bluuebunny/crossref_metadata_2025_split huggingface dataset:
Open label extension studies and patient selection biases
Authors: Hemming Karla , Hutton Jane L. , Maguire Melissa J. , Marson Anthony G. 
Published: September 2010

AbstractRationale  Long‐term observational studies are essential in assessing the effect of interventions for chronic diseases on long‐term safety and tolerability, as well as informing on efficacy in a non‐clinical trial setting. Concerns over the scientific validity of open label extension studies to randomized controlled trials have recently been raised. Patients experiencing adverse events will be withdrawn before the follow‐on period of the study, and those experiencing milder side‐effects will be less likely to opt to continue into the open label extension.Methods  The usual method of analysis of the open label extension study, which ignores any patients not continuing into the follow‐on period of the study, is outlined. It is shown that ignoring patients who exit the trial is equivalent to assuming the outcome data are missing completely at random. Where this assumption is not met, treatment effect estimates will be biased. An alternative method of analysis is proposed, which does not rely on the often unjustifiable assumption of outcomes being missing completely at random.Results  In an example open label extension study, with reported responder rate 43%, we show how an analysis allowing for patient selection biases produces a responder rate of just 28%.Conclusions  The method of analysis proposed here, minimizes the effect of patient selection biases. Future reporting ideals for open label extension studies are recommended to minimize future biases. For studies which have not reported results in detail we suggest a sensitivity based on the worst case scenario, as a minimum treatment effect estimator.
Individualized population care: linking personal care to population care in general practice
Authors: Buetow Stephen , Getz Linn , Adams Peter 
Published: September 2010

Abstract
Background  General practice is increasingly expected to deliver population care to individual patients. The feasibility and ethics of this policy shift have been challenged.
Aim  Our aim is to suggest how to deliver population care while protecting personal care.
Methods  We outline and discuss concepts of these types of care, their relation to the prevailing discourse regarding intervention benefits, and arguments for individualized population care.
Results  Individualized population care can enable general practice to meet the health targets of individual patients in the light of population‐based goals. It unifies the concepts of personal care and whole population care. Personal care focuses on the individual good in particular consultations. Whole population care focuses on the overall health good of a population without reference to the individuality of each population member. These types of care constitute elements of a continuum that varies in purpose and objects of focus. The limitations of a crude dichotomy of personal care and population care are made explicit in a series of five arguments that lend support to the concept of individualized population care.
Conclusions  We advocate a constructive but critical attitude towards the idea of population‐based interventions in everyday general practice. Traditional personal care and whole population care can theoretically be integrated into individualized population care. However, this presupposes clinical–epidemiological expertise and moral awareness in practising clinicians.
Do we practice what we preach? A qualitative assessment of resident–preceptor interactions for adherence to evidence‐based practice
Authors: Tilburt Jon C. , Mangrulkar Rajesh S. , Goold Susan Dorr , Siddiqui Nazema Y. , Carrese Joseph A. 
Published: September 2010

Abstract
Background  Evidence‐based medicine (EBM) is important in training doctors for high‐quality care. Yet little is known about whether ambulatory precepting incorporates the concepts and principles of EBM.
Methods  The authors observed and audiotaped 95 internal medicine residency precepting interactions and rated interactions using a qualitative analytic template consisting of three criteria: (1) presence of clinical questions; (2) presence of an evidence‐based process; and (3) resident ability to articulate a clinical question.
Results  Sixty‐seven of 95 audio tapes (71%) were of acceptable quality to allow template analysis. Thirty (45%) contained explicit clinical questions; 11 (16%) included an evidence‐based process. Resident ability to articulate a clinical question when prompted was rated as at least ‘fair’ in 59 of 67 interactions (88%).
Conclusions  EBM was not optimally implemented in these clinics. Future research could explore more systematically what factors facilitate or impair the use of EBM in the real‐time ambulatory training context.
User‐driven health care – answering multidimensional information needs in individual patients utilizing post–EBM approaches: a conceptual model
Authors: Biswas Rakesh , Martin Carmel M. , Sturmberg Joachim , Shanker Ravi , Umakanth Shashikiran , Shanker Shiv , Kasturi A. S. 
Published: September 2010

AbstractEvidence based on average patient data, which occupies most of our present day information databases, does not fulfil the needs of individual patient‐centred health care. In spite of the unprecedented expansion in medical information we still do not have the types of information required to allow us to tailor optimal care for a given individual patient. As our current information is chiefly provided in disconnected silos, we need an information system that can seamlessly integrate different types of information to meet diverse user group needs. Groups of certain individual medical learners namely patients, medical students and health professionals share the patient's need to increasingly interact with and seek knowledge and solutions offered by others (individual medical learners) who have the lived experiences that they would benefit to access and learn from. A web‐based user‐driven learning solution may be a stepping‐stone to address the present problem of information oversupply in medicine that mostly remains underutilized, as it doesn't meet the needs of the individual patient and health professional user. The key to its success would be to relax central control and make local trust and strategic health workers feel more engaged in the project such that it is truly user‐driven.
Harnessing experience: exploring the gap between evidence‐based medicine and clinical practice
Authors: Hay M. Cameron , Weisner Thomas S. , Subramanian Saskia , Duan Naihua , Niedzinski Edmund J. , Kravitz Richard L. 
Published: September 2010

Abstract
Rationale, aims and objectives  There is mounting evidence of a gap between Evidence‐based Medicine (EBM) and physician clinical practice, in part because EBM is averaged global evidence gathered from exogenous populations which may not be relevant to local circumstances. Local endogenous evidence, collected in particular and ‘real world’ patient populations may be more relevant, convincing and timely for clinical practice. Evidence Farming (EF) is a concept to provide such local evidence through the systematic collection of clinical experience to guide more effective practice.
Methods  We report on the findings of a pilot study of 29 individual and three focus group (n = 10) interviews exploring physicians' evaluations how they use multiple sources of information in clinical decision making and their thoughts on EF.
Results  Physicians recognize a gap in translating EBM to practice. Physicians reported that when making clinical decisions, they more often rely on clinical experience, the opinions of colleagues and EBM summarizing electronic clinical resources rather than refer directly to EBM literature. Confidence in making decisions based on clinical experience increases over time, yet few physicians reported having systems for tracking their clinical experience in designing treatment plans and patient outcomes. Most physicians saw EF as a promising way to track experience, thereby making scientific evidence more relevant to their own clinical practices.
Conclusion  Clinical experience is relatively neglected by the EBM movement, but if that experience were systematically gathered through an approach such as EF, it would meet a need left unfulfilled by EBM.
Evaluation of the Evidence‐Based practice Attitude and utilization SurvEy for complementary and alternative medicine practitioners
Authors: Leach Matthew J. , Gillham David 
Published: September 2010

Abstract
Rationale  This paper describes the development of the Evidence‐Based practice Attitude and utilization SurvEy (EBASE), which was designed to measure complementary and alternative medicine (CAM) practitioner attitude to and utilization of evidence‐based practice (EBP).
Aim  The aim of this study was to evaluate the validity and reliability of the EBASE as a measure of CAM practitioner skill, attitude and use of EBP in order to adequately inform clinicians and researchers about this comprehensive survey tool.
Methods  EBASE and the clinical effectiveness and EBP questionnaire (EBPQ) were distributed to nine experts in CAM education, research, questionnaire design and/or EBP. Responses to these questionnaires were used to evaluate the content validity, convergent validity, test‐retest reliability and internal consistency of EBASE.
Results  EBASE has found to have good internal consistency (Cronbach's alpha = 0.84) and acceptable test‐retest reliability (ICC = 0.578–0.986). The instrument also demonstrated good content validity (CVI = 0.899), and adequately measured practitioner skill and utilization of EBP when compared to the EBPQ.
Conclusion  The current study supports the validity and reliability of EBASE as a measure of CAM practitioner skill, attitude, experience and training in, as well as barriers and facilitating factors of EBP.
Urinary incontinence management in women: audit in general practice
Authors: Gerrits Marloes , Avery Tony , Lagro‐Janssen Antoine 
Published: September 2010

Abstract
Objectives  In several Western European countries guidelines regarding urinary incontinence (UI) management in general practice have been drawn up. The aim of this study was to evaluate guideline adherence with feedback in general practice in order to improve UI management.
Methods  First, a retrospective audit of female patient records was performed with Egton Medical Information System compared with the NICE Guideline regarding UI. Between 1 January 2000 and 31 December 2006 patients, 18–65 years of age, with newly diagnosed UI (ICPC U04) were included in two general practices in Nottingham, UK. Second, results were presented to the general practitioners (GPs) in a feedback session.
Results  Sixty‐five patients were identified to have newly reported UI. Gynaecological examination was performed in 51% of cases. Additionally, in 40% of patients a urine sample was obtained for dipstick. Follow‐up was performed in 34% of the 65 cases. During a feedback session GPs became aware they do not adhere to these guideline items consistently. Patients often report UI as final after several other problems during one single consultation.
Conclusion  Most women with UI were not managed according to the NICE Guideline. Audit feedback created awareness of current UI management in general practice and can therefore be used in improving UI management.
Improved guideline adherence to pharmacotherapy of chronic systolic heart failure in general practice – results from a cluster‐randomized controlled trial of implementation of a clinical practice guideline
Authors: Peters‐Klimm Frank , Müller‐Tasch Thomas , Remppis Andrew , Szecsenyi Joachim , Schellberg Dieter 
Published: September 2010

Abstract
Rationale and aims  Clinical practice guidelines (CPG) reflect the evidence of effective pharmacotherapy of chronic (systolic) heart failure (CHF) which needs to be implemented. This study aimed to evaluate the effect of a new, multifaceted intervention (educational train‐the‐trainer course plus pharmacotherapy feedback = TTT) compared with standard education on guideline adherence (GA) in general practice.
Method  Thirty‐seven participating general practitioners (GPs) were randomized (18 vs. 19) and included 168 patients with ascertained symptomatic CHF [New York Heart Association (NYHA) II‐IV]. Groups received CPG, the TTT intervention consisted of four interactive educational meetings and a pharmacotherapy feedback, while the control group received a usual lecture (Standard). Outcome measure was GA assessed by prescription rates and target dosing of angiotensin converting enzyme (ACE) inhibitors (ACE‐I) or angiotensin receptor blockers (ARB), beta‐blockers (BB) and aldosterone antagonists (AA) at baseline and 7‐month follow‐up. Group comparisons at follow‐up were adjusted to GA, sex, age and NYHA stage at baseline.
Results  Prescription rates at baseline (n = 168) were high (ACE‐I/ARB 90, BB 79 and AA 29%) in both groups. At follow up (n = 146), TTT improved compared with Standard regarding AA (43% vs. 23%, P = 0.04) and the rates of reached target doses of ACE‐I/ARB (28% vs. 15%, P = 0.04). TTT group achieved significantly higher mean percentages of daily target dose (52% vs. 42%, mean difference 10.3%, 95% CI 0.84–19.8, P = 0.03).
Conclusion  Despite of pre‐existing high GA in both groups and an active control group, the multifaceted intervention was effective in quality of care measured by GA. Further research is needed on the choice of interventions in different provider populations.
Towards an evidence‐based ‘Medicine of the Person’: the contribution of psychiatry to health care provision
Authors: Cox John L. 
Published: September 2010

AbstractThe purpose of this essay is to outline how the conceptual and clinical approaches of psychiatry contribute to increased understanding about the nature of evidence, and the art and science of medicine. It is based on the author's search for a more integrative medicine, the influence of Paul Tournier's ‘Medicine de la Personne’ and the Institutional Programme on Psychiatry for the Person led by the World Psychiatric Association. Evidence to support this approach from palliative care and general practice is cited, but new educational and research initiatives from other international organizations, such as the World Medical Association, the World Federation for Medical Education and the World Association of Family Practice and the medical Royal Colleges, are proposed.
Improving participant selection in disease management programmes: insights gained from propensity score stratification
Authors: Linden Ariel , Adams John L. 
Published: September 2010

AbstractWhile the randomized controlled trial (RCT) remains the gold‐standard study design for evaluating treatment effect, outcomes researchers turn to powerful quasi‐experimental designs when only observational studies can be conducted. Within these designs, propensity score matching is one of the most popular to evaluate disease management (DM) programme effectiveness. Given that DM programmes generally have a much smaller number of participants than non‐participants in the population, propensity score matching will typically result in all or nearly all participants finding successful matches, while most of the non‐participants in the population remain unmatched and thereby excluded from the analysis. By excluding data from the unmatched population, the effect of non‐treatment in the remaining population with the disease is not captured. In the present study, we examine changes in hospitalization rates stratified by propensity score quintiles across the entire population allowing us to gain insight as to how well the programme chose its participants, or if the programme could have been effective on those individuals not explicitly targeted for the intervention. These data indicate the presence of regression to the mean, and suggest that the DM programme may be overly limited to only the highest strata when there is evidence of a potential benefit for those in all the lower strata as well.
Analysis and calibration of Ca ii triplet spectroscopy of red giant branch stars from VLT/FLAMES observations
Authors: Battaglia G. , Irwin M. , Tolstoy E. , Hill V. , Helmi A. , Letarte B. , Jablonka P. 
Published: September 2010

Abstract
We demonstrate that low-resolution Ca ii triplet (CaT) spectroscopic estimates of the overall metallicity ([Fe/H]) of individual red giant branch (RGB) stars in two nearby dwarf spheroidal galaxies (dSphs) agree to ±0.1–0.2 dex with detailed high-resolution spectroscopic determinations for the same stars over the range −2.5 &lt; [Fe/H] &lt; −0.5. For this study, we used a sample of 129 stars observed in low- and high-resolution modes with VLT/FLAMES in the Sculptor and Fornax dSphs. We also present the data-reduction steps we used in our low-resolution analysis and show that the typical accuracy of our velocity and CaT [Fe/H] measurement is ∼2 km s−1 and 0.1 dex, respectively. We conclude that CaT–[Fe/H] relations calibrated on globular clusters can be applied with confidence to RGB stars in composite stellar populations over the range −2.5 &lt; [Fe/H] &lt; −0.5.
Comparison of bar strengths in optical and near-infrared for the OSUBSGS sample
Authors: Speltincx T. , Laurikainen E. , Salo H. 
Published: September 2010

Abstract
We use a gravitational bar torque method to compare bar strengths (the maximum tangential force normalized by radial force) in B and H-band images of 152 galaxies from the Ohio State University Bright Spiral Galaxy Survey. Our main motivation is to check how much the difference in the rest-frame wavelength could affect the comparisons of bar strengths in low- and high-redshift observations. Between these two bands, we find an average bar strength ratio QB/H= 1.25 which factor is nearly independent of the morphological type. We show that QB/H &gt; 1 is mostly due to reduced bulge dilution of radial forces in the B band. The bar torque method needs an estimate for the vertical scaleheight of the galaxy, based on the radial scalelength of the disc and the galaxy's morphological type. Since these two might not always be possible to determine at high redshifts in a reliable manner, we also checked that similar results are obtained with vertical scaleheights estimated from the radii corresponding to the K-band surface brightness of 20 mag arcsec−2. Also, we made a simple test of the usability of the bar torque method at high redshifts by checking the effects of image degradation (nearest neighbour sampling without any adjustment of noise levels): we found that the estimated bar strengths varied by ±10 per cent at most as long as the total extent of the bar was at least 10 pixels. Overall, we show that the gravitational bar torque method should provide a proficient tool for quantifying bar strengths also at high redshifts.
The Norma cluster (ACO 3627) – I. A dynamical analysis of the most massive cluster in the Great Attractor
Authors: Woudt P. A. , Kraan-Korteweg R. C. , Lucey J. , Fairall A. P. , Moore S. A. W. 
Published: September 2010

Abstract
A detailed dynamical analysis of the nearby rich Norma cluster (ACO 3627) is presented. From radial velocities of 296 cluster members, we find a mean velocity of 4871 ± 54 km s−1 and a velocity dispersion of 925 km s−1. The mean velocity of the E/S0 population (4979 ± 85 km s−1) is offset with respect to that of the S/Irr population (4812 ± 70 km s−1) by Δv= 164 km s−1 in the cluster rest frame. This offset increases towards the core of the cluster. The E/S0 population is free of any detectable substructure and appears relaxed. Its shape is clearly elongated with a position angle that is aligned along the dominant large-scale structures in this region, the so-called Norma wall. The central cD galaxy has a very large peculiar velocity of 561 km s−1 which is most probably related to an ongoing merger at the core of the cluster. The spiral/irregular galaxies reveal a large amount of substructure; two dynamically distinct subgroups within the overall spiral population have been identified, located along the Norma wall elongation. The dynamical mass of the Norma cluster within its Abell radius is 1–1.1 × 1015h−173 M⊙. One of the cluster members, the spiral galaxy WKK 6176 which recently was observed to have a 70 kpc X-ray tail, reveals numerous striking low-brightness filaments pointing away from the cluster centre suggesting strong interaction with the intracluster medium.
The association of time in the US and diet during pregnancy in low‐income women of Mexican descent
Authors: Harley Kim , Eskenazi Brenda , Block Gladys 
Published: September 2010

SummaryThis study compared nutritional intake during pregnancy among women of Mexican descent according to country of birth (US vs. Mexico) and, for Mexico‐born women, according to number of years lived in the US (≤5 years, 6–10 years, ≥ 11 years). A 72‐item food frequency questionnaire (FFQ) was used to assess dietary intake in 474 pregnant Mexico‐born immigrants and US‐born Mexican‐Americans. Mexico‐born women had significantly higher intakes of calories (P = 0.02), fibre (P < 0.001), vitamin A (P < 0.001), vitamin C (P = 0.03), vitamin E (P < 0.01), folate (P < 0.01), calcium (P < 0.001) and zinc (P = 0.02) from their diets than US‐born women. Intakes of all nutrients except vitamin C and zinc remained significantly higher in Mexico‐born women when nutrients from both diet and vitamin supplements were considered. Among Mexico‐born women, increasing years of residence in the US was associated with lower intake of calories (Ptrend < 0.01), fibre (Ptrend < 0.01), folate (Ptrend = 0.03), iron (Ptrend = 0.05) and zinc (Ptrend = 0.03), although only the trend for iron remained significant when vitamin supplement sources were included. A large percentage of women had inadequate intake of vitamin E (58%), folate (61%), iron (77%) and zinc (47%) from their diets during pregnancy and these rates were higher in US‐born women than Mexico‐born women.
Genetic and environmental factors influencing pupal colour in the Swallowtail butterflies Battus philenor (L.) and Papilio polytes L.
Authors: CLARKE C. A. , SHEPPARD P. M. 
Published: September 2010

SYNOPSISAn account is given of the correlation of pupal coloration in Battus philenor and Papilio polytes with the colour of the substratum on which the larva pupates.
The structure of the female reproductiiye system in the Agaonidae (Chalcidoidea, Hymenoptera)
Authors: COPLAND M. J. W. , KING P. E. , HILL D. S. 
Published: September 2010

SYNOPSISAn account is given of the gaster, ovipositor mechanism and reproductive system in female Agaonidae. The structure and possible functions are compared with that of other chalcid families and the phylogenetic relationships of the group are discussed.
Defensive behaviour of the wheat aphid, Schizaphis graminum (Rondani) (Hemiptera: Aphididae), against Coccinellidae
Authors: BROWN H. DICK 
Published: September 2010

SYNOPSISAn account is given of the behaviour of the wheat aphid, Schizaphis graminum, in response to attacks by two coccinellid predators Scymnus morelleti and Exochomus concavus. Various responses are described and their influence on predator efficiency is investigated.
Pharmacological observations on body fluids from the milkweed bug, Oncopeltus fasciatus (Dallas) (Heteroptera: Lygaeidae)
Authors: GRAHAM J. D. P. , STADDON B. W. 
Published: September 2010

SYNOPSISA report is given on the pharmacological activity of body fluids from milkweed bugs maintained on a diet of sunflower seeds, together with observations on the toxin accumulating system of the adult insect.
Stridulation and defensive behaviour in the ground beetle,Cychrus caraboides(L.)
Authors: CLARIDGE M. F. 
Published: September 2010

ABSTRACTAdults of both sexes ofC.caraboidesstridulate by means of an elytroabdominal mechanism. The stridulatory surfaces consist of opposing series of microlamellae, only seen clearly with the surface scanning electron microscope. Sound emission covers a wide band of frequencies from audible to about 80 kHz. It is suggested that stridulation may act as an acoustic warning to certain vertebrate predators.