bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fatty acid analyses reveal high degrees of omnivory and dietary plasticity in pond‐dwelling tadpoles
Authors: WHILES MATT R. , GLADYSHEV MICHAIL I. , SUSHCHIK NADEZDA N. , MAKHUTOVA OLESIA N. , KALACHOVA GALINA S. , PETERSON SCOT D. , REGESTER KURT J. 
Published: December 2009

Summary1. Understanding the trophic relationships of consumers is central to ecology, but constructing meaningful food webs is often difficult because of a lack of detailed information on consumption versus assimilation and high degrees of omnivory.2. We used fatty acid analyses to examine the trophic relationships of three common larval anurans (Pseudacris crucifer, Lithobates catesbeianus and Lithobates clamitans) that are often classified as grazers or detritivores. Tadpoles and potential food sources were sampled in four ponds in southern Illinois and analysed for fatty acid composition. Single linkage cluster analysis was then used to compare fatty acid profiles among tadpole gut contents, tadpole muscle tissues and available food resources.3. Diets varied among species and within species among ponds, but organic sediments consistently contributed most to the fatty acid composition of the gut contents of all species. Fatty acid profiles also indicated that larval insects and phytoplankton were consumed by both L. catesbeianus and L. clamitans in one pond, while L. clamitans and P. crucifer consumed mainly periphyton along with sediments in another pond, and these diet differences appeared linked to physical differences among ponds, with periphyton and/or phytoplankton contributing more to tadpole diets in less shaded ponds.4. The fatty acid composition of muscle tissues of L. clamitans, the dominant tadpole in these systems, indicated that plant detritus and bacteria, which were the dominant components of organic sediments in the ponds, were common components of the assimilatory diet.5. Results demonstrate the utility of fatty acid analyses for assessing both consumption and assimilation. The tadpole assemblages we examined derive much of their energy from heterotrophic and allochthonous sources and exhibit high dietary plasticity. This information will allow for more accurate and comprehensive assessments of trophic interactions in freshwater habitats, as well as aid in amphibian conservation, management and captive propagation efforts.
DNA mismatch repair deficiency in sporadic colorectal cancer and Lynch syndrome
Authors: Poulogiannis George , Frayling Ian M , Arends Mark J 
Published: December 2009

Poulogiannis G, Frayling I M & Arends M J (2010) Histopathology56, 167–179 DNA mismatch repair deficiency in sporadic colorectal cancer and Lynch syndrome DNA mismatch repair (MMR) deficiency is one of the best understood forms of genetic instability in colorectal cancer (CRC), and is characterized by the loss of function of the MMR pathway. Failure to repair replication‐associated errors due to a defective MMR system allows persistence of mismatch mutations all over the genome, but especially in regions of repetitive DNA known as microsatellites, giving rise to the phenomenon of microsatellite instability (MSI). A high frequency of instability at microsatellites (MSI‐H) is the hallmark of the most common form of hereditary susceptibility to CRC, known as Lynch syndrome (LS) (previously known as hereditary non‐polyposis colorectal cancer syndrome), but is also observed in ∼15–20% of sporadic colonic cancers (and rarely in rectal cancers). Tumour analysis by both MMR protein immunohistochemistry and DNA testing for MSI is necessary to provide a comprehensive picture of molecular abnormality, for use in conjunction with family history data and other clinicopathological features, in order to distinguish LS from sporadic MMR‐deficient CRC. Identification of the gene targets that become mutated in MMR‐deficient tumours may explain, at least in part, some of the clinical, pathological and biological features of MSI‐H CRCs and holds promise for developing novel therapeutics.
Microchimerism in renal allografts: clinicopathological associations according to the type of chimeric cells
Authors: Ferlicot Sophie , Vernochet Amélia , Romana Serge , Ortin‐Serrano Monique , Letierce Alexia , Brégerie Olivier , Durrbach Antoine , Guettier Catherine 
Published: December 2009

Ferlicot S, Vernochet A, Romana S, Ortin‐Serrano M, Letierce A, Brégerie O, Durrbach A & Guettier C (2010) Histopathology56, 188–197 Microchimerism in renal allografts: clinicopathological associations according to the type of chimeric cells Aims:  Recent studies have highlighted the presence of microchimerism in various solid allografts. The biological significance of these chimeric cells is controversial. They may be beneficial, leading to better tolerance of grafts or participating in tissue repair or, in contrast, deleterious if involved in chronic lesions. The aim was to assess the frequency and cellular nature of microchimerism in female renal grafts of male recipients by combined fluorescence in situ hybridization (FISH) for Y chromosome and immunohistochemistry and to investigate associations between intragraft microchimerism and histological lesions or allograft outcome.Methods and results:  We screened 33 renal biopsy specimens, including 11 with acute T‐cell‐mediated rejection and nine with transplant glomerulopathy, from 22 male recipients transplanted with female kidneys by FISH and immunohistochemistry with antibodies against smooth muscle actin (mesangial cells), CD31 (endothelial cells), KL1 (epithelial cells), CD45 (leucocyte common antigen) and glomerular epithelial protein 1 (podocytes). Tubular microchimerism was detected in 71% of the patients with a mean percentage of chimeric epithelial cells of 1.4%. Glomerular microchimerism involving podocytes, mesangial and endothelial cells was present with a mean number of chimeric cells per glomerular section of, respectively, 0.6, 2.66 and 3.53. There was an association between endothelial microchimerism and a previous episode of acute T‐cell‐mediated rejection.Conclusions:  In conclusion, microchimerism in renal grafts occurs frequently, but at a low level and affects tubular cells and all glomerular cell compartments in human renal allografts.
Adherence to hypertension treatment guidelines in state facilities in KwaZulu‐Natal, South Africa
Authors: Cassimjee Mariam , Suleman Fatima 
Published: December 2009

Abstract
Rationale, aims and objectives  The province of KwaZulu‐Natal, South Africa, embarked on the Essential Drugs Programme (EDP) consisting of standard treatment guidelines (STGs) and essential drugs lists in May 1999. The use of these tools was aimed at promoting rational drug use. This study sought to determine the percentage of compliance to the STGs of the EDP in the treatment of hypertension in patients in the district of eThekwini.
Methods  A retrospective cross‐sectional randomized sampling of 100 prescriptions for hypertension per 21 health facility was conducted for the period of 3 months in 2007. Each prescription was assessed against modified World Health Organization indicators to determine compliance to STGs.
Results  The mean age of the sample was 55.235 years (±0.62). Hypertension featured as the most common diagnosis in the sample (57.5%). The mean result of compliance to the STGs for the eThekwini District was 22.05% (±20.03). The results of the multiple linear regression equation suggest that the variables selected in this study explain 86.79% of the variables impacting on treatment guideline adherence.
Conclusion  The low mean results for compliance to the STGs was due mainly to the absence of a diagnosis recorded on the prescription, and the addition of a new drug for each symptom without due consideration of polypharmacy, drug–disease and drug–drug interactions.
The intended and unintended consequences of clinical guidelines
Authors: Shackelton Rebecca J. , Marceau Lisa D , Link Carol L. , McKinlay John B. 
Published: December 2009

Abstract
Objectives  First, we examine whether clinical guidelines, designed to improve health care and reduce disparities in clinical practice, are achieving their intended consequences. Second, we contemplate potential unintended consequences of clinical guidelines.
Method  As part of a factorial experiment we presented primary care doctors (n = 192) with clinically authentic vignettes of a ‘patient’ with already diagnosed diabetes with an emerging foot neuropathy. Their proposed clinical actions were compared with established practice guidelines for this clinical situation.
Results  After establishing the existence of consistent socioeconomic disparities in the proposed management of the case presented, we found that reported use of practice guidelines had no measurable effect towards their reduction (one intended consequence). However, the reported use of practice guidelines appeared to precipitate more clinical actions, without eliminating documented disparities.
Conclusions  Consistent with other research we find that clinical practice guidelines are not producing a principal intended result, and may even produce unintended consequences.
Quantitative evaluation of a clinical intervention aimed at changing prescriber behaviour in response to new guidelines
Authors: Doyon Sophie , Perreault Mélissa , Marquis Christopher , Gauthier Josianne , Lebel Denis , Bailey Benoit , Collin Johanne , Bussières Jean‐François 
Published: December 2009

Abstracts
Rational, aims and objectives  The objective of the study was to assess prescribers' compliance with guidelines for acute community‐acquired pneumonia management in a paediatric university hospital centre before and after its dissemination.
Method  This quasi‐experimental study without a control group was conducted before and after new community‐acquired pneumonia management guidelines were disseminated in a tertiary care paediatric hospital. The pre‐intervention (baseline) period was from October 2004 to March 2005. The intervention period was divided into two phases: (1) October 2005 to January 14, 2006 (consultation by peer leaders and networking) and (2) January 15, 2006, to March 2006 (dissemination of official guidelines and of a pre‐printed prescription sheet, an educational session led by a peer leader for residents and further networking). We used a compliance score to assess prescriptions written by prescribers who practised in the units where the guidelines had to be followed.
Results  The study included a total of 1151 prescriptions. The prescription compliance with the guidelines increased from 131/652 (20.1%) in the pre‐intervention period to 264/499 (52.9%) in the post‐intervention intervention period: a difference of 32.8% (CI 95% 27.4–38.0). Similar results were found if analysed according to affiliation (emergency department or wards). An inappropriate choice of antibiotic agent represented 347/521 (66.6%) of the causes of non‐compliance in the pre‐intervention period and 99/235 (42.1) in the intervention period: a difference of −24.5% (95% CI −31.8, −16.8).
Conclusion  Guideline dissemination for the management of acute community‐acquired pneumonia significantly increased prescriber compliance in the emergency department and on wards.
Diagnostic test evaluation by patient‐outcome study in homeopathy: balancing of feasibility and validity
Authors: Rutten A. L. B. , Stolper C. F. 
Published: December 2009

Abstract
Background  Signs and symptoms can be considered as diagnostic tests, updating prior odds by applying Bayes' theorem. In homeopathy, signs and symptoms guide the doctor when prescribing appropriate medicines but the powers of these indicators are largely based on common experience.
Objective  We want to know whether it is possible to calculate the power of arguments of signs and symptoms indicating homeopathic medicines, expressed in likelihood ratios.
Methods  An observational patient‐outcome study as advocated for diagnostic test evaluation. There was no independent observation of symptoms and results. Instead, observers were extensively trained in assessing each other's cases and the process was regularly monitored.
Results  A total of 4072 prescriptions for 4094 patients were recorded. The relation between six clinical symptoms and outcome was calculated. Variance between observers in assessing symptoms and results were considerable. Some indications of confirmation bias were detected by follow‐up, and 48 statistically significant likelihood ratios regarding six symptoms were calculated.
Conclusion  A diagnostic patient‐outcome study within homeopathy collecting a large amount of data is demonstrated. Results partly confirm clinical practice at a 95% confidence level. This kind of research could validate knowledge from practical experience.
Let Evidence Guide Every New Decision (LEGEND): an evidence evaluation system for point‐of‐care clinicians and guideline development teams
Authors: Clark Eloise , Burkett Karen , Stanko‐Lopp Danette 
Published: December 2009

AbstractObjective To develop tools for use by teams of point‐of‐care clinicians to improve access to evidence evaluation.Method A search of the literature was conducted to review available evidence evaluation systems for their applicability to the project. Fourteen systems were reviewed in depth for strengths and limitations of the systems to meet the objective. Using these strengths and addressing the limitations, tools were developed and pilot‐tested among an interprofessional team of clinicians.Results Five principles were drawn from the review of the literature and from our experience to guide development of six tools. The tools form a comprehensive evidence evaluation system known as Let Evidence Guide Every New Decision (LEGEND). LEGEND included a glossary, a table of evidence levels, an algorithm, a set of evidence appraisal forms, and worksheets to guide grading a body of evidence and judging the strength of a recommendation.Conclusion LEGEND provides tools for point‐of‐care clinicians that assist them in synthesizing evidence from published studies. The tools provide a balance between quality processes and simplicity, use terminology friendly to multiple disciplines, assist comprehensively with the evidence evaluation process, incorporate factors familiar to the user, and provide flexibility for a diverse range of evidence evaluation projects and users.
Registered nurses' application of evidence‐based practice: a national survey
Authors: Boström Anne‐Marie , Ehrenberg Anna , Gustavsson J. Petter , Wallin Lars 
Published: December 2009

Background  Evidence‐based practice (EBP) is a worldwide approach to improving health care. There is, however, a shortage of studies examining whether or not newly graduated health care professionals are actually applying EBP in their daily work.
Objectives  To examine the application of EBP in clinical practice by registered nurses (RNs) 2 years post graduation and to explore whether the application of EBP differed with regard to the clinical settings where RNs were working.
Method  A cross‐sectional design using a national sample. Data were collected in 2007 from 987 RNs (response rate 76%). Six items measuring respondents' self‐reported extent of applying EBP were used.
Results  Of the 987 RNs, 19% formulated questions and performed searches in data bases, 56% used other information sources, 31% appraised the literature, 30% participated in practice development and 34% participated in evaluating clinical practice. A greater proportion of the RNs working in elder care applied EBP compared with the RNs working in hospitals, psychiatric care and primary care.
Conclusions  The RNs applied the components of EBP to a rather low extent 2 years post graduation despite EBP being an important objective in Swedish health care and educational programmes since the 1990s. These findings support other studies reporting the implementation of EBP in organizations as a complex and often slow process. The differences in the RNs extent of applying EBP in relation to their workplace indicate that contextual factors and the role of the RN in the organization are of importance for getting EBP into practice.
Are therapeutic decisions made on the medical admissions unit any more evidence‐based than they used to be?
Authors: Ayre Stephen , Walters Gareth 
Published: December 2009

AbstractRationale, aims and objectives To determine whether inpatients in a medical admissions unit in a UK district general hospital received evidence‐based therapies in 2008.Methods The diagnoses of and therapies received by inpatients at the George Eliot Hospital National Health Service Trust in Nuneaton were recorded. A clinical librarian searched the literature (Clinical Knowledge Summaries, Cochrane Library, Medline and Embase) for the best evidence for each diagnosis–therapy pair. Evidence was graded on the following scale: systematic review, randomized controlled trial, non‐experimental evidence and no or contrary evidence.Results One hundred and two patients generated 150 diagnosis–therapy pairs. Of these 61 (41%) had systematic review level evidence supporting them, 17 (11%) randomized controlled trial evidence, 48 (32%) non‐experimental evidence and 24 (16%) no evidence.Conclusions Results were comparable with previous studies. Care in a medical admissions unit in 2008 is still evidence‐based, but, despite the vast growth in medical literature, no more than it was. The process was a useful collaboration between medical and library staff to audit the quality of patient care.
O knowledge, where art thou?
Authors: Boehnert Markus U. , Zimmermann Heinz , Exadaktylos Aristomenis K. 
Published: December 2009

Abstract
Background  Much effort goes into developing and publishing guidelines which physicians fail to implement. We feel that major discrepancies still exist between theory and reality and that the translational approach to this aspect of medical care has not yet established itself. We therefore decided to investigate in an exemplary audit how liberally inappropriate imaging is used in our emergency department (ED) to rule out acute appendicitis.
Material and methods  Our electronic medical record ED database ‘Qualicare’ (http://www.qualidoc.ch) was searched using the ‘appendicitis’ sub data base. The frequency and accuracy of abdominal imaging was determined in patients with clinically suspected appendicitis on admission over a 5‐year period at a university hospital emergency unit.
Results  In total, 272 (41.2%) of the 577 patients were male and 305 (46.3%) were female. The attending physicians ordered abdominal X‐rays in 133 patients, abdominal ultrasounds in 319, and abdominal computerized tomography (CT) scans in 93 patients. 125 patients underwent more than one imaging procedure. In all, 85/125 patients received a combination of X‐rays, ultrasound and CT scanning!
Discussion  Physicians are often insecure about indications for surgery and therefore order useless imaging procedures. The reliability of such procedures in excluding acute appendicitis is limited, which was confirmed by our results. Although evidence‐based medicine guidelines exist, they are neglected for many reasons. Future academic efforts should therefore focus more on knowledge translation and the implementation of existing knowledge by heightening awareness, rather than on simply creating new guidelines.
Personal experience in doctor and patient decision making: from psychology to medicine
Authors: Li Simon Y. W. , Rakow Tim , Newell Ben R. 
Published: December 2009

AbstractTraditional decision research shows that when people are told the probability of a rare event (e.g. the chance of side effects), they generally treat this event as if it were more likely than its objective probability (overweighting). In contrast, recent studies indicate that when outcomes are experienced firsthand, people tend to underweight the probability of rare events. In this paper, we suggest that the distinction between described and experienced information can play a significant role in shared decision making, and can provide a plausible explanation for some discrepancies between the perspectives of doctors and patients. We highlight some of the advantages and disadvantages of experiential and description‐based information, and how knowledge of these might be used to improve risk communication.
Identifying women with severe angiographic coronary disease
Authors: Kreatsoulas C. , Natarajan M. K , Khatun R. , Velianou J. L , Anand S. S 
Published: December 2009

Abstract.  Kreatsoulas C, Natarajan MK, Khatun R, Velianou JL, Anand SS (McMaster University; CARING Network, McMaster University; Population Health Research Institute, McMaster University and Hamilton Health Sciences; Interventional Cardiology, Hamilton Health Sciences; Eli Lilly Canada–May Cohen Chair in Women's Health, McMaster University; Michael G. DeGroote‐Heart and Stroke Foundation of Ontario Chair in Population Health Research, McMaster University; Population Genomics Program, McMaster University; McMaster University, Hamilton, ON, Canada). Identifying women with severe angiographic coronary disease. J Intern Med 2010; 268:66–74.Objectives.  To determine sex/gender differences in the distribution of risk factors according to age and identify factors associated with the presence of severe coronary artery disease (CAD).Design.  We analysed 23 771 consecutive patients referred for coronary angiography from 2000 to 2006.Subjects.  Patients did not have previously diagnosed CAD and were referred for first diagnostic angiography.Outcome measures.  Patients were classified according to angiographic disease severity. Severe CAD was defined as left main stenosis ≥50%, three‐vessel disease with ≥70% stenosis or two‐vessel disease including proximal left anterior descending stenosis of ≥70%. Univariate and multivariate logistic regression was used to assess the association between risk factors and angina symptoms with severe CAD.Results.  Women were less likely to have severe CAD (22.3% vs. 36.5%) compared with men. Women were also significantly older (69.8 ± 10.6 vs. 66.3 ± 10.7 years), had higher rates of diabetes (35.0% vs. 26.6%), hypertension (74.8% vs. 63.3%) and Canadian Cardiovascular Society (CCS) class IV angina symptoms (56.7% vs. 47.8%). Men were more likely to be smokers (56.9% vs. 37.9%). Factors independently associated with severe CAD included age (OR = 1.05; 95% CI 1.05–1.05, P < 0.01), male sex (OR = 2.43; CI 2.26–2.62, P < 0.01), diabetes (OR = 2.00; CI 1.86–2.18, P < 0.01), hyperlipidaemia (OR = 1.50; CI 1.39–1.61, P < 0.01), smoking (OR = 1.10; CI 1.03–1.18, P = 0.06) and CCS class IV symptoms (OR = 1.43; CI 1.34–1.53, P < 0.01). CCS Class IV angina was a stronger predictor of severe CAD amongst women compared with men (women OR = 1.82; CI 1.61–2.04 vs. men OR = 1.28; CI 1.18–1.39, P < 0.01).Conclusions.  Women referred for first diagnostic angiography have lower rates of severe CAD compared with men across all ages. Whilst conventional risk factors, age, sex, diabetes, smoking and hyperlipidaemia are primary determinants of CAD amongst women and men, CCS Class IV angina is more likely to be associated with severe CAD in women than men.