Careful study of medical informatics research and library-resource projects is necessary to increase the productivity of the research and development enterprise. Medical informatics research projects can present unique problems with respect to evaluation. It is not always possible to adapt directly the evaluation methods that are commonly employed in the natural and social sciences. Problems in evaluating medical informatics projects may be overcome by formulating system development work in terms of a testable hypothesis; subdividing complex projects into modules, each of which can be developed, tested and evaluated rigorously; and utilizing qualitative studies in situations where more definitive quantitative studies are impractical.
The rapid accumulation of data through increasingly sophisticated computer technology has created an unprecedented information explosion which might better be called an ignorance explosion. Data gathering emphasizing quantity rather than quality, speed of transmission rather than reliability or relevance, poses a challenge to the future of librarianship. Two concerns are discussed: (1) Relationship of technology to the information age. Librarians must be concerned with the methodology used in data collection, including the value judgments reflected in this activity. (2) Preparation of medical librarianship for the future. The profession will grow only as a result of individual effort, the recognition of people, and an appreciation of human values. Thus far, attempts to evaluate needs focus on technology while neglecting research into the human aspect. The author proposes that dimensions of the total professional model for medical librarianship must include research, as well as education and practice. The need to aid in the development of library researchers at the Ph.D. level through a National Library of Medicine program similar to that offered to researchers by the National Institutes of Health is stressed. By way of federal assistance and scholarships made available through national library associations...
A database containing descriptive information on ongoing research projects in family practice has been developed by the Huffington Library of the Family Health Foundation of America. Between May 1983 and April 1985, 460 research projects and 661 researchers were added to the database. The data were gathered by a questionnaire sent to departments of family medicine, family practice residencies, and state chapter offices of the American Academy of Family Physicians. The projects in the database are described in several dimensions: funding sources; study categories; research design; data sources; study setting; gender and ages studied; and project topics, analyzed broadly by Medical Subject Heading terms.
Seroreactivity of sera from 109 patients with first-infection primary syphilis was 98.2% in the fluorescent treponemal antibody absorption test, 92.7% in the rapid plasma reagin 18-mm circle card test, 72.5% in the microhemagglutination test (MHA-TP), and 72.5% in the Venereal Disease Research Laboratory test. Seroreactivity of sera from 18 patients with primary syphilis with documented previous infection(s) was 100% in the fluorescent treponemal antibody absorption test, the rapid plasma reagin 18-mm circle card test, and the MHA-TP test and 88.9% in the Venereal Disease Research Laboratory test. The MHA-TP test failed to confirm reactivity in 13 of 79 sera which were reactive in the Venereal Disease Research Laboratory test and in 24 of 101 sera which were reactive in the rapid plasma reagin 18-mm circle card test. Testing another production lot of MHA-TP reagents resulted in even poorer correlation. The reactivity of the MHA-TP test in primary syphilis appeared to vary with the sensitivity of the production lot of reagents.
A multidisciplinary team approach with focused objectives characterizes research at Baylor College of Medicine into the causes, prevention, and treatment of atherosclerotic disease. Current clinical activities range from programs to modify lifestyle for the primary prevention of coronary artery disease to a large, angiographically monitored lipid-lowering trial. In basic research, much attention has been focused on the plasma lipoproteins and their roles in atherogenesis. The current review highlights recent advances in ongoing basic research involving 1) apolipoprotein (apo) B, whose form apo B-100 serves as a ligand for the low-density lipoprotein receptor; 2) lipoprotein[a], elevated plasma levels of which are predictive of atherosclerotic disease; and 3) transplantation arteriopathy, which impedes long-term survival of cardiac transplant recipients.
Problems with case ascertainment in epidemiological research on multiple sclerosis (MS) make it necessary to use indirect sources. However, there is a lack of information about the characteristics of cases drawn from different sources and thus little basis on which sampling frames for large scale surveys may be constructed. The characteristics of a population drawn from the membership of Action for Research into Multiple Sclerosis (ARMS) were compared with those of 10 other British MS populations reported between 1980 and 1987. Demographic variables examined were geographical location, nationality, ethnicity, sex ratio and age. Diagnostic status, age at diagnosis and duration since diagnosis were considered together with data on the comparative populations based on date of onset. On all the variables investigated the ARMS population fell close to or within the range shown by the comparative populations. The relative youth of the ARMS population and its bias towards a high proportion of females were differences in keeping with existing knowledge about the membership of mutual support organisations. A population drawn from such an organisation may usefully complement other MS research populations provided that the likely biases in each are understood.
STUDY OBJECTIVE--The aims were: (1) to identify methodological problems that may explain the inconsistencies and contradictions in the research evidence on social support and health, and (2) to validate a frequently used measure of social support in order to determine whether or not it could be used in multivariate analyses of population data in research on social support and health. DESIGN AND METHODS--Secondary analysis of data collected in a cross sectional survey of a multistage cluster sample of the population of the United States, designed to study relationships in behavioural, social support and health variables. Statistical models based on item response theory and graph theory were used to validate the measure of social support to be used in subsequent analyses. PARTICIPANTS--Data on 1755 men and women aged 20 to 64 years were available for the scale validation. RESULTS--Massive evidence of item bias was found for all items of a group membership subscale. The most serious problems were found in relationship to an item measuring membership in work related groups. Using that item in the social network scale in multivariate analyses would distort findings on the statistical effects of education, employment status, and household income. Evidence of item bias was also found for a sociability subscale. When marital status was included to create what is called an intimate contacts subscale...
OBJECTIVE: To propose an initial agenda for a systematic international research strategy designed to meet the information needs of injury prevention worldwide. CRITERIA FOR INCLUSION AND EXCLUSION OF ARTICLES: The world literature since 1977 was surveyed to obtain an overview of the current research effort on injury epidemiology and prevention. Articles were cited to illustrate the breadth and nature of work published on the topic with special reference to the prevention of home and traffic injuries. CONCLUSIONS: There has been a recent upsurge of interest in injury prevention, although much of the work has been descriptive rather than analytical or evaluative. The implementation of existing knowledge has been patchy. To meet the information needs of effective injury prevention, several elements of an international research agenda are proposed. These include: the achievement of a consensus on terminology, definition, and classification; clarification of the roles of social deprivation, gender, risk taking behaviour, personality, stress, alcohol, drugs, chronic illness, and disability in the aetiology of injury; the development of multi-agency models of good injury prevention practice; the evaluation of counter-measures; the development and evaluation of routine injury surveillance systems.
Purchasing health care is at the core of the reforms of the UK NHS and yet there is little research evidence on which the policy is based. Research in this area is hampered by a lack of clarity over the aims of purchasing and the pace of change within the NHS. Purchasing developments such as general practice fund-holding are proceeding without a large scale evaluation of their impact. At a national level a research effort is required to investigate this key area of the NHS reforms.
Mr. Zamberlan is one of seven major executives in the Department of Veterans Affairs (VA) Veterans Health Services and Research Administration (VHS&RA), directing health care in a five-state region that includes 21 medical centers, 7 outpatient clinics, and 19 veterans outreach centers. As a medical center director in the 1970s, he was one of the earliest advocates for using health services research to support executive decision making and was the first medical center director selected to serve on the VA HSR&D Research Advisory Committee. In this editorial, Mr. Zamberlan outlines his perspective on HSR&D in VA and relates it to the activities of the HSR&D Field Program in the region he directs, which is based at the VA Medical Center in Ann Arbor, MI.
This paper reviews available data describing issues and research findings with implications for hospital closings. Factors contributing to fiscal problems of hospitals (e.g., inadequate reimbursement, inflation, management problems, organizational structure, societal factors) are discussed. Selected studies offering examples of hospital and community characteristics associated with closure are presented. This review suggests that future directions for research should focus not only on hospital cost control but also on insuring equity in the distribution of hospital services. Specifically, research is needed that further describes the hospital closure phenomenon, the effects of closure, and the policy choices that might be pursued to insure equity in the continuation of hospital services to disadvantaged populations.
OBJECTIVE. This study examined ways in which race/ethnicity has been conceptualized and used in the health services research literature as published in Health Services Research (HSR). DATA SOURCE. All articles published in HSR from its inception in 1966 to 1990. STUDY DESIGN. The analyses were restricted to U.S.-based empirical research on humans or in which human population characteristics are described. This study identifies the terms used for race and/or ethnicity, the frequency with which they occur, and the purposes for which they are utilized. PRINCIPAL FINDINGS. The study documents that race/ethnicity is widely used in the health services literature to stratify or adjust results and to describe the sample or population of the study. Terms used for race are seldom defined and race is frequently employed in a routine and uncritical manner to represent ill-defined social and cultural factors. CONCLUSIONS. Researchers and practitioners must give more careful attention to the conceptualization and measurement of race. An understanding of racial/ethnic differences in patterns of health service utilization will require efforts to catalog and quantify the specific social and cultural factors that are differentially distributed by racial and ethnic status.
OBJECTIVE: To discuss the value of promoting coexistent and complementary relationships between qualitative and quantitative research methods as illustrated by presentations made by four respected health services researchers who described their experiences in multi-method projects. DATA SOURCES: Presentations and publications related to the four research projects, which described key substantive and methodological areas that had been addressed with qualitative techniques. PRINCIPAL FINDINGS: Sponsor interest in timely, insightful, and reality-anchored evidence has provided a strong base of support for the incorporation of qualitative methods into major contemporary policy research studies. In addition, many issues may be suitable for study only with qualitative methods because of their complexity, their emergent nature, or because of the need to revisit and reexamine previously untested assumptions. CONCLUSION: Experiences from the four projects, as well as from other recent health services studies with major qualitative components, support the assertion that the interests of sponsors in the policy realm and pressure from them suppress some of the traditional tensions and antagonisms between qualitative and quantitative methods.
An attempt to achieve an agreed set of priorities for research in occupational medicine was undertaken by the Delphi technique. Fifty three senior practitioners of occupational medicine in academe (25) and industry or government (28) were canvassed about their views and choices for priority activity. Forty six (86%) responded to the initial enquiry and 48 (91%) provided rank order choices from a second, more detailed questionnaire. The first priority for more research on the natural history of work related ill health identified musculoskeletal disorders of the back and upper limbs followed by asthma, accidents, skin disorders, vibration induced disease, suicide and depression, and finally hearing loss. The second priority area was audit and particularly the need for its use in occupational health screening procedures. Environmental impact of industrial activity was third with the community health effects being more important than individual health effects. Stress related disease was fourth with emphasis on risk factors. The fifth area was neuropsychological effects of work exposures particularly the need for more research on diagnostic tests. Other assorted areas of concern were the cost effectiveness of occupational health, risk assessment...
A historical cohort study was carried out in an agricultural research institute in the Republic of Ireland to investigate a perceived excess of cancer deaths among employees. The objectives of the study were (a) to confirm whether or not total or cause specific death rates among selected employees were higher than expected based on national figures, and to quantify any excess, and (b) to identify centres and employee grades associated with any excess risk. The cohort comprised all administrative, research, and technical staff employed for at least two years between 1960 and 1980, giving a final total for analysis of 1323 employees. Employment history was categorised by place of work and employment grade. Deaths among the cohort were identified and causes of deaths verified. Overall the cohort had a lower than expected mortality compared with national rates (O/E = 0.67). Female deaths were too few for analysis but, among the male employees, there was an excess of all cancers (O/E = 1.24; 95% confidence interval (95% CI) 0.8-1.9), in particular brain cancer (O/E = 4.69; 95% CI 1.2-11.4) and bladder cancer (O/E = 9.31, 95% CI 1.9-27.2). The pattern of brain tumour deaths was consistent with an occupational aetiology but it was not possible to identify specific exposures associated with the excess. All four cases occurred among research workers in the plant and soil science area. The pattern of bladder cancers was difficult to interpret. The authors are at present participating in a multicentre study to further investigate cancer risk in laboratory workers.
OBJECTIVES: To achieve a coherent programme of topics for research in occupational health and safety, with well founded priorities and to relate them to perceived gaps and needs in The Netherlands. METHODS: In the first phase of the study 33 key informants were interviewed. In the second phase questionnaires were sent to 150 Dutch experts (including the key informants). Four groups were recruited, originating from: occupational health and safety services; scientific research institutes; governmental and other administrative bodies; and companies. Using the Delphi technique, the experts were asked to prioritize several topics, which were placed under different headings. In the third phase five workshops were organised to elaborate on the highly prioritized topics. RESULTS: The response rates were 86% for the first and 81% for the second questionnaire. In the second round consistency was reached and consensus proved to be satisfactory; so that the Delphi process was stopped. There were surprisingly few differences in opinion between the four groups. The most important heading was "design/implementation/evaluation of measures", in which the topic cost-benefit analysis of measures had the highest score. "Assessment of relations between exposure and effect" was the second most important heading. Under this heading...
Research activity in primary care is increasing rapidly, and raises a range of specific ethical issues. Many of these relate to the involvement of individuals in the community who are not seeking medical care and to the impact of research participation on relationships between general practitioners and their patients. The ethical issues pertinent to a range of quantitative and qualitative research methodologies in primary care are identified and considered.
There is need for the assessment of long-term effects of outdoor air pollution. In fact, a considerable part of the large amount of U.S. research money that has been dedicated to investigate effects of ambient particulate pollution should be invested to address long-term effects. Studies that follow the health status of large numbers of subjects across long periods of time (i.e., cohort studies) should be considered the key research approach to address these questions. However, these studies are time consuming and expensive. We propose efficient strategies to address these questions in less time. Apart from long-term continuation of the few ongoing air pollution cohort studies in the United States, data from large cohorts that were established decades ago may be efficiently used to assess cardiorespiratory effects and to target research on detection of the most susceptible subgroups in the population, which may be related to genetic, molecular, behavioral, societal, and/or environmental factors. This approach will be efficient only if the available air pollution monitoring data will be used to spatially model long-term outdoor pollution concentrations across a given country for each year with available pollution data. Such concentration maps will allow researchers to impute outdoor air pollution levels at any residential location...
In the last decade four international agreements have focused on a group of chemical substances known as persistent organic pollutants (POPs). Global agreement on the reduction and eventual elimination of these substances by banning their production and trade is a long-term goal. Negotiations for these agreements have focused on the need to correlate data from scientists working on soil and water sampling and air pollution monitoring. Toxicologists and epidemiologists have focused on wildlife and human health effects and understanding patterns of disease requires better access to these data. In the last 20 years, substantial databases have been created and now are becoming available on the Internet. This review is a detailed examination of 2 of the 12 POPs, aldrin and dieldrin, and how scientific groups identify and measure their effects. It draws on research findings from a variety of environmental monitoring networks in the United States. An overview of the ecologic and health effects of aldrin and dieldrin provides examples of how to streamline some of the programs and improve access to mutually useful scientific data. The research groups are located in many government departments, universities, and private organizations. Identifying databases can provide an "information accelerator" useful to a larger audience and can help build better plant and animal research models across scientific fields.
Activists in the environmental justice movement are challenging expert-driven scientific research by taking the research process into their own hands and speaking for themselves by defining, analyzing, and prescribing solutions for the environmental health hazards confronting communities of the poor and people of color. I highlight the work of El Puente and The Watchperson Project--two community-based organizations in the Greenpoint/Williamsburg neighborhood in Brooklyn, New York, that have engaged in community-based participatory research (CBPR) to address asthma and risks from subsistence-fish diets. The CBPR process aims to engage community members as equal partners alongside scientists in problem definition, information collection, and data analysis--all geared toward locally relevant action for social change. In the first case I highlight how El Puente has organized residents to conduct a series of asthma health surveys and tapped into local knowledge of the Latino population to understand potential asthma triggers and to devise culturally relevant health interventions. In a second case I follow The Watchperson Project and their work surveying subsistence anglers and note how the community-gathered information contributed key data inputs for the U.S. Environmental Protection Agency Cumulative Exposure Project in the neighborhood. In each case I review the processes each organization used to conduct CBPR...