bluuebunny/crossref_metadata_2025 huggingface dataset:
Demand for emergency health service: factors associated with inappropriate use
Authors: Carret Maria LV , Fassa Anaclaudia G , Kawachi Ichiro
Published: August 2007

Background

The inappropriate use of emergency room (ER) service by patients with non-urgent health problems is a worldwide problem. Inappropriate ER use makes it difficult to guarantee access for real emergency cases, decreases readiness for care, produces negative spillover effects on the quality of emergency services, and raises overall costs.

Methods

We conducted a cross-sectional study in a medium-sized city in southern Brazil. The urgency of the presenting complaint was defined according to the Hospital Urgencies Appropriateness Protocol (HUAP). Multivariable Poisson regression was carried out to examine factors associated with inappropriate ER use.

Results

The study interviewed 1,647 patients over a consecutive 13-day sampling period. The prevalence of inappropriate ER use was 24.2% (95% CI 22.1–26.3). Inappropriate ER use was inversely associated with age (P = 0.001), longer stay in the waiting room, longer duration of symptoms and morning shift. However, the determinants of inappropriate ER use differed according age groups (P value for interaction = 0.04). Within the younger age-group (15–49 years), inappropriate ER use was higher among females, patients who reported visiting the ER because there was no other place to go, patients reporting that the doctor at the regular place of care refused to attend to them without a prior appointment, and individuals who reported that the PHC clinic which they use is open for shorter periods during the day. Among older patients (50+ years), those with highest level of education, absence of self-reported chronic diseases and lack of social support were more likely to engage in higher inappropriate ER use.

Conclusion

Efforts should be made to redirect inappropriate ER demand. Besides expanding access to, and improving the quality of primary and secondary care, it is important to mobilize social support for older patients, to enhance the relationship between different levels of care, as well as to develop campaigns to educate the public about the appropriate use of medical services.
Thottapalayam virus is genetically distant to the rodent-borne hantaviruses, consistent with its isolation from the Asian house shrew (Suncus murinus)
Authors: Yadav Pragya D , Vincent Martin J , Nichol Stuart T
Published: August 2007

Thottapalayam (TPM) virus belongs to the genus Hantavirus, family Bunyaviridae. The genomes of hantaviruses consist of three negative-stranded RNA segments (S, M and L) encoding the virus nucleocapsid (N), glycoprotein (Gn, Gc), and polymerase (L) proteins, respectively. The genus Hantavirus contains predominantly rodent-borne viruses, with the prominent exception of TPM virus which was isolated in India in 1964 from an insectivore, Suncus murinus, commonly referred to as the Asian house shrew or brown musk shrew. Analysis of the available TPM virus S (1530 nt) RNA genome segment sequence and the newly derived M (3621 nt) and L (6581 nt) segment sequences demonstrate that the entire TPM virus genome is very unique. Remarkably high sequence differences are seen at the nucleotide (up to S – 47%, M – 49%, L – 38%) and protein (up to N – 54%, Gn/Gc – 57% and L – 39%) levels relative to the rodent-borne hantaviruses, consistent with TPM virus having a unique host association.
CD117 immunoexpression in canine mast cell tumours: correlations with pathological variables and proliferation markers
Authors: Gil da Costa Rui M , Matos Eduarda , Rema Alexandra , Lopes Célia , Pires Maria A , Gärtner Fátima
Published: August 2007

Background

Cutaneous mast cell tumours are one of the most common neoplasms in dogs and show a highly variable biologic behaviour. Several prognosis tools have been proposed for canine mast cell tumours, including histological grading and cell proliferation markers. CD117 is a receptor tyrosine kinase thought to play a key role in human and canine mast cell neoplasms. Normal (membrane-associated) and aberrant (cytoplasmic, focal or diffuse) CD117 immunoexpression patterns have been identified in canine mast cell tumours. Cytoplasmic CD117 expression has been found to correlate with higher histological grade and with a worsened post-surgical prognosis. This study addresses the role of CD117 in canine mast cell tumours by studying the correlations between CD117 immunoexpression patterns, two proliferation markers (Ki67 and AgNORs) histological grade, and several other pathological variables.

Results

Highly significant (p < 0,001) correlations were found between CD117 immunostaining patterns and histological grade, cell proliferation markers (Ki67, AgNORs) and tumoral necrosis. Highly significant (p < 0,001) correlations were also established between the two cellular proliferation markers and histological grade, tumour necrosis and epidermal ulceration. A significant correlation (p = 0.035) was observed between CD117 expression patterns and epidermal ulceration. No differences were observed between focal and diffuse cytoplasmic CD117 staining patterns concerning any of the variables studied.

Conclusion

These findings highlight the key role of CD117 in the biopathology of canine MCTs and confirm the relationship between aberrant CD117 expression and increased cell proliferation and higher histological grade. Further studies are needed to unravel the cellular mechanisms underlying focal and diffuse cytoplasmic CD117 staining patterns, and their respective biopathologic relevance.
The influence of smoking and other risk factors on the outcome after radiochemotherapy for anal cancer
Authors: Mai Sabine Kathrin , Welzel Grit , Haegele Verena , Wenz Frederik
Published: August 2007

Background

Smoking is an important risk factor for the development of cancer. Smoking during radiochemotherapy therapy may have a negative influence on prognosis. We evaluated the effect of smoking during radiochemotherapy on the outcome for patients with anal cancer.

Methods

Sixty-eight patients (34 smokers, 34 non-smokers) treated by radiochemotherapy for anal cancer were analysed. The effect of smoking during radiochemotherapy and other risk factors (gender, T- and N category, tumor site, dose, therapy protocol) on disease-specific survival (DSS), local control (LC) and colostomy free survival (CFS) was evaluated.

Results

There was a significant difference in age and male:female ratio between the two groups. With a median follow up of 22 months (max. 119) DSS, LC, and CFS were 88%, 84% and 84%. A significant difference in local control between smokers (S) and non-smokers (NS) was found (S 74% vs. NS 94%, p = .03). For DSS and CFS a difference in terms of outcome between smokers and non-smokers was seen (DSS: S 82% vs. NS 96%, p = .19, CFS: S 75% vs. 91%, p = .15), which did not reach statistical significance. In multivariate analyses only gender had a significant association with LC and T category with CFS. The other risk factors did not reach statistical significance.

Conclusion

Even though our evaluation reached statistical significance only in univariate analysis, we suggest, that the role of smoking during radiochemotherapy for anal cancer should not be ignored. The potential negative effect on prognosis should be explained to patients before therapy.
Combined sterno-clavicular approach as an alternative technique in hybrid exclusion of aortic arch aneurysm
Authors: Protopapas Aristotle D , Rao Christopher , Choong Andrew , Cheshire Nicholas JW , Athanasiou Thanos
Published: August 2007

Background

We describe a modified access technique for the proximal (open) part of single stage hybrid exclusion of aneurysm of the aortic arch.

Case presentation

3 patients had a bifurcated Dacron graft for the innominate and left subclavian arteries and an additional end-to-side anastomosis of the left common carotid artery on the limb to the left subclavian artery. With our modification, access to the left subclavian artery is by left subclavicular incision and creation of an anterior tunnel via the left thoracic outlet from the origin of the left subclavian artery along its anatomical course to the subclavicular plane.

Discussion

Advantages and disadvantages of this technique in relation to anatomy and pathology.
Species-specific shifts in centromere sequence composition are coincident with breakpoint reuse in karyotypically divergent lineages
Authors: Bulazel Kira V , Ferreri Gianni C , Eldridge Mark DB , O'Neill Rachel J
Published: August 2007

Background

It has been hypothesized that rapid divergence in centromere sequences accompanies rapid karyotypic change during speciation. However, the reuse of breakpoints coincident with centromeres in the evolution of divergent karyotypes poses a potential paradox. In distantly related species where the same centromere breakpoints are used in the independent derivation of karyotypes, centromere-specific sequences may undergo convergent evolution rather than rapid sequence divergence. To determine whether centromere sequence composition follows the phylogenetic history of species evolution or patterns of convergent breakpoint reuse through chromosome evolution, we examined the phylogenetic trajectory of centromere sequences within a group of karyotypically diverse mammals, macropodine marsupials (wallabies, wallaroos and kangaroos).

Results

The evolution of three classes of centromere sequences across nine species within the genus Macropus (including Wallabia) were compared with the phylogenetic history of a mitochondrial gene, Cytochrome b (Cyt b), a nuclear gene, selenocysteine tRNA (TRSP), and the chromosomal histories of the syntenic blocks that define the different karyotype arrangements. Convergent contraction or expansion of predominant satellites is found to accompany specific karyotype rearrangements. The phylogenetic history of these centromere sequences includes the convergence of centromere composition in divergent species through convergent breakpoint reuse between syntenic blocks.

Conclusion

These data support the 'library hypothesis' of centromere evolution within this genus as each species possesses all three satellites yet each species has experienced differential expansion and contraction of individual classes. Thus, we have identified a correlation between the evolution of centromere satellite sequences, the reuse of syntenic breakpoints, and karyotype convergence in the context of a gene-based phylogeny.
PyCogent: a toolkit for making sense from sequence
Authors: Knight Rob , Maxwell Peter , Birmingham Amanda , Carnes Jason , Caporaso J Gregory , Easton Brett C , Eaton Michael , Hamady Micah , Lindsay Helen , Liu Zongzhi , Lozupone Catherine , McDonald Daniel , Robeson Michael , Sammut Raymond , Smit Sandra , Wakefield Matthew J , Widmann Jeremy , Wikman Shandy , Wilson Stephanie , Ying Hua , Huttley Gavin A
Published: August 2007

We have implemented in Python the COmparative GENomic Toolkit, a fully integrated and thoroughly tested framework for novel probabilistic analyses of biological sequences, devising workflows, and generating publication quality graphics. PyCogent includes connectors to remote databases, built-in generalized probabilistic techniques for working with biological sequences, and controllers for third-party applications. The toolkit takes advantage of parallel architectures and runs on a range of hardware and operating systems, and is available under the general public license from http://sourceforge.net/projects/pycogent.
Quantitative genomics of locomotor behavior in Drosophila melanogaster
Authors: Jordan Katherine W , Carbone Mary Anna , Yamamoto Akihiko , Morgan Theodore J , Mackay Trudy FC
Published: August 2007

Background

Locomotion is an integral component of most animal behaviors, and many human health problems are associated with locomotor deficits. Locomotor behavior is a complex trait, with population variation attributable to many interacting loci with small effects that are sensitive to environmental conditions. However, the genetic basis of this complex behavior is largely uncharacterized.

Results

We quantified locomotor behavior of Drosophila melanogaster in a large population of inbred lines derived from a single natural population, and derived replicated selection lines with different levels of locomotion. Estimates of broad-sense and narrow-sense heritabilities were 0.52 and 0.16, respectively, indicating substantial non-additive genetic variance for locomotor behavior. We used whole genome expression analysis to identify 1,790 probe sets with different expression levels between the selection lines when pooled across replicates, at a false discovery rate of 0.001. The transcriptional responses to selection for locomotor, aggressive and mating behavior from the same base population were highly overlapping, but the magnitude of the expression differences between selection lines for increased and decreased levels of behavior was uncorrelated. We assessed the locomotor behavior of ten mutations in candidate genes with altered transcript abundance between selection lines, and identified seven novel genes affecting this trait.

Conclusion

Expression profiling of genetically divergent lines is an effective strategy for identifying genes affecting complex behaviors, and reveals that a large number of pleiotropic genes exhibit correlated transcriptional responses to multiple behaviors.
MicroRNAs show a wide diversity of expression profiles in the developing and mature central nervous system
Authors: Kapsimali Marika , Kloosterman Wigard P , de Bruijn Ewart , Rosa Frederic , Plasterk Ronald HA , Wilson Stephen W
Published: August 2007

Background

MicroRNA (miRNA) encoding genes are abundant in vertebrate genomes but very few have been studied in any detail. Bioinformatic tools allow prediction of miRNA targets and this information coupled with knowledge of miRNA expression profiles facilitates formulation of hypotheses of miRNA function. Although the central nervous system (CNS) is a prominent site of miRNA expression, virtually nothing is known about the spatial and temporal expression profiles of miRNAs in the brain. To provide an overview of the breadth of miRNA expression in the CNS, we performed a comprehensive analysis of the neuroanatomical expression profiles of 38 abundant conserved miRNAs in developing and adult zebrafish brain.

Results

Our results show miRNAs have a wide variety of different expression profiles in neural cells, including: expression in neuronal precursors and stem cells (for example, miR-92b); expression associated with transition from proliferation to differentiation (for example, miR-124); constitutive expression in mature neurons (miR-124 again); expression in both proliferative cells and their differentiated progeny (for example, miR-9); regionally restricted expression (for example, miR-222 in telencephalon); and cell-type specific expression (for example, miR-218a in motor neurons).

Conclusion

The data we present facilitate prediction of likely modes of miRNA function in the CNS and many miRNA expression profiles are consistent with the mutual exclusion mode of function in which there is spatial or temporal exclusion of miRNAs and their targets. However, some miRNAs, such as those with cell-type specific expression, are more likely to be co-expressed with their targets. Our data provide an important resource for future functional studies of miRNAs in the CNS.
Randomized Dose-Ranging Trial of Tamoxifen at Low Doses in Hormone Replacement Therapy Users
Authors: Decensi Andrea , Gandini Sara , Serrano Davide , Cazzaniga Massimiliano , Pizzamiglio Maria , Maffini Fausto , Pelosi Giuseppe , Daldoss Cristina , Omodei Umberto , Johansson Harriet , Macis Debora , Lazzeroni Matteo , Penotti Mauro , Sironi Laura , Moroni Simona , Bianco Vanda , Rondanina Gabriella , Gjerde Jennifer , Guerrieri-Gonzaga Aliana , Bonanni Bernardo
Published: August 2007

Purpose

The combination of hormone replacement therapy (HRT) and low-dose tamoxifen may retain the benefits while reducing the risks of either agent. We assessed the optimal biologic dose and schedule of tamoxifen in HRT users using surrogate end point biomarkers and menopausal symptoms.

Subjects and Methods

Two hundred ten current or de novo HRT users were randomly assigned to one of the following four arms: tamoxifen 1 mg/day and placebo/week, placebo/day and tamoxifen 10 mg/week, tamoxifen 5 mg/day and placebo/week, or both placebos for 12 months. The primary end point was the change of plasma insulinlike growth factor 1 (IGF-I) through 12 months, and secondary end points were IGF-I/IGF binding protein-3 (IGFBP-3) ratio, fibrinogen, antithrombin III, C reactive protein, C-telopeptide, mammographic percent density, and endometrial thickness. Endometrial proliferation was assessed by Pipelle biopsy in superficial, deep glandular, and stromal compartments after 12 months.

Results

Compared with placebo, IGF-I declined in all tamoxifen arms (P = .005), with a greater change on 5 mg/day (P = .019 v 10 mg/week or 1 mg/day). Tamoxifen increased IGFBP-3 and lowered antithrombin-III, C reactive protein, and mammographic density, with greater effects of 5 mg/day. Tamoxifen increased endometrial thickness but not Ki-67 expression, which was lower on 5 mg/day among the three doses. Menopausal symptoms were not significantly worsened by tamoxifen.

Conclusion

Doses of tamoxifen ≤ 5 mg/day modulate favorably biomarkers of breast carcinogenesis and cardiovascular risk in HRT users with no increase of endometrial proliferation and menopausal symptoms. A dose of 5 mg/day was the most effective and has been selected for a phase III trial in HRT users.
Drugstore personnel's management of a tuberculosis suspect: consideration of actual and perceived management
Authors: Rojpibulstit Malee , Chongsuvivatwong Virasakdi
Published: August 2007

Objective

To explore drugstore personnel's knowledge and practice on management of a suspected case of tuberculosis (TB).

Method

Seventy randomly selected drugstores in Songkhla province of Southern Thailand were visited by simulated clients (SCs) who asked for medication for relieving a one-month cough with fever. All questions asked by the drugstore personnel, advice given and drugs dispensed were noted and analysed. The drugstores were subsequently visited and the managers were interviewed.

Key findings

For the SC study, 55 out of 70 (79%) drugstore personnel took a history before dispensing drugs, but only 14 (20%) asked about cough duration. Only four drugstore personnel identified TB as a possible diagnosis for a case with one-month cough and fever, and only three recommended the SC to see a doctor. From the interviews, 46 (66%) perceived the probability of encountering TB at their workplace to be low. The knowledge on symptoms of suspected TB was poor. Sixty-eight (97%) would suspect TB if and only if the client with prolonged cough also had tiredness, weight loss, difficulty breathing or haemoptysis. In contrast to their practice with the SC, 46 (66%) claimed that they would recommend a client with one-month cough and fever to see a doctor.

Conclusions

The majority of drugstore personnel failed to detect suspected TB cases and did not give a proper referral. Interventions to educate drugstore personnel to recognise symptoms of suspected TB and to become aware in TB epidemics in this setting are urgently needed.
The benefits of providing benefit information in a patient information leaflet
Authors: Bersellini Elisabetta , Berry Diane
Published: August 2007

Objective

To examine the effects of providing two different types of written information about medicine benefits in a patient information leaflet (PIL).

Setting

Participants were 358 adult volunteers from the general population recruited from a London railway station and central Reading.

Method

The study used a controlled empirical methodology in which people were given a hypothetical, but realistic, scenario about visiting their doctor and being prescribed medication. They then read an information leaflet about the medicine that contained neither, one, or both benefit statements, and finally completed a number of Likert rating scales. Outcome measures included perceived satisfaction and helpfulness of the information, effectiveness and appropriateness of the medicine, benefit and risk to health, and intention to comply.

Key findings

Both types of benefit information led to significantly higher ratings on all of the measures taken.

Conclusions

Provision of a relatively short ‘benefit’ statement can significantly improve people's judgements and intention to take a medicine. The findings are important and timely as the European Union is currently considering reviewing their regulations to allow for the inclusion of limited non-promotional benefit information in PILs.
Reducing medication errors: perceived information needs of healthcare practitioners
Authors: Warner Bruce , Gerrett David
Published: August 2007

Objective

The aim of this study was to determine the perceived information needs of healthcare practitioners (HCPs) in relation to reducing medication error.

The objectives were to gather, identify and list relevant perceptions from medical and pharmaceutical HCPs in primary and secondary settings. Progressive data reduction and refining techniques were used to identify the key perceived issues for consideration in information transfer so as to minimise medication error.

Setting

One acute NHS foundation trust in Southern Derbyshire, one acute NHS foundation trust in Sheffield and one primary care trust in Sheffield.

Method

Following ethical and managerial approval, 30 semi-structured interviews guided by hypothetical case-based scenarios were undertaken with: medical prescribers in secondary care general medicine and care of the elderly; medical prescribers in primary care; hospital pharmacists; and, community pharmacists. Following a thematic analysis of transcripts using NUDist software, a series of summary statements was established. These were ranked by HCPs according to their perceptions of the relative importance to the research objective. Key statements, as determined by the kappa test of agreement, were identified and further refined to produce questions that were explored at a multidisciplinary focus group in July 2005.

Key findings

Data analysis identified that it was of paramount importance there should be a minimum dataset, including diagnosis, medication and rationale behind medication changes, which should be available to all HCPs involved in the medication aspects of a patient's care. This core information should be overseen by a multidisciplinary working party. Access to additional information should be determined on an individual basis. Further it was important that the gatekeeper of patient-specific information should normally be the general practitioner, in conjunction with properly informed and counselled patients wherever possible.

Conclusion

Medical and pharmaceutical HCPs have a clear understanding of the complex issues concerning availability of patient information, and critically agree the need to share information. If HCPs are able to share relevant patient information then there is an understanding that medication error will be minimised.
Occupational stress of hospital pharmacists in South Africa
Authors: Rothmann Sebastiaan , Malan Madelaine
Published: August 2007

Objective

To investigate the construct validity and reliability of the Pharmacist Stress Inventory (PSI) and to identify occupational stressors for hospital pharmacists in South Africa.

Method

A cross-sectional survey design was used. Exploratory factor analyses, descriptive statistics, and multivariate analysis were used to analyse the results. The PSI was developed as a measuring instrument and administered together with a biographical questionnaire.

Setting

A stratified random sample (n = 187) of pharmacists in South African hospitals was studied.

Key findings

Three internally consistent factors, namely job demands, pharmacy-specific stressors and lack of resources were extracted. The level of severity of the various stressors was calculated, and it seems that unavailability of medicine is the stressor that has the highest level of severity. Other stressors that had high severity ratings include: frequent interruptions, poorly motivated coworkers, high levels of workload and insufficient salaries. The type of pharmacy influenced the levels of stress experienced.

Conclusion

The levels of stress currently experienced by South African hospital pharmacists need to be identified and addressed in order to reduce the stress experienced and improve the quality of work life for these individuals.
Analgesic users' sources of medicine information
Authors: Närhi Ulla , Helakorpi Satu
Published: August 2007

Objective

To identify the sources of medicine information used by Finnish analgesic users. Method A questionnaire on health behaviour was sent to a random sample (n = 5000) of 15–64-year-old Finnish adults in 2005. The respondents were asked to list the sources of medicine information (both self-medication and prescription medicines) used by them. Only those respondents who had used only analgesics during the week prior to the study were included.

Key findings

The response rate was 66%, and 15% of those (n = 502) had used only analgesics during the previous week. Doctors (35%), patient information leaflets (PILs) (33%), and pharmacists (33%) were the most common sources of medicine information. Other sources were nurses (9%), relatives and friends (7%), advertisements (4%), internet (4%), radio and TV (3%), newspapers and books (3%) and health food stores (1%). Almost half of the respondents (49%) had not received medicine information from health professionals. Women reported PILs, pharmacists, newspapers and books as sources of medicine information more often than men. The differences were statistically significant.

Conclusions

Analgesic-only users seem not to receive much medicine information from health professionals, which may be a risk especially with self-medication. Women seem to have more sources of medicine information than men.
Reallocating resources: how should the National Institute for Health and Clinical Excellence guide disinvestment efforts in the National Health Service?
Authors: Pearson Steven , Littlejohns Peter
Published: August 2007

The recent acute budgetary pressures within the English National Health Service (NHS) have accentuated calls for targeted disinvestment thereby eliminating ineffective or low-value services to provide resources that can be reallocated toward more cost-effective purposes. This challenge extends beyond allocating new resources wisely, a goal that has been, since its inception, the primary focus of the National Institute for Health and Clinical Excellence (NICE). But on 6 September 2006, the Department of Health announced a new mandate for NICE to help the NHS identify interventions that are not effective.

This paper discusses current NICE efforts to support value in the NHS and then explores the policy options available to the Institute as it prepares to launch a programme to meet the NHS request for guidance on disinvestment. All of the possible options present challenges. NICE will need to collaborate in new ways with partners inside, and perhaps outside, the NHS. However, the Institute has an established reputation for rigour, transparency and political durability that makes it well qualified to sustain public support in the face of difficult decisions. Disinvestment will provide a stern test of these qualities.
Inter-rater reliability of case-note audit: a systematic review
Authors: Lilford Richard , Edwards Alex , Girling Alan , Hofer Timothy , Di Tanna Gian Luca , Petty Jane , Nicholl Jon
Published: August 2007

Objective: The quality of clinical care is often assessed by retrospective examination of case-notes (charts, medical records). Our objective was to determine the inter-rater reliability of case-note audit.

Methods: We conducted a systematic review of the inter-rater reliability of case-note audit. Analysis was restricted to 26 papers reporting comparisons of two or three raters making independent judgements about the quality of care.

Results: Sixty-six separate comparisons were possible, since some papers reported more than one measurement of reliability. Mean kappa values ranged from 0.32 to 0.70. These may be inflated due to publication bias. Measured reliabilities were found to be higher for case-note reviews based on explicit, as opposed to implicit, criteria and for reviews that focused on outcome (including adverse effects) rather than process errors. We found an association between kappa and the prevalence of errors (poor quality care), suggesting alternatives such as tetrachoric and polychoric correlation coefficients be considered to assess inter-rater reliability.

Conclusions: Comparative studies should take into account the relationship between kappa and the prevalence of the events being measured.
Do patients value continuity of care in general practice? An investigation using stated preference discrete choice experiments
Authors: Turner David , Tarrant Carolyn , Windridge Kate , Bryan Stirling , Boulton Mary , Freeman George , Baker Richard
Published: August 2007

Objectives: To estimate the relative importance to patients of continuity of care compared with other aspects of a primary care consultation.

Methods: We carried out a discrete choice experiment in Leicestershire and London on a stratified random sample of 646 community dwelling adults taken from general practitioner (GP) registers, plus 20 interviews with Punjabi, Urdu and Gujarati speakers. The attributes examined were: the type of professional consulted, relational continuity, informational continuity and access.

Results: Individuals' values changed according to their reason for making a primary care consultation. If consulting for minor familiar symptoms, individuals would be prepared to trade off one extra day's wait to see a GP rather than a nurse, 0.9 days for relational continuity, and 1.6 days for informational continuity. If consulting for a new condition they were uncertain about, they would be prepared to trade off an additional wait of 3.5 days to see a GP rather than a nurse, 2.4 days for relational continuity and 3.9 days for informational continuity. For a routine check-up, an individual would be prepared to trade off an additional wait of 3.5 days to see a GP rather than a nurse, 4.2 days for relational continuity and 7.8 days for informational continuity.

Conclusions: Respondents stated their preference to wait longer to see a familar medical practitioner who was well informed about their case when they had a problem causing uncertainty or needed a routine check-up. They preferred quick access for likely minor 'low impact' symptoms. Appointment systems in general practice should be sufficiently flexible to meet these different preferences.
Impact of patients' socioeconomic status on the distance travelled for hospital admission in the English National Health Service
Authors: Propper Carol , Damiani Michael , Leckie George , Dixon Jennifer
Published: August 2007

Objectives: To compare the distances travelled for inpatient treatment in England between electoral wards prior to the introduction of a policy to extend patient choice and to consider the impact of patients' socio-economic status.

Methods: Using Hospital Episode Statistics for 2003–04, the distance from a patient's residence to a National Health Service hospital was calculated for each admission. Distances were summed to electoral ward level to give the distribution of distances travelled at ward level. These were analysed to show the distance travelled for different admission types, ages of patient, rural/urban location, and the socioeconomic deprivation of the population of the ward.

Results: There is considerable variation in the distances travelled for hospital admission between electoral wards. Some of this is explained by geographical location: individuals living in more rural areas travel further for elective (median 27.2 versus 15.0 km), emergency (25.3 versus 13.9 km) and maternity (25.0 versus 13.9 km) admissions. But individuals located in highly deprived wards travel less far, and this shorter distance is not explained simply by the closer location of hospitals to these wards.

Conclusions: Before the introduction of more patient choice, there were considerable differences between individuals in the distances they travelled for hospital care. An increase in patient choice may disproportionately benefit people from less deprived areas.
Are the best available clinical effectiveness data used in economic evaluations of drug therapies?
Authors: Hanratty Barbara , Craig Dawn , Nixon John , Rice Stephen , Christie James , Drummond Michael
Published: August 2007

Objectives: Use of evidence on clinical effectiveness that is of poor quality or is biased in favour of the therapy under study is a concern in economic evaluations and may contribute to a mistrust of pharmacoeconomic studies. This study aimed to determine whether the authors of economic evaluations use the best available evidence for clinical effectiveness.

Methods: One hundred economic evaluations of drug therapies (published in 2001–2003) were sampled randomly from the National Health Service Economic Evaluation Database, and the source of clinical evidence was identified. For each therapy, alternative, high quality sources of clinical effectiveness data were sought by searching the Database of Abstracts of Reviews of Effects and Health Technology Assessment databases. The magnitude and direction of the effect size in the different sources of evidence were compared.

Results: Relevant systematic reviews were found for only 32 of the 100 economic evaluations in the sample. In three cases these reviews had been identified by the authors of the economic evaluations and two of these cases were used in the evaluation. Comparisons were possible in 21 cases. The clinical effects reported in all 21 comparisons were similar in direction but differed in magnitude. Compared to the systematic reviews, the authors of economic evaluations used evidence that was more favourable in five cases, less favourable in four cases, and similar in 12 cases. Six of the economic evaluations and corresponding systematic reviews did not present measures of effectiveness in a manner that allowed comparison.

Conclusions: Authors of economic evaluations have not made sufficient use of the evidence available from systematic reviews of clinical effectiveness. The central role of economic evaluations in health policy makes it essential that improvements in economic methods are accompanied by a structured search for the highest quality information on clinical effectiveness.
Toward a general theory of indifference to research-based evidence
Authors: Lewis Steven
Published: August 2007

Evidence-based medicine (EBM) and evidence-based decision-making (EBDM) were intended to revolutionize health care and health policy. Thus far they have not. A great deal of research has demonstrated the persistent ubiquity of error in health care, wide and unjustifiable variations in practice and the minimal impact of decision aids such as clinical practice guidelines. This paper attempts to explain why EBM and EBDM have remained largely unrealized ambitions. It advances 10 propositions that together constitute a general theory of indifference to research-based evidence. Some of these propositions are conceptual (e.g. the epistemic resistance to the randomized trial), some are empirical (e.g. the impact of the corruption of science by industry), some are cognitive (e.g. human problems are holistic while science is typically fragmented and narrative free) and some are normative (e.g. the primary goal is not adherence to methods, but to make better decisions with better outcomes, irrespective of their origins). EBM and EBDM over-reached, and their failure was, as a consequence, inevitable. However, with corrective action on a number of fronts, research-based evidence can and should be more influential. The first step is to reconceive EBM and EBDM as habits of mind rather than a toolbox and to recognize that the sociology of knowledge is as important as its technical content.
Impact of managed care on physicians' decisions to manipulate reimbursement rules: an explanatory model
Authors: VanGeest Jonathan , Weiner Saul , Johnson Timothy , Cummins Deborah
Published: August 2007

Objective: To develop and test an explanatory model of the impact of managed care on physicians' decisions to manipulate reimbursement rules for patients.

Methods: A self-administered mailed questionnaire of a national random sample of 1124 practicing physicians in the USA. Structural equation modelling was used. The main outcome measure assessed whether or not physicians had manipulated reimbursement rules (such as exaggerated the severity of patients conditions, changed billing diagnoses, or reported signs or symptoms that the patients did not have) to help patients secure coverage for needed treatment or services.

Results: The response rate was 64% ( n = 720). Physicians' decisions to manipulate reimbursement rules for patients are directly driven not only by ethical beliefs about gaming the system but also by requests from patients, the perception of insufficient time to deliver care, and the proportion of Medicaid patients. Covert advocacy is also the indirect result of utilization review hassles, primary care specialty, and practice environment.

Conclusions: Managed care is not just a set of rules that physicians choose to follow or disobey, but an environment of competing pressures from patients, purchasers, and high workload. Reimbursement manipulation is a response to that environment, rather than simply a reflection of individual physicians' values.
What motivates health professionals? Opportunities to gain greater insight from theory
Authors: Buetow Stephen
Published: August 2007

Health care policy-makers and researchers need to pay more attention to understanding the influence of motivation on professional behaviour. Goal setting theory, including two hypotheses – the business case and the pride case – dominates current attempts to motivate professionals. However, the predominance of goal setting theory stifles other approaches to conceptualizing professional motivation. These approaches include other cognitive theories of motivation, such as self-determination theory (concerned with how to use extrinsic rewards that enhance intrinsic motivation), as well as content, psychoanalytic and environmental theories. A valuable opportunity exists to develop and test such theories in addition to possible hybrids, for example, by elaborating goal setting theory in health care. The results can be expected to inform health policy and motivate individual professionals, groups, organizations and workforces to improve and deliver high quality care.
Learning from Experience in Software Development: A Multilevel Analysis
Authors: Fong Boh Wai , Slaughter Sandra A. , Espinosa J. Alberto
Published: August 2007

This study examines whether individuals, groups, and organizational units learn from experience in software development and whether this learning improves productivity. Although prior research has found the existence of learning curves in manufacturing and service industries, it is not clear whether learning curves also apply to knowledge work like software development. We evaluate the relative productivity impacts from accumulating specialized experience in a system, diversified experience in related and unrelated systems, and experience from working with others on modification requests (MRs) in a telecommunications firm, which uses an incremental software development methodology. Using multilevel modeling, we analyze extensive data archives covering more than 14 years of systems development work on a major telecommunications product dating from the beginning of its development process. Our findings reveal that the relative importance of the different types of experience differs across levels of analysis. Specialized experience has the greatest impact on productivity for MRs completed by individual developers, whereas diverse experience in related systems plays a larger role in improving productivity for MRs and system releases completed by groups and organizational units. Diverse experience in unrelated systems has the least influence on productivity at all three levels of analysis. Our findings support the existence of learning curves in software development and provide insights into when specialized or diverse experience may be more valuable.
Existence of Coordinating Transshipment Prices in a Two-Location Inventory Model
Authors: Hu Xinxin , Duenyas Izak , Kapuscinski Roman
Published: August 2007

We consider a two-location production/inventory model where each location makes production decisions and is subject to uncertain capacity. Each location optimizes its own profits. Transshipment (at a cost) is allowed from one location to another. We focus on the question of whether one can globally set a pair of coordinating transshipment prices, i.e., payments that each party has to make to the other for the transshipped goods, that induce the local decision makers to make inventory and transshipment decisions that are globally optimal. A recent paper suggests, for a special case of our model, that there always exists a unique pair of coordinating transshipment prices. We demonstrate through a counterexample that this statement is not correct and derive sufficient and necessary conditions under which it would hold. We show that in some conditions, coordinating prices may exist for only a narrow range of problem parameters and explore conditions when this can happen. Finally, we study the effects of demand and capacity variability on the magnitude of coordinating transshipment prices.
Risk Mitigation in Newsvendor Networks: Resource Diversification, Flexibility, Sharing, and Hedging
Authors: Van Mieghem Jan A.
Published: August 2007

This paper studies how judicious resource allocation in networks mitigates risk. Theory is presented for general utility functions and mean-variance formulations and is illustrated with networks featuring resource diversification, flexibility (e.g., inventory substitution), and sharing (commonality). In contrast to single-resource settings, risk-averse newsvendors may invest more in networks than risk-neutral newsvendors: some resources and even total spending may exceed risk-neutral levels. With normally distributed demand, risk-averse newsvendors change resource levels roughly proportionally to demand variance, while risk-neutral agents adjust only proportionally to standard deviation.

Two effects explain this operational hedge and suggest rules of thumb for strategic placement of safety capacity and inventory in networks: (1) Risk pooling suggests rebalancing capacity toward inexpensive resources that serve lower-profit variance markets. This highlights the role of profit variance (instead of demand variance) in risk-averse network investment. (2) Ex post revenue maximization suggests rebalancing capacity toward substitutable flexible but away from shared capacity when markets differ in profitability. Capacity imbalance and allocation flexibility thus mitigate profit risk and truly are operational hedges.
Effects of a Behavioral Sleep Medicine Intervention on Trauma Symptoms in Adolescents Recently Treated for Substance Abuse
Authors: Stevens Sally , Haynes Patricia L. , Ruiz Bridget , Bootzin Richard R.
Published: August 2007

This study tested whether improvement in sleep by an integrative, behavioral sleep intervention was associated with improvement in traumatic stress (TS) symptoms in a sample of 20 adolescents who were recently treated for substance abuse. Sleep was measured throughout the intervention via daily sleep diaries, and traumatic stress symptoms were assessed by the Global Appraisal of Individual Needs (GAIN) at baseline, post-intervention, 3-months post-intervention, and 12-months post-intervention. Individuals with more time in bed and more total sleep time at the beginning of the intervention had more improvement in TS symptom trajectories across the intervention and at the 12-month follow-up assessment. Interaction trends also emerged indicating that adolescents who, throughout the sleep intervention, went to bed later and fell asleep faster had greater improvements in TS symptoms over time. Overall, these results indicate that stimulus control, a therapy that encourages patients to attempt sleep only when they are sleepy, may be particularly helpful for adolescents with TS symptoms, sleep disturbances, and substance abuse histories.
The role of language, social cognition, and social skill in the functional social outcomes of young adolescents with and without a history of SLI
Authors: Botting Nicola , Conti‐Ramsden Gina
Published: August 2007

Social skill and language are known to relate, not least in the example of those with specific language impairment (SLI). However, most of the research examining this trend has been conducted on young primary school age children and the nature of the relationships is unclear. Furthermore, little is known about which young people in general have social difficulties and whether language, social cognition, and social skills are directly associated at this age. In this study, a large cohort made up of young people with a history of SLI (N = 134) and a typically developing (TD) group (N = 124) of the same age were followed up in their final year of compulsory schooling (aged 16). Language, social cognition, social skills, and functional social outcomes (friendships and levels of social activity) were assessed using tasks and questionnaires. Modest associations were found between social cognition, language, and social behaviours, the strongest being between language and social cognition. Regression analyses showed that as a combined group, the adolescents' functional social outcomes were most associated with expressive language, social skill, and social cognitive ability. However, the patterns differed when the groups were analysed separately, with social cognition playing more of a role for those with SLI. These findings suggest that poor language may play a complex role in adolescents' social development.
Psychosocial interventions for carers of survivors of stroke: A systematic review of interventions based on psychological principles and theoretical frameworks
Authors: Eldred Clare , Sykes Catherine
Published: August 2007

Purpose Most stroke survivors are cared for at home by informal carers, usually their partners or children. The chronic burden of meeting these care needs can have a significant impact on the psychological well‐being of the carer. The aim of this review is to analyse interventions that target psychosocial functioning in carers of stroke survivors to understand how such interventions can reduce the burden of caring.

Method Seven studies that reported on randomized controlled trials of psychosocial interventions for informal adult carers of a survivor of stroke, which reported validated measures of psychological health outcome and met a satisfactory rating of quality were included in this systematic review.

Results A forest plot of two studies that used education and counselling as the intervention for patients and spouses indicate a more favourable outcome for the intervention on the global family functioning scale. The Clarke, Rubenach, and Winsor (2003) study showed that patients were more likely to benefit from an intervention consisting of counselling and education than spouses.

Conclusions It is noted that there are relatively few studies investigating the impact of psychologically based interventions for carers of stroke survivors and the quality of evidence is varied. However, there is evidence of good quality to show that stroke patients benefit from a counselling combined with education intervention. The clinical implications of this review suggests, according to current available evidence, that those working with survivors of stroke and their families should consider providing counselling and education interventions to patients in the first instance. More research is needed to determine the effectiveness of interventions aimed at improving the psychosocial functioning of carers of survivors of stroke.