Snake oil for the 21st century

Evidence-based medicine is the use of the best current evidence in making decisions about the care of individual patients. Practicing EBM requires recognition that in most encounters with patients, questions arise that should be answered to provide the patient with the best available medical care. Asking well-built clinical questions that contain 4 elements--a patient or problem, an intervention, a comparison intervention (if necessary), and an outcome--is an important step in practicing EMB. Once appropriate questions have been formulated, the best source for finding most types of best evidence is by searching the MEDLINE database by computer. MEDLINE searches have inherent software and operator limitations that make their reliability quite variable. One should be aware of these limitations and improve one's skills in searching. The Cochrane Collaboration Controlled Clinical Trials Registry contains more than 190,000 controlled clinical trials and is the best source of evidence about treatment. The quality (strength) of evidence is based on a hierarchy of evidence: results of systematic reviews of well-designed clinical studies, results of 1 or more well-designed clinical studies, results of large case series, expert opinion, and personal experience. Once the best evidence has been found, the EBM approach involves critically appraising the quality of the evidence, determining its magnitude and precision, and applying it to the specific patient. Guidelines to critically appraise and apply evidence are available. The clinical question, best evidence, and its critical appraisal should be saved in a format that can be easily retrieved for future use.     

Nursing and genetics for the 21st century

This article reviews basic information about the science of genetics and examines the new genetics. It explains the principles of cytogenetics and molecular genetics. Also included is information about genetic abnormalities and the different chromosomal defects that occur. The implications for nursing practice are delineated.     

Feminism: a perspective for the 21st century

This article details some of the key elements related to feminism in American society. It suggests that the meaning and significance of a feminist perspective need to be reexamined for their importance and utility in this dynamic and rapidly changing society. A discussion of the meaning of feminism provides a framework for the article. Issues related to cultural diversity and the need for competent health care delivery for all people are some major themes. The other emphasis is related to research and women. Numerous challenges are outlined. A feminist perspective is recommended as a conceptual model through which health care reform can be enhanced. If feminism were embraced, the health status of people would be improved.     

Clinical health psychology: a specialty for the 21st century

To meet its potential in the 21st century, clinical health psychology must develop an accumulated body of knowledge relevant to practice, disseminate this knowledge, use this knowledge in practice and policy, and provide appropriate education and training for future psychologists. In this Division of Health Psychology Presidential Address, the author articulates issues in each of these areas, highlighting changes in health care and problems in research as well as issues in the development of practice guidelines and policies relevant to organized psychology.     

Community health collaboration models for the 21st century

The development of partnerships with physicians and other health professionals is a key strategy to improving the community's health. This article reviews the role of nurse leaders as advocates for health care improvement and leading community improvement efforts.     

Adapting human lifestyles for the 21st century.

A number of ecological problems (e.g., global warming, ozone depletion, deforestation, acid rain) have been identified, which threaten to reduce the quality of human life in the 21st century. These problems are human produced, resulting primarily from overpopulation and overconsumption. Alterations in people's awareness, attitudes, beliefs, and behaviors may stimulate changes in their political and economic systems, which in turn might foster the kind of lifestyle changes that could mitigate these ecological problems. Psychologists can play a role in helping individuals and systems advance toward the goal of becoming a sustainable society: one that satisfies its current needs without jeopardizing the prospects of future generations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family health care delivery for the 21st century

The objective of this study was to investigate whether and how parotid saliva flow and composition correlated with the perception of gustatory and/or trigeminal stimuli in foods. Thirty (15 male and 15 female) subjects tasted seven foods or beverages (lemonade, beer, wine, soup, methyl cellulose, peanut butter, and crackers) with three levels each of a gustatory or trigeminal stimulus and rated the perceived intensity of the corresponding sensation over time using the time-intensity (TI) method while their parotid saliva was being collected. Salivary flow rates of males were significantly higher than those of females for all stimuli (p < 0.001). That did not translate, however, into consistent differences in perception of sensory attributes between males and females. Significant positive correlations were found between saliva flow and (1) TI parameters for adhesiveness of peanut butter and cohesiveness of mass of crackers (p < 0.05 or lower) and (2) time from intake to swallowing of crackers and peanut butter (p < 0.05). No correlations were found between saliva composition (e.g., sodium and total protein) and TI parameters. These results indicate that parotid saliva flow may correlate with the perception of some texture and mouthfeel attributes (presumably through oral work and bolus formation) but not with that of the taste attributes examined in this study (at the concentrations studied).     

A Head Start for the 21st century.

Social and economic conditions since the creation of Head Start in 1965 have worsened. The stresses of economic restructuring in the US and the pervasiveness of violence have severely eroded the capacity of many families to provide safe and caring homes in strong communities. The necessary adaptation of Head Start to these new conditions involves the essential linkage of early childhood and family support approaches with community economic development. This strategy must include a reappraisal of mental health paradigms that will enable children, youth, and families to be healthy and productive members of their neighborhoods and country. Although public support for Head Start remains strong, considerable rethinking about a Head Start for the 21st century is now occurring; results will affect the quality of life for the entire society. (PsycINFO Database Record (c) 2010 APA, all rights reserved)