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Innovative Strategies (innovative + strategy)
Selected AbstractsAn Innovative Strategy for Conducting Clinical Research: The Academic Associate ProgramACADEMIC EMERGENCY MEDICINE, Issue 2 2002Judd E. Hollander MD Performance of high-quality clinical research usually requires procurement of substantial funding to support and sustain the research infrastructure. The authors have developed a program to support a research infrastructure that minimizes financial start-up costs and maximizes productivity of clinical-educator faculty with limited protected time. The program integrates clinical research with undergraduate education. The authors report the experience with the academic associate program at two academic institutions. They describe the program, provide measures of program success, and discuss potential methods for other institutions to initiate similar programs. Similar programs can be developed in a variety of outpatient and inpatient settings allowing the performance of high-quality clinical research in a time-efficient and cost-effective manner. [source] Asthma Outcomes at an Inner-City School-Based Health CenterJOURNAL OF SCHOOL HEALTH, Issue 1 2001Nicole Lurie§ ABSTRACT Childhood asthma has reached near-epidemic levels in the US cities. Innovative strategies to identify children with asthma and prevent asthma morbidity are needed. This study measured asthma outcomes after initiation of an inner-city elementary school health center with a schoolwide focus on asthma detection and treatment. The site was an inner-city elementary school in Minneapolis, Minn. The study design incorporated a pre and post comparison with a longitudinal cohort of children (n=67) and a cross-sectional cohort of children before (n=156) and after (n=114) the intervention. Hospitalization rates for asthma decreased 75% to 80% over the study period. Outpatient visits for care in the absence of asthma symptoms doubled (p<.01), and the percentage of students seeing a specialist for asthma increased (p<.01). Use of peak flow meters, use of asthma care plans, and use of inhalers also improved (p<.01). While no change occurred in school absenteeism, parents reported that their children had less awakening with asthma and that asthma was less disruptive to family plans. This schoolwide intervention that included identification of children with asthma, education, family support, and clinical care using an elementary school health center was effective in improving asthma outcomes for children. [source] Using Acquired Knowledge and New Technologies in Alcoholism Treatment TrialsALCOHOLISM, Issue 3 2002Barbara A. Flannery This article represents the proceedings of a symposium held at the 2001 RSA meeting in Montreal, Canada. The organizer and chair was Barbara A. Flannery and the discussant was Raye Z. Litten. The presentations were (1) The use of biomarkers in alcohol-dependence treatment trials, by John P. Allen; (2) Strategies for enhancing patient compliance in clinical treatment trials, by Helen M. Pettinati; (3) The predictive utility of an alcohol-craving measure, by Barbara A. Flannery; (4) What should be the primary outcome measures in a clinical trial, by Damaris J. Rohsenow; (5) Innovative strategies for assessing functional outcomes in alcoholism treatment clinical trials, by Ron A. Cisler. [source] Violence against pregnant women: prevalence and characteristics.BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2005A population-based study in Nicaragua Objective This study aims to estimate the prevalence and characteristics of partner abuse during pregnancy as well as to investigate associated social factors in León, Nicaragua. Design Cross-sectional community-based study. Setting All pregnant women from 50 randomly selected geographical clusters out of 208 in the municipality of León, Nicaragua. Sample A total of 478 pregnant women were included; only one woman refused to participate. Method The domestic violence questionnaire from the WHO-co-ordinated Multi-Country Study on Women's Health and Life Events was used with each participant being interviewed twice during pregnancy. Main outcome measures Prevalence and characteristics of partner violence during pregnancy. Results The prevalence of emotional, physical and sexual abuse during pregnancy was 32.4%, 13.4% and 6.7%, respectively. Seventeen percent reported experience of all three forms of violence. Two-thirds of the victims reported repeated abuse. Half of the abused women had experienced punches and kicks directed towards the abdomen and 93% had been injured. Most women had not sought health care in relation to the abuse, but those who did were usually hospitalised. Factors such as women's age below 20 years, poor access to social resources and high levels of emotional distress were independently associated with violence during pregnancy. Conclusion Violence against pregnant women in Nicaragua is common and often repeated. Although these women have poor access to social resources and high levels of emotional distress, they are rarely assisted by the health services. Innovative strategies are needed to provide support and counselling. [source] The Essential Ingredients of Successful Sibling Relationships: An Emerging Framework for Advancing Theory and PracticeCHILD DEVELOPMENT PERSPECTIVES, Issue 2 2010Laurie Kramer Abstract, Although conflict is a frequent and dynamic interpersonal process in children's sibling relationships, ambivalence (i.e., combinations of, or shifts between, positive and negative behaviors and affects) may better characterize normative sibling interactions. Nonetheless, there is a general assumption that reducing conflict is the most effective mechanism for improving sibling relationships. This review argues that the focus on conflict as the predominant attribute of sibling relationships is misplaced and has served to overshadow research on other relationship processes; it has also handicapped the development of effective prevention and intervention tools. Strategies are presented for moving theory, research, and practice toward the identification and development of factors and social processes that promote prosocial forms of sibling engagement and manage conflict. Innovative strategies are needed on two fronts: to help young siblings set their relationship on a positive trajectory and to help them avoid or remediate conflictual interactions. [source] Neuronal plasticity: implications in epilepsy progression and managementDRUG DEVELOPMENT RESEARCH, Issue 8 2007Sherifa A. HamedArticle first published online: 12 FEB 200 Abstract Epilepsy is a common neurological disease. A growing number of research studies provide evidence regarding the progressive neuronal damage induced by prolonged seizures or status epilepticus (SE), as well as recurrent brief seizures. Importantly, seizure is only one aspect of epilepsy. However, cognitive and behavioral deficits induced by progressive seizures or antiepileptic treatment can be detrimental to individual function. The neurobiology of epilepsy is poorly understood involving complex cellular and molecular mechanisms. The brain undergoes changes in its basic structure and function, e.g., neural plasticity with an increased susceptibility in neuronal synchronization and network circuit alterations. Some of these changes are transient, while others are permanent with an involvement of both glutamatergic and ,-aminobutyric acid (GABA)ergic systems. Recent data suggest that impaired neuronal plasticity may underlie the cognitive impairment and behavioral changes associated with epilepsy. Many neurologists recognize that the prevention or suppression of seizures by the use of antiepileptic drugs (AEDs) alone is insufficient without clear predictions of disease outcome. Hence, it is important to understand the molecular mechanisms underlying epileptogenesis because this may allow the development of innovative strategies to prevent or cure this condition. In addition, this realization would have significant impact in reducing the long-term adverse consequences of the disease, including neurocognitive and behavioral adverse effects. Drug Dev Res 68:498,511, 2007. © 2008 Wiley-Liss, Inc. [source] Modality options for renal replacement therapy: The integrated care concept revisitedHEMODIALYSIS INTERNATIONAL, Issue 2 2006Gihad NESRALLAH Abstract As the End-stage renal disease population continues to grow, innovative strategies that optimize patient outcomes while capitalizing on the relative strengths of the existing modalities must be sought. Renal transplantation remains the preferred form of renal replacement therapy, but given the limited supply of donor organs, dialytic therapies will continue to constitute a large part of the modality mix. Matching patients to the most suitable modalities requires that a number of factors be considered. These include the patient's autonomy, medical and social factors, system-related issues, patient outcomes, and finances. While peritoneal dialysis and hemodialysis (HD) have traditionally been viewed as competing modalities, we propose that they, along with home and frequent HD regimens, may be used in a complementary manner, which is based on current evidence, and may provide optimal outcomes while containing treatment costs. In this review, we attempt to synthesize the current literature describing the various issues that affect modality selection, and offer an approach to achieving a balance between these many competing factors. [source] Clinical islet transplant: current and future directions towards toleranceIMMUNOLOGICAL REVIEWS, Issue 1 2003A. M. James Shapiro Summary:, The ultimate goal of islet transplantation is to completely correct the diabetic state from an unlimited donor source, without the need for chronic immunosuppressive drug therapy. Although islet transplantation provides an opportunity to develop innovative strategies for tolerance in the clinic, both alloimmune and autoimmune barriers must be controlled, if stable graft function is to be maintained long-term. After islet extraction from the pancreas, the cellular graft may be stored in tissue culture or cryopreserved for banking, providing an opportunity not only to optimally condition the recipient but also to allow in vitro immunologic manipulation of the graft before transplantation, unlike solid organ grafts. As such, islets may be considered a ,special case.' Remarkable progress has occurred in the last three years, with dramatic improvements in outcomes after clinical islet transplantation. The introduction of a steroid-free, sirolimus-based, anti-rejection protocol and islets prepared from two (or rarely three) donors led to high rates of insulin independence. The ,Edmonton Protocol' has been successfully replicated by other centers in an international multicenter trial. A number of key refinements in pancreas transportation, processing, purification on non-ficoll-based media, storage of islets in culture for two days and newer immunological conditioning and induction therapies have led to continued advancement through extensive collaboration between key centers. This review outlines the historical development of islet transplantation over the past 30 years, provides an update on current clinical outcomes, and summarizes a series of unique opportunities for development and early testing of tolerance protocols in patients. [source] Opportunities for an improved role for nurses in psychoactive substance use: Review of the literatureINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2004Annette M Nkowane RN RM BSc MA Nurses form a core component of many health care systems so their role in responding to problems related to psychoactive substance use is crucial. They are often under-utilized, mainly because of anxieties concerning role adequacy, legitimacy, lack of support and failure to implement interventions in a variety of settings. Nurses have unique opportunities through interactions they have with young people, families and significant others. Training and career preparation should encompass development of innovative strategies, taking a leading role in management of substance use patients, involvement in the treatment of the homeless mentally ill, HIV-infected individuals and persons with dual disorders of mental health and substance use. Future directions should focus on developing skills for critical thinking, preventive and therapeutic interventions, clinical judgement, effective organizational capacity and team work. Barriers such as scope of practice, authority, ethical and legal issues surrounding health care for substance use need to be addressed. [source] New avenues to be opened for social protection in the Arab world: the case of Egypt,INTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 1 2004Markus Loewe This article looks at social protection in the Arab world. Giving the example of Egypt, it asks why poverty is so widespread and why , despite the country's numerous social protection systems , social risks are a major contributing factor to it. It concludes that reforms are due. The existing systems are well funded but inefficient and more to the benefit of the better-off than the poor. A reform approach is proposed which builds on both conventional and more innovative strategies: campaigns should be launched to raise public awareness of social risks; social assistance spending should be increased; and the operating public pension schemes should be reformed. At the same time, new avenues have to be opened to meet the specific needs of informal sector workers who have extreme difficulty in being covered by social insurance or social assistance. To this purpose, micro-insurance is a promising approach for the Arab-world region. [source] Trauma in organizations: Prevention and treatment with emergent strategies from alternative psychologyJOURNAL OF PSYCHOLOGICAL ISSUES IN ORGANIZATIONAL CULTURE, Issue 1 2010John Hartung Ph.D. Effective organizations intend to select employees who are already emotionally healthy and can be resilient in the face of difficult challenges. There is also growing interest in helping employees learn to be even more resilient, on the principle that prevention is preferred to subsequent treatment. Plans are also made for treatment for situations where selection and prevention efforts prove inadequate and when employees become negatively affected by difficult events. This article describes innovative strategies that can be used for both prevention and treatment. [source] Current diagnosis and management of primary sclerosing cholangitisLIVER TRANSPLANTATION, Issue 6 2008Jens J. W. Tischendorf Primary sclerosing cholangitis (PSC) is an important liver disease with major morbidity and mortality. The diagnosis of PSC is confirmed by magnetic resonance cholangiopancreaticography, and endoscopic retrograde cholangiopancreaticography is performed in patients needing therapeutic endoscopy. As a result of the unknown cause of the disease, current medical therapies are unsatisfactory. Nevertheless, high-dose ursodeoxycholic acid should be recommended for treatment of PSC patients because there is a trend toward increased survival. Dominant bile duct stenoses should be treated endoscopically. However, liver transplantation continues to be the only therapeutic option for patients with advanced disease. Estimation of prognosis and timing of liver transplantation should be determined individually for each PSC patient on the basis of all results. The diagnosis and treatment of cholangiocarcinoma (CC) still remain a challenge in PSC patients. Early diagnosis of CC certainly is a prerequisite for successful treatment with surgical resection or innovative strategies such as neoadjuvant radiochemotherapy with subsequent orthotopic liver transplantation. Therefore, endoscopic techniques such as cholangioscopy and/or intraductal ultrasound may be useful diagnostic tools in patients with stenoses suspicious for malignancy. Liver Transpl 14:735,746, 2008. © 2008. [source] Physical therapy in Parkinson's disease: Evolution and future challengesMOVEMENT DISORDERS, Issue 1 2009Samyra H.J. Keus PT Abstract Even with optimal medical management using drugs or neurosurgery, patients with Parkinson's disease (PD) are faced with progressively increasing mobility problems. For this reason, many patients require additional physical therapy. Here, we review the professional evolution and scientific validation of physical therapy in PD, and highlight several future challenges. To gain insight in ongoing, recently completed or published trials and systematic reviews, we performed a structured literature review and contacted experts in the field of physical therapy in PD. Following publication of the first controlled clinical trial in 1981, the quantity and quality of clinical trials evaluating the efficacy of physical therapy in PD has evolved rapidly. In 2004 the first guideline on physical therapy in PD was published, providing recommendations for evidence-based interventions. Current research is aiming to gather additional evidence to support specific intervention strategies such as the prevention of falls, and to evaluate the implementation of evidence into clinical practice. Although research focused on physical therapy for PD is a relatively young field, high-quality supportive evidence is emerging for specific therapeutic strategies. We provide some recommendations for future research, and discuss innovative strategies to improve the organization of allied health care in PD, making evidence-based care available to all PD patients. © 2008 Movement Disorder Society [source] A strategy for supervising occupational therapy students at community sitesOCCUPATIONAL THERAPY INTERNATIONAL, Issue 1 2005Susan Mulholland Academic Coordinator of Clinical Education Abstract Within the field of occupational therapy various innovative strategies have been used to provide students with effective clinical education (fieldwork) opportunities. One of the more unusual strategies involves the student participating in a placement at a site where there is no occupational therapist and no well-defined role. The University of Alberta, Canada developed and piloted a new fieldwork supervisory position. Feedback was collected from both the sites and students to explore the impact of this position on the fieldwork experience for stakeholders. As well, sites and students were asked to give their opinions on more general aspects of these placements. Both sites and students positively endorsed the fieldwork educator for independent community placement's role. Most recommendations for improvement revolved around increasing the time dedicated to this position and making it permanent. Caution must be taken in generalizing the results of this study, as there may be various considerations that make this an appropriate supervision strategy in Alberta, Canada but not in other locations. Further research is required to determine whether this supervision strategy could be used with other students or professions in other locations. Copyright © 2005 Whurr Publishers Ltd. [source] Practitioner Review: How can epidemiology help us plan and deliver effective child and adolescent mental health services?THE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 9 2008Tamsin Ford This review focuses on ways in which epidemiological research can inform mental health service development and clinical practice. Data from epidemiological studies can provide cross-sectional and secular estimates of the prevalence of psychopathology to support rational service development. Epidemiological surveys have difficulties in finding large enough samples of children with rare disorders, although these disorders are often severely debilitating and require extensive service input. Systematic surveillance provides a rigorous method for studying rare disorders and events. Only a minority of children with impairing psychopathology reach mental health services, although a larger proportion have mental health related contacts with other services. The gap in provision is such that an expansion of mental health services is unlikely to reach all children who could benefit, suggesting that mental health professionals need to develop innovative strategies to increase the number of children seen and the effectiveness of interventions that they receive. Training and supervision of non-mental-health professionals working with children in the identification and management of mental health problems is also extremely important. Most studies suggest that the children with the severest problems are getting to specialist mental health services, and service contact is more likely if important adults can perceive the child's difficulty or find it to be burdensome. The latter suggests that education of key adults would improve detection if services had the capacity to cope. Studies consistently suggest that the region in which the child lives affects the likelihood of service contact, but studies of other characteristics predicting service contact are so contradictory that studies should only be (cautiously) applied to similar populations to assess which types of children may currently be falling through gaps in service provision. Academics are beginning to explore the use of structured measures developed for epidemiological studies in clinical assessment and outcome monitoring. [source] Profile of occupational therapy practice in rural and remote South AustraliaAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2008Kobie Boshoff Abstract Objective:,The aim of this report is to discuss the results of a questionnaire conducted with occupational therapists providing services in rural and remote South Australia. It is envisaged that the results will be of interest to health professionals working in country areas of Australia. The questionnaire aimed at capturing descriptive information from these therapists in regards to the type of services they deliver and the strategies they employ to deliver services, including information on human resources and staff retention. Design and methods:,A questionnaire sent to occupational therapy managers and yielded a 44% response rate. Results:,Results provide descriptive information on the services provided, for example, the vast geographical areas covered. Respondents described the challenges they face in service delivery and these include the wide range of services to diverse client groups, high client,therapist ratio and limited human resources. Examples of strategies used are less labour-intensive service delivery models, multi-skilling of staff, networking and use of problem-solving techniques. Most perceived their services to be addressing client needs and they felt supported in their roles by other occupational therapists and their organisations. Conclusions:,Occupational therapists working in rural and remote South Australia are overcoming the challenges identified in this questionnaire by implementing innovative strategies. [source] Performance analysis and improvement for BitTorrent-like file sharing systemsCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 13 2007Ye Tian Abstract In this paper, we present a simple mathematical model for studying the performance of the BitTorrent (http://www.bittorrent.com) file sharing system. We are especially interested in the distribution of peers in different states of the download job progress. With the model we find that the distribution of the download peers follows an asymmetric U-shaped curve under the stable state, due to BitTorrent's unchoking strategies. In addition, we find that the seeds' departure rate and the download peers' abort rate will influence the peer distribution in different ways notably. We also analyze the content availability under the dying process of the BitTorrent file sharing system. We find that the system's stability deteriorates with decreasing and unevenly distributed online peers, and BitTorrent's built-in ,tit-for-tat' unchoking strategy could not help to preserve the integrity of the file among the download peers. We propose an innovative ,tit-for-tat' unchoking strategy which enables more peers to finish the download job and prolongs the system's lifetime. By playing our innovative strategy, download peers could cooperate to improve the stability of the system by making a trade-off between the current downloading rate and the future service availability. Finally, experimental results are presented to validate our analytical results and support our proposals. Copyright © 2007 John Wiley & Sons, Ltd. [source] One-year glargine treatment can improve the course of lung disease in children and adolescents with cystic fibrosis and early glucose derangementsPEDIATRIC DIABETES, Issue 3 2009Enza Mozzillo Background:, Diabetes increases morbidity and mortality in cystic fibrosis (CF) patients, but several studies indicate that also prediabetic status may have a potential impact on both nutrition and lung function. Objective:, To evaluate the effect of glargine on the clinical course in CF patients with early glucose derangements. Methods:, CF population was screened for glucose tolerance. CF patients with age >10 yr were screened with fasting hyperglycemia (FH). CF patients with age >10 yr without FH and those with age <10 yr with occasional FH were evaluated for glucose abnormalities on the basis of oral glucose tolerance test and/or continuous glucose monitoring system. All CF patients with glucose derangements were enrolled in an open clinical trial with glargine. Body mass index (BMI) z-score, forced expiratory volume in the first second (FEV1), number of acute pulmonary exacerbations and hemoglobin A1c, were as outcome measures at baseline and after 1 yr of treatment. Results:, After 12 months of therapy, BMI z-score improved only in patients with baseline BMI z-score less than ,1 (p = 0.017). An 8.8% increase in FEV1 (p = 0.01) and 42% decrease in the number of pulmonary exacerbations (p = 0.003) were found in the whole group compared with previous 12 months of therapy. Conclusion:, Glargine could represent an innovative strategy to prevent lung disease progression in CF patients with early glucose derangements. Larger controlled trials are needed to better clarify the effects of insulin on clinical status in CF patients with early glucose derangements. [source] Vertebral anatomy in the Florida manatee, Trichechus manatus latirostris: A developmental and evolutionary analysisTHE ANATOMICAL RECORD : ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY, Issue 6 2007Emily A. Buchholtz Abstract The vertebral column of the Florida manatee presents an unusual suite of morphological traits. Key among these are a small precaudal count, elongate thoracic vertebrae, extremely short neural spines, lack of a sacral series, high lumbar variability, and the presence of six instead of seven cervical vertebrae. This study documents vertebral morphology, size, and lumbar variation in 71 skeletons of Trichechus manatus latirostris (Florida manatee) and uses the skeletons of Trichechus senegalensis (west African manatee) and Dugong dugon (dugong) in comparative analysis. Vertebral traits are used to define morphological, and by inference developmental, column modules and to propose their hierarchical relationships. A sequence of evolutionary innovations in column morphology is proposed. Results suggest that the origin of the fluke and low rates of cervical growth originated before separation of trichechids (manatees) and dugongids (dugongs). Meristic reduction in count is a later, trichechid innovation and is expressed across the entire precaudal column. Elongation of thoracic vertebrae may be an innovative strategy to generate an elongate column in an animal with a small precaudal count. Elimination of the lumbus through both meristic and homeotic reduction is currently in progress. Anat Rec, 290:624,637, 2007. © 2007 Wiley-Liss, Inc. [source] | ||||||||||||||||