest communities in the world to interrogate the central imperatives of bioethics and medical ethics. AIDS, tuberculosis, and malaria are the three leading infectious killers of adults in the world today. Because each disease is treatable with already available therapies, the lack of access to medical care is widely perceived in heavily disease-burdened areas as constituting an ethical and moral dilemma. In settings in which research on these diseases are conducted but there is little in the way of therapy, there is much talk of first world diagnostics and third world therapeutics. Here we call for the 'resocialising' of ethics. To resocialise medical ethics will involve using the socialising disciplines to contextualise fully ethical dilemmas in settings of poverty and, a related gambit, the systematic participation of the destitute sick. Clinical research across steep gradients also needs to be linked with the interventions that are demanded by the poor and otherwise marginalised. We conclude that medical ethics must grapple more persistently with the growing problem posed by the yawning 'outcome gap' between rich and poor.     

线上线下混合式教学模式在中医院校“医学微生物学”教学中的探索与实践

在分析中医院校"医学微生物学"课程性质以及当前理论教学中存在的突出问题的基础上,以"超星学习通"网络教学平台作为依托,构建线上线下相结合的"三环一体,双边互动"混合式教学模式。设计了学生自主学习、生生自由讨论、师生互动教学等活动,把课前、课中和课后3个学习环节融为一体,师生全程交流互动。通过比较法研究了混合式学习对教学效果的影响,初步教学实践表明,相比传统教学,该教学模式提高了学生的课堂参与度、学习成绩和自主学习积极性,更有利于学生对知识的理解和掌握。因此,在中医院校"医学微生物学"课程中,混合式教学是值得深度研究和推广的教学模式。     

Bacterial expression and characterization of a novel human anti-IgE scFv fragment

Antibodies highly specific to human immunoglobulin (Ig) E are capable of selectively blocking the IgE interaction or eliminating IgE-producing cells, thus providing valuable agents for diagnostics and treatment of various allergic illness. An example is omalizumab, a humanized monoclonal anti-IgE antibody that is approved for the treatment of patients with moderate-to-severe allergic diseases in the United States, European Union and other countries. Here, we describe the generation and characterization of a novel human anti-IgE as a single-chain antibody fragment (scFv). The bacterially-synthesized scFv showed high affinity (86 nM) and specificity to the Fc region of human IgE. To our knowledge, this is the first report of the production of a human anti-IgE scFv in E. coli. Its further development as a potential candidate for medical applications is discussed.     

FDA regulation of computerized cytology devices

When talking about computerized cytology devices, a "different" aspect of quality assurance must be addressed. Any medical device intended for in vitro diagnostic use in the United States must be cleared or approved by the Food and Drug Administration (FDA): the May 28, 1976, Medical Device Amendments to the Federal Food, Drug and Cosmetic Act granted authority to the FDA to regulate medical devices. The FDA regulatory process as it relates to computerized cytology devices is discussed. This includes an explanation of the differences between the two types of documents used to clear a medical device: (1) premarket notification [510(k)] and (2) premarket approval (PMA) application. Devices intended for "research use only" are also discussed. A computerized cytology device of current interest, the "automated Pap smear reader," is used as an example to further discuss performance and software considerations.     

Polyhydroxyalkanoates in Gram-positive bacteria: insights from the genera <Emphasis Type="Italic">Bacillus</Emphasis> and <Emphasis Type="Italic">Streptomyces</Emphasis>

Gram-positive bacteria, notably Bacillus and Streptomyces, have been used extensively in industry. However, these microorganisms have not yet been exploited for the production of the biodegradable polymers, polyhydroxyalkanoates (PHAs). Although PHAs have many potential applications, the cost of production means that medical applications are currently the main area of use. Gram-negative bacteria, currently the only commercial source of PHAs, have lipopolysaccharides (LPS) which co-purify with the PHAs and cause immunogenic reactions. On the other hand, Gram- positive bacteria lack LPS, a positive feature which justifies intensive investigation into their production of PHAs. This review summarizes currently available knowledge on PHA production by Gram- positive bacteria especially Bacillus and Streptomyces. We hope that this will form the basis of further research into developing either or both as a source of PHAs for medical applications.     

New directions for improving the management of agricultural soils

Idowu et al., in this edition of Plant and Soil describe a welcome new tool that allows farmers to optimize the management of their fields. It is based on a holistic approach that integrates assays of soil physical, chemical and biological parameters into an easily understandable, low-cost and quantitative estimate of soil quality or “health”. It can facilitate tracking and understanding of the short and long term effects of different management approaches on soil (and crop) health. Most of the assays used are based on traditional, labour-intensive techniques. The tool could be improved through employment of assay technologies that are under development. For example, Idowu et al., in this edition investigated the use of near infra-red spectroscopy as a replacement for some of the traditional soil assays. Similarly, future developments in remote spectroscopic assays, using satellite, airborne or land-based platforms may facilitate further improvement.     

Influence of grass proportion in stands of burr medic and subterranean clover on legume re-establishment and productivity following wheat

A field-plot experiment investigated the re-establishment and productivity in 1987 (following wheat (Triticum aestivum) in 1986) of burr medic (Medicago polymorpha) and subterranean (sub-) clover (Trifolium subterraneum), which were each sown with 0, 20, 40, 60, 80, or 100% grass in 1985. There was no difference in the amount of dry matter production by medic or sub-clover over the whole growing season but medic was more productive earlier and sub-clover more productive later. Grass generally had little effect on legume or total dry matter production at proportions <40%, though medic productivity was slightly more vulnerable to the effect of grass-infestation than sub-clover.     

Evaluation of Nine Consensus Indices in Delphi Foresight Research and Their Dependency on Delphi Survey Characteristics: A Simulation Study and Debate on Delphi Design and Interpretation

The extent of consensus (or the lack thereof) among experts in emerging fields of innovation can serve as antecedents of scientific, societal, investor and stakeholder synergy or conflict. Naturally, how we measure consensus is of great importance to science and technology strategic foresight. The Delphi methodology is a widely used anonymous survey technique to evaluate consensus among a panel of experts. Surprisingly, there is little guidance on how indices of consensus can be influenced by parameters of the Delphi survey itself. We simulated a classic three-round Delphi survey building on the concept of clustered consensus/dissensus. We evaluated three study characteristics that are pertinent for design of Delphi foresight research: (1) the number of survey questions, (2) the sample size, and (3) the extent to which experts conform to group opinion (the Group Conformity Index) in a Delphi study. Their impacts on the following nine Delphi consensus indices were then examined in 1000 simulations: Clustered Mode, Clustered Pairwise Agreement, Conger’s Kappa, De Moivre index, Extremities Version of the Clustered Pairwise Agreement, Fleiss’ Kappa, Mode, the Interquartile Range and Pairwise Agreement. The dependency of a consensus index on the Delphi survey characteristics was expressed from 0.000 (no dependency) to 1.000 (full dependency). The number of questions (range: 6 to 40) in a survey did not have a notable impact whereby the dependency values remained below 0.030. The variation in sample size (range: 6 to 50) displayed the top three impacts for the Interquartile Range, the Clustered Mode and the Mode (dependency = 0.396, 0.130, 0.116, respectively). The Group Conformity Index, a construct akin to measuring stubbornness/flexibility of experts’ opinions, greatly impacted all nine Delphi consensus indices (dependency = 0.200 to 0.504), except the Extremity CPWA and the Interquartile Range that were impacted only beyond the first decimal point (dependency = 0.087 and 0.083, respectively). Scholars in technology design, foresight research and future(s) studies might consider these new findings in strategic planning of Delphi studies, for example, in rational choice of consensus indices and sample size, or accounting for confounding factors such as experts’ variable degrees of conformity (stubbornness/flexibility) in modifying their opinions.