Are medical informatics and nursing informatics distinct disciplines? The 1999 ACMI debate.

The 1999 debate of the American College of Medical Informatics focused on the proposition that medical informatics and nursing informatics are distinctive disciplines that require their own core curricula, training programs, and professional identities. Proponents of this position emphasized that informatics training, technology applications, and professional identities are closely tied to the activities of the health professionals they serve and that, as nursing and medicine differ, so do the corresponding efforts in information science and technology. Opponents of the proposition asserted that informatics is built on a re-usable and widely applicable set of methods that are common to all health science disciplines, and that "medical informatics" continues to be a useful name for a composite core discipline that should be studied by all students, regardless of their health profession orientation.

Show me the money: funding informatics research.

About 60% of medical informatics papers published in the proceedings of recent AMIA Fall symposia acknowledge receiving some support from American sources for the work. Two-thirds of those citing support include NLM as one of the donors. Papers in JAMIA have even higher funding rates. Funding rates for published informatics papers compare well with papers in a number of other fields. Although medical informatics receives support from a wide variety of sources, the federal government, through the various organizations within DHSS, is clearly the major source of grant and contract support for this field. Within DHSS, NLM is the most frequently cited donor by a large margin. Yet to be determined are the relative dollar values of the support provided by the various donors cited, the difficulty of obtaining funding for informatics projects, the means by which unfunded projects are sustained, and the variation, if any, in the funding success rates of the subfields of informatics.

Managing information technology in academic medical centers: a "multicultural" experience.

Based on a session at the 1997 conference on Information Resources and Academic Medicine sponsored by the Association of American Medical Colleges, this article illustrates how the beliefs and concerns of academic medicine's diverse professional cultures affect the management of information technology. Two scenarios--one dealing with the standardization of desktop PCs, the other with publication of syllabi on an institutional intranet--form the basis of this exercise. Four prototypical members of a hypothetical medical center community--the chairman of surgery, a senior basic scientist, the chief information officer of an affiliated hospital, and the chief administrative officer--offer their perspectives on each scenario. Their statements illustrate many of the challenges of planning, deploying, and maintaining effective information technology in the "multicultural" environment of academic medical centers.

Airborne fiber concentrations during splitting open and boxing bags of asbestos.

Measured airborne concentrations of asbestos are often unavailable to assess different epidemiologic estimates of past personal exposure levels or concentrations near specific operations involving handling asbestos. The purpose of this study was to assess the potential use of a laboratory study in estimating exposure to asbestos in operations that ceased for many years. The asbestos transfer operations were simulated by splitting and boxing 4.5-kg paper bags of chrysotile asbestos in an enclosed chamber ventilated at 28.2 air changes per hour (ACH). Two recirculation fans achieved chamber air mixing. The airborne concentration of asbestos fibers was determined by sampling air through membrane filters at a rate of 10 l/min and by analysing fibers by phase contrast optical microscopy to determine 15-min average airborne concentrations. Samplers were located at four equidistant locations from the operation. Opening a maximum of seven bags in 15 min was associated with an asbestos-in-air concentration of less than 2 x 10(-6) fibers/m3 (f/m3) in splitting open and boxing and less than 0.85 x 10(-6) f/m3 in boxing of pre-split bags. The measured airborne asbestos concentration exhibited a linear trend with the number of bags opened per 15 min. The empirical results were utilised to model fiber concentrations for various ventilation rates. It was concluded that the distribution of the operation within the workday and the ventilation rate are the two most important variables in the determination of the estimated time-weighted average concentration. Splitting open and boxing 32 bags of asbestos over an 8-h period at a rate of 4 bags/h over an 8-h period results in a calculated time-weighted average exposure of about 1 x 10(-6) f/m3 in a work space with 20 ACH and approximately 7 x 10(-6) f/m3 in a work space with 2 ACH. Splitting open and boxing at a rate of 12 bags/h for 2 h and 45 min yielded calculated concentrations less than one-half of the above mentioned values. These results should serve as a useful benchmark for epidemiologists concerned with the magnitude of exposure in historically dusty industrial tasks.

Lymphedema management training for physical therapy students in the United States.

BACKGROUND: The objective of this study was to determine to what extent accredited physical therapy programs in the United States were presenting the principles of lymphedema management and whether regional differences existed. METHODS: States were grouped into four geographic regions: Northeast, South, Midwest, and West. From mid-June to mid-July, 1997, 63 of 148 (42.6%) accredited physical therapy (PT) programs in the United States completed and returned the questionnaires. Participants received a cover letter, consent form, and lymphedema survey by e-mail, facsimile, or regular post. The lymphedema survey covered a wide variety of issues relating to five areas: 1) general and 2) specific anatomy and physiology of the lymphatic system, 3) pathogenesis of lymphedema, 4) traditional (compression pumps/garments), and 5) innovative (European/Australian) treatment techniques for lymphedema. "Yes" responses indicated that specific information was included in the curriculum. Frequency of yes responses for each of the five areas were counted and converted into percentages. Regional responses were compared with the total combined responses with a modified binomial technique. RESULTS: PT programs in the United States were providing 89% of our designated content in the general anatomy and physiology of the lymphatic system, 73% in the pathogenesis of lymphedema, 65% in traditional treatment techniques, 48% in innovative treatment techniques, and 42% in the specific anatomy and physiology of the lymphatic system. No individual region differed significantly (P > 0.05) from the combined results. CONCLUSIONS: The participating PT programs appeared to be providing instruction in general anatomy and physiology of the lymphatic system, pathogenesis of lymphedema, and traditional treatment techniques. However, far less instruction on the specific anatomy and physiology of the lymphatic system and innovative treatment techniques is offered. We believe that PT students would benefit with more curricular content in these latter two categories in order to acquire the knowledge and skills to combat the devastating effects of lymphedema.

Asbestos exposure of building maintenance personnel.

The exposures of building maintenance personnel and occupants to airborne asbestos fibers, and the effects of operations and maintenance programs on those exposures, continue to be an important public health issue. The subject of this investigation was a large metropolitan county with numerous public buildings which routinely conducted air sampling for asbestos. A total of 302 personal air samples in nine task categories collected during maintenance worker activities in proximity to asbestos-containing materials were analyzed; 102 environmental air samples in four task categories were also analyzed. The arithmetic means of the 8-hr time weighted average exposures for personal sampling for each task category were all below the Occupational Safety and Health Administration permissible exposure level of 0.1 fibers (f)/cc > 5 microm. The highest mean 8-hr time weighted average exposure was 0.030 f/cc > 5 microm for ceiling tile replacement. The maximum asbestos concentration during sample collection for environmental samples was 0.027 f/cc > 5 microm. All asbestos-related maintenance work was done within the framework of an Operations and Maintenance Program (OMP) which utilized both personal protective equipment and controls against fiber release/dispersion. Results are presented in association with specific OMP procedures or controls. These results support the effectiveness of using Operations and Maintenance Programs to manage asbestos in buildings without incurring unacceptable risk to maintenance workers performing maintenance tasks.

Ethylene glycol ethers and risks of spontaneous abortion and subfertility.

Potential reproductive effects from occupational exposures to ethylene glycol ethers (EGE) are of concern since these organic solvents have been used widely in industry, and their reproductive toxicity has been well documented in animal studies. For determination of whether occupational exposure to EGE was associated with increased risks of spontaneous abortion and subfertility (i.e., taking more than 1 year of unprotected intercourse to conceive), a retrospective cohort study was conducted among workers at two semiconductor manufacturing plants in the eastern United States in 1980-1989 as part of a larger evaluation of reproductive health. Reproductive and occupational histories were obtained from interviews of semiconductor manufacturing workers and spouses. Assessment of potential exposure to mixtures containing EGE (none, low, medium, and high) was based on reported processes and company records. There were 1,150 pregnancies to semiconductor manufacturers, 561 to female employees and 589 to wives of male employees. Among female manufacturers, potential exposure to mixtures containing EGE was associated with increased risks of spontaneous abortion (relative risk in the high exposure group = 2.8; 95% confidence interval (CI) 1.4-5.6) and subfertility (odds ratio in the high exposure group = 4.6; 95% CI 1.6-13.3). Both of these risks exhibited a dose-response relation with potential EGE exposure (p for trend = 0.02). Among spouses of male manufacturers potentially exposed to mixtures containing EGE, there was no increased risk of spontaneous abortion, but there was a nonsignificant increased risk of subfertility (odds ratio in the high exposure group = 1.7; 95% CI 0.7-4.3).

Changing approaches to assessment of environmental inhalation risk: a case study.

Approaches to assessing environmental inhalation risk from asbestos have undergone profound change. In addition to social and political changes, a number of factors have come into play: 1. new technologies 2. new measuring instruments 3. new biological data 4. increased utilization of asbestos 5. regulatory imperatives 6. a redefinition of health risks associated with asbestos. This has occurred over a period of little more than 60 years. Early air-sampling instruments were developed to measure particles and fibers in air. Because asbestosis was a fibrotic disease, all measurements quantitated fibrotic disease risk in the environment by focusing on fibers and particles. Subsequently, the understanding that asbestos forms only fibers in air refocused measurement on fibers, not fibers and particles. As research clarified which fibers reached the lungs, new ways to sample and evaluate air were required. At the same time, changes in understanding of the disease process created the need for a better way to measure risk. In the 1960s, acceptance of the knowledge that asbestos causes both cancer (based on the no threshold assumption for carcinogens) and fibrosis raised the question of which fiber sizes should be measured and what the standard should be. The scientific assumption, prevailing both in 1985-86 and today, of a linear nonthreshold dose-response curve for carcinogens was applied to estimates of risk for asbestos exposure in the workplace, which led OSHA to lower the U.S. standard. In summary, we have attempted to illustrate the close link between state-of-the-art scientific and technical knowledge and policy decisions to control a toxic substance in industrial society. In the best of all possible worlds the science should permit valid estimates of risk and construct measurement techniques that lead to the desired control. If awareness comes early, then the process of policy making should be an iterative one, with incrementally more restrictive control as knowledge of the toxicant improves. The imperative for control of asbestos, as with many other toxic materials, was regulation, not science. That, however, is another story. Regulation of the workplace environment activated use of the science that permits valid estimates of risk and the techniques for measurement and control. The evolving science became part of the debates on control and constantly refocused them. Setting acceptable workplace exposure levels to control inhalation risk from asbestos did not occur on a wide scale until after 1970.(ABSTRACT TRUNCATED AT 400 WORDS)

Hazard prevention and control in the work environment. Report of a WHO meeting.

On the 19-21 September 1994 an international meeting of experts was convened at the World Health Organization office in Geneva. The result of this meeting was the formation of the PACE working group. PACE stands for 'Prevention And Control Exchange'. It is a programme designed to stimulate the sharing of solutions and control measures in order to reduce occupational hazards. Internationally there is wide agreement on the need for sharing of knowledge and a realisation that a collaborate effort is required.