Priority setting for health research: lessons from developing countries. The Working Group on Priority Setting.
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Research resources for addressing health problems of developing countries remain disproportionately low compared with the tremendous disease burdens borne by these countries. There is a need to focus these scarce resources on research that will optimize health benefits and lead to equity. This paper reviews processes and methods that have been used for setting research priorities. Past and current processes have focused on expert-driven research agenda, emphasizing scientific autonomy and global analyses. Methods for setting priorities have focused on the metrics of disease burdens, while less attention has been placed on who sets priorities and how choices are made. The paper proposes a strategy of priority setting, based on lessons learned from essential national health research (ENHR) approaches attempted in several developing countries. With equity in health and development as its goal, the proposed model is demand-driven, and involves multi-dimensional inputs and multiple stakeholders. Various steps of the process are discussed: getting participants involved; gathering evidence and information; determining criteria for priority setting; and implementation and evaluation. The paper concludes with a discussion of the gap between national research priorities and the research agenda set at regional and global levels, an issue that needs to be satisfactorily addressed in the future. (+info)
Judging surgical research: how should we evaluate performance and measure value?
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OBJECTIVE: To establish criteria to evaluate performance in surgical research, and to suggest strategies to optimize research in the future. SUMMARY BACKGROUND DATA: Research is an integral component of the academic mission, focusing on important clinical problems, accounting for surgical advances, and providing training and mentoring for young surgeons. With constraints on healthcare resources, there is increasing pressure to generate clinical revenues at the expense of the time and effort devoted to surgical research. An approach that would assess the value of research would allow prioritization of projects. Further, alignment of high-priority research projects with clinical goals would optimize research gains and maximize the clinical enterprise. METHODS: The authors reviewed performance criteria applied to industrial research and modified these criteria to apply to surgical research. They reviewed several programs that align research objectives with clinical goals. RESULTS: Performance criteria were categorized along several dimensions: internal measures (quality, productivity, innovation, learning, and development), customer satisfaction, market share, and financial indices (cost and profitability). A "report card" was proposed to allow the assessment of research in an individual department or division. CONCLUSIONS: The department's business strategy can no longer be divorced from its research strategy. Alignment between research and clinical goals will maximize the department's objectives but will create the need to modify existing hierarchical structures and reward systems. Such alignment appears to be the best way to ensure the success of surgical research in the future. (+info)
The role of behavioral and psychosocial science in reducing cancer morbidity and mortality.
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Behavioral and psychosocial science has the potential to contribute much to the overall effort to reduce cancer morbidity and mortality and to improve the quality of life for cancer patients and their families. However, for a variety of reasons, including a lack of sustained funding for research and training and a lack of confidence by some in the potential payoff for investments in the area, this potential has not only not been realized but also not been adequately explored. A special subcommittee of "The March" Research Task Force studied research in this area and issued a report making several recommendations for future funding for psychosocial and behavioral research in cancer. This article reports those recommendations and the reasons the committee supported them. (+info)
Research in primary care: extent of involvement and perceived determinants among practitioners from one English region.
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The lack of research evidence relevant to and generated by general practitioners (GPs) has been a concern in the context of a putative primary care-led National Health Service (NHS). However, very little has been published on the current extent or determinants of research activity among United Kingdom primary care doctors. We surveyed all (n = 2770) service GPs in the West Midlands Region in order to quantify their research involvement and to explore determinants of this. The response rate was 49% (n = 1351). A total of 84% of responders reported participating in research or audit, with 16% having initiated their own research; 9% of GPs had been published in a peer-reviewed journal; 6% had generated research funding; and 3% had held a research training fellowship. The characteristics positively associated with initiating research included an involvement in teaching, having research-active partners, the availability of protected time, and working in a larger practice. The most commonly perceived barriers to undertaking research were lack of time (92%), lack of staff to collect data (73%), and a lack of funding (71%). In all, 41% of responders reported no interest in research. Overall, the extent of research activity among responding GPs appears to be greater than is often assumed. Recent NHS research and development proposals to strengthen and develop research in primary care are, therefore, relevant in highlighting changes to address these issues. (+info)
Impact of the National Cancer Act on grant support.
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The National Cancer Act of 1971 resulted in a threefold increase in appropriations for the National Cancer Institute (NCI) within a 4-year period. A major effect was the increase for the Grants Program from +93 million in fiscal year 1970 to more than +280 million in 1974. Grant programs, administered by the Division of Cancer Research Resources and Centers, account for more than 50% of the total NCI extramural research budget and fall into four broad categories: research, training (including fellowships), cancer control, and construction. With the exception of the training area, funding for all grant programs has increased dramatically as a result of the Act. The ocst of research has also risen, as reflected in the average twofold increase in cost per NCI traditional grant over the past 10 years. This rise in cost is due to a number of factors, including inflation, more sophisticated equipment and supplies and, in some cases, more ambitious projects. The principal type of research grants include traditional awarded for investigator-initiated research projects, and center, awarded for comprehensive and specialized cancer centers. While support for traditional grants has remained in the forefront of NCI funding, money for cancer center grants has increased at a greater rate in recent years, reflecting emphasis on the development of cancer centers throughout the country. Compared to other institutes at the NIH, NCI is in a very favorable funding position; in fiscal year 1974 NCI awarded more money for its research grant programs than all of the other institutes (with the exception of the National Heart and Lung Institue) obligated for their entire budgets. The Act has stimulated a large increase in new cancer applications received, and the increased funding has made it possible for NCI to award a greater number of grants. Young investigators have competed well for the additional monies made available by the Act and funding for cancer research outside the United States, still only a small part of NCI's budget, has increased. (+info)
Mapping cancer, cardiovascular and malaria research in Brazil.
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This paper presents performance indicators for the Brazilian cancer, cardiovascular and malaria research areas from 1981 to 1995. The data show an increasing number of papers since 1981 and author numbers indicate a continuous growth of the scientific community and suggest an expected impact of scientific activity on biomedical education. The data also characterize cardiovascular research as a well-established area and cancer research as a faster growing consolidating field. The 1989-1994 share of Brazilian articles among world publications shows a growing trend for the cancer (1.61) and cardiovascular (1.59) areas, and a decrease for the malaria area (0. 89). The burden of the three diseases on society is contrasted by the small number of consolidated Brazilian research groups, and a questionable balance of thematic activity, especially with regard to malaria. Brazilian periodicals play an important role in increasing the international visibility of science produced in the country. Cancer and cardiovascular research is strongly concentrated in the Southeastern and in Southern regions of Brazil, especially in Sao Paulo (at least one address from Sao Paulo in 64.5% of the 962 cancer articles and in 66.9% of the 2250 cardiovascular articles, the second state being Rio de Janeiro with at least one address in 14.1 and 11% of those articles, respectively). Malaria research (468 articles) is more evenly distributed across the country, following the pattern of the endemic distribution of the disease. Surveying these national indicator trends can be useful to establish policies in the decision process about health sciences, medical education and public health. (+info)
Queen's University alternative funding plan. Effect on patients, staff, and faculty in the Department of Family Medicine.
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OBJECTIVE: To determine the effect of the Queen's University alternative funding plan (AFP) on the Department of Family Medicine in terms of patient, staff, and faculty satisfaction; patient encounter logistics; clinical volume; and academic activity. DESIGN: Before-after study. SETTING: Department of Family Medicine at Queen's University of Kingston, Ont. PARTICIPANTS: Patients, faculty, and staff of the Department of Family Medicine's Family Medicine Centre. INTERVENTIONS: The AFP of Queen's University. MAIN OUTCOME MEASURES: Patient satisfaction, staff and faculty job satisfaction, patient waiting time, time spent with patients, patient volume, number of publications, and amount of research funding obtained by faculty members. These outcomes were measured before the AFP began (time 0), 1 year post-AFP (time 1), and 2.5 years post-AFP (time 2). RESULTS: In some categories patients' satisfaction decreased at time 1, but in all cases it was either unchanged or improved at time 2. Staff and faculty job satisfaction did not change over time. Patients spent less time in the waiting room at time 2 than at time 0. Patient volume dropped about 10% between time 0 and time 2. Publication rate did not change, but external research funding increased significantly during the study period. CONCLUSION: The AFP has improved academic productivity, decreased patient volume by 10%, and improved patient flow during clinics. No negative effects on patient satisfaction or on job satisfaction of staff or faculty are apparent. (+info)
The National Institutes of Health agenda for international research in micronutrient nutrition and infection interactions.
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Nutrition is a central public health concern in the twenty-first century. Previous international research in nutrition was primarily descriptive epidemiology and included large-scale intervention trials. There has been insufficient attention to the mechanisms by which nutrient supplements appear to reduce mortality and little specificity in application and delineation of the forms of a specific nutrient to maximize benefits and minimize adverse affects and on the effect of nutrient combinations. After the dramatic success of the green revolution, agricultural research support was reduced despite an expanding world population and an increasing need for agricultural products. The potential of molecular genetics to improve food quality, specific nutrient content, and yield and disease resistance has just begun to be explored. In addition, the development of edible vaccines as a way to immunize a greater proportion of the world's children is a highly desirable goal and is achievable with sufficient resources. (+info)