Paradigm Shift In Healthcare Research Articles

Advancing Patient Care: Everyone Wins

In this issue of the Journal, 2 papers are devoted to the assessment of treatment outcomes. The first, ‘‘Using Disablement Models and Clinical Outcomes Assessment to Enable Evidence-Based Athletic Training Practice, Part I: Disablement Models,’’ addresses the theoretic foundations on which contemporary outcomes assessments are built. The second, ‘‘Using Disablement Models and Clinical Outcomes Assessment to Enable Evidence-Based Athletic Training Practice, Part II: Clinical Outcomes Assessment,’’ describes the links between disablement models and outcomes assessment. The authors discuss the need for and development of instruments used to capture the effects of injury, illness, and treatment responses from the patient’s perspective. In the accompanying commentary, the links between evidence-based athletic training practice and outcomes assessment are further highlighted. This discussion is followed by a series of recommendations that the authors believe are necessary for the further development of athletic training and recognition of the field as a health care profession. I applaud all the authors of these papers for their hard work and contributions to the Journal and the profession. I agree wholeheartedly with the recommendations they make, and I believe these papers are ‘‘must reading’’ for all those concerned about the future of the athletic training profession. Outcomes assessment and evidence-based practice are complex and multifaceted issues. Certainly athletic training is not alone in its struggles to embrace a paradigm of evidence-based medicine, described by Akai1(p731) as ‘‘equal in enormity to the human genome project.’’ There are political, educational, and research implications of a paradigm of evidence-based practice. What is sometimes overlooked when the implications of evidence-based athletic training are discussed is the fundamental need for this new paradigm. As pointed out by Snyder and colleagues, cliniciangenerated assessments cannot capture the full effects of injury or treatment on the patient’s life. Without a full evaluation of the effects of injury, illness, and treatments on impairments and functional and performance limitations, as well as on the patient’s quality of life, a true critical appraisal of health care interventions is not possible. Capturing this information is challenging and is an evolving science. However, these efforts focus on what really matters in health care: the experience of the patient. We are in an era that requires more from clinicians than simply believing that what they are doing or recommending is what is best for the patient. To the greatest extent possible, the clinician should be able to offer evidence that the recommendations made and the interventions provided are the most likely to achieve the outcomes the patient desires. Thus, as we collectively ponder the continuing evolution of evidence-based athletic training and the implications for educational programming, status as a profession, and governmental recognition, let us not forget the genesis behind the dominant paradigm shift in health care over the past 20 years: the need to apply what we learn through research to improve patient care. When the needs of and care for the patient come first, the collective effort in developing a strong foundation for the practice of evidence-based athletic training is easily recognized as time and money well spent. Moreover, recognizing athletic trainers as important members of a massive and interconnected health care team brings with it the obligation that they practice to the fullest extent of their training. By placing the patient first, everyone wins.

PET versus SPECT: strengths, limitations and challenges

The recent introduction of high-resolution molecular imaging technology is considered by many experts as a major breakthrough that will potentially lead to a revolutionary paradigm shift in health care and revolutionize clinical practice. This paper intends to balance the capabilities of the two major molecular imaging modalities used in nuclear medicine, namely positron emission tomography (PET) and single photon emission computed tomography (SPECT). The motivations are many-fold: (1) to gain a better understanding of the strengths and limitations of the two imaging modalities in the context of recent and ongoing developments in hardware and software design; (2) to emphasize that certain issues, historically and commonly thought as limitations of one technology, may now instead be viewed as challenges that can be addressed; (3) to point out that current state of the art PET and SPECT scanners can (greatly) benefit from improvements in innovative image reconstruction algorithms; and (4) to identify important areas of research in PET and SPECT imaging that will be instrumental to further improvements in the two modalities. Both technologies are poised to advance molecular imaging and have a direct impact on clinical and research practice to influence the future of molecular medicine.

The Difficulty of Making Psychology Research and Clinical Practice Relevant to Medicine: Experiences and Observations

Psychology and medicine research and practice have demonstrated substantial and unique bodies of knowledge designed to both improve patient care and respond to contemporary health care needs for use of evidence and cost consciousness. At their full potential they represent a significant paradigm shift in healthcare. Despite impressive successes, it is clear that we are just on the cusp of such a change. These findings have had limited impact and penetration into medical practice, particularly outside of academic medicine and large, organized systems of health care, and there are multiple examples of such limitations in various arenas of health care. There also appear to be common themes to such examples which provide us opportunities to consider how psychologists might move things ahead. They also suggest how our unique position in academic medicine can both limit our impact and provide ways of creating continued shifts in the healthcare paradigm.

The paradigm shift in healthcare — Overcoming challenges in giving patients access to their electronic records

As the delivery of healthcare by an increasing number of service providers becomes more complex, there is an increasing need for patients to understand their treatment plans and to compare them with what they should expect to receive. Changes in society mean that patients may now have the opportunity and desire to view their electronic health record and share it with others electronically. This is the basis of the paradigm shift in healthcare. But patients, clinicians and managers need to consider how to do this safely and responsibly. There are a number of challenges that need to be overcome including informing patients and empowering them, understanding the financial model to support this as well as the change management and data protection issues, understanding how information is recorded in the record, producing tools to encourage patients to be active participants, reducing the digital divide, enabling easy identification of high-quality information, producing a framework for enabling safe sharing of information, understanding the role of a local care record development board which helps to manage the change, enabling semantic interoperability in a global market and understanding how we can assess its success. This heralds a new era of 'real-time digital medicine'.

Baroja's Rejection of Traditional Medicine in El árbol de la ciencia

El dolor es un conocimiento. El dolor es una fuerza impulsora del progreso.1 This would mean that health includes disease, and disease includes health.2 1Pio Baroja, ‘Sufrir y pensar’ (1899), in Ob...

Is MR-guided Attenuation Correction a Viable Option for Dual-Modality PET/MR Imaging?

Habib Zaidi, PhD This is an exciting time for molecular imaging because molecular medicine is expected to lead to a revolutionary paradigm shift in health care. While the nuclear medicine community is witnessing a revolution in the practice of this specialty with the introduction of dual-modality positron emission tomography (PET) and computed tomography (CT), many groups in academic and corporate settings are focusing their efforts on the development of promising multimodality imaging technologies that will combine magnetic resonance (MR) imaging and PET components in a single gantry. One such preclinical system is described by Judenhofer et al (1) in this issue of Radiology, and different design trends have been reported in the literature (2–8). Similar design concepts are also being investigated for combined single photon emission CT (SPECT) and MR imaging instrumentation (9). The recent interest in simultaneous PET/MR imaging is not the consequence of controversies surrounding the role and clinical benefits of PET/CT (10,11) but will likely be the subject of similar critique and debates. The development of PET/MR imaging has been motivated by various factors and has several important incentives (12). First, MR imaging is used to obtain anatomic and structural images with submillimeter spatial resolution that offers better soft-tissue contrast sensitivity than that offered by CT. MR imaging has excellent contrast between white and gray matter and allows for functional imaging in brain studies, and, more importantly, it can be used to assess flow, diffusion, perfusion, and cardiac motion in one examination (13). In addition, MR imaging can be combined with MR spectroscopy to measure the regional biochemical content and to assess the metabolic status or the presence of neoplasia and other diseases in specific tissue areas. Finally, MR imaging does not involve the use of ionizing radiation; thus, it can be used without restrictions in serial studies, for pediatric studies, and in many other situations where radiation exposure is a concern. PET imaging is used to record the regional distribution of radiolabeled tracers; however, unlike MR spectroscopy, it cannot be used to distinguish the specific molecular species to which the radionuclide is attached, and, unlike MR imaging, it provides little anatomic information. While many technical problems have recently been solved, there are still several important challenges to the implementation and operation of a PET/MR imaging system that must be overcome. In comparison with x-ray CT, MR imaging typically is more costly, involves longer examination times, and produces anatomic images from which it is more difficult or at least not as straightforward to derive attenuation maps for photon correction of the emission data (14). The latter issue was not described by Judenhofer et al (1), as it has received only limited attention in the scientific literature and few investigators have addressed the problem of the use of segmented MR data to construct an attenuation map for attenuation correction purposes with PET (15). However, interest in PET/MR imaging has been the driving force behind many worthwhile research efforts recently undertaken by different research groups. The major difficulty lies in the fact that the MR signal or tissue intensity level is not directly related to electronic attenuation, which renders conversion of MR images to attenuation maps less obvious when compared with CT. It is worth emphasizing that the optimal transmission scanning technique for PET/CT (ie, CT versus radionuclide sources) is still an open issue that remains to be addressed (16). This is not an issue for PET/MR imaging because of the limited space available, and thus, placement of external Published online 10.1148/radiol.2443070092

Simultaneous PET/MR will replace PET/CT as the molecular multimodality imaging platform of choice

Suggestions for topics suitable for these Point/Counterpoint debates should be addressed to Colin G. Orton, Professor Emeritus, Wayne State University, Detroit: ortonc@comcast.net. Persons participating in Point/Counterpoint discussions are selected for their knowledge and communicative skill. Their positions for or against a proposition may or may not reflect their personal opinions or the positions of their employers.

Wellness Promotion Beliefs and Practices of Pediatric Physical Therapists

The purpose of this study was to elucidate wellness promotion beliefs and practices of pediatric physical therapists. From a random sample of 500 American Physical Therapy Association Pediatric Section active members, 257 physical therapists (51%) returned usable questionnaires designed to gather information on professional and personal wellness beliefs and practices. Descriptive statistics and chi-square analyses were performed to describe current wellness promotion practices. Most participants considered wellness multidimensional, valued wellness, and incorporated wellness practices into their personal life. Only 54.5% of respondents, however, reported incorporating wellness into pediatric physical therapy practice. A third of the respondents identified themselves as either thinking or preparing to incorporate wellness promotion into practice. Factors associated with wellness promotion were older age group, knowledge, belief that wellness promotion was a physical therapy responsibility, and participation in personal wellness lifestyle activities. The most frequent barriers cited were external factors related to resources, time, and the child/family. Current pediatric physical therapy practice reflects a more traditional model of care rather than a wellness promotion approach. With a paradigm shift in healthcare toward wellness promotion, pediatric physical therapists need to align practice with current societal needs and national healthcare campaigns. Continuing education programs that are participatory and well matched to the characteristics and needs of the attendees combined with collegial support may prove fruitful in providing pediatric physical therapists with the knowledge, motivation, and strategies needed to accomplish this goal.

Occupational Therapy and Evidence-Based Practice in Mental Health

Evidence-based practice (EBP) represents a paradigm shift in health care. This review has two aims. The first is to consider the merits of EBP, especially in respect of its use in mental health settings. The second is both to identify psychosocial interventions that have an established evidence base for effectiveness and to provide an analysis of the quality of this evidence and its implications for occupational therapy. Supported employment, family psychoeducation, assertive case management and integrated substance use treatment are examined in detail. It is proposed that occupational therapists working in mental health give priority to psychosocial interventions that are based on evidence and incorporate these into their practice. It is further proposed that, in implementing EBP, practitioners take an active evaluating position in relation to published evidence, paying particular attention to the evidence of effectiveness in equivalent clinical environments.

From death and disability to patient empowerment: an interprofessional partnership to achieve cardiovascular health in Canada.

This paper proposes a paradigm shift in health care from a focus on death and disability to one on health empowerment resulting in improved cardiovascular lifestyles for all Canadians. It describes a national interprofessional initiative to achieve this new vision in the area of cardiovascular health promotion. Achieving Cardiovascular Health in Canada (ACHIC) is a partnership of health professional associations and other health advocate groups whose vision is to promote optimal cardiovascular health (including cerebrovascular health) for all Canadians through interprofessional partnership initiatives and support systems. ACHIC's objectives are to: 1) identify system barriers and supports to cardiovascular health; 2) develop strategies that will have a positive impact on the practices of health professionals/educators in the promotion of cardiovascular health; 3) develop an interprofessional national approach to support strategies to achieve cardiovascular health in Canada; and 4) support the development and delivery of consistent, evidence-based messages by health professionals/educators for promotion of cardiovascular health.

From Death and Disability to Patient Empowerment: An Interprofessional Partnership to Achieve Cardiovascular Health in Canada

This paper proposes a paradigm shift in health care from a focus on death and disability to one on health empowerment resulting in improved cardiovascular lifestyles for all Canadians. It describes a national interprofessional initiative to achieve this new vision in the area of cardiovascular health promotion. Achieving Cardiovascular Health in Canada (ACHIC) is a partnership of health professional associations and other health advocate groups whose vision is to promote optimal cardiovascular health (including cerebrovascular health) for all Canadians through interprofessional partnership initiatives and support systems. ACHIC's objectives are to: 1) identify system barriers and supports to cardiovascular health; 2) develop strategies that will have a positive impact on the practices of health professionals/educators in the promotion of cardiovascular health; 3) develop an interprofessional national approach to support strategies to achieve cardiovascular health in Canada; and 4) support the development and delivery of consistent, evidence-based messages by health professionals/educators for promotion of cardiovascular health.

Hildegard E. Peplau: The Psychiatric Nursing Legacy of a Legend

Hildegard Peplau is remembered by nurses worldwide as the "mother of psychiatric nursing." Her scope of influence transcended her psychiatric nursing specialty and had a profound effect on the nursing profession, nursing science, and nursing practice. Peplau played a leadership role by influencing and emphasizing the advancement ofprofessional educational, and practice standards, and the importance of professional self-regulation through credentialing. She made a major contribution to nursing science, professional nursing and, of course, to the psychiatric nursing specialty through development of the Interpersonal Relations paradigm, a mid-range theory that has influenced the importance with which the nurse-patient relationship is regarded. The essential nature of the nursepatient relationship and its significance as a therapeutic modality operationalizes Peplau's scholarship and provides the basis for both the art and science of nursing practice. Peplau would challenge psychiatric nurses to thrive in the new millennium through continued commitment to the importance of the nurse-patient relationship, engagement in evidence-based practice, support of competence in information technology, and provision of leadership in influencing the health care paradigm shift to community-based health care delivery.

More questions than answers: the commodification of health care.

The changing world of health care finance has led to a paradigm shift in health care with health care being viewed more and more as a commodity. Many have argued that such a paradigm shift is incompatible with the very nature of medicine and health care. But such arguments raise more questions than they answer. There are important assumptions about basic concepts of health care and markets that frame such arguments.

Quality of Life assessment: A paradigm shift in healthcare?

The assessment of patient quality of life is assuming increasing importance in medicine and healthcare. In addition to their biological effects, illnesses, diseases and their treatments can have significant impact on mobility, mood, life satisfaction, cognition and the ability to fulfil occupational, social and family roles. The emerging quality of life construct may be viewed as a paradigm shift in outcome measurement since it shifts the focus of attention from symptoms to functioning. This holistic approach more clearly establishes the patient as the centre of attention and subsumes many of the traditional measures of outcome. This paper introduces the concept of quality of life and describes the significant difficulties in definition, measurement and interpretation that must be addressed before such measures can be used as reliable and valid indicators of disease impact and treatment outcomes. It is argued that the unique individual perspective of the patient on his or her own quality of life must be i...

A paradigm shift in health care: marketing implications for physicians in solo practice.

A paradigm shift in health care: marketing implications for physicians in solo practice.