High Priority Issue Research Articles

Improving eye care for veterans with diabetes: An example of using the QUERI steps to move from evidence to implementation: QUERI Series

BackgroundDespite being a critical part of improving healthcare quality, little is known about how best to move important research findings into clinical practice. To address this issue, the Department of Veterans Affairs (VA) developed the Quality Enhancement Research Initiative (QUERI), which provides a framework, a supportive structure, and resources to promote the more rapid implementation of evidence into practice.MethodsThis paper uses a practical example to demonstrate the use of the six-step QUERI process, which was developed as part of QUERI and provides a systematic approach for moving along the research to practice pipeline. Specifically, we describe a series of projects using the six-step framework to illustrate how this process guided work by the Diabetes Mellitus QUERI (DM-QUERI) Center to assess and improve eye care for veterans with diabetes.ResultsWithin a relatively short time, DM-QUERI identified a high-priority issue, developed evidence to support a change in the diabetes eye screening performance measure, and identified a gap in quality of care. A prototype scheduling system to address gaps in screening and follow-up also was tested as part of an implementation project. We did not succeed in developing a fully functional pro-active scheduling system. This work did, however, provide important information to help us further understand patients' risk status, gaps in follow-up at participating eye clinics, specific considerations for additional implementation work in the area of proactive scheduling, and contributed to a change in the prevailing diabetes eye care performance measure.ConclusionWork by DM-QUERI to promote changes in the delivery of eye care services for veterans with diabetes demonstrates the value of the QUERI process in facilitating the more rapid implementation of evidence into practice. However, our experience with using the QUERI process also highlights certain challenges, including those related to the hybrid nature of the research-operations partnership as a mechanism for promoting rapid, system-wide implementation of important research findings. In addition, this paper suggests a number of important considerations for future implementation work, both in the area of pro-active scheduling interventions, as well as for implementation science in general.

Identifying research priorities for midwifery in Ireland

Objective to identify research priorities for midwifery in Ireland in the short, medium and long term. Method a three-round Delphi survey design was used to identify midwifery research topics. Issues identified through content analysis formed Questionnaires 2 and 3. Participants rated the importance of each topic (1=low importance to 7=high importance), and a mean score of 6.0 or more was considered a priority issue. A final discussion group set short-, medium- or long-term timeframes for the research topics. Participants 334 midwives were recruited from a national invitation to all midwives. Response rates were 43% (Round 1; 142/334), 85% (Round 2; 121/142) and 81% (Round 3; 98/121). Nine consumers of maternity services were included in the discussion group workshop. Findings participants identified 11 clinical, eight management, and seven education midwifery research topics with six high-priority issues: promoting woman-centred care (management), promoting the distinctiveness of midwifery (education), satisfaction with care (clinical), care in labour (clinical), preparation for practice (clinical), and promoting research/evidence-based practice (education). Key conclusions this research sought to achieve consensus amongst a representative sample of midwives on the priorities for midwifery research in Ireland. Midwives can now select topics for graduate or other research studies of importance to practice, management and education. Funding agencies can confidently direct the allocation of national and local funding for priority areas of midwifery research within Ireland.

梁通し型木造住宅における新築・解体・再築施工実験の結果と考察

Recently, our action against global environmental concerns including global warming is high priority issue. Then an energy saving, effective use of the resource, the reduction in the construction waste and the reuse of the material are important problems in the architectural production field. In a word, it is necessary to review the architectural production method. The authors are researching the timber house rebuilding system that uses the used structural members again. This rebuilding system dose not apply the steel joint to raise the reuse rate of wood members. To facilitate the construction work, the demolition work and rebuilding of the timber house, a built up system with continuous beam is adopted. The case study house was constructed to clarify the effectiveness of this system. In this paper, the outline of this rebuilding system, the results of construction, demolition experiments and re-construction are described.

Advocacy training in neurology: scope and impact

In this Training Matters article, the authors highlight the need for neurologists to develop advocacy skills that they can use to promote high-priority issues facing the practice of neurology. The authors describe a training program that teaches participants to identify issues related to clinical practice, develop an action plan for dealing with these problems, and apply strategies to improve their communication skills.

Social Science Research Needs for the Hurricane Forecast and Warning System

This article begins to identify high-priority social science research issues focused on the hurricane forecast and warning system. The research agenda was distilled as faithfully as possible from the efforts of a host of scientists. These included a series of white papers; a workshop in Pomona, Calif., in February 2005; several sessions at the 2004 and 2005 Natural Hazards workshops held in Boulder, Colo.; and additional input from the broader social science research community unable to attend these events. Expected results from this effort are (1) a focused applied research agenda designed to generate short-term immediate benefits; (2) a broader, more basic research agenda addressing fundamental theoretical and exploratory research designed to generate long-term improvements; (3) methods to enable the social science research community to gather and further develop research priorities and future agendas; and (4) a concept for a long-term, multidisciplinary, institutional approach to undertaking identified research priorities. This paper is presented as a call to action for the appropriate agencies and organizations to support social science research on the high-priority issues in the hurricane forecast and warning system to meet societal goals of protecting lives and property in the face of the ever-present threat of hurricanes.

Pleomorphic carcinoma of the lung: A surgical outcome

Pleomorphic carcinoma of the lung, a rare malignant disease with a dual-cell component of spindle and/or giant cells, and of epithelial cells, was defined in the World Health Organization classification updated in 1999. Reported prognoses are heterogeneous, and optimal treatment remains undefined. Data were retrospectively examined for 45 consecutive patients (41 men and 4 women) who had undergone surgical resection for pulmonary pleomorphic carcinoma. Sarcomatous elements were as follows: 23 spindle cell types (51.1%), 11 giant cell types (24.4%), and 11 combined spindle and giant cell types (24.4%). Epithelial components were adenocarcinoma in 25 (55.6%) patients, squamous cell carcinoma in 8 (17.8%) patients, and large call carcinoma in 12 (26.7%) patients. Nodal status was classified as pN0 disease in 28 (62.2%) patients, pN1 disease in 5 (11.1%) patients, and pN2 disease in 12 (26.7%) patients. Even patients with pN0 disease frequently manifested vascular invasion (16/28 [57.1%]). Five-year overall survival and disease-free survival were 39.2% and 47.1%, respectively. Although the subtype of epithelial components, as well as sarcomatous elements, did not affect prognosis, overall survival (P = .02) and disease-free survival (P = .002) in patients with pN1/N2 disease were significantly worse than those in patients with pN0 disease. Most recurrences occurred at distant sites (14/20 [70.0%]), and recurrence within 6 months after resection was found in 10 patients (10/20 [50.0%]). Moreover, median survival time after confirmation of initial relapse was 2.6 months. Pulmonary pleomorphic carcinoma, which often presented in symptomatic male smokers as a large peripheral lesion, carried a poor prognosis, even when early-stage disease was diagnosed and resected. Distant metastases occurred more frequently and earlier, and the survival after relapse was very short, suggesting that this entity should be considered to have a tremendously aggressive malignant behavior. Further investigation of biologic features of pulmonary pleomorphic carcinoma and therapeutic response is a high-priority issue, so that suitable treatment strategies can be planned.

The current status of palliative care teams in Japanese University Hospitals: a nationwide questionnaire survey

Although the importance of the palliative care team (PCT) to university hospitals is widely accepted, the issues of palliative care at the national level have not been clarified. We conducted a nationwide survey of the current status of PCTs in all (123) Japanese university hospitals. In 2003, 2004 and 2005, the authors conducted a self-reporting cross-sectional survey. Questionnaires were mailed to nursing directors and selected PCT members of all Japanese university hospitals. Of 123 hospitals in 2005, 99 (80%) returned the questionnaire; 33% used PCTs, and 11% used certified PCTs. Our findings include: annual number of patients treated by PCTs (83/70 +/- 64, mean/median +/- SD), daily number of patients treated by PCTs (12/11 +/- 14), and days of PCT care per patient (30/30 +/- 22). Certified PCTs treated more patients per year (p = 0.004) and more patients per day (p < 0.001) compared to noncertified PCTs. Over the 3-year period, the number of hospitals utilizing PCTs only slightly increased (2003: 27%, 2004: 29%, 2005: 33%), as did those using certified PCTs (2003: 3%, 2004: 9%, 2005: 11%). In 2005, the reasons for noncertification of PCTs included "lack of physicians who specialize in palliative care (82%)" and "lack of nurses who specialize in palliative care (56%)." The entire system of palliative care in Japanese university hospitals is currently insufficient. The lack of physicians and nurses who specialize in palliative care is a significant barrier, and therefore, the initiation of a formal training system for these health care professionals is a high priority issue.

Enhancing nursing students’ clinical placement experiences: A quality improvement project

Clinical experience is recognised as the core of nursing education. Quality clinical placements across a variety of venues are vital to the development of capable and competent professionals. However there is evidence, both anecdotal and empirical, suggesting that students’ clinical placement experiences are fraught with problems. The quality improvement project described in this paper aimed to improve the clinical learning experience of nursing students by strengthening communication and partnerships between the university and the two local health services. To achieve this goal, clinicians’ perceptions of the problems related to clinical placements and their recommendations for improvement were explored. Focus groups, brainstorming sessions, personal interviews and surveys were used to collect qualitative and quantitative data. Problems and priority issues were identified as more than five hundred clinicians expressed their concerns, claims and issues.Key findings from the project are described under five themes: communication breakdown between the university and clinicians; mentorship; preparation for clinical placements; clinical competence; and graduates’ readiness for practice.Utilising a quality improvement framework this project promoted vigorous debate and dialogue between university and health service partners. The nature and extent of the problems surrounding clinical placements were examined, high priority issues targeted for improvement, and the subsequent results measured through feedback from clinicians and students. The success of this project, although impressive in the early stages, will depend upon ongoing communication and evaluation to ensure sustainability of the improvements made.

Implementation intentions and the willful pursuit of prosocial goals in negotiations

Three studies examined whether the self-regulation strategy of forming implementation intentions (i.e., if-then plans) facilitates the attainment of prosocial goals when a limited resource is to be distributed between two parties who hold adverse cognitive orientations. In three experiments, pairs of negotiators were assigned prosocial goals that either had to be supplemented with plans (if-then plans, Gollwitzer, 1999) on how to act on these goals or not. Experiment 1 used a mixed-frames negotiation paradigm in which one negotiation partner operated on a gain-frame, the other on a loss-frame. When participants had the prosocial goal to find fair agreements and furnished it with a respective if-then plan, unfair agreements in favor of the loss-frame negotiator no longer occurred. Experiment 2 used a same-frame negotiation paradigm, where both negotiation partners had either a loss or a gain-frame. When loss-frame pairs had furnished their prosocial goals to cooperate with the negotiation partner with a respective if-then plan, reduced profits as compared to gain-frame pairs of negotiators were no longer observed. In addition, negotiators who had formed implementation intentions were more likely to use the integrative negotiation strategy of logrolling (i.e., making greater concessions on low rather than high priority issues). Experiment 3 used a computer-mediated negotiation task in order to analyze the effects of prosocial goals and respective implementation intentions on the course of the negotiation. Again, implementation intentions facilitated the pursuit of prosocial goals in the face of adversity (i.e., loss frames) by use of the integrative negotiation strategy of logrolling. The present research adds a self-regulation perspective to the research on negotiation by pointing out that the effects of negotiation goals can be enhanced by furnishing them with respective plans (i.e., implementation intentions).

Public Perceptions and Actions towards Sustainable Groundwater Management in the Pacific Northwest Region, USA

A 50-question survey was developed by the land grant universities in the Pacific Northwest to document public awareness, aptitudes, attitudes and actions toward water issues in the states of Alaska, Idaho, Oregon and Washington, USA. Demographic data were also collected about the survey respondents. The statistically designed survey was completed by over 50% of the 1800 residents who were solicited for the study. The public consider clean groundwater a high priority issue. Survey respondents currently consider groundwater quality to be good; however, most people are unaware of groundwater quantity issues. In the last 5 years, a majority of survey respondents have taken voluntary actions both to protect groundwater quality and to conserve the use of this resource. People want the government to focus more attention on groundwater issues; however, they are unwilling to pay increased taxes to achieve this end. Based on this survey, the land grant universities need to increase groundwater education programmes for the public using television, radio, newspapers and the Internet rather than by the traditional workshop delivery methods.

Specific therapies for ischaemic stroke: rTPA and others

In the last few years there have been several important advances in the understanding of cerebrovascular disorder pathophysiology that have impacted on stroke management. The development of timely and effective treatment strategies was and is still considered a high priority issue. Therapeutic options dramatically increased both in the prevention and overall in the treatment of acute ischaemic stroke (AIS). At present, whereas neuroprotection remains experimental, intravenous (i.v.) thrombolysis is the only specific therapy effective in reducing mortality and disability associated with stroke. The efficacy and safety of the antithrombotic therapy in AIS treatment are not well established, and few issues in clinical stroke management are more controversial. However, some studies have brought new light and new doubts on the roles of these traditional therapies.

A study towards implementation of a standalone environmental monitoring device

Environment is an issue of major concern all round the world. Protection of environmental resources such as groundwater or marine environment from contamination became an issue of high priority, which requires special consideration. In order to protect the shores water used in desalination and groundwater from various contaminants that may leak from industrial and ship activities, a remote monitoring system was designed in this study to continuously monitor the state of pollution near potential sources. The system was designed to operate without operator intervention and is connected to a central computer using state-of-the-art wireless communication network. The system was tested recently to monitor environmental parameters of the inland lagoon in the city of Sharjah. This paper describes the design requirements, methodology and microcontroller-based implementation of the monitoring unit and the results of the test study.

Epidemiology of hip fracture in Japan: incidence and risk factors

Hip fracture is the most serious complication of osteoporosis and has been recognized as a major public health problem. The prevention of hip fractures is an high-priority issue because of the rapid increase of the number of elderly people in Japan. The General Research Committee for the Prevention and Treatment of Osteoporosis in Silver Health Science Researches sponsored by the Ministry of Health and Welfare (Director, Hajime Orimo) first undertook a nationwide survey of femoral neck fracture in 1987. This nationwide survey has been continued every 5 years, in 1992, 1997, and 2002. The total number of new cases was nearly 120,000 in the latest survey, and has been rising in every survey. Total number of new cases was about 1.4 times the baseline 1987 figures in 1992, 1.7 times in 1997, and 2.2 times in 2002. The total number of new female patients was about three times higher than that of new male patients, a finding identical to those of the previous surveys. The incidences of hip fracture (per 10,000) according to sex and age was increased in both men and women, particularly among individuals 80 years old or over. The Epidemiological Research Group on Osteoporosis, Ministry of Health and Welfare (Chairman; Hajime Orimo) undertook a nation-wide case-control study to clarify the risk factors for hip fractures among Japanese in 1994. Cases of hip fracture in people aged 65-89 were selected from 21 hospitals in seven areas of Japan. Two sex- and age-matched controls were selected from the same residential area for each case using resident registration lists. During this 1-year survey, 249 cases of hip fractures (43 men and 206 women) were reported. The following risk factors for hip fractures were identified using multivariate analysis: past history of stroke with hemiplegia, sleep disturbance, sleeping in a Western-style bed, and drinking more than 3 cups of coffee daily.

SPATIAL PLANNING FOR INTEGRATED WATERSHED MANAGEMENT

Spatial planning is a valuable tool to support sustainable development by basing the plans, measures and interventions on key sustainability principles. The development of a spatial plan runs through three main processes; baseline data analysis of the existing situation and problems and potentials; formulation of objectives and strategies; and integration across sectors and synthesis of all aspects into a coherent balanced spatial framework. The technical part of planning was based on development of a comprehensive Geographic Information System (GIS) and database system and also included mathematical models to predict outcomes of certain measures. The planning maps of the relevant issues are constructed in order to plan for watershed management. As an example, the initial analysis determined that reforestation was a high priority issue for many reasons, both related to preservation and enhancement of nature and environment and people′s living conditions. GIS was applied to define potential zones for reforestation and mathematical models calculated the result in terms of runoff, sedimentation and water quality. The potential zones for reforestation were then used as a framework for integrated planning. This paper will demonstrate the planning maps used for integrated water shed management on the basis of spatial planning concept.

From the National Academies: The Challenges and Opportunities for Improving Undergraduate Science Education through Introductory Courses

Unlike previous articles that have informed readers of Cell Biology Education about education initiatives at the National Academies, this article is written primarily to stimulate and elicit your comments and feedback about introductory undergraduate science courses and ways to better serve a changing and more diverse student body. I hope to stimulate an exchange of ideas through an electronic discussion forum (details are provided below). Contributions from readers will be posted by CBE and made available to the members of the National Research Council’s Board on Science Education, which is seeking input from the postsecondary science education community about the most critical issues related to introductory undergraduate science courses. Input from CBE readers, participants at a small workshop held in June 2004, and participants in other activities will guide the Board in deciding on possible studies or other programs that will explore high-priority issues in greater detail.

Thermal processes in the context of EarthScope

The EarthScope project is designed to elucidate the dynamics and evolution of the North American continent. To reach that goal, focused studies of the continental seismic structure, the strength of the lithosphere and modes of deformation, the patterns of stresses and strain, and the manner in which the lithosphere responds to excitation during earthquakes are all a high priority.The common factor linking these EarthScope centric issues is the thermal state of the lithosphere. Although not an explicit component of EarthScope in the sense of US Array, PBO or SAFOD, an understanding of the thermal structure and associated thermal processes plays a key role in interpreting the observations generated by the EarthScope infrastructure. In order to help guide EarthScope science to exploit most effectively the links among these observations, a workshop was held to bring together practitioners from the fields of seismology geodesy thermochronology and crustal deformation with researchers who focus on thermal processes. The goal was to define the high priority issues to be addressed through integration of thermal geophysics with Earth‐Scope science.

Potential for Growth and Security in Internet File-Sharing: The VPN Concept of Gnutella

ABSTRACT The integration and use of the Internet and database management systems serve as a foundation for management of data flows for IT strategic purposes, such as using bar codes in distribution warehouses' informational and material flows. Although these trends are fairly common to B2B and C2B transactions, little research has been done on the concepts of Internet file sharing initiated on the consumers' side. Literature and conceptual research for this position paper were conducted to determine the potential for growth and security in Internet file sharing, namely the VPN concept of Gnutella. Internet file sharing is rapidly becoming a high priority issue in developing competitive advantage in customer service within an e-commerce environment. Management is finding the topic to be timely and interesting, especially with the recent press about music downloads and copyright infringement. The Internet coupled with near transparent automatic identification and data capture/collection systems, to ensure accuracy of data input, has been the key enabler of these worldwide product design/delivery technologies. Application of Rogers' (1995) Diffusions of Innovations model, a conceptual model concerning the diffusion of innovation and technological acceptance, may lead to an important step in describing and capturing the essential elements of potential end-users' marketing acceptance. Leveraging the VPN concept of Gnutella through examination of the technology's strengths and weaknesses (although it is unreasonable to forecast the rate of adoption of peer-to-peer (P2P) Internet sharing characteristics) may generate useful insights to its development.

The Global Invasive Species Information Network: What's in It for You?

—probably the most widely cited scientific study on invasive species in recent years—calculated the annual costof invasive species in the United Statesalone at $138 billion per year (Pimentelet al. 2000). The total annual cost of in-vasive species to human societies world-wide can therefore be estimated to bein the hundreds of billions of dollars,including the costs of control, detri-mental effects on human health, andlosses in agricultural production andecosystem services.This enormous sumfar exceeds the combined annual cost ofall natural disasters (Munich Re Group2004), making the problem of invasivespecies in both agricultural and naturalecosystems a high-priority issue. Butthere is hope for counteracting the in-vasive species challenge, and much ofthat hope stems from new strategies be-ing developed for managing informa-tion about invasive species and theireffects.

Tricyclics vs. SSRIs in Primary Care

The cost of medication is a high-priority issue in the U.S. Tricyclic antidepressants are available in relatively inexpensive generic formulations,

Fuzzy logic controlled RED: congestion control in TCP/IP differentiated services networks

The use of the Internet for time-sensitive services, such as voice and video applications, requires a predictable quality of service. The TCP/IP differentiated services (Diff-Serv) architecture was introduced to achieve such performance. Network congestion control, however, still remains a critical and high priority issue. A number of researchers are looking at alternative schemes such as random early detection (RED) and its variants to handle congestion. In this paper we present the results of a fuzzy logic control approach to the implementation of RED --- Fuzzy-RED. We believe that with fuzzy logic we are able to use linguistic knowledge to implement better understood nonlinear probability discard functions, achieve better differentiation for packet discarding behaviors for aggregated flows, and so provide better quality of service to different kinds of traffic whilst maintaining high utilization.