Medicine Public Health, Environmental and Occupational Health

Health and Medical Research Impacts

Description

This cluster of papers explores the challenges and opportunities in translational research, focusing on the career development of physician-scientists, research training in academic medicine, NIH funding for medical research, and the obstacles and opportunities in conducting clinical and translational science. It addresses the importance of promoting scholarly activity, increasing research interest among medical students, and overcoming barriers to successful research participation.

Keywords

Physician-Scientist; Medical Research; Academic Medicine; NIH Funding; Career Development; Research Training; Clinical Research; Scholarly Activity; Obstacles and Opportunities; Translational Science

The vision of creating accessible, reliable clinical evidence by accessing the clincial experience of hundreds of millions of patients across the globe is a reality. Observational Health Data Sciences and … The vision of creating accessible, reliable clinical evidence by accessing the clincial experience of hundreds of millions of patients across the globe is a reality. Observational Health Data Sciences and Informatics (OHDSI) has built on learnings from the Observational Medical Outcomes Partnership to turn methods research and insights into a suite of applications and exploration tools that move the field closer to the ultimate goal of generating evidence about all aspects of healthcare to serve the needs of patients, clinicians and all other decision-makers around the world.
The NIH Roadmap is a set of bold initiatives aimed at accelerating medical research. These initiatives will address challenges that no single NIH institute could tackle alone, but the agency … The NIH Roadmap is a set of bold initiatives aimed at accelerating medical research. These initiatives will address challenges that no single NIH institute could tackle alone, but the agency as a whole must undertake. The Roadmap identifies the most compelling opportunities in three arenas: new pathways to discovery, research teams of the future, and reengineering the clinical research enterprise.
Case reports and case series have their own role in the progress of medical science. They permit discovery of new diseases and unexpected effects (adverse or beneficial) as well as … Case reports and case series have their own role in the progress of medical science. They permit discovery of new diseases and unexpected effects (adverse or beneficial) as well as the study of mechanisms, and they play an important role in medical education. Case reports and series have a high sensitivity for detecting novelty and therefore remain one of the cornerstones of medical progress; they provide many new ideas in medicine. At the same time, good case reporting demands a clear focus to make explicit to the audience why a particular observation is important in the context of existing knowledge.
Pneumonia contributes to between 750 000 and 1.2 million neonatal deaths and an unknown number of stillbirths each year world wide. The aetiology depends on time of onset. Gram negative … Pneumonia contributes to between 750 000 and 1.2 million neonatal deaths and an unknown number of stillbirths each year world wide. The aetiology depends on time of onset. Gram negative bacilli predominate in the first week of life, and Gram positive bacteria after that. Streptococcus pneumoniae probably causes about 25% of neonatal pneumonia. Interventions that would reduce mortality from this condition would have a large range of beneficial effects: improved maternal health, better management of other common neonatal conditions, and reduced long term childhood and adult morbidity.
Interview with Dr. Elias Zerhouni on NIH support for translational and clinical research. (07:29)Download Dr. Elias Zerhouni, director of the National Institutes of Health, discusses translational and clinical research and … Interview with Dr. Elias Zerhouni on NIH support for translational and clinical research. (07:29)Download Dr. Elias Zerhouni, director of the National Institutes of Health, discusses translational and clinical research and presents a new plan to provide additional financial support for this important area of investigation.
Peer review is at the heart of the processes of not just medical journals but of all of science. It is the method by which grants are allocated, papers published, … Peer review is at the heart of the processes of not just medical journals but of all of science. It is the method by which grants are allocated, papers published, academics promoted, and Nobel prizes won. Yet it is hard to define. It has until recently been unstudied. And its defects are easier to identify than its attributes. Yet it shows no sign of going away. Famously, it is compared with democracy: a system full of problems but the least worst we have. When something is peer reviewed it is in some sense blessed. Even journalists recognize this. When the BMJ published a highly controversial paper that argued that a new `disease', female sexual dysfunction, was in some ways being created by pharmaceutical companies, a friend who is a journalist was very excited—not least because reporting it gave him a chance to get sex onto the front page of a highly respectable but somewhat priggish newspaper (the Financial Times). `But,' the news editor wanted to know, `was this paper peer reviewed?'. The implication was that if it had been it was good enough for the front page and if it had not been it was not. Well, had it been? I had read it much more carefully than I read many papers and had asked the author, who happened to be a journalist, to revise the paper and produce more evidence. But this was not peer review, even though I was a peer of the author and had reviewed the paper. Or was it? (I told my friend that it had not been peer reviewed, but it was too late to pull the story from the front page.)
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
The long-held but erroneous assumption of never-ending rapid growth in biomedical science has created an unsustainable hypercompetitive system that is discouraging even the most outstanding prospective students from entering our … The long-held but erroneous assumption of never-ending rapid growth in biomedical science has created an unsustainable hypercompetitive system that is discouraging even the most outstanding prospective students from entering our profession--and making it difficult for seasoned investigators to produce their best work. This is a recipe for long-term decline, and the problems cannot be solved with simplistic approaches. Instead, it is time to confront the dangers at hand and rethink some fundamental features of the US biomedical research ecosystem.
In the past 50 years we have made substantial progress in understanding the biology of disease and in devising new ways to prevent or treat it. However, there has been … In the past 50 years we have made substantial progress in understanding the biology of disease and in devising new ways to prevent or treat it. However, there has been a substantial lag in applying what we know to actual patient care. In this article, based on his Shattuck Lecture, Claude Lenfant outlines the magnitude of the problem of translating research knowledge into clinical practice and offers suggestions for closing this gap.
We need less research, better research, and research done for the right reasons What should we think about a doctor who uses the wrong treatment, either wilfully or through ignorance, … We need less research, better research, and research done for the right reasons What should we think about a doctor who uses the wrong treatment, either wilfully or through ignorance, or who uses the right treatment wrongly (such as by giving the wrong dose of a drug)? Most people would agree that such behaviour was unprofessional, arguably unethical, and certainly unacceptable. What, then, should we think about researchers who use the wrong techniques (either wilfully or in ignorance), use the right techniques wrongly, misinterpret their results, report their results selectively, cite the literature selectively, and draw unjustified conclusions? We should be appalled. Yet numerous studies of the medical literature, in both general and specialist journals, have shown that all of the above phenomena are common.1 2 3 4 5 6 7 This is surely a scandal. When I tell friends outside medicine that many papers published in medical journals are misleading because of methodological weaknesses they are rightly shocked. Huge sums of money are spent annually on research that is seriously flawed through the use of inappropriate designs, unrepresentative samples, small samples, incorrect methods …
We investigated the association between a U.S. National Institutes of Health (NIH) R01 applicant's self-identified race or ethnicity and the probability of receiving an award by using data from the … We investigated the association between a U.S. National Institutes of Health (NIH) R01 applicant's self-identified race or ethnicity and the probability of receiving an award by using data from the NIH IMPAC II grant database, the Thomson Reuters Web of Science, and other sources. Although proposals with strong priority scores were equally likely to be funded regardless of race, we find that Asians are 4 percentage points and black or African-American applicants are 13 percentage points less likely to receive NIH investigator-initiated research funding compared with whites. After controlling for the applicant's educational background, country of origin, training, previous research awards, publication record, and employer characteristics, we find that black applicants remain 10 percentage points less likely than whites to be awarded NIH research funding. Our results suggest some leverage points for policy intervention.
Reporting of ethical matters in The Journal is very important. To advise and assist authors, particularly those who may be less familiar with the legislation in the UK, this article … Reporting of ethical matters in The Journal is very important. To advise and assist authors, particularly those who may be less familiar with the legislation in the UK, this article sets out the basic principles and methods that should be used and provides many key web sources of information. It addresses the structure of regulations, and introduces the concept of research governance. The UK law is summarized. Advice is given on the format and description of experiments, and common problems addressed. Aspects of human studies are addressed. Ethical considerations of publication such as authorship and originality, and problems such as plagiarism and fabrication are described. Updates will be published regularly.
Medical scientists and public health policy makers are increasingly concerned that the scientific discoveries of the past generation are failing to be translated efficiently into tangible human benefit. This concern … Medical scientists and public health policy makers are increasingly concerned that the scientific discoveries of the past generation are failing to be translated efficiently into tangible human benefit. This concern has generated several initiatives, including the Clinical Research Roundtable at the Institute of Medicine, which first convened in June 2000. Representatives from a diverse group of stakeholders in the nation's clinical research enterprise have collaborated to address the issues it faces. The context of clinical research is increasingly encumbered by high costs, slow results, lack of funding, regulatory burdens, fragmented infrastructure, incompatible databases, and a shortage of qualified investigators and willing participants. These factors have contributed to 2 major obstacles, or translational blocks: impeding the translation of basic science discoveries into clinical studies and of clinical studies into medical practice and health decision making in systems of care. Considering data from across the entire health care system, it has become clear that these 2 translational blocks can be removed only by the collaborative efforts of multiple system stakeholders. The goal of this article is to articulate the 4 central challenges facing clinical research at present--public participation, information systems, workforce training, and funding; to make recommendations about how they might be addressed by particular stakeholders; and to invite a broader, participatory dialogue with a view to improving the overall performance of the US clinical research enterprise.
This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2010, Issue 4, Art. No.: MR000013 DOI: 10.1002/14651858.MR000013.pub5 (see www.thecochranelibrary.com for … This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2010, Issue 4, Art. No.: MR000013 DOI: 10.1002/14651858.MR000013.pub5 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review.To identify interventions designed to improve recruitment to randomised controlled trials, and to quantify their effect on trial participation.Systematic review.The Cochrane Methodology Review Group Specialised Register in the Cochrane Library, MEDLINE, EMBASE, ERIC, Science Citation Index, Social Sciences Citation Index, C2-SPECTR, the National Research Register and PubMed. Most searches were undertaken up to 2010; no language restrictions were applied.Randomised and quasi-randomised controlled trials, including those recruiting to hypothetical studies. Studies on retention strategies, examining ways to increase questionnaire response or evaluating the use of incentives for clinicians were excluded. The study population included any potential trial participant (eg, patient, clinician and member of the public), or individual or group of individuals responsible for trial recruitment (eg, clinicians, researchers and recruitment sites). Two authors independently screened identified studies for eligibility.45 trials with over 43 000 participants were included. Some interventions were effective in increasing recruitment: telephone reminders to non-respondents (risk ratio (RR) 1.66, 95% CI 1.03 to 2.46; two studies, 1058 participants), use of opt-out rather than opt-in procedures for contacting potential participants (RR 1.39, 95% CI 1.06 to 1.84; one study, 152 participants) and open designs where participants know which treatment they are receiving in the trial (RR 1.22, 95% CI 1.09 to 1.36; two studies, 4833 participants). However, the effect of many other strategies is less clear, including the use of video to provide trial information and interventions aimed at recruiters.There are promising strategies for increasing recruitment to trials, but some methods, such as open-trial designs and opt-out strategies, must be considered carefully as their use may also present methodological or ethical challenges. Questions remain as to the applicability of results originating from hypothetical trials, including those relating to the use of monetary incentives, and there is a clear knowledge gap with regard to effective strategies aimed at recruiters.
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
This study aimed to review the literature describing and quantifying time lags in the health research translation process. Papers were included in the review if they quantified time lags in … This study aimed to review the literature describing and quantifying time lags in the health research translation process. Papers were included in the review if they quantified time lags in the development of health interventions. The study identified 23 papers. Few were comparable as different studies use different measures, of different things, at different time points. We concluded that the current state of knowledge of time lags is of limited use to those responsible for R&D and knowledge transfer who face difficulties in knowing what they should or can do to reduce time lags. This effectively 'blindfolds' investment decisions and risks wasting effort. The study concludes that understanding lags first requires agreeing models, definitions and measures, which can be applied in practice. A second task would be to develop a process by which to gather these data.
Because translational research is not clearly defined, developers of translational research programs are struggling to articulate specific program objectives, delineate the knowledge and skills (competencies) that trainees are expected to … Because translational research is not clearly defined, developers of translational research programs are struggling to articulate specific program objectives, delineate the knowledge and skills (competencies) that trainees are expected to develop, create an appropriate curriculum, and track outcomes to assess whether program objectives and competency requirements are being met. Members of the Evaluation Committee of the Association for Clinical Research Training (ACRT) reviewed current definitions of translational research and proposed an operational definition to use in the educational framework. In this article, the authors posit that translational research fosters the multidirectional and multidisciplinary integration of basic research, patient-oriented research, and population-based research, with the long-term aim of improving the health of the public. The authors argue that the approach to designing and evaluating the success of translational training programs must therefore be flexible enough to accommodate the needs of individual institutions and individual trainees within the institutions but that it must also be rigorous enough to document that the program is meeting its short-, intermediate-, and long-term objectives and that its trainees are meeting preestablished competency requirements. A logic model is proposed for the evaluation of translational research programs.
Our ability, as leaders in public health scholarship and practice, to achieve and measure progress in addressing racial/ethnic disparities in health status and health care is severely constrained by low … Our ability, as leaders in public health scholarship and practice, to achieve and measure progress in addressing racial/ethnic disparities in health status and health care is severely constrained by low levels of participation of racial/ethnic minority populations in health-related research. Confining our review to those minority groups federally defined as underrepresented (African Americans/blacks, Latinos/Hispanics, and Native Americans/American Indians), we identified 95 studies published between January 1999 and April 2005 describing methods of increasing minority enrollment and retention in research studies, more than three times the average annual output of scholarly work in this area during the prior 15-year period. Ten themes emerged from the 75 studies that were primarily descriptive. The remaining 20 studies, which directly analyzed the efficacy or effectiveness of recruitment/retention strategies, were examined in detail and provided useful insights related to four of the ten factors: sampling approach/identification of targeted participants, community involvement/nature and timing of contact with prospective participants, incentives and logistical issues, and cultural adaptations. We then characterized the current state of this literature, discussing implications for future research needs and directions.
Randomized, controlled trials have become the gold standard of medical knowledge. Yet their scientific and political history offers lessons about the complexity of medicine and disease and the economic and … Randomized, controlled trials have become the gold standard of medical knowledge. Yet their scientific and political history offers lessons about the complexity of medicine and disease and the economic and political forces shaping the production and circulation of knowledge.
John Ioannidis argues that problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency define useful clinical research. He suggests most clinical research is not … John Ioannidis argues that problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency define useful clinical research. He suggests most clinical research is not useful and reform is overdue.
This year, the 2012 Trainee Forum will take the form of a grant writing workshop, to be held Sunday, 12 August, from 8:00 a.m.–1:00 p.m. Have you wondered how grant … This year, the 2012 Trainee Forum will take the form of a grant writing workshop, to be held Sunday, 12 August, from 8:00 a.m.–1:00 p.m. Have you wondered how grant applications are reviewed? Would you like information that will help you write more competitive proposals? Then don't miss the opportunity to participate in a mock grant review study section immediately prior to the 2012 SSR meeting. Drs. Susan Taymans, Stuart Moss, and Gary Hunnicutt will help demystify the NIH grant review process, discussing K99, R03, and R01 grants. Dr. Taymans is the Program Director of Reproductive Genetics and Epigenetics, and Basic Ovarian Biology at NICHD and the co-chair of NICHD's Training Policy Committee. Dr. Moss is the Program Director of Male Reproductive Health at NICHD and has served as a Scientific Review Officer (SRO). Dr. Hunnicutt is the SRO of the Cellular, Molecular and Integrative Reproduction (CMIR) study section in the Center for Scientific Review at NIH. In addition to this comprehensive mock review, Dr. Dori Woods, a faculty member at Harvard Medical School/Mass General Hospital at the Vincent Center for Reproductive Biology, will give a brief presentation about the NIH Loan Repayment Program granting mechanism. This event is FREE for meeting attendees, but you must register for the NIH Grant Workshop on the SSR Registration form to reserve a space.
NIH consensus and state-of-the-science statements are prepared by independent panels of health professionals and public representatives on the basis of (1) the results of a systematic literature review prepared under … NIH consensus and state-of-the-science statements are prepared by independent panels of health professionals and public representatives on the basis of (1) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality (AHRQ), (2) presentations by investigators working in areas relevant to the conference questions during a 2-day public session, (3) questions and statements from conference attendees during open discussion periods that are part of the public session, and (4) closed deliberations by the panel during the remainder of the second day and morning of the third. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. The statement reflects the panel's assessment of medical knowledge available at the time the statement was written. Thus, it provides a “snapshot in time” of the state of knowledge on the conference topic. When reading the statement, keep in mind that new knowledge is inevitably accumulating through medical research.
一、关于“推荐规范”1.“推荐规范”的目的:国际医学期刊编辑委员会(International Committee of Medical Journal Editors,ICMJE)制定这份“推荐规范”是用于检查发表于医学期刊的研究工作及其他资料在实施和报告过程中的最佳实践及伦理标准,帮助作者、编辑,以及同行评议和生物医学出版过程中的其他相关人员创作和传播准确、清晰、无偏倚的医学期刊论文.这份“推荐规范”还有助于大众媒体、患者及其家属,以及普通读者更好地了解医学编辑和出版过程. 关键词:规范;作者;编辑;出版;医学论文;临床试验 一、关于“推荐规范”1.“推荐规范”的目的:国际医学期刊编辑委员会(International Committee of Medical Journal Editors,ICMJE)制定这份“推荐规范”是用于检查发表于医学期刊的研究工作及其他资料在实施和报告过程中的最佳实践及伦理标准,帮助作者、编辑,以及同行评议和生物医学出版过程中的其他相关人员创作和传播准确、清晰、无偏倚的医学期刊论文.这份“推荐规范”还有助于大众媒体、患者及其家属,以及普通读者更好地了解医学编辑和出版过程. 关键词:规范;作者;编辑;出版;医学论文;临床试验
Undertaking a review of the literature is an important part of any research project. The researcher both maps and assesses the relevant intellectual territory in order to specify a research … Undertaking a review of the literature is an important part of any research project. The researcher both maps and assesses the relevant intellectual territory in order to specify a research question which will further develop the knowledge base. However, traditional 'narrative' reviews frequently lack thoroughness, and in many cases are not undertaken as genuine pieces of investigatory science. Consequently they can lack a means for making sense of what the collection of studies is saying. These reviews can be biased by the researcher and often lack rigour. Furthermore, the use of reviews of the available evidence to provide insights and guidance for intervention into operational needs of practitioners and policymakers has largely been of secondary importance. For practitioners, making sense of a mass of often-contradictory evidence has become progressively harder. The quality of evidence underpinning decision-making and action has been questioned, for inadequate or incomplete evidence seriously impedes policy formulation and implementation. In exploring ways in which evidence-informed management reviews might be achieved, the authors evaluate the process of systematic review used in the medical sciences. Over the last fifteen years, medical science has attempted to improve the review process by synthesizing research in a systematic, transparent, and reproducible manner with the twin aims of enhancing the knowledge base and informing policymaking and practice. This paper evaluates the extent to which the process of systematic review can be applied to the management field in order to produce a reliable knowledge stock and enhanced practice by developing context-sensitive research. The paper highlights the challenges in developing an appropriate methodology.
The beauty of science may be pure and eternal, but the practice of science costs money. And scientists, being human, respond to incentives and costs, in money and glory. Choosing … The beauty of science may be pure and eternal, but the practice of science costs money. And scientists, being human, respond to incentives and costs, in money and glory. Choosing a research topic, deciding what papers to write and where to publish them, sticking with a familiar area or going into something new—the payoff may be tenure or a job at a highly ranked university or a prestigious award or a bump in salary. The risk may be not getting any of that. At a time when science is seen as an engine of economic growth, Paula Stephan brings a keen understanding of the ongoing cost-benefit calculations made by individuals and institutions as they compete for resources and reputation. She shows how universities offload risks by increasing the percentage of non-tenure-track faculty, requiring tenured faculty to pay salaries from outside grants, and staffing labs with foreign workers on temporary visas. With funding tight, investigators pursue safe projects rather than less fundable ones with uncertain but potentially path-breaking outcomes. Career prospects in science are increasingly dismal for the young because of ever-lengthening apprenticeships, scarcity of permanent academic positions, and the difficulty of getting funded. Vivid, thorough, and bold, How Economics Shapes Science highlights the growing gap between the haves and have-nots—especially the vast imbalance between the biomedical sciences and physics/engineering—and offers a persuasive vision of a more productive, more creative research system that would lead and benefit the world.
U.S. health care costs currently exceed 17% of GDP and continue to rise. One fundamental reason that providers are unable to reverse the trend is that they don't understand what … U.S. health care costs currently exceed 17% of GDP and continue to rise. One fundamental reason that providers are unable to reverse the trend is that they don't understand what it costs to deliver patient care or how those costs compare with outcomes. To put it bluntly, few health care providers measure the actual costs for treating a given patient with a given medical condition over a full cycle of care, or compare the costs they incur with the outcomes they achieve. What isn't measured cannot be managed or improved, and this is all too true in health care, where poor costing systems mean that effective and efficient providers go unrewarded, and inefficient ones have little incentive to improve. But all this can be remedied by exploring the concept of value in health care and carefully measuring costs. This article describes a new way to analyze costs that uses patients and their conditions--not organizational units or narrow diagnostic treatment groups--as the fundamental unit of analysis for measuring costs and outcomes. The new approach, called time-driven activity-cased costing, is currently being implemented in pilots at the Head and Neck Center at MD Anderson, the Cleft Lip and Palate Program at Children's Hospital in Boston, and units performing knee replacements at Schön Klinik in Germany and Brigham & Women's Hospital in Boston. As providers and payors better understand costs, they will be positioned to achieve a true "bending of the cost curve" from within the system, not in response to top-down mandates. Accurate costing also unlocks a whole cascade of opportunities, such as process improvement, better organization of care, and new reimbursement approaches that will accelerate the pace of innovation and value creation.
The term “Global Health” has been widely used in literature over the last decade. In its broader sense, global health is all about tackling health gaps cross the world considering … The term “Global Health” has been widely used in literature over the last decade. In its broader sense, global health is all about tackling health gaps cross the world considering different disciplines, regions, socio-economic status and cultural perspectives to find solutions. There are great differences in perceptions across the globe, and what is appropriate in one place might not be in another. Koplan et al define “Global health” is a field of study, research and practice that places a priority on achieving equity in health for all people.1
Nello Cristianini | CRC Press eBooks
Recent attention to diversity, equity and inclusion (DEI) has led to positionality wherein investigators and authors disclose their identity and social position, allowing readers to interpret findings through the lens … Recent attention to diversity, equity and inclusion (DEI) has led to positionality wherein investigators and authors disclose their identity and social position, allowing readers to interpret findings through the lens of authors' biases. This article describes positionality via meanings of identity and impact of positionality on readers and authors themselves.
<title>Abstract</title> <bold>Background:</bold> The <bold>Com</bold>munity Based Study of the E<bold>p</bold>idemiology of Chronic Kidney Dise<bold>as</bold>e in Cuba New Mexico and <bold>S</bold>urrounding Areas (COMPASS) was designed to screen for chronic kidney disease (CKD) … <title>Abstract</title> <bold>Background:</bold> The <bold>Com</bold>munity Based Study of the E<bold>p</bold>idemiology of Chronic Kidney Dise<bold>as</bold>e in Cuba New Mexico and <bold>S</bold>urrounding Areas (COMPASS) was designed to screen for chronic kidney disease (CKD) and discover novel related biomarkers in rural New Mexico, NM. As part of this study, we qualitatively explored participants’ opinions about CKD research and best practices for delivering lab results to patients. <bold>Methods:</bold>This cross-sectional descriptive qualitative study was part of a larger longitudinal, epidemiological community-based mixed methods project. In COMPASS, participants were aged 18-80 years; lived in or near Cuba, NM; and had up to seven study visits over five years, including receiving a kidney lab results letter using National Kidney Foundation (NKF) visualization tools. All participants were invited to participate in an interview after one year, the focus of the current manuscript. We asked them about their thoughts of research participation and solicited feedback on the results letter. Using a team-based, iterative process, we elicited themes from transcribed interviews using NVivo software. <bold>Results:</bold>We interviewed 33 adults of whom were 64% Hispanic, 24% American Indian, 55% female, 67% aged ≥50 years, and 42% high school graduates. Interviewees were positive toward participating in kidney health research; they appreciated the results letter, but most said they needed help interpreting and/or had suggestions for improvement. Many made positive lifestyle changes. <bold>Conclusions: </bold>Community members in one rural NM area embraced the opportunity to participate in kidney health research. The NKF visualization tools were well-received and inspired positive lifestyle change, but results should be written in plain language. The letter demonstrates the potential efficacy of such interventions to improve understanding and care of medical conditions but also illustrates the opportunity to improve the effectiveness of this type of communication.
In this issue, we speak to Dr Christine McAlpine or “Christine Corbett” as she was known back in the days of Glasgow Medical School. Dr McAlpine broke through the ceiling … In this issue, we speak to Dr Christine McAlpine or “Christine Corbett” as she was known back in the days of Glasgow Medical School. Dr McAlpine broke through the ceiling and entered the history books as the first woman President elected to lead MedChir Society. Radiologists Brian Mucci and John Shand were on her committee while Sam Galbraith was her Honorary President (1945- 2014; https://www.scotsman.com/news/obituaries/obituary-sam-galbraith-brain-surgeon-and-politician-1528621; https://www.theguardian.com/politics/2014/aug/19/sam-galbraith). 1) Dr McAlpine, since it is graduation season, please tell us a little of your career after you qualified MBChB and why you chose the specialty you did. Up to my retirement 3 months ago, I was a Consultant Geriatrician and Stroke Physician. I find Geriatric Medicine interesting and a nice mix when compared to a single-organ-based specialty. I became interested in Stroke Medicine when it became a specialty in the 1990s. I really enjoyed the mix of acute and rehabilitation aspects of managing patients in the Stroke service. 2) Can you share some of your career highlights? I have always enjoyed being a doctor! Locally, I was for many years the clinical lead for the NHS GGC Stroke Managed Clinical Network, which was a varied and interesting role. I was, over the course of my career, the Geriatric Medicine Advisor to the Chief Medical Officer of Scotland and Chair of the British Geriatrics Society (Scotland). I had a long and fruitful collaboration with Healthcare Improvement Scotland and the Scottish Stroke Care Audit. I was co-Chair of the Scottish Care of Older People Audit until my retirement – and I am still on the committee to improve care of this group of people in Scotland. I was able to maintain an interest in research via the Scottish Stroke Research Network and had various roles in the Royal College of Physicians and Surgeons of Glasgow. I have been fortunate to have had a very enjoyable career. 3) Tell us a little of your time as a student at Glasgow University, especially about your time in MedChir? We celebrated the 45th reunion of our graduation just last week! I thoroughly enjoyed being a medical student in Glasgow and my time in MedChir. Take a look at the pristine MedChir membership book I found recently. The MedChir afforded me the opportunity to meet students from other year groups - it was good fun! I enjoyed working with Sam Galbraith and we were kept busy organising all the educational activities and lectures, at least once a month! Before each event, a couple of committee members would head to the Ubiquitous Chip with that evening’s speakers for dinner – those were the days! Outside of Medicine, I was part of the University of Glasgow Cecilian Society – still running today! – where I played the clarinet with the orchestra. As a “Western Infirmary” girl, I was sad to see it demolished, but I am very impressed with the new buildings appearing. 4) What would you say to your medical student self if you had the chance? “Believe that you can do things” and “Read up on Imposter Syndrome”. I think women in particular are more prone to this. 5)What would you say to medical students today? I would tell them something which was said to me as a student: “You are usually more content regretting the things you did, than the thing you didn’t do.” Take any opportunity you are offered. I generally did that when I was a student and most times I was glad for the experiences they brought. There were a few opportunities I didn’t take and I regretted later - for example I regret not taking the opportunity of intercalating to do a BSc. I wasn’t sure I wanted to do a science degree in the middle of my medical training. Now, with hindsight, it would have been a very good thing. But I think I have always been a ‘glass half full’ person, which I hope has stood me in good stead over the years!
The theme "Beyond the Framework: Leaping between Disciplines" addresses the growing importance of cross-disciplinary research, particularly in Life Sciences, Medicine, and Biomedicine. This Special Issue, explores how research that transcends … The theme "Beyond the Framework: Leaping between Disciplines" addresses the growing importance of cross-disciplinary research, particularly in Life Sciences, Medicine, and Biomedicine. This Special Issue, explores how research that transcends traditional disciplinary boundaries can lead to breakthroughs in complex health challenges. The convergence of these fields fosters innovation by integrating diverse methodologies, perspectives, and technologies. This Special Issue highlights the value of interdisciplinary approaches in advancing understanding of diseases, developing novel treatments, and improving patient outcomes. Our contributors delve into a wide range of topics, including regenerative medicine, personalized healthcare, and biomaterials, showcasing collaborative research that has led to significant advancements. By breaking down silos, researchers from these domains can create more holistic solutions to pressing health concerns such as cancer, neurodegenerative disorders, and metabolic diseases. This issue aims to inspire researchers and clinicians to pursue collaborative projects that transcend traditional boundaries, fostering innovation and promoting sustainable healthcare solutions.
Physician-scientists in academic medical centers require extramural grant support to launch and maintain their research careers. In order to cultivate the next generation of biomedical researchers, including physician-scientists, the NIH … Physician-scientists in academic medical centers require extramural grant support to launch and maintain their research careers. In order to cultivate the next generation of biomedical researchers, including physician-scientists, the NIH supports multiple career development (K series) awards. For many, their first experience in grant writing is composing a career development award (CDA) application. From the applicant's perspective, this process can be difficult. For one, NIH institute-specific differences between the same K mechanism can be confusing. Additionally, the importance of the various elements that make up the K application are frequently misunderstood. Furthermore, many K applications will not be funded on the initial submission; therefore, the need to resubmit an application should not be viewed as a sign of failure, but rather can be viewed as an element of resilience in biomedical research. In this piece, we aim to provide guidance for aspiring K applicants - in particular, from the reviewer perspective - with the intent of making the application process more understandable. We offer dos and don'ts on different components of the K application, advice on when to reach out to a program officer, and tips on resubmission. Our overarching goal is to provide support for prospective K applicants in their effort to obtain a K award. While targeted to K applications, most of the contents of this summary apply to any CDA.
The system for disseminating and publishing bachelor’s and master’s degree theses in Library &amp; Information Science (LIS) at 14 Spanish universities is explored through analysis of the documents regulating open … The system for disseminating and publishing bachelor’s and master’s degree theses in Library &amp; Information Science (LIS) at 14 Spanish universities is explored through analysis of the documents regulating open access at universities, the documents regulating thesis preparation, and thesis course syllabi. The dissemination criteria include the grade the student earns at the thesis defence and permission from several of the participants in thesis advising and grading. University repositories hold a small number of theses compared to the total number of graduates from their undergraduate and master’s degree programmes, and in some cases, the few theses that are on file are not easy to retrieve. In the light of the findings, it is recommended to establish a policy to address thesis publication and dissemination issues.
| Journal of Thoracic and Cardiovascular Surgery
| Journal of Thoracic and Cardiovascular Surgery
Background: Undergraduate research is vital for developing critical thinking and academic identity in medical students, yet traditional models often fail to overcome institutional and personal barriers. Peer-led approaches may offer … Background: Undergraduate research is vital for developing critical thinking and academic identity in medical students, yet traditional models often fail to overcome institutional and personal barriers. Peer-led approaches may offer more accessible, supportive environments that promote deeper engagement and leadership in research. Methods: This study evaluated medical students’ experiences in a peer-led research initiative from 2022 to 2024. Students were then invited to complete a qualitative questionnaire reflecting on their perceptions towards research, development in research skills, confidence, and academic identity. Results: Code saturation was achieved after 9 responses (N = 15). Participants reported intrinsic interest, peer encouragement, and opportunities to publish as motivating factors. The peer-led model made research feel more approachable, fostering technical growth and academic confidence. Peer mentorship and a gradual learning structure were especially valued. While challenges such as workload and team dynamics emerged, students reported growth in resilience and self-reflection. Conclusions: Peer-led research initiatives can effectively support academic identity formation by integrating motivation, support, and skill development. Despite obstacles, students gained competence and confidence.
Purpose Supervision and leadership are regarded to have a major role in promoting responsible research. Various approaches to training for supervisors and leaders have been proposed. However, little is known … Purpose Supervision and leadership are regarded to have a major role in promoting responsible research. Various approaches to training for supervisors and leaders have been proposed. However, little is known about what works best, what kind of hurdles are faced in implementation and engagement, and what methods of assessing the effectiveness of training programs are available. Through exploring these points, this research aims to propose a roadmap to good practice for training supervisors and leadership. Design A virtual marketplace for exchanging current practices and approaches for training supervisors and leadership took place in March 2024. Twenty-two policy makers from thirteen European countries, supervisors and senior research leaders were selected to participate, using opportunistic and purposive sampling. Facilitated using the Gather platform, the marketplace commenced with a non-European keynote speaker on training supervisors and leadership. Three main questions were brought forward for discussion separately— What works well for successful implementation ? What are the challenges ? How do we assess effectiveness ? After the keynote presentation, marketplace participants rotated in groups between three market stalls to share thoughts on good practices for training supervisors and leadership framed around the three questions. Moderators for each of the stalls recorded detailed field notes to inform the study findings. Findings During the exchange, mandatory training, especially when tailored to specific disciplines and conducted in small groups using a problem-based learning approach, was deemed effective. Awareness of power imbalances between early career researchers, supervisors, and leaders were to the fore. Critical challenges included a need for senior supervisors and leaders to participate and support research training. Also a need for systemic processes, tailored to specific local settings to avoid ad hoc implementation of policies, procedures and training. In assessing effectiveness there was an emphasis to share more research data and to utilize incidents of breaches of research integrity. The latter to be leveraged for learning purposes and transparency around the investigative process. Originality There are multiple facets to good practice for training supervisors and leadership, along with a multitude of practices, however there is little evidence of practices that work, challenges around implementation, and assessing effectiveness.
Objective: The goal of this study was to evaluate trends in the cost-share required to support NIH funded surgeon trainees and faculty. Summary of Background Data: Surgeon-scientists are critical to … Objective: The goal of this study was to evaluate trends in the cost-share required to support NIH funded surgeon trainees and faculty. Summary of Background Data: Surgeon-scientists are critical to advancing our understanding of surgical diseases and innovating care of surgical patients. However, demands for clinical productivity while securing extramural funding in the setting of increasingly competitive National Institutes of Health (NIH) funding paylines has limited growth of the surgeon-scientist workforce. Methods: The NIH salary cap and postdoctoral fellow stipends were obtained from the NIH website. The median total compensation for faculty at the Associate Professor rank (Non-Clinical, Clinical Faculty, Surgeons, and Surgical Subspecialties) and PGY3 level residents were obtained from Association of American Medical College data. Data were analyzed for fiscal years 2001-2023 (faculty) and 2005-2003 (trainees). Changes in the salary cap gap over time were forecasted using an exponential smoothing algorithm. Results: Over the study period, no cost-share was required for non-clinical faculty, while the cost-share for a surgeon investigator increased from $18,360 to $68,660 per year. For a single postdoctoral fellow trainee, the cost-share increased from $22,932 to $31,608 annually. In 2023, the total cost-share to support the program director and four positions on a T32 training grant was estimated to be $250,631. The cost-share for surgeon investigators is projected to expand by another 47% by 2035. Conclusions: This analysis demonstrates that the NIH salary cap gap creates a financial challenge for institutions and Departments of Surgery, which is projected to increase substantially over the next decade. These data highlight the urgency to advocate for policy development to adequately compensate federally funded surgical investigators and should facilitate dialogue within institutions to develop alternative funding mechanisms for surgeon-scientists.
Science involves the use of specialized epistemic practices that lead to an increased probability of solving certain kinds of intellectual and applied problems. Science has been extraordinarily successful at solving … Science involves the use of specialized epistemic practices that lead to an increased probability of solving certain kinds of intellectual and applied problems. Science has been extraordinarily successful at solving an enormous number of these problems. However, psychology, particularly clinical science, has not shared a similar outcome regarding the number and degree of such problem solutions-what famously called the "slow progress of soft psychology." Scholars have identified problematic conceptions of the scientific method, replication failures, publishing biases, questionable research practices, faked data, and political biases influencing the scientific literature and thus have questioned the quality of this literature. We analyze this general problem using two constructs: "ugly science" and "dirty science." The first denotes a problematic conception of science, and the second is a problematic instantiation of an image of science. The critical question is, how can clinical science function with the unknown prevalence of such problematic science?
David Gieseke | American Journal of Veterinary Research
Abigail Shaw | Policy Press eBooks
Introduction: There are no established family medicine (FM) residency-level global health objectives or curricula for program directors who want to offer ethical and meaningful global health experiences to residents. We … Introduction: There are no established family medicine (FM) residency-level global health objectives or curricula for program directors who want to offer ethical and meaningful global health experiences to residents. We sought to develop and evaluate a toolkit of resources that family medicine educators can use to improve residents’ knowledge of this important aspect of family practice. Methods: We reviewed and categorized peer-reviewed and grey literature publications and global health curricula from FM and non-FM residency programs related to clinical topics, standards of global health practice and partnerships, decolonization, and others. The toolkit uses six standard Accreditation Council for Graduate Medical Education (ACGME) competencies to organize learning objectives, content areas, and resources. Resources were further categorized based on complexity, cost, and time. We developed the toolkit with a focus on patient safety and ethical engagement with global partners. We evaluated the toolkit using an online survey of global health educators from inside and outside the United States. Results: The toolkit was vetted by the Society of Teachers of Family Medicine Board of Directors and published as an open-access resource on the STFM website (https://stfm.org/teachingresources/curriculum/globalhealthtoolkit/overview/). The toolkit had 1,446 unique views in the 18 months after it was published. Most global health educators surveyed found the toolkit to be appropriate for resident-level education and ethically sound. Respondents indicated that they would most likely use the toolkit to improve an existing global health experience or track. Conclusion: A novel toolkit provides resources curated and presented by topic, complexity, and estimated cost that residency programs can use to create or augment global health offerings. Educators can use resources and associated learning objectives presented using standard ACGME competencies to connect knowledge, skills, and attitudes gained through global health education to their residents’ overall learning needs.
Abigail Shaw | Policy Press eBooks
Scientifically well-established methods do not automatically get used in regulations. Even when there is an urgent need for regulatory relevant test methods, methods need to pass through a so-called standardization … Scientifically well-established methods do not automatically get used in regulations. Even when there is an urgent need for regulatory relevant test methods, methods need to pass through a so-called standardization process. This involves following specific agreed processes, which define the timeline and requirements (e.g., validation, documentation, approval) before the method can be integrated in regulatory oriented standards or Test Guidelines from the Organization of Economic Cooperation and Development (OECD). The process is often seen as too complex or too resource (and time) consuming by the scientific community, which inhibits method developers from translating their scientific methods and protocols into standards or OECD Test Guidelines. Numerous incentives exist for scientists to be (more) active in the standardization process and allow regulation to keep up with new scientific developments. These include an increase in research impacts, an expansion and diversification of the international expert network, and an access to more fundings. This paper shows scientists how to reach such outcomes, by providing guidance on how to navigate successfully through the standards and OECD Test Guidelines development processes. Especially the requirements for method validation, which is a prerequisite in this process and common across the different standardization bodies. For further details and insights, readers are invited to consult the various freely available resources generated by the NanoHarmony EU project. These are compiled in the OECD Test Guideline Process Mentor ( https://testguideline-development.org/ ). The active participation of scientists along the entire process toward standards and OECD Test Guidelines is key. Only then can their methods be expanded into a wider, regulatory application toward a safer world.