bluuebunny/crossref_metadata_2025_split huggingface dataset:
Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice
Authors: Apekey Tanefa A. , McSorley Gerry , Tilling Michelle , Siriwardena A. Niroshan 
Published: April 2010

AbstractBackground  Leadership and innovation are currently seen as essential elements for the development and maintenance of high‐quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice.Method  Self‐administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12‐item scale to assess leadership behaviour, a seven‐dimension self‐rating scale for culture of innovation and questions on current use of quality improvement tools and techniques.Results  Sixty‐three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P < 0.001). Apart from clinical audit and significant event analysis, quality improvement methods were not adopted by most participating practices.Conclusions  Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate.
Current treatment of chronic heart failure in primary care; still room for improvement
Authors: Bosch Marije , Wensing Michel , Bakx J. Carel , Van Der Weijden Trudy , Hoes Arno W. , Grol Richard P.T.M. 
Published: April 2010

AbstractRational and aims  In recent years, guidelines for treatment of patients with chronic heart failure (CHF) have been updated. Insight in current pharmacological and non‐pharmacological treatment of CHF in primary care, which was non‐optimal in earlier studies, is limited. We aim to describe current pharmacological and non‐pharmacological treatment of CHF in primary care.Methods  In this cross‐sectional observational study, we included a representative sample of 357 patients diagnosed with CHF from 42 primary care practices in the Netherlands. We combined medical record data with data from patient and doctor questionnaires.Results  Mean age of patients was 75.7 years (SD 10.2), 53% were male, and 73% of patients had mild heart failure (New York Heart Association class I or II). 76.5% of patients received diuretics. Angiotensin‐converting enzyme inhibitors were prescribed in 40.6% and angiotensin‐II receptor blockers in 20.7%; β‐blockers were prescribed to 54.6%, while 24.9% received spironolactone. Patients with more severe heart failure had a lower probability of being treated according to guideline recommendations. Relevant lifestyle advice was given to 40–60% of the patients, depending on the specific lifestyle advice.Conclusions  Implementation of evidence‐based pharmacotherapy for heart failure in primary care has improved since clinical guidelines have been updated; especially with respect to prescription of β‐blockers. However, there still seems ample room for improvement, as in the case for providing lifestyle advice.
Confined displacement algorithm determines true and random colocalization in fluorescence microscopy
Authors: RAMÍREZ O. , GARCÍA A. , ROJAS R. , COUVE A. , HÄRTEL S. 
Published: April 2010

SummaryThe quantification of colocalizing signals in multichannel fluorescence microscopy images depends on the reliable segmentation of corresponding regions of interest, on the selection of appropriate colocalization coefficients, and on a robust statistical criterion to discriminate true from random colocalization. Here, we introduce a confined displacement algorithm based on image correlation spectroscopy in combination with Manders colocalization coefficients M1ROI and M2ROI to quantify true and random colocalization of a given florescence pattern. We show that existing algorithms based on block scrambling exaggerate the randomization of fluorescent patterns with resulting inappropriately narrow probability density functions and false significance of true colocalization in terms of p values. We further confine our approach to subcellular compartments and show that true and random colocalization can be analysed for model dendrites and for GABAB receptor subunits GABABR1/2 in cultured hippocampal neurons. Together, we demonstrate that the confined displacement algorithm detects true colocalization of specific fluorescence patterns down to subcellular levels.
Transcriptomes of the desiccation‐tolerant resurrection plant Craterostigma plantagineum
Authors: Rodriguez Maria C. Suarez , Edsgärd Daniel , Hussain Syed S. , Alquezar David , Rasmussen Morten , Gilbert Thomas , Nielsen Bjørn H. , Bartels Dorothea , Mundy John 
Published: April 2010

SummaryStudies of the resurrection plant Craterostigma plantagineum have revealed some of the mechanisms which these desiccation‐tolerant plants use to survive environments with extreme dehydration and restricted seasonal water. Most resurrection plants are polyploid with large genomes, which has hindered efforts to obtain whole genome sequences and perform mutational analysis. However, the application of deep sequencing technologies to transcriptomics now permits large‐scale analyses of gene expression patterns despite the lack of a reference genome. Here we use pyro‐sequencing to characterize the transcriptomes of C. plantagineum leaves at four stages of dehydration and rehydration. This reveals that genes involved in several pathways, such as those required for vitamin K and thiamin biosynthesis, are tightly regulated at the level of gene expression. Our analysis also provides a comprehensive picture of the array of cellular responses controlled by gene expression that allow resurrection plants to survive desiccation.
Outcome assessment of decentralization of antiretroviral therapy provision in a rural district of Malawi using an integrated primary care model
Authors: Chan Adrienne K. , Mateyu Gabriel , Jahn Andreas , Schouten Erik , Arora Paul , Mlotha William , Kambanji Marion , van Lettow Monique 
Published: April 2010

SummaryObjective  To assess the effect of decentralization (DC) of antiretroviral therapy (ART) provision in a rural district of Malawi using an integrated primary care model.Methods  Between October 2004 and December 2008, 8093 patients (63% women) were registered for ART. Of these, 3440 (43%) were decentralized to health centres for follow‐up ART care. We applied multivariate regression analysis that adjusted for sex, age, clinical stage at initiation, type of regimen, presence of side effects because of ART, and duration of treatment and follow‐up at site of analysis.Results  Patients managed at health centres had lower mortality [adjusted OR 0.19 (95% C.I. 0.15–0.25)] and lower loss to follow‐up (defaulted from treatment) [adjusted OR 0.48 (95% C.I. 0.40–0.58)]. During the first 10 months of follow‐up, those decentralized to health centres were approximately 60% less likely to default than those not decentralized; and after 10 months of follow‐up, 40% less likely to default. DC was significantly associated with a reduced risk of death from 0 to 25 months of follow‐up. The lower mortality may be explained by the selection of stable patients for DC, and the mentorship and supportive supervision of lower cadre health workers to identify and refer complicated cases.Conclusion  Decentralization of follow‐up ART care to rural health facilities, using an integrated primary care model, appears a safe and effective way to rapidly scale‐up ART and improves both geographical equity in access to HIV‐related services and adherence to ART.
Tracking a sample of patients lost to follow‐up has a major impact on understanding determinants of survival in HIV‐infected patients on antiretroviral therapy in Africa
Authors: Geng Elvin H. , Glidden David V. , Emenyonu Nneka , Musinguzi Nicolas , Bwana Mwebwesa Bosco , Neilands Torsten B. , Muyindike Winnie , Yiannoutsos Constantin T. , Deeks Steven G. , Bangsberg David R. , Martin Jeffrey N. 
Published: April 2010

SummaryObjective  To date, data regarding the determinants of mortality in HIV‐infected patients starting antiretroviral therapy (ART) in Africa have been primarily derived from routine clinical care settings practicing the public health approach. Losses to follow‐up, however, are high in these settings and may lead to bias in understanding the determinants of mortality.Methods  We evaluated HIV‐infected adults initiating ART between January 1, 2004 and September 30th, 2007 in an ART clinic in southwestern Uganda. Clinical and demographic characteristics were obtained through routine clinical care. In evaluating determinants of mortality, a ‘naïve’ analysis used only deaths known through routine processes. A ‘sample‐corrected’ approach incorporated, through probability weights, outcomes from a representative sample of patients lost to follow‐up whose vital status was ascertained through tracking in the community.Results  In 3,628 patients followed for up to 3.75 years after ART initiation, the ‘naïve’ approach identified male sex and lower pre‐ART CD4 count as independent determinants of mortality. The ‘sample‐corrected’ approach found lower pre‐ART CD4 count, older age, lower weight and calendar year of ART initiation, but not male sex, to be independent determinants of mortality.Conclusions  Analyses to identify determinants of mortality in HIV‐infected patients on ART in Africa that do not account for losses to follow‐up can identify spurious associations and miss actual relationships – both with the potential to mislead public health efforts. A sampling‐based approach to account for losses to follow‐up represents a feasible and potentially scalable method to strengthen the evidence available for implementation of ART delivery in Africa.
Patient retention in antiretroviral therapy programs up to three years on treatment in sub‐Saharan Africa, 2007–2009: systematic review
Authors: Fox Matthew P. , Rosen Sydney 
Published: April 2010

SummaryObjectives  To estimate the proportion of all‐cause adult patient attrition from antiretroviral therapy (ART) programs in service delivery settings in sub‐Saharan Africa through 36 months on treatment.Methods  We identified cohorts within Ovid Medline, ISI Web of Knowledge, Cochrane Database of Systematic Reviews and four conference abstract archives. We summarized retention rates from studies describing observational cohorts from sub‐Saharan Africa reporting on adult HIV 1‐ infected patients initiating first‐line three‐drug ART. We estimated all‐cause attrition rates for 6, 12, 18, 24, or 36 months after ART initiation including patients who died or were lost to follow‐up (as defined by the author), but excluding transferred patients.Results  We analysed 33 sources describing 39 cohorts and 226 307 patients. Patients were more likely to be female (median 65%) and had a median age at initiation of 37 (range 34–40). Median starting CD4 count was 109 cells/mm3. Loss to follow‐up was the most common cause of attrition (59%), followed by death (41%). Median attrition at 12, 24 and 36 months was 22.6% (range 7%–45%), 25% (range 11%–32%) and 29.5% (range 13%–36.1%) respectively. After pooling data in a random‐effects meta‐analysis, retention declined from 86.1% at 6 months to 80.2% at 12 months, 76.8% at 24 months and 72.3% at 36 months. Adjusting for variable follow‐up time in a sensitivity analysis, 24 month retention was 70.0% (range: 66.7%–73.3%), while 36 month retention was 64.6% (range: 57.5%–72.1%).Conclusions  Our findings document the difficulties in retaining patients in care for lifelong treatment, and the progress being made in raising overall retention rates.
Early loss to follow up after enrolment in pre‐ART care at a large public clinic in Johannesburg, South Africa
Authors: Larson Bruce A. , Brennan Alana , McNamara Lynne , Long Lawrence , Rosen Sydney , Sanne Ian , Fox Matthew P. 
Published: April 2010

SummaryObjective  To estimate loss to follow up (LTFU) between initial enrolment and the first scheduled return medical visit of a pre‐antiretroviral therapy (ART) care program for patients not eligible for ART.Methods  The study was conducted at a public‐sector HIV clinic in Johannesburg. We reviewed records of all patients newly enrolled in the pre‐ART care program and not yet eligible for ART between January 2007 and February 2008. Crude proportions of patients completing their first return medical visit stratified by patient characteristics were calculated. A modified‐Poisson approach was used to estimate directly relative risks of returning for their first return medical visit within 1 year adjusting for patient characteristics as potential confounders.Results  A total of 356 patients were identified. Two‐thirds had a CD4 count > 350 cells/μl (median [IQR] CD4 = 458 [394, 585]) and were scheduled to return in 6 months for a first medical visit. Seventy‐four percent of these patients did not return within one year for this visit. The remaining 36% of all patients had a baseline CD4 count 251–350 cells/μl and were scheduled to return in 3 months. Only 6% of these patients returned within 4 months; 41% returned within one year. Relative risks were positively associated with a patient being employed and negatively associated with the baseline CD4 count.Conclusions  Given the high rate of LTFU immediately after enroling in pre‐ART care, it is clear that care programs are not expediting the timely initiation of ART. Significantly improved adherence to pre‐ART care and monitoring for patients not yet eligible for ART is required for South Africa to achieve its AIDS strategy goals and reduce the problem of late presentation and initiation of ART.
Why are antiretroviral treatment patients lost to follow‐up? A qualitative study from South Africa
Authors: Miller Candace M. , Ketlhapile Mpefe , Rybasack‐Smith Heather , Rosen Sydney 
Published: April 2010

SummaryObjectives  To better understand the reasons why patients default from antiretroviral treatment (ART) programmes to help design interventions that improve treatment retention and ultimately, patient outcomes.Methods  Prospective cohort study at two treatment sites in South Africa followed by qualitative interviews with patients that had defaulted.Results  Respondents overwhelmingly reported that ART improved their health status and quality of life. Nevertheless, despite improved health from taking ART and worse health when treatment is stopped, serious barriers to treatment remained: transport costs, time needed for treatment, and logistical challenges were barriers to treatment, whereas stigma around HIV/AIDS, and side effects associated with ART were less influential.Conclusion  With a better understanding of the reasons for defaulting, interventions can be designed that improve treatment retention and ultimately, patient outcomes. This study argues for realistic interventions and policy changes designed to reduce the financial and time burden of ART and to reduce logistical barriers, such as simplifying the referral and transfer process, employing patient advocates, and adopting extended and weekend clinic hours.
CLINICAL STUDY: FULL ARTICLE: Immunomodulating properties of gamma‐hydroxybutyrate (GHB), flunitrazepam and ethanol in ‘club drugs’ users
Authors: Pichini Simona , Farré Magi , Abanades Sergio , Pacifici Roberta , Zuccaro Piergiorgio , Langohr Klaus , De La Torre Rafael 
Published: April 2010

ABSTRACTDespite the increasing concern about gamma‐hydroxybutyrate (GHB) toxicity in users, no studies have addressed GHB and other club drugs effects on the immune system under controlled administration. Lymphocyte subsets and functional responsiveness of lymphocytes to mitogenic stimulation were measured in 10 healthy male recreational users of GHB who participated in five experimental sessions within the framework of a clinical trial. The study was randomized, double blind, double dummy and cross‐over. Drug conditions were: a single oral dose of GHB (40 mg/kg or 60 mg/kg), ethanol (0.7 g/kg), flunitrazepam (1.25 mg) and placebo. Acute GHB produced a time‐dependent immune impairment in the first 4 hours after drug administration associated with an increase in cortisol secretion. Although total leukocyte count remained unchanged, there was a significant decrease in the CD4 T/CD8 T‐cell ratio, as well as in the percentage of mature T lymphocytes, probably because of a decrease in both the percentage and absolute number of T helper cells. A significant decrease was also observed in natural killer cells and in functional responsiveness of lymphocytes to mitogenic stimulation. Flunitrazepam administration did not produce any change in the immune system, while ethanol intake produced a decrease in B lymphocytes and in lymphocyte proliferative response to mitogens. These results provide the first evidence that GHB intake under a controlled environmental setting impairs the immunological status and confirms the alterations in the immune function caused by ethanol.
PRECLINICAL STUDY: FULL ARTICLE: The dopamine D3 receptor partial agonist CJB090 and antagonist PG01037 decrease progressive ratio responding for methamphetamine in rats with extended‐access
Authors: Orio Laura , Wee Sunmee , Newman Amy H. , Pulvirenti Luigi , Koob George F. 
Published: April 2010

ABSTRACTPrevious work suggests a role for dopamine D3‐like receptors in psychostimulant reinforcement. The development of new compounds acting selectively at dopamine D3 receptors has opened new possibilities to explore the role of these receptors in animal models of psychostimulant dependence. Here we investigated whether the dopamine D3 partial agonist CJB090 (1–10 mg/kg, i.v) and the D3 antagonist PG01037 (8–32 mg/kg, s.c.) modified methamphetamine (0.05 mg/kg/injection) intravenous self‐administration under fixed‐ (FR) and progressive‐ (PR) ratio schedules in rats allowed limited (short access, ShA; 1‐hour sessions 3 days/week) or extended access (long access, LgA; 6 hour sessions 6 days/week). Under a FR1 schedule, the highest dose of the D3 partial agonist CJB090 selectively reduced methamphetamine self‐administration in LgA but not in ShA rats, whereas the full D3 antagonist PG01037 produced no effect in either group. Under a PR schedule of reinforcement, the D3 partial agonist CJB090 reduced the maximum number of responses performed (‘breakpoint’) for methamphetamine in LgA rats at the doses of 5 and 10 mg/kg, and also it produced a significant reduction in the ShA group at the highest dose. However, the D3 full antagonist PG01037 only reduced PR methamphetamine self‐administration in LgA rats at the highest dose of 32 mg/kg with no effect in the ShA group. The results suggest that rats might be more sensitive to pharmacological modulation of dopamine D3 receptors following extended access to methamphetamine self‐administration, opening the possibility that D3 receptors play a role in excessive methamphetamine intake.
REVIEW: Behavioral evidence for the significance of serotoninergic (5‐HT) receptors in cocaine addiction
Authors: Filip Małgorzata , Alenina Natalia , Bader Michael , Przegaliński Edmund 
Published: April 2010

ABSTRACTCocaine addiction has somatic, psychological, psychiatric, socio‐economic and legal implications in the developed world. Presently, there is no medication approved for the treatment of cocaine addiction. In recent years, data from the literature (pre‐clinical studies and clinical trials) have provided several lines of evidence that serotonin (5‐HT) and 5‐HT receptors play a modulatory role in the mechanisms of action of cocaine. Here we review the contribution of 5‐HT receptor subtypes to cocaine sensitization, discrimination, conditioned place preference, self‐administration, reinstatement of seeking behavior and withdrawal symptoms in laboratory animals. Additionally, the consequences of chronic cocaine exposure on particular 5‐HT receptor‐assigned functions in pre‐clinical studies are presented.
Liver transplant from Anti‐HBc‐positive, HBsAg‐negative donor into HBsAg‐negative recipient: is it safe? A systematic review of the literature
Authors: Avelino‐Silva Vivian Iida , D′Albuquerque Luiz Augusto Carneiro , Bonazzi Patrícia Rodrigues , Song Alice Tung Wan , Miraglia João Luiz , De Brito Neves Alan , Abdala Edson 
Published: April 2010

Avelino‐Silva VI, D′Albuquerque LAC, Bonazzi PR, Song ATW, Miraglia JL, de Brito Neves A, Abdala E. Liver transplant from Anti‐HBc‐positive, HBsAg‐negative donor into HBsAg‐negative recipient: is it safe? A systematic review of the literature.  Clin Transplant 2010: 24: 735–746. © 2010 John Wiley & Sons A/S.Abstract: Introduction:  After liver transplant (LT) from Anti‐HBc+/HBsAg− donors into HBsAg− recipients, transmission of hepatitis B virus (HBV) may occur (de novo HBV infection). This study analyzes the incidence of de novo HBV infection in HBsAg− recipients of Anti‐HBc+/HBsAg− LT with respect to: (i) the recipients’ HBV serology and (ii) the type of preventive therapy adopted.Methods:  A systematic review of the literature using the electronic database Medline.Results:  Five hundred and fifty‐two LT in 36 articles were selected. Lamivudine, Hepatitis B immune globulin (HBIG), revaccination, and combined therapies were employed in multiple strategies as preventive interventions. Naïve recipients had a high risk of de novo HBV infection, with smaller incidences when HBIG and lamivudine were used, either alone or in association. Vaccinated recipients or those with isolated hepatitis B core antibodies (Anti‐HBc) and previous HBV infection had lower risks of viral transmission, additionally reduced by any prophylaxis adoption.Discussion:  LT from Anti‐HBc+/HBsAg− donors into HBsAg− recipients is apparently safe, as long as the recipient is vaccinated or presents an isolated Anti‐HBc or previous HBV infection and some prophylaxis is employed. Currently lamivudine seems the best alternative; other nucleoside analogs and revaccination strategies should be considered in future studies. Follow‐up and preventive therapies should be maintained for five yr or preferably throughout the recipients’ life span.