Top ten biotechnologies for improving health in developing countries.

Most research into genomics and other related biotechnologies is concerned with the priorities of industrialized nations, and yet a limited number of projects have shown that these technologies could help improve health in developing countries. To encourage the successful application of biotechnology to global health, we carried out a study in which we asked an international group of eminent scientists with expertise in global health issues to identify the top ten biotechnologies for improving health in developing countries. The results offer concrete guidance to those in a position to influence the direction of research and development, and challenge common assumptions about the relevance and affordability of biotechnology for developing countries.

Ethical issues related to cardiac report cards.

Health care report cards are gaining a high profile among policy makers, clinicians and the public, and are most well developed in the context of cardiac care. Although there are important ethical issues relevant to developing and implementing cardiac report cards, there currently is no explicit examination of these issues. As a consequence, outcomes researchers lack ethical guidance while designing and implementing cardiac report cards. This paper will examine four key ethical issues related to cardiac report cards: quality, informed consent, equity and legitimacy. Cardiac report cards may help improve the quality of cardiac care, help cardiac patients make informed decisions and guide interventions to enhance regional equity in cardiac care. To achieve these important goals, different types of report cards may be required. However, to achieve these goals, cardiac report cards must be legitimate. To push forward the report card initiative, a close relationship among stakeholders is encouraged, ie, among those developing cardiac report cards, those whom report cards evaluate and the intended audiences of report cards.

Anticoagulation management in remote primary care.

OBJECTIVE: To examine anticoagulation management at the Bella Coola Medical Clinic in British Columbia. DESIGN: Charts of all patients in the Bella Coola Valley receiving warfarin were assessed. Data were analyzed using Microsoft Excel. SETTING: Bella Coola Medical Clinic on the remote central coast of British Columbia. PARTICIPANTS: Twenty-one patients at the Bella Coola Medical Clinic who were receiving warfarin. MAIN OUTCOME MEASURES: All international normalized ratio (INR) tests over the preceding 12 months were examined for results, time elapsed since previous test, and interval until next scheduled test. RESULTS: An in-range INR rate of 60% is considered acceptable for anticoagulation services. The clinic had performed 406 INR tests on these 21 patients over the last 12 months. We found that 53% of all INR results fell strictly within the recommended therapeutic range. The relative success of anticoagulation management in Bella Coola probably results from several factors. For instance, physicians usually responded to out-of-range INR results with close monitoring: in 71% of cases, follow-up tests were scheduled within 1 week. On average, patients attended 77% of these visits on schedule; 58% of all out-of-range INR results were followed up with retesting within 1 week. CONCLUSION: Our results suggest that primary care physicians can manage anticoagulation adequately, even in remote settings.