bluuebunny/crossref_metadata_2025_split huggingface dataset:
Baseline radiological staging in primary breast cancer: impact of educational interventions on adherence to published guidelines
Authors: McWhirter Elaine , Yogendran Geetha , Wright Frances , Pharm George Dranitsaris M. , Clemons Mark 
Published: August 2007

Abstract
Rationale  The purpose of baseline radiological staging in newly diagnosed breast cancer patients is to rule out overt metastatic disease. We have previously compared the use of radiological staging at our institution with the recommendations of the Cancer Care Ontario Practice Guidelines Initiative (CCOPGI). Our results demonstrated that between January 2000 to December 2002, a high proportion of our cohort (n = 135) of patients underwent unnecessary investigations.
Objectives  To implement and assess an educational intervention to encourage staging guideline utilization in a cohort of early breast cancer patients.
Methods  In January 2003, multidisciplinary educational rounds were held, highlighting the CCOPGI guidelines, and reporting results of the audit of staging investigations. The staging guidelines were then included in the Clinical Practice Guidelines of the Breast Disease Site Group, Toronto‐Sunnybrook Regional Cancer Centre. A retrospective chart review was completed that assessed staging investigations from a random sample of a similar group of patients (n = 134) from January 2003 to April 2005, to explore the effects of these educational interventions on clinical practice.
Results  For patients with Stage I breast cancer, there was a significant decrease (P < 0.004) in each type of investigation: a twofold decrease in chest X‐rays; 2.5‐fold decrease bone scans and fourfold decrease in the number of abdominal ultrasounds. For patients in Stage II, there was no significant change in the proportion of patients undergoing radiological investigations. There was a non‐significant trend towards appropriately receiving all three investigations for patients with Stage III disease.
Conclusions  Our results demonstrate that prior to the educational intervention, many patients with early breast cancer were undergoing inappropriate radiological staging. Since 2003 however, for Stage I patients there has been a significant improvement in adherence with the guidelines. We hypothesize that our educational intervention had a positive impact on improving the utilization of baseline radiological staging in patients with primary breast cancer.
Prioritizing guideline topics: development and evaluation of a practical tool
Authors: Ketola Eeva , Toropainen Erja , Kaila Minna , Luoto Riitta , Mäkelä Marjukka 
Published: August 2007

Abstract
Rationale, aims and objectives  A clear process for selecting and adopting clinical practice guidelines in the new topic areas is needed. The aim of this study is to design and develop a practical tool to assess guideline topics that have been suggested to the organization responsible for producing guidelines.
Methods  We carried out an iterative development, feasibility and validation study of a guideline topic prioritization tool. The setting included the guideline producer organization and the tax‐funded health care system. In the first stage of the tool development, participants were researchers, members of the Current Care Board and experts from health care organizations. In the second stage, the evaluation was done internally within the project by three independent reviewers. The main outcome measures were responses to an evaluation questionnaire, qualitative process feedback and analysis of the performance of the instrument on a random set of guidelines.
Results  Evaluations by three independent reviewers revealed good agreement and face validity with respect to its feasibility as a planning tool at the guideline board level. Feedback from board members suggested that the instrument is useful in prioritizing guideline topics.
Conclusion  This instrument was accepted for use by the Board. Further developments are needed to ensure feedback and acceptability of the instrument by those proposing topics.
Creating clinically relevant knowledge from systematic reviews: the challenges of knowledge translation
Authors: Scott N. Ann , Moga Carmen , Barton Pamela , Rashiq Saifudin , Schopflocher Donald , Taenzer Paul , Harstall Christa ,   the Alberta Ambassador Program Team
Published: August 2007

Abstract
Rationale and objective  A research translation strategy for chronic pain was developed that has significant potential to advance the usefulness of systematic reviews (SRs) in clinical practice.
Method  The strategy used interactive case‐based workshops that summarize current evidence on treatments for chronic non‐cancer pain. Health technology assessment researchers and clinicians collaborated to translate SR evidence into education aids, but this proved far from straightforward.
Results  Sourcing and selecting the SR evidence required maintaining a credible balance between the diametrical concepts of comprehensiveness and efficiency, and relevance and validity. On examination of the collated evidence base, further challenges were encountered in dealing with the lack of consistency among the SRs in the quality of execution, the scales used to rate the quality of the evidence, and the conclusions on common topic areas. Strategies for overcoming these difficulties are discussed.
Conclusions  The key elements for creating clinically relevant knowledge from SRs are: a flexible, consistent and transparent methodology; credible research; involvement of renowned content experts to translate the evidence into clinically meaningful guidance; and an open, trusting relationship among all contributors.
The process of evidence‐based medicine and the search for meaning
Authors: Biswas Rakesh , Umakanth Shashikiran , Strumberg Joachim , Martin Carmel M. , Hande Manjunath , Nagra Jagbir S. 
Published: August 2007

Abstract
Background and Rationale  Evidence based medicine is the present backbone of rational and objective, modern medical problem solving and is a meeting ground for quantitative and qualitative researchers alike as it culminates into applying the fruits of clinical research to the individual patient.A systematic enquiry into the evolving paradigms in EBM is a need of the hour.
Aims and methods  A qualitative enquiry examining the impact of different methodologies in EBM and their role in generating meaning interpretable at individual levels.
Results  Present day outcome based research deals less with patients as individuals than as populations. Evidence based medicine struggles to apply the fruits of population based research to individuals who are often not as predictable as linear quantitative research would like them to be. The present EBM literature neglects a lot of events it doesn’t believe to be statistically significant and perhaps here is an area that needs to be improved on – it assumes that because associations are demonstrated between interventions and outcomes in RCTs/meta‐analysis, these associations are linear and causal in the real world. While they may be demonstrated repeatedly in highly controlled environments, in the real ‘uncontrolled’ world of clinical practice with real people, their validity breaks down.
Conclusions  One needs to make the EBM standard model patient‐individual (a projection of collective patient event data) resemble the real human individual patient so that optimal EBM individual data that matches our query can be easily and quickly spotted from the dense jungle of information that has grown over the years. This hints at rethinking our entire research methodology and modifying it to suit the needs of the individual patient.
Doctors’ views of clinical practice guidelines: a qualitative exploration using innovation theory
Authors: Hader Joanne M. , White Robin , Lewis Steven , Foreman Jeanette L. B. , McDonald Paul W. , Thompson Laurence G. 
Published: August 2007

Abstract
Rationale, aims and objectives  The authors undertook this qualitative study as part of a larger evaluation of the effect of eight clinical practice guidelines issued by an arm’s‐length government agency in a Canadian province. Using Orlandi and colleagues’ version of the Rogers diffusion of innovation model as a framework, the authors mapped doctors’ views on implementation of clinical practice guidelines.
Methods  In semi‐structured interviews with 45 representative doctors, the authors elicited doctors’ framework of meaning for behaviour change in general and for clinical practice guideline uptake in particular. These were then compared with the adapted Orlandi/Rogers diffusion of innovation model to confirm, amend or challenge that model.
Results  Doctors identified the following influences on changes to their clinical practice and on clinical practice guideline uptake, within a five‐step innovation model:
1 innovation: evidence change is required, perceived need for change;
2 communication: awareness of innovation;
3 adoption: evidence of improved outcomes without increased patient risk, opinion leader support, consistency with current trends;
4 implementation: patient and family acceptability; and
5 maintenance: system support, patient and family support, observed improved patient outcomes without increased risk
Conclusions  Innovation for doctors is a complex decision process rather than a single decision point. Change occurs in the context of professional networks and patient and family support and demand.
Neuropsychological predictors of everyday functioning in adults with intellectual disabilities
Authors: Su C.‐Y. , Chen C.‐C. , Wuang Y.‐P. , Lin Y.‐H. , Wu Y.‐Y. 
Published: August 2007

AbstractBackground  Very little is known about the neuropsychological correlates of adaptive functioning in people with intellectual disabilities (ID). This study examined whether specific cognitive deficits and demographic variables predicted everyday functioning in adults with ID.Method  People with ID (n = 101; ages 19–41 years; mean education = 11 years; 34% women; 54% competitively employed; 41% with mild ID) completed a comprehensive neuropsychological battery grouped into four cognitive domains: processing speed, verbal memory and comprehension, visual perception/constructive function, and executive function. In addition, parents completed an 89‐item rating scale developed to assess a wide range of independent living skills.Results  Confirmatory factor analysis results confirmed a correlated four‐factor model of cognitive function and a unidimensional model of everyday functioning. Furthermore, structural equation modelling results supported the predictive relationship of verbal memory/comprehension and employment status (standardized regression coefficients 0.45, 0.22, P ≤ 0.01 for each) to measures of everyday functioning. The two variables together explained 35% of the variance in everyday functioning.Conclusions  Both general cognitive dysfunction and specific verbal memory and comprehension deficit impair daily functions in people with ID. These findings have implications for predictive models of adaptive functioning, and for cognitive rehabilitation and deficit compensation strategies for this group.
Circulating E‐selectin as a risk marker in patients with end‐stage renal disease
Authors: Malatino L. S. , Stancanelli B. , Cataliotti A. , Bellanuova I. , Fatuzzo P. , Rapisarda F. , Leonardis D. , Tripepi G. , Mallamaci F. , Zoccali C. 
Published: August 2007

Abstract.Background.  E‐selectin is a key adhesion molecule which plays a fundamental role in endothelial progenitor cell‐dependent reparative mechanisms in experimental ischaemia and it serves to anchor leucocytes to the endothelium in inflammatory processes. Inflammation is one of the strongest risk factors for death and cardiovascular (CV) events in end‐stage renal disease (ESRD).Objective.  The objective of the current study was to evaluate whether E‐selectin is a useful biomarker of clinical outcome in ESRD patients. We tested the prediction power of circulating E‐selectin for mortality and CV events in a cohort of 265 ESRD patients.Results.  During the follow‐up, 59 patients died and 58 had CV events. All‐cause mortality was inversely related to serum E‐selectin, the risk of death being the lowest in patients in the third E‐selectin tertile (HR: 1, reference group), intermediate in those in the second tertile (HR: 1.30) and the highest in patients in the first tertile (HR: 2.02, P = 0.01). Similarly, the risk of fatal and nonfatal CV events followed an inverse pattern being lowest in the third tertile (reference group) and highest in the first tertile (HR: 1.73, P = 0.03). The prediction power of E‐selectin for death and CV events was confirmed in a Cox regression analysis where E‐selectin emerged as an inverse predictor of these outcomes, particularly so in patients with severe inflammation.Conclusions.  These data are in keeping with the hypothesis that in systemic inflammation altered E‐selectin shedding may play a role in arterial damage and implicates this adhesion molecule in atherosclerotic complications in a high‐risk condition like ESRD.
Cardiomyopathy, pericarditis and myocarditis in a population‐based cohort of inpatients with coeliac disease
Authors: Elfström P. , Hamsten A. , Montgomery S. M. , Ekbom A. , Ludvigsson J. F. 
Published: August 2007

Abstract.Objectives:  We investigated the risk of myocarditis, cardiomyopathy, and pericarditis in patients with celiac disease (CD) from a general population cohort.Subjects and methods:  Through the Swedish national registers we identified 9363 children and 4969 adults with a diagnosis of CD (1964–2003). These individuals were matched with upto five reference individuals for age, sex, calendar year and county (n = 69 851). Cox regression estimated hazard ratios (HRs) for later heart disease.Main outcome measures:  Myocarditis, cardiomyopathy (any or dilated), and pericarditis defined according to relevant international classification of disease codes in the Swedish national inpatient register.Results:  Celiac disease diagnosed in childhood was not associated with later myocarditis (HR = 0.2; 95% CI = 0.0–1.5), cardiomyopathy of any type (HR = 0.8; 95% CI = 0.2–3.7), or pericarditis (HR = 0.4; 95% CI = 0.1–1.9). Restricting our analyses to adulthood CD and heart disease diagnosed from 1987 and onwards in departments of cardiology/internal medicine, we found no association between CD and later myocarditis (HR = 2.1; 95% CI = 0.4–11.7), dilated cardiomyopathy (HR = 1.7; 95% CI = 0.4–6.5) or pericarditis (HR = 1.5; 95% CI = 0.5–4.0).Conclusion:  This study found no association between CD, later myocarditis, cardiomyopathy or pericarditis.
Do patient characteristics or factors at resuscitation influence long‐term outcome in patients surviving to be discharged following in‐hospital cardiac arrest?
Authors: Skrifvars M. B. , Castren M. , Nurmi J. , Thoren A. B. , Aune S. , Herlitz J. 
Published: August 2007

Abstract.Introduction.  Few studies have focused on factors influencing long‐term outcome following in‐hospital cardiac arrest. The present study assesses whether long‐term outcome is influenced by difference in patient factors or factors at resuscitation.Methods.  An analysis of cardiac arrest data collected from one Swedish tertiary hospital and from five Finnish secondary hospitals supplemented with data on 1 year survival. Multiple logistic regression analysis was used to identify factors associated with survival at 12 months.Results.  A total of 441 patients survived to hospital discharge following in‐hospital cardiac arrest and 359 (80%) were alive at 12 months. Factors independently associated with survival [odds ratio (OR) >1 indicates increased survival and <1 decreased survival] at 12 months were; age [OR 0.95, 95% confidence interval (CI) 0.93–0.98], renal disease (OR 0.3, CI 0.1–0.9), good functional status at discharge (OR 4.9, CI 1.3–18.9), arrest occurring at (compared with arrests on general wards) emergency wards (OR 4.7, CI 1.4–15.3), cardiac care unit (OR 2.8, CI 1.2–6.4), intensive care unit (OR 2.4, CI 1.1–5.7), ward for thoracic surgery (OR 10.2, CI 2.6–40.1) and unit for interventional radiology (OR 13.3, CI 3.4–52.0). There was no difference in initial rhythm, delay to defibrillation or delay to return of spontaneous circulation between survivors and nonsurvivors.Conclusion.  Several patient factors, mainly age, functional status and co‐morbid disease, influence long‐term survival following cardiac arrest in hospital. The location where the arrest occurred also influences survival, but initial rhythm, delay to defibrillation and to return of spontaneous circulation do not.
Acute effects of haemodialysis on biochemical modulators of endothelial function
Authors: Hewitson C. L. , Whiting M. J. , Barbara J. A. , Mangoni A. A. 
Published: August 2007

Abstract.Objectives.  To assess the acute effects of haemodialysis (HD) on biochemical factors modulating endothelial function.Setting.  Academic medical centre.Subjects.  Forty patients (age 63.5 ± 2.2 years, mean ± SEM) undergoing HD.Interventions.  Folic acid (F), homocysteine (tHcy), asymmetric dimethylarginine (ADMA), high‐sensitivity C‐reactive protein (CRP) and malondialdehyde (MDA) were measured pre‐HD, 1 h after commencing HD and within the last hour of HD (end‐HD). Endothelium‐dependent and ‐independent vasodilatation were measured by applanation tonometry (changes in augmentation index, AIx, postinhaled salbutamol and postsublingual nitroglycerin) in conjunction with biochemical measurements.Results.  Marked reductions in serum F (616 ± 73 vs. 273 ± 30 nmol L−1, P < 0.001), tHcy (16.3 ± 0.7 vs. 11.2 ± 0.5 μmol L−1, P < 0.001) and ADMA (0.64 ± 0.02 vs. 0.47 ± 0.02 μmol L−1, P < 0.001) occurred end‐HD, whereas CRP and MDA levels did not significantly change. There was no significant change in endothelium‐dependent vasodilatation, whereas endothelium‐independent vasodilatation improved end‐HD (−23.1 ± 1.9 vs. −17.3 ± 1.3%, P = 0.018). Regression analysis showed that both higher ADMA (P = 0.029) and lower F levels (P = 0.040) end‐HD were determinants of reduced endothelium‐dependent vasodilatation end‐HD (R2 = 0.23).Conclusions.  HD is associated with significant reductions in F, tHcy and ADMA serum concentrations. The lack of significant effects of HD on endothelium‐dependent vasodilatation could be secondary to the concomitant loss of factors either enhancing (F) or impairing (ADMA) endothelial function.
Statistical analysis of amplified fragment length polymorphism data: a toolbox for molecular ecologists and evolutionists
Authors: Bonin A. , Ehrich D. , Manel S. 
Published: August 2007

AbstractRecently, the amplified fragment length polymorphism (AFLP) technique has gained a lot of popularity, and is now frequently applied to a wide variety of organisms. Technical specificities of the AFLP procedure have been well documented over the years, but there is on the contrary little or scattered information about the statistical analysis of AFLPs. In this review, we describe the various methods available to handle AFLP data, focusing on four research topics at the population or individual level of analysis: (i) assessment of genetic diversity; (ii) identification of population structure; (iii) identification of hybrid individuals; and (iv) detection of markers associated with phenotypes. Two kinds of analysis methods can be distinguished, depending on whether they are based on the direct study of band presences or absences in AFLP profiles (‘band‐based’ methods), or on allelic frequencies estimated at each locus from these profiles (‘allele frequency‐based’ methods). We investigate the characteristics and limitations of these statistical tools; finally, we appeal for a wider adoption of methodologies borrowed from other research fields, like for example those especially designed to deal with binary data.
Multiple paternity and kin recognition mechanisms in a guppy population
Authors: HAIN TIMOTHY J. A. , NEFF BRYAN D. 
Published: August 2007

AbstractHelp directed toward kin (nepotism) is an important example of social behaviour. Such helping behaviour requires a mechanism to distinguish kin from nonkin. The prevailing kin recognition hypothesis is that when familiarity is a reliable cue of relatedness, other mechanisms of recognition will not evolve. However, when familiarity is an unreliable cue of relatedness, kin recognition by phenotype matching is instead predicted to evolve. Here we use genetic markers to show that guppies (Poecilia reticulata) from a population in a tributary of the Paria River in Trinidad are characterized by a high degree of multiple mating with 95% of broods having more than one sire and some dams having offspring sired by six males. These levels of multiple mating are the highest reported among live‐bearing fishes. The mean relatedness of brood‐mates was 0.36 (as compared to 0.5 for full‐siblings). Therefore, familiarity does not seem to be a reliable mechanism to assess full‐sibling relatedness. Using two‐choice behavioural trials, we found that juveniles from this population use both phenotype matching and familiarity to distinguish kin from nonkin. However, we did not find strong evidence that the guppies use these mechanisms to form shoals of related individuals as adults, which is similar to results from other guppy populations in Trinidad. The use of both familiarity and phenotype matching is discussed in the context of the Paria River guppy population's mating system and ecology. Overall, these data provide support for the kin recognition hypothesis and increase our understanding of the evolution of kin recognition systems.
Historical and biological determinants of genetic diversity in the highly endemic triploid sea lavender Limonium dufourii (Plumbaginaceae)
Authors: PALOP‐ESTEBAN M. , SEGARRA‐MORAGUES J. G. , GONZÁLEZ‐CANDELAS F. 
Published: August 2007

AbstractMicrosatellite markers were used to evaluate the genetic diversity and population genetic structure in the critically endangered Limonium dufourii (Plumbaginaceae), a highly endemic triploid species from the coasts of eastern Spain. Sixty‐five alleles from 13 microsatellite regions were amplified in a sample of 122 individuals collected from the six extant populations. Microsatellite patterns were consistent with the triploid nature of L. dufourii. Alleles were unambiguously assigned to two different parental subgenomes in this hybrid species and the greater contribution of the diploid parental subgenome was confirmed. Eleven, 25 and 26 multilocus genotypes were recorded from the haploid, diploid and from the combined information of both subgenomes, respectively. Genetic diversity was mostly distributed among populations (72.06% of the total genetic variation). Genotypes from Marjal del Moro populations grouped into two highly structured clusters (88.41% of the total variance). The observed patterns of distribution of genetic diversity are interpreted to result from multiple hybridization events and isolation between populations. Threats to this species are mainly anthropogenic (urbanization and tourism pressure), although stochastic risks cannot be ignored. Therefore, in order to preserve extant genetic variation of L. dufourii, in situ strategies such as the preservation of its habitat are a high priority. Several recommendations in order to assist ex situ measures to guarantee the success of conservation strategies and maintain the relationships between individuals and populations are proposed.