bluuebunny/crossref_metadata_2025_split huggingface dataset:
041 Making Recommendations About Diagnostic Tests And Strategies: What Do Experts Say?
Authors: Mustafa R , Brozek J , Wiercioch W , Ventresca M , Lloyd N , Schünemann H 
Published: August 2013

BackgroundCurrent practices in developing guidelines about the use of diagnostic tests and strategies (DTS) are out of step with the conceptual discussion among experts.ObjectivesIdentify the essential factors to consider when making recommendations about DTS.MethodsWe conducted semi-structured in-depth interviews with experts in assessing evidence and producing guidelines about DTS.ResultsWe interviewed 23 international experts. Although diagnostic test accuracy (DTA) was the factor most commonly considered by organisations when developing recommendations, experts agreed that DTA is never sufficient and may be misleading. Experts identified the following additional essential factors in making decisions about DTS: resource implications, complications, inconclusive results, additional benefits of the test, diagnostic/therapeutic impact, safety, feasibility, ethical, legal, and organisational considerations, patients’ and societies’ values and preferences and the link between the test results and patient important outcomes. Because direct evidence on DTS’s effects on patient outcomes and resource implications is frequently unavailable, most experts agreed that decision analysis and mathematical modelling will be useful, but their opinion varied about the extent of details needed.DiscussionFormal decision modelling can be a useful framework for organising the clinical, cost, and preference data relevant to the use of diagnostic tests. Although it requires resources, it is useful for integrating these factors into decision making, identifying evidence gaps, and high priority research areas.ImplicationsDeveloping guidelines about the use of DTS requires considering factors beyond solely DTA but implementing this demand is challenging. Further development and testing of a framework that can guide this process is needed.
044 Collegial Collaboration Managing Joint Projects Across Societies
Authors: Fatheree L , Wick M , Larsen S , Olsen J 
Published: August 2013

BackgroundPooling resources for the development and dissemination of guidelines receives important consideration due to the extensive amount of expertise, money and staff time needed within an organisation. Partnered guidelines may increase the administrative cost and timeline of development, but is positively offset in the value partnering brings in the ultimate success and implementation.ContextOver the last three years we formally partnered with other professional medical societies in over 70% of our guidelines, learning many core and nuanced components of a successful jointly-developed guideline. We share those lessons learned with GIN members.Description of Best PracticeWe tackle critically important aspects of joint collaborations, beginning with the determination of appropriate partners. We explore the creation of a solid memorandum of understanding (MOU), addressing questions like: How will we select panel membership and manage their conflicts of interest? What grading system will we utilise with an evidence-based guideline or consensus conference? How will we approach our respective organisation’s approval process? What is needed to produce a simultaneous joint publication between journals? How will we disseminate effectively to our target audiences? What is our future plan for a revision? And the ultimate questions - How do we cost share and work share in the development equally?Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersThese experiences will help guideline developers create a framework for partnered collaborations, balancing value gained in partnership versus challenges realised in completion and resourcing.
045 Strategies for Clinical Expert and Stakeholder Involvement in Updating and Implementing Clinical Guidance for New and Emerging Medical Interventions
Authors: Loughren E 
Published: August 2013

BackgroundLack of sufficient clinical expert and stakeholder involvement in the routine updating of guidance on new and emerging medical interventions can lead to inefficient use of resources and inadvertently create unnecessary barriers to implementation.ContextAn evidence services unit within a large health care organisation developed a stakeholder-centred process for rapid updating and implementation of guidance related to the use of breast magnetic resonance imaging (MRI).Description of Best PracticeThe process focused on the following: 1) asking clinical stakeholders to identify the indications for which use of breast MRI remained unresolved or controversial; 2) conducting a search for high-quality systematic reviews and clinical trials for the specific indications, and contacting well-known external content experts to identify unpublished evidence; 3) obtaining data on the organisation’s current breast MRI utilisation and practice variation; 4) engaging experts/stakeholders in guidance development and revision based on current utilisation/practice variation compared to findings from the evidence review; 5) obtaining endorsement of guidance and commitment to implementation efforts from clinical opinion leaders and other stakeholders; and 6) initiating routine monitoring and feedback on breast MRI use.Lessons for Guideline Developers, Adaptors, Implementers, and/or UsersLimiting evidence updates to controversial or unresolved areas of clinical practice, engaging stakeholders in guidance development based on a review of current utilisation data and scientific evidence, and engaging key opinion leaders and stakeholders in implementation and performance monitoring leads to more efficient use of resources, stronger implementation and improved performance.
047 Identifying Factors Predictive of Managing Patients with Low Back Pain without Using X-Rays Among North American Chiropractors: Applying Psychological Theories to Evidence-Based Clinical Practice
Authors: Bussières A , Francis J , Patey A , Gagnon M , Sales A , Eccles M , Lemyre L , Godin G , Grimshaw J 
Published: August 2013

BackgroundThis study aimed to identify theoretically based modifiable factors that predict whether chiropractors manage patients with low back pain without ordering lumbar x-rays.MethodsA mailed survey with psychological measures was collected from a random sample of Ontario (Canada) and Practice Network (US) chiropractors. The outcome measures were behavioural intention and behavioural simulation (scenario decision-making). Explanatory variables included constructs from motivational theories (Theory of Planned Behaviour (TPB), Theory of Interpersonal Behaviour (TIB)), action theories (Operant Learning Theory (OLT) and Planning (action and coping)), and two other constructs: personal moral norm and habit as measured by the Self-Reported Habit Index (SRHI). Multiple regression analyses examined the predictive value of each theoretical model individually for simulation and intention outcomes.Results31% of North American chiropractors returned completed questionnaires. Overall, TPB and TIB, followed by personal moral norms and OLT best explained behavioural simulation. Theory level variance explained among Ontario and US chiropractors was respectively: TPB 59%; 52.0%, TIB 57%; 54.0%, personal moral norm 49%; 46.0%, OLT 49%; 52.0%, action planning 28%; 29%, and SRHI 42%; 48%. Constructs from TPB and TIB best explained behavioural intention. Theory level variance explained was respectively: TPB 85%; 74%, TIB; 83%; 81%, OLT 62%; 69%, and SRHI 59% and 52% for SRHI.ConclusionThese models explained up to 59% of the variation in behavioural simulation and up to 85% in intention to manage back pain patients without x-rays. Results may inform development of theory-based behaviour change interventions to implement imaging guideline recommendations among North American chiropractors. These models explained up to 59% of the variation in behavioural simulation and up to 85% in intention to manage back pain patients without x-rays. Results may inform development of theory-based behaviour change interventions to implement imaging guideline recommendations among North American chiropractors.
049 Evidence Based Treatment Guidelines: At Work in a Microcosm
Authors: Whelan P , Denniston P 
Published: August 2013

BackgroundMedical treatment under workers’ compensation represents just a miniscule portion (about 3 percent) of total medical costs in the US Furthermore, legislation and rules are determined autonomously by each state. Worker’ comp medical care, and the outcomes of that care, in each state theoretically can represent a microcosm of what could be achieved in an entire country. Impact of Evidence-based Treatment Guidelines: A trend began in 2003, starting with California, for states to consider adopting Evidence-Based Treatment Guidelines as a mechanism to insure timely and quality care for injured workers by following the least invasive, most-effective treatments today’s science has to offer. Bi-products to the effective implementation of EBTG, include earlier return to work, better outcomes resulting in reduced indemnity costs, less friction in the system (providers know what treatments are authorised and will be paid for), fewer episodes of over-utilisation of services, and decreased medical costs, benefiting employers, insurers, providers and business. Outcomes where true EBTG have been implemented: Ohio adopted EBTG in 2003. A Pilot conducted in 2005 showed a decrease in medical costs by 64%, lost days by 69% and treatment delays by 77%. Texas adopted EBTG in 2006; Total costs have declined by 50%, patients are recovering more quickly, more providers are willing to treat these patients, opioid abuses have declined and many states are looking to adopt this model. Other state outcomes and essential elements needed in an EBTG will be discussed.
053 Implementing Nutrition Guidelines Through Practice Tools for Registered Dietitians
Authors: Kren K , Moloney L , Ziegler P , Acosta A 
Published: August 2013

BackgroundEvidence Based Dietetics Practice Toolkits are resources intended to assist registered dietitians (RDs) in implementing nutrition guidelines derived from systematic reviews.ObjectivesSurveys, sent at least one year past publication, were used to explore who uses toolkits, how toolkits are used, and if RDs find toolkits useful for implementation of guidelines.MethodsA standard questionnaire was sent to 1379 individuals for six toolkits (Celiac Disease, Critical Illness, Diabetes, Heart Failure, Oncology, and Paediatric Overweight) in 2011 and 2012, using Survey Monkey.ResultsResponses received were 131 (9%), of which 42% were RDs in practice >15 years, in direct care (63%), and in settings of outpatient (51%) and inpatient (31%). Respondents mostly used toolkits for patient care (66%), nutrition counselling (40%) and development of forms (37%). Regarding the tools provided, 66% of respondents indicated that they found the summary of nutrition care and patient education materials to be very/somewhat useful or useful. The same was true for 63% for the case studies, 61% for the flowchart of patient encounters, 60% for the patient encounter process instructions and 56% for the sample documentation forms. Some respondents (24%) seldom or never used the guidelines prior to toolkit use; however, 65% indicated that the toolkit was useful in translating the guidelines to practice.DiscussionThe implementation of guidelines is often overlooked yet is crucial to changing practice. These toolkits allow a useful strategy for assisting with implementation. Similar practice tools, tailored to practitioners and setting, may be useful in guideline implementation for a variety of conditions.
058 Assessment of the Evidence for Diagnostic Tests and Strategies: A Systematic Review of Available Tools
Authors: Mustafa R , Wiercioch W , Falavigna M , Zhang Y , Prediger B , Cheung A , Ivanova L , Arevalo-Rodriguez I , Schünemann H 
Published: August 2013

BackgroundThe challenges facing guideline developers when making recommendations about diagnostic tests and strategies (DTS) are considerably different when compared to treatment recommendations.ObjectivesTo identify, describe and compare all available instruments, checklists, critical appraisal tools, and indices designed for assessing the quality of evidence (QoE) or strength of recommendations (SoR) dealing with diagnostic tests and strategies.MethodsWe conducted a comprehensive systematic search of the literature including state of the art diagnostic guidelines, methods papers and diagnostic systematic reviews.ResultsWe identified 45 tools and modifications of existing tools to assess the QoE and SoR of DTS. Most tools acknowledge the importance of assessing the QoE and SoR separately. Most tools include individual quality criteria and study design but no tool rates all quality criteria suggested by the GRADE working group. Only two tools explicitly consider factors that increase the confidence in the evidence. When moving from evidence to recommendations, patient values and preferences and resources were rarely considered.DiscussionThere is confusion about the terminology that describes the various factors that influence the QoE and SoR. The criteria for evaluating the QoE and moving from evidence to recommendations are incomplete for most guideline development frameworks that we evaluated.Implications for Guideline Developers/UsersThe GRADE approach is the most complete approach encompassing all factors but users will benefit from a better description of the evidence to recommendation framework in GRADE and clarification of issues that relate to laboratory validity parameters.
Body Mass Index and Prognosis of Metastatic Breast Cancer Patients Receiving First-Line Chemotherapy
Authors: Gennari Alessandra , Nanni Oriana , Puntoni Matteo , DeCensi Andrea , Scarpi Emanuela , Conte PierFranco , Antonucci Giancarlo , Amadori Dino , Bruzzi Paolo 
Published: August 2013

Abstract
Background: The effect of body mass index (BMI) on the prognosis of metastatic breast cancer (MBC) has not been explored so far.
Methods: The relationship between BMI (kg/m2) and progression-free survival (PFS) or overall survival (OS) was assessed in 489 patients with MBC enrolled in three clinical trials of first-line chemotherapy. World Health Organization BMI categories were used: normal, 18.5–24.9 kg/m2; overweight, 25–29.9 kg/m2; and obese, 30+ kg/m2. Univariate PFS and OS curves were estimated; multivariate Cox analysis was conducted adjusting for age, menopausal status, performance status (PS), hormonal status and site, and number of metastases.
Results: Overall, 39.9% of the patients were normal or underweight, 37.8% were overweight, and 22.3% were obese. Median age was 57 years (range 25–73); median PS was 0. Median PFS was 10.9 months [interquartile range (IQR) 5.5 to 19.9] in normal weight women, 13.0 months (IQR 7.8 to 23.7) in overweight, and 12.2 (IQR 7.1 to 23.0) in obese women, P = 0.17. Median OS was 32.0 months [95% confidence interval (CI), 14.5–88.3] versus 33.2 months (95% CI, 19.4–81.1) and 30.7 (95% CI, 17.6–50.8), respectively. In multivariate analyses, no statistically significant association between BMI category and PFS or OS was observed.
Conclusions: In this study, BMI was not associated with the outcome of patients with MBC treated with first-line chemotherapy.
Impact: In the absence of any evidence in support of a prognostic role of obesity in patients with MBC treated with chemotherapy, dietary restrictions, medical interventions aimed at reducing BMI/insulin resistance, or specific anticancer treatment strategies do not seem to be appropriate. Cancer Epidemiol Biomarkers Prev; 22(10); 1862–7. ©2013 AACR.
MicroRNA-31 Predicts the Presence of Lymph Node Metastases and Survival in Patients with Lung Adenocarcinoma
Authors: Meng Wei , Ye Zhenqing , Cui Ri , Perry James , Dedousi-Huebner Vaia , Huebner Alexander , Wang Yao , Li Bin , Volinia Stefano , Nakanishi Hiroshi , Kim Taewan , Suh Sung-Suk , Ayers Leona W. , Ross Patrick , Croce Carlo M. , Chakravarti Arnab , Jin Victor X. , Lautenschlaeger Tim 
Published: August 2013

Abstract
Purpose: We conducted genome-wide miRNA-sequencing (miRNA-seq) in primary cancer tissue from patients of lung adenocarcinoma to identify markers for the presence of lymph node metastasis.
Experimental Design: Markers for lymph node metastasis identified by sequencing were validated in a separate cohort using quantitative PCR. After additional validation in the The Cancer Genome Atlas (TCGA) dataset, functional characterization studies were conducted in vitro.
Results: MiR-31 was upregulated in lung adenocarcinoma tissues from patients with lymph node metastases compared with those without lymph node metastases. We confirmed miR-31 to be upregulated in lymph node-positive patients in a separate patient cohort (P = 0.009, t test), and to be expressed at higher levels in adenocarcinoma tissue than in matched normal adjacent lung tissues (P &lt; 0.0001, paired t test). MiR-31 was then validated as a marker for lymph node metastasis in an external validation cohort of 233 lung adenocarcinoma cases of the TCGA (P = 0.031, t test). In vitro functional assays showed that miR-31 increases cell migration, invasion, and proliferation in an ERK1/2 signaling-dependent manner. Notably, miR-31 was a significant predictor of survival in a multivariate cox regression model even when controlling for cancer staging. Exploratory in silico analysis showed that low expression of miR-31 is associated with excellent survival for T2N0 patients.
Conclusions: We applied miRNA-seq to study microRNomes in lung adenocarcinoma tissue samples for the first time and potentially identified a miRNA predicting the presence of lymph node metastasis and survival outcomes in patients of lung adenocarcinoma. Clin Cancer Res; 19(19); 5423–33. ©2013 AACR.
Nutrition as a link between obesity and cardiovascular disease: how can we stop the obesity epidemic?
Authors: van Baak Marleen A. 
Published: August 2013

summaryOverweight and obesity are associated with excess cardiovascular risk. To reduce cardiovascular risk at the population level, the prevention of overweight and obesity is key. This requires adoption of a healthy lifestyle, including less inactivity and more moderate-to-vigorous physical activity, and a healthy diet. Diet composition may facilitate weight gain prevention and weight loss. Effects of dietary fats, carbohydrates and proteins will be discussed in this context. Current evidence indicates that moderation of the intake of (saturated) fat, a moderate increase in protein content of the diet, a replacement of refined grain/high glucose index (GI) by whole-grain/low GI carbohydrates and limitation of the consumption of calorically-sweetened beverages are likely to facilitate weight control.
Differentiating haemostasis from thrombosis for therapeutic benefit
Authors: McFadyen James D. , Jackson Shaun P. 
Published: August 2013

SummaryThe central role of platelets in the formation of the primary haemostatic plug as well as in the development of arterial thrombosis is well defined. In general, the molecular events underpinning these processes are broadly similar. Whilst it has long been known that disturbances in blood flow, changes in platelet reactivity and enhanced coagulation reactions facilitate pathological thrombus formation, the precise details underlying these events remain incompletely understood. Intravital microscopy studies have highlighted the dynamic and heterogeneous nature of thrombus development and demonstrated that there are considerable spatiotemporal differences in the activation states of platelets within a forming thrombus. In this review we will consider the factors regulating the activation state of platelets in a developing thrombus and discuss how specific prothrombotic factors may influence this process, leading to excessive thrombus propagation. We will also discuss some potentially novel therapeutic approaches that may reduce excess thrombus development whilst minimising bleeding risk.
Dynamics of Tropical Cyclone Intensification: Deep Convective Cyclonic “Left Movers”
Authors: Hogsett Wallace A. , Stewart Stacy R. 
Published: August 2013

Abstract
Deep convective processes play an important role in tropical cyclone (TC) formation and intensification. In this study, the authors investigate the interaction between discrete buoyant updrafts and the vertically sheared azimuthal flow of an idealized TC vortex by adapting the updraft–shear dynamical framework to the TC. The authors argue theoretically that deep updrafts initiating near the TC radius of maximum wind (RMW) may propagate with a component left of the mean tangential flow, or radially inward toward the TC center. Results suggest that these unique TC updrafts, or “left movers” with respect to the mean azimuthal flow, may play an active role in TC intensification.
The notion that updraft-scale convection may propagate with a component transverse to the mean flow is not at all new. Cyclonic midlatitude supercell thunderstorms often deviate from their mean environmental flow, always to the right of the environmental vertical shear vector. The deviant motion arises owing to nonlinear interactions between the incipient updraft and the environmental vertical shear. Although significant differences exist between the idealized TC considered here and real TCs, observational and high-resolution operational modeling evidence suggests that some intense TC updrafts may propagate with a radially inward and right-of-shear component and exhibit structural characteristics consistent with theory.
The authors propose that left movers constitute a unique class of intense TC updrafts that may be favored near the TC RMW where local vertical shear of the TC azimuthal winds may be maximized. To simulate these left movers in a realistic way, mesoscale TC forecasting models must resolve nonlinear interactions between updrafts and vertical shear.
Missed opportunities for HIV diagnosis: a three-year audit in the West of Scotland
Authors: Brawley D , MacConnachie A , Nandwani R , Bell DJ , Fargie F , Fox R , Peters E , Seaton RA , Winter A 
Published: August 2013

Background National specialty guidelines for HIV testing aim to increase diagnosis and reduce late presentation. An audit of new HIV diagnoses in Glasgow was performed to assess local performance against these guidelines and estimate the proportion of patients presenting who had previous missed opportunities for diagnosis. Methods A retrospective case note review of 339 patients diagnosed from September 2008 to September 2011 was performed. Documented past medical history was assessed for HIV clinical indicator conditions prior to HIV diagnosis and prior review by medical services. Results Ninety (26%) individuals had at least one documented clinical indicator condition prior to HIV diagnosis, of whom 80 had prior contact with at least one speciality. This group also had a lower mean nadir CD4 count (258 cells/cmm versus 393 cells/cmm, p = <0.005) and were more likely to be severely immunocompromised at diagnosis, with a CD4 count below 50 cells/cmm (31% versus 9%, p = <0.005). AIDS-defining illnesses were also more common (31% versus 8%, p ≤ 0.005) as was HIV-related mortality ( p ≤ 0.005). Conclusion Additional support and training are required to increase adherence to HIV-testing guidelines within primary and secondary care in order to prevent ongoing late presentation with both individual clinical and public health implications.