Priority setting and rehabilitation research
Rehabilitation is one of the most recently recognized fields of medicine and dates much of its history to the period when medicine was required to respond to the needs of the last century’s polio survivors and injured war veterans. The field’s evolution was extraordinary. Nevertheless, even today its practice and research remain fragmented and frequently incorporated into programs that may, or may not, always share its goals. (In the U.S., for example, at least 11 NIH divisions (National Institutes of Health) as well as a few other federal agencies share responsibility for supporting rehabilitation research.) The inefficiencies inherent in this fragmentation could not continue. Populations are aging; 1 of 6 people have a significant disability; funding is limited; and people expect to remain active longer than ever before. The result is that rehabilitation is being forced to prioritize its efforts; improve its evidence base; defend the economic basis of its treatments; and compete for funding with other medical interests. Priorities, unfortunately, are never easy to establish as they require redirection and the sacrifice of well established activities and modes of thought. Choices are easiest when they can be based on objective evidence alone. Unfortunately, they seldom are and priorities with implications for society as a whole, are typically the product of a consensus process that is only in part scientific, with the rest requiring a more political and subjective balancing of personal, professional and societal values. Choices seem especially difficult in rehabilitation where our constituency is huge and our goal of an accurate and uniform means of quantifying function has yet to be achieved. The above forces have resulted in the formation of a variety of priority setting symposiums and forums that were composed of individuals representing a gamut of clients, healthcare providers, researchers, clinicians, payers and policy makers. It is instructive, that while each may have differed in focus, they tended to identify a limited number of common needs which consist of: ABSTRACT Rehabilitation has a history of being considered a necessary evil by the rest of medicine; its results are costly and its existence emphasizes the limits of medical care. Nevertheless, the field’s acceptance is increasing as lifespans lengthen and the burden of chronic and disabling diseases becomes more apparent. However, with recognition comes responsibility. We can no longer merely complain about being underappreciated. Rather, we are now being forced to improve the care we provide, prioritize our goals and develop the scientific basis to support them. However, priorities are difficult to establish and maybe particularly so in rehabilitation, where the goal, improving function, is so wide ranging and our treatments so individualized. This brief paper is designed to review the factors involved in establishing rehabilitation research priorities and note that when goals are defined broadly, a number of panels have emphasized the need for a focus on improving mobility; developing and uniformly applying better metrics; conducting better outcome studies and increasing our research infrastructure. Priority setting and rehabilitation research JR Basford1
Priorities for stroke rehabilitation and research: results of a 2003 Canadian Stroke Network consensus conference.
The Canadian Stroke Network Consensus Conference panel met in 2003 in Toronto, Canada, to address areas of stroke rehabilitation that require additional research as well as increased efforts to knowledge translation. The results of an extensive literature review, of a study of factors related to poststroke quality of life, and a survey of clinicians were presented to the panel. From this review, the panel compiled a consensus list of 5 priority areas in stroke rehabilitation research that warrant further investigation. The priorities are: (1) multimodal programs for reintegration into the community; (2) rehabilitation of patients with severe strokes; (3) the ideal timing and intensity of aphasia therapy; (4) cognitive rehabilitation; and (5) and the timing and intensity of rehabilitation after mild-to-moderate stroke. The panel recommended that agencies that fund research create special competitions to support large, multicenter randomized controlled studies to investigate these areas of research. In addition, the panel identified 3 priority areas for knowledge translation where research was convincing: (1) lower-extremity (leg) interventions; (2) upper-extremity (arm) interventions; and (3) detection of clients who are at risk of complications, specifically depression, dysphagia, or cognitive impairment, as well as those at risk for falls and pressure ulcers.
Mastering Web Services Security
Acknowledgments. Foreword. Introduction. Overview of Web Services Security. Web Services. Getting Started with Web Services Security. XML Security and WS-Security. Security Assertion Markup Language. Principles of Securing Web Services. Security of Infrastructures for Web Services. Securing .NET Web Services. Securing Java Web Services. Interoperability of Web Services Security Technologies. Administrative Considerations for Web Services Security. Planning and Building a Secure Web Services Architecture. Glossary. References. Index.