bluuebunny/crossref_metadata_2025_split huggingface dataset:
Part II, Provider perspectives: should patients be activated to request evidence-based medicine? a qualitative study of the VA project to implement diuretics (VAPID)
Authors: Buzza Colin D , Williams Monica B , Vander Weg Mark W , Christensen Alan J , Kaboli Peter J , Reisinger Heather Schacht 
Published: April 2010

Abstract

Background
Hypertension guidelines recommend the use of thiazide diuretics as first-line therapy for uncomplicated hypertension, yet diuretics are under-prescribed, and hypertension is frequently inadequately treated. This qualitative evaluation of provider attitudes follows a randomized controlled trial of a patient activation strategy in which hypertensive patients received letters and incentives to discuss thiazides with their provider. The strategy prompted high discussion rates and enhanced thiazide-prescribing rates. Our objective was to interview providers to understand the effectiveness and acceptability of the intervention from their perspective, as well as the suitability of patient activation for more widespread guideline implementation.

Methods
Semi-structured phone interviews were conducted with 21 primary care providers. Interviews were transcribed verbatim and reviewed by the interviewer before being analyzed for content. Interviews were coded, and relevant themes and specific responses were identified, grouped, and compared.

Results
Of the 21 providers interviewed, 20 (95%) had a positive opinion of the intervention, and 18 of 20 (90%) thought the strategy was suitable for wider use. In explaining their opinions of the intervention, many providers discussed a positive effect on treatment, but they more often focused on the process of patient activation itself, describing how the intervention facilitated discussions by informing patients and making them more pro-active. Regarding effectiveness, providers suggested the intervention worked like a reminder, highlighted oversights, or changed their approach to hypertension management. Many providers also explained that the intervention 'aligned' patients' objectives with theirs, or made patients more likely to accept a change in medications. Negative aspects were mentioned infrequently, but concerns about the use of financial incentives were most common. Relevant barriers to initiating thiazide treatment included a hesitancy to switch medications if the patient was at or near goal blood pressure on a different anti-hypertensive.

Conclusions
Patient activation was acceptable to providers as a guideline implementation strategy, with considerable value placed on the activation process itself. By 'aligning' patients' objectives with those of their providers, this process also facilitated part of the effectiveness of the intervention. Patient activation shows promise for wider use as an implementation strategy, and should be tested in other areas of evidence-based medicine.

Trial registration
National Clinical Trial Registry number NCT00265538
Use of kilovoltage X-ray volume imaging in patient dose calculation for head-and-neck and partial brain radiation therapy
Authors: Hu Weigang , Ye Jinsong , Wang Jiazhou , Ma Xuejun , Zhang Zhen 
Published: April 2010

Abstract

Background
To evaluate the accuracy of using kilovoltage x-ray cone-beam computed tomography (kV-CBCT) imaging for in vivo dose calculations.

Methods
A Region-of-Interest (ROI) CT number mapping method was developed to generate the cone-beam CT number vs. relative electron density calibration curve for 3D dose calculations. The stability of the results was validated for three consecutive months. The method was evaluated on three brain tumors and three head-and-neck tumor cases. For each patient, kV-CBCT images were acquired on the first treatment day and two-week intervals on the Elekta XVI system. The delivered dose distributions were calculated by applying the patients' treatment plans to the kV-CBCT images. The resulting dose distributions and dose volume histograms (DVHs) of the tumor and critical structures were compared to the original treatment plan.

Results
The kV-CBCT electron density calibration was stable within 1.5% over a three-month period. The DVH and dose distribution comparison based on the planning CT and the initial kV-CBCT showed good agreements for majority of cases. The doses calculated from the planning CT and kV-CBCT were compared on planes perpendicular to the beam axes and passing through the isocenter. Using γ analysis with a criterion of 2 mm/2% and a threshold of 10%, more than 99.5% of the points on the iso-planes exhibited γ <1. For one patient, kV-CBCT images detected 5.8% dose variation in the right parotid due to tumor shrinkage and patient weight loss.

Conclusions
ROI mapping method is an effective method for the creation of kV-CBCT electron density calibration curves for head-and-neck and brain tumor patients. Dose variations as monitored using kV-CBCT imaging suggest that some patients can benefit from adaptive treatment plan re-optimization.
Estimating the cost of care giving on caregivers for people living with HIV and AIDS in Botswana: a cross‐sectional study
Authors: Ama Njoku O , Seloilwe Esther S 
Published: April 2010

BackgroundCommunity home‐based care is the Botswana Government's preferred means of providing care for people living with HIV (PLHIV). However, primary (family members) or volunteer (community members) caregivers experience poverty, are socially isolated, endure stigma and psychological distress, and lack basic care‐giving education. Community home‐based care also imposes considerable costs on patients, their caregivers and families in terms of time, effort and commitment. An analysis of the costs incurred by caregivers in providing care to PLHIV will assist health and social care decision makers in planning the most appropriate ways to meet future service needs of PLHIV and their caregivers.MethodsThis study estimated the cost incurred in providing care for PLHIV through a stratified sample of 169 primary and volunteer caregivers drawn from eight community home‐based care groups in four health districts in Botswana.ResultsThe results show that the mean of the total monthly cost (explicit and indirect costs) incurred by the caregivers was $(90.45 ± 9.08) while the mean explicit cost of care giving was $(65.22 ± 7.82). This mean of the total monthly cost is about one and a half times the caregivers' mean monthly income of $66.00 (± 5.98) and more than six times the Government of Botswana's financial support to the caregivers. In addition, the cost incurred per visit by the caregivers was $15.26, while the total expenditure incurred per client or family in a month was $184.17.ConclusionsThe study, therefore, concludes that as the cost of providing care services to PLHIV is very high, the Government of Botswana should substantially increase the allowances paid to caregivers and the support it provides for the families of the clients. The overall costs for such a programme would be quite low compared with the huge sum of money budgeted each year for health care and for HIV and AIDS.
Febrile neutropenia in French emergency departments: results of a prospective multicentre survey
Authors: André Stéphanie , Taboulet Pierre , Elie Caroline , Milpied Noël , Nahon Michel , Kierzek Gérald , Billemont Mariève , Perruche Franck , Charpentier Sandrine , Clément Hélène , Pourriat Jean-Louis , Claessens Yann-Erick 
Published: April 2010

Abstract
Introduction
Febrile neutropenia (FN) is common in cancer patients receiving myelotoxic therapy. The procedures to treat FN are well established in oncology, but it is unclear whether management is adequate in the emergency department (ED).

Methods
This prospective, multicentre, observational study was carried out in 47 French EDs for 6 months. Patients were adults presenting at the ED with FN after myelotoxic treatment for cancer. Severity of infection was defined according to Bone criteria for severe sepsis and septic shock (SS/SSh) and risk was determined according to Multinational Association of Supportive Care in Cancer (MASCC) criteria. The end point was the implementation of guidelines. Management of patients with SS/SSh required: (i) adequate intravenous (IV) antimicrobial therapy for the first 90 min (broad-spectrum beta-lactam with or without an aminoglycoside); (ii) fluid challenge (500 mL); (iii) lactate measurement; (iv) at least one blood culture; and (v) hospitalization. Management of patients without SS/SSh required: (1) no initiation of granulocyte - cell stimulating factor (G-CSF); (2) adequate IV antimicrobial therapy (broad-spectrum beta-lactam) and hospitalization if the patient was high-risk according to MASCC criteria; (3) adequate oral antimicrobial therapy (quinolone or amoxicillin/clavulanate or cephalosporin) and hospital discharge if the patient was low-risk.

Results
198 patients were enrolled; 89 patients had SS/SSh, of whom 19 received adequate antimicrobial therapy within 90 min and 42 received appropriate fluid challenge. Blood cultures were obtained from 87 and lactate concentration was measured in 29. Overall, only 6 (7%) patients with SS/SSh received adequate management. Among 108 patients without SS/SSh, 38 (35%) were high-risk and 70 (65%) low-risk. In the high-risk group, adequate antimicrobial therapy was given to 31 patients, G-CSF was initiated in 4 and 35 were hospitalized. In the low-risk group, 4 patients received adequate oral antimicrobial therapy, IV antimicrobial therapy was prescribed in 59, G-CSF was initiated in 12 and six patients were discharged. Adequate management was given to 26/38 (68%) high-risk and 1/70 low-risk patients. Factors associated with adequate management were absence of SS/SSh (P = 0.0009) and high-risk according to MASCC criteria (P < 0.0001).

Conclusions
In this French sample of cancer patients presenting to the ED with FN, management was often inadequate and severity was under-evaluated in the critically ill.
Restriction Site Tiling Analysis: accurate discovery and quantitative genotyping of genome-wide polymorphisms using nucleotide arrays
Authors: Pespeni Melissa H , Oliver Thomas A , Manier Mollie K , Palumbi Stephen R 
Published: April 2010

AbstractHigh-throughput genotype data can be used to identify genes important for local adaptation in wild populations, phenotypes in lab stocks, or disease-related traits in human medicine. Here we advance microarray-based genotyping for population genomics with Restriction Site Tiling Analysis. The approach simultaneously discovers polymorphisms and provides quantitative genotype data at 10,000s of loci. It is highly accurate and free from ascertainment bias. We apply the approach to uncover genomic differentiation in the purple sea urchin.
American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Immunohistochemical Testing of Estrogen and Progesterone Receptors in Breast Cancer
Authors: Hammond M. Elizabeth H. , Hayes Daniel F. , Dowsett Mitch , Allred D. Craig , Hagerty Karen L. , Badve Sunil , Fitzgibbons Patrick L. , Francis Glenn , Goldstein Neil S. , Hayes Malcolm , Hicks David G. , Lester Susan , Love Richard , Mangu Pamela B. , McShane Lisa , Miller Keith , Osborne C. Kent , Paik Soonmyung , Perlmutter Jane , Rhodes Anthony , Sasano Hironobu , Schwartz Jared N. , Sweep Fred C.G. , Taube Sheila , Torlakovic Emina Emilia , Valenstein Paul , Viale Giuseppe , Visscher Daniel , Wheeler Thomas , Williams R. Bruce , Wittliff James L. , Wolff Antonio C. 
Published: April 2010

Purpose To develop a guideline to improve the accuracy of immunohistochemical (IHC) estrogen receptor (ER) and progesterone receptor (PgR) testing in breast cancer and the utility of these receptors as predictive markers. Methods The American Society of Clinical Oncology and the College of American Pathologists convened an international Expert Panel that conducted a systematic review and evaluation of the literature in partnership with Cancer Care Ontario and developed recommendations for optimal IHC ER/PgR testing performance. Results Up to 20% of current IHC determinations of ER and PgR testing worldwide may be inaccurate (false negative or false positive). Most of the issues with testing have occurred because of variation in preanalytic variables, thresholds for positivity, and interpretation criteria. Recommendations The Panel recommends that ER and PgR status be determined on all invasive breast cancers and breast cancer recurrences. A testing algorithm that relies on accurate, reproducible assay performance is proposed. Elements to reliably reduce assay variation are specified. It is recommended that ER and PgR assays be considered positive if there are at least 1% positive tumor nuclei in the sample on testing in the presence of expected reactivity of internal (normal epithelial elements) and external controls. The absence of benefit from endocrine therapy for women with ER-negative invasive breast cancers has been confirmed in large overviews of randomized clinical trials.
“My Travail’s History”: Perspectives on the Roads to Othello , Stratford-upon-Avon 1959
Authors: Howard Tony 
Published: April 2010

This article seeks to unite theatre history with the 'real' histories of economics, ideology and race by looking beyond conventional archive materials, tracing the genesis of one of the 20th century's most lauded yet also undermined performances: that of singer, actor, athlete, and anti-fascist activist Paul Robeson as Othello in 1959. The study incorporates archival materials from the RSC and the Shakespeare Birthplace Trust, as well as those from less likely sources, including records held by the FBI and MI5. These materials reveal the tireless efforts of the American and British authorities to prevent Robeson from using the role of Othello as a vehicle for his activism, drawing parallels between the actor's plight and Sergei Yutkevich's 1956 Russian Othello , in which he was refused the right to star despite having received great acclaim for his performances of the role in London (1930) and on Broadway (1942-45). In contextualising the socio-political backdrops against which these earlier productions were set, the article addresses the racial opposition and misrepresentation faced by Robeson for more than 30 years, shedding light on the ways the actor made Othello a symbol of race relations in the twentieth century and how his opponents, echoing the conflicts in Shakespeare's play.
Assessment of Screening Tests for Sleep Apnea Syndrome in the Workplace
Authors: Tanaka Shigemi , Shima Masayuki 
Published: April 2010

Assessment of Screening Tests for Sleep Apnea Syndrome in the Workplace: Shigemi Tanaka, et al. Tanaka Internal Medicine ClinicObjectivesThe Epworth sleepiness scale (ESS) is often used for screening of sleep apnea syndrome (SAS) in the workplace. We conducted pulse oximetry for workers of a large transportation company, who were selected based on their response to a questionnaire that included ESS and breathing pattern during sleep.MethodsPulse oximetry was performed for 803 of 3,761 male workers. A 3% oxygen desaturation index (ODI) ≥15 was defined to represent sleep disordered breathing (SDB). We evaluated the frequencies of severe snoring and sleep apnea in the past three months reported by the bed partner or a family member. The relationships between 3% ODI ≥15 and various parameters were analyzed.ResultsOf the 715 workers with valid recordings, 3% ODI was ≥15 in 108. The prevalence of 3% ODI ≥15 was high among workers with a body mass index (BMI) ≥25 kg/ m2, or for whom severe snoring (≥4 days/wk) or sleep apnea (≥2 days/mo) was reported, but did not correlate with ESS scores. Multivariate analysis showed that 3% ODI ≥15 correlated significantly with BMI, and reported severe snoring and sleep apnea, but not ESS scores. The prevalence of 3% ODI ≥15 was high among obese workers. ESS scores did not correlate with 3% ODI ≥15, irrespective of obesity.ConclusionsOur findings suggest that severe snoring, sleep apnea and BMI, but not ESS, are useful screening tools for SAS.
Risk Factors for Upper Extremity Musculoskeletal Symptoms among Call Center Employees
Authors: d'Errico Angelo , Caputo Patrizia , Falcone Umberto , Fubini Lidia , Gilardi Luisella , Mamo Carlo , Migliardi Alessandro , Quarta Denis , Coffano Elena 
Published: April 2010

Risk Factors for Upper Extremity Musculoskeletal Symptoms among Call Center Employees: Angelo d'Errico, et al. Epidemiology Unit ASL TO3‐Piedmont Region, ItalyObjectivesTo investigate the prevalence of musculoskeletal symptoms in the upper extremity (UE) in a sample of Italian call center (CC) operators, and the relationship between the symptoms and potential workplace risk factors.MethodsDuring 2005‐2006, 775 workers from seven CCs in the Turin area participated in a questionnaire survey of exposure to ergonomic, organizational and psychosocial factors at work, socio‐demographics, lifestyle, symptoms and diseases. Musculoskeletal symptoms were defined as self‐reported musculoskeletal symptoms in the UE during the previous 28 days, for which a physician was consulted and/or drugs were taken. Relative risks were estimated through Poisson regression models with the Huber‐White sandwich estimator of variance.ResultOverall, 45% of workers reported UE symptoms in the last four weeks. Symptoms in the neck were the most prevalent (39%), followed by the shoulder (22%), handwrist (10%) and elbow (4%). Among workplace risk factors, neck‐shoulder symptoms were associated with low job control, elevated noise, poor desk lighting and impossibility to lean back while sitting; whereas elbow‐hand/wrist symptoms were associated with short intervals between calls, insufficient working space, lack of forearm support, job insecurity and long seniority in the CC industry.ConclusionsThe high prevalence of UE symptoms in this sample was similar to that reported by other studies conducted in this industry. Our results confirm previously reported associations, such as poor characteristics of the workstation and psychological stressors. The striking difference between the set of risk factors for neck‐shoulder and elbow/wrist‐hand symptoms indicates that the two regions should be investigated separately.
The Plight of Clinical Waste Pickers: Evidence from the Northwest Region of Cameroon
Authors: Mochungong Peter I. K. 
Published: April 2010

The Plight of Clinical Waste Pickers: Evidence from the Northwest Region of Cameroon: Peter I. K. Mochungong. Unit for Health Promotion Research, University of Southern Denmark, DenmarkObjectiveTo present the pitiable working conditions of clinical waste pickers in hospitals in the Northwest region of Cameroon and associated exposure to health hazards.MethodsObserve clinical waste pickers as they carry out their functions for three days and carry out informal consultations (discussion) with the waste pickers on their working conditions, possible health risks and avenues and resources to improve the current situation.ResultsLack of immunization, protective equipment, and poor work postures, absence of support groups and lack of awareness on associated health hazards contributes to the current plight of clinical waste pickers in Cameroon. Improving hospital infrastructure and equipment is prioritized over safety and management of risks faced by the clinical waste pickers.ConclusionClinical waste pickers in Cameroon certainly work in poor conditions which endanger their health and those of their families. There is an urgent need for the implementation of health and safety protocols together with an overhaul of equipment currently in use.
Updated Meta-analysis of Probiotics for Preventing Necrotizing Enterocolitis in Preterm Neonates
Authors: Deshpande Girish , Rao Shripada , Patole Sanjay , Bulsara Max 
Published: April 2010

OBJECTIVE:
Systematic reviews of randomized, controlled trials (RCTs) indicate lower mortality and necrotizing enterocolitis (NEC) and shorter time to full feeds after probiotic supplementation in preterm (&lt;34 weeks' gestation) very low birth weight (VLBW; birth weight &lt;1500 g) neonates. The objective of this study was to update our 2007 systematic review of RCTs of probiotic supplementation for preventing NEC in preterm VLBW neonates.

METHODS:
We searched in March 2009 the Cochrane Central register; Medline, Embase, and Cinahl databases; and proceedings of the Pediatric Academic Society meetings and gastroenterology conferences. Cochrane Neonatal Review Group search strategy was followed. Selection criteria were RCTs of any enteral probiotic supplementation that started within first 10 days and continued for ≥7 days in preterm VLBW neonates and reported on stage 2 NEC or higher (Modified Bell Staging).

RESULTS:
A total of 11 (N = 2176), including 4 new (n = 783), trials were eligible for inclusion in the meta-analysis by using a fixed-effects model. The risk for NEC and death was significantly lower. Risk for sepsis did not differ significantly. No significant adverse effects were reported. Trial sequential analysis) showed 30% reduction in the incidence of NEC (α = .05 and .01; power: 80%).

CONCLUSIONS:
The results confirm the significant benefits of probiotic supplements in reducing death and disease in preterm neonates. The dramatic effect sizes, tight confidence intervals, extremely low P values, and overall evidence indicate that additional placebo-controlled trials are unnecessary if a suitable probiotic product is available.
Children's Hospitals Do Not Acutely Respond to High Occupancy
Authors: Fieldston Evan S. , Hall Matthew , Sills Marion R. , Slonim Anthony D. , Myers Angela L. , Cannon Courtney , Pati Susmita , Shah Samir S. 
Published: April 2010

OBJECTIVE:High hospital occupancy may lead to overcrowding in emergency departments and inpatient units, having an adverse impact on patient care. It is not known how children's hospitals acutely respond to high occupancy. The objective of this study was to describe the frequency, direction, and magnitude of children's hospitals' acute responses to high occupancy.METHODS:Patients who were discharged from 39 children's hospitals that participated in the Pediatric Health Information System database during 2006 were eligible. Midnight census data were used to construct occupancy levels. Acute response to high occupancy was measured by 8 variables, including changes in hospital admissions (4 measures), transfers (2 measures), and length of stay (2 measures).RESULTS:Hospitals were frequently at high occupancy, with 28% of midnights at 85% to 94% occupancy and 42% of midnights at ≥95% occupancy. Whereas half of children's hospitals used occupancy-mitigating responses, there was variability in responses and magnitudes were small. When occupancy was &gt;95%, no more than 8% of hospitals took steps to reduce admissions, 13% increased transfers out, and up to 58% reduced standardized length of stay. Two-day lag response was more common but remained of too small a magnitude to make a difference in hospital crowding. Additional modeling techniques also revealed little response.CONCLUSIONS:We found a low rate of acute response to high occupancy. When there was a response, the magnitude was small.