A review of policy dissemination and implementation research funded by the National Institutes of Health, 2007–2014

BACKGROUND: Policy has a tremendous potential to improve population health when informed by research evidence. Such evidence, however, typically plays a suboptimal role in policymaking processes. The field of policy dissemination and implementation research (policy D&I) exists to address this challenge. The purpose of this study was to: (1) determine the extent to which policy D&I was funded by the National Institutes of Health (NIH), (2) identify trends in NIH-funded policy D&I, and (3) describe characteristics of NIH-funded policy D&I projects. METHODS: The NIH Research Portfolio Online Reporting Tool was used to identify all projects funded through D&I-focused funding announcements. We screened for policy D&I projects by searching project title, abstract, and term fields for mentions of “policy,” “policies,” “law,” “legal,” “legislation,” “ordinance,” “statute,” “regulation,” “regulatory,” “code,” or “rule.” A project was classified as policy D&I if it explicitly proposed to conduct research about the content of a policy, the process through which it was developed, or outcomes it produced. A coding guide was iteratively developed, and all projects were independently coded by two researchers. ClinicalTrials.gov and PubMed were used to obtain additional project information and validate coding decisions. Descriptive statistics—stratified by funding mechanism, Institute, and project characteristics—were produced. RESULTS: Between 2007 and 2014, 146 projects were funded through the D&I funding announcements, 12 (8.2 %) of which were policy D&I. Policy D&I funding totaled $16,177,250, equivalent to 10.5 % of all funding through the D&I funding announcements. The proportion of funding for policy D&I projects ranged from 14.6 % in 2007 to 8.0 % in 2012. Policy D&I projects were primarily focused on policy outcomes (66.7 %), implementation (41.7 %), state-level policies (41.7 %), and policies within the USA (83.3 %). Tobacco (33.3 %) and cancer (25.0 %) control were the primary topics of focus. Many projects combined survey (58.3 %) and interview (33.3 %) methods with analysis of archival data sources. CONCLUSIONS: NIH has made an initial investment in policy D&I research, but the level of support has varied between Institutes. Policy D&I researchers have utilized a variety of designs, methods, and data sources to investigate the development processes, content, and outcomes of public and private policies. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13012-015-0367-1) contains supplementary material, which is available to authorized users

An adolescent girl with signs and symptoms of anaphylaxis and negative immunologic workup: a case report.

BackgroundThe increasing incidence of allergies and allergic reactions among children and adults has become a major public health concern. The etiology of allergic reactions can often be confirmed based on a detailed history and supportive testing. However, there are cases where the underlying factors are more complex and difficult to identify.Case presentationHere we present the case report of a 14-year-old Caucasian  girl with weight loss and a 3-year history of reported angioedema culminating in five intensive care unit admissions over the course of 2.5 months. Her initial clinical presentation included hypotension, dyspnea, and reported facial edema, but allergy and immunological workup were negative. A psychiatric workup identified an eating disorder with food restriction, comorbid major depression, obsessive compulsive disorder, and posttraumatic stress disorder. A close collaboration between Adolescent Medicine, Allergy and Immunology, and Psychiatry helped disentangle medical from psychiatric problems, including fluoxetine medication effects, as well as develop a treatment plan that was acceptable to the family. The angioedema was ultimately diagnosed as factitious disorder.ConclusionsThis patient's treatment highlights the importance of a multidisciplinary team approach, a multifactorial etiology that needed to be addressed by multiple specialists, and the importance of long-term treatment and support

Designing Drugs for Parasitic Diseases of the Developing World

McKerrow outlines three new strategies, all originating within academic centers, that provide a new drug pipeline for treating parasitic diseases

The Origins of Covid-19 — Why It Matters (and Why It Doesn’t)

When Health emergencies arise, scientists seek to discover the cause — such as how a pathogen emerged and spread — because this knowledge can enhance our understanding of risks and strategies for prevention, preparedness, and mitigation. Yet well into the fourth year of the Covid-19 pandemic, intense political and scientific debates about its origins continue. The two major hypotheses are a natural zoonotic spillover, most likely occurring at the Huanan Seafood Wholesale Market, and a laboratory leak from the Wuhan Institute of Virology (WIV). It is worth examining the efforts to discover the origins of SARS-CoV-2, the political obstacles, and what the evidence tells us. This evidence can help clarify the virus’s evolutionary path. But regardless of the origins of the virus, there are steps the global community can take to reduce future pandemic threats

Global Governance and the Limits of Health Security

The Ebola outbreak in West Africa has exposed the limits of the current approach to the global governance of infectious diseases, which mixes public health and security interests. International efforts to strengthen ‘health security’ quickly faltered when confronted with weak national health systems. Costly attempts by Western governments to strengthen global health security by developing new medical countermeasures, though important, did not yield a single, effective, widely available treatment or vaccine before the outbreak occurred. The World Health Organization (WHO), which had made strengthening global health security a strategic objective, was unable to marshal a rapid international response to the epidemic due to its institutional structure and recent cutbacks in its outbreak and emergency response department. In the end, governments could only try to get ‘ahead’ of the disease via a heavily militarised response that came too late for the thousands who have already died, that remains of uncertain sustainability, and that raises profound challenges for already stretched armed forces. The time has come to move from a focus on health security and international crisis response, to a system of global governance capable of addressing infectious disease outbreaks in an orderly, organised and sustainable manner.UK Department for International Developmen

APPROPRIATE EMPIRICAL MANAGEMENT OF MICROBIAL INFECTIONS IN A TERTIARY CARE HOSPITAL: A COST- EFFECTIVENESS APPROACH.

 Objective: Antibiotics are mostly prescribed empirically to decrease health-care costs. This has led to the misuse of antibiotics thereby making them inefficient in the treatment of infections. The aim of this study was to determine the appropriate, cost-effective drug for the empirical therapy in microbial infections.Methods: A prospective observational study was conducted for a period of 6 months. Cost-effectiveness ratio (CER) of these antibiotics prescribed was calculated to determine the cost-effective drugs for the common microorganisms and common infections.Results: In a population of 205 patients, 54.6% were treated based on antibiotic sensitivity pattern whereas 45.3% were treated empirically. In known microbial infections, the prevailing microorganism was extended-spectrum beta-lactamase (ESBL) producing Escherichia-coli (14.3%), Staphylococcus aureus (10.6%), Pseudomonas aeruginosa (9.8%), Klebsiella pneumonia (9.8%), and K. pneumoniae ESBL (6.81%). Based on the CER, the most cost-effective drugs for these organisms were found to be ciprofloxacin, clindamycin, ofloxacin, levofloxacin, and amikacin, respectively. In unknown microbial infection (empirical treatment), Diabetic Foot Infection (DFT) (25.8%), respiratory tract infection (RTI) (23.6%), and urinary tract infection (UTI) (16.1%) were the most common infections. The most cost-effective drugs for these infections were clindamycin, levofloxacin, and azithromycin, respectively. The predominant microorganism in DFT was found to be S. aureus (71%), in UTI was found to be E. coli ESBL (52%), and in RTI were found to be P. aeruginosa (42.4%) and K. pneumonia (32.3%).Conclusion: Appropriate empirical antibiotic treatment is associated with a lower medical cost and a better success rate in patients with microbial infections