bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evidence, Research, Knowledge: A Call for Conceptual Clarity
Authors: Scott‐Findlay Shannon , Pollock Carolee 
Published: May 2004

ABSTRACTObjective:To dispel some of the conceptual confusion in the field of evidence‐based practice that has resulted from the overlapping use of the termsresearch,evidence, andknowledge.Approach:Theoretical discussion.Findings:Often the termsresearchandknowledgeare used as synonyms forevidence, but the overlap is never complete. The termevidencehas long been understood to mean the findings of research.Discussion:Recent attempts to broaden the definition of evidence to include clinical experience and experiential knowledge have been misguided. Broadening our understanding of the basis for clinical decision making and conceptualizing evidence are quite different tasks. Other factors (not other forms of evidence) do shape the clinical decision‐making process, but they are not evidence. We might better term them knowledge. Confusing evidence with these other factors has hindered research and the improvement of clinical decision making in health care. We argue that this confusion results from the use of the termevidencewhen we really mean either research findings or knowledge.Conclusions:In this article, we have argued for specificity in the use of the termevidence. We urge the restriction of the termevidenceto research findings, and while we acknowledge the importance of other influences on the clinical decision‐making process, we insist that they are not evidence. The time has come to value personal experience and experiential knowledge for what they are—we should not have to disguise them as types of evidence for them to be deemed of any value. Being specific to language, the goal is to improve clinical decision making by increasing practitioners' reliance on research findings (evidence) while acknowledging (and valuing) the important part played by other forms of knowledge in the decision‐making process. The distinctions are important.
A Qualitative Study to Identify Barriers and Facilitators to Implementation of Pilot Interventions in the Veterans Health Administration (VHA) Northwest Network
Authors: Sharp Nancy D. , Pineros Sandra L. , Hsu Clarissa , Starks Helene , Sales Anne E. 
Published: May 2004

ABSTRACT Objective: To identify barriers and facilitators to implementation of pilot interventions designed to improve measurement and management of low‐density lipoprotein cholesterol (LDL‐c) levels in coronary heart disease patients using the evidence/context/facilitation model of implementation of evidence‐based practice. Design: Theory‐based conceptual content analysis of structured interviews conducted between January and April 2001. Setting: Six medical centers in the United States Veterans Health Administration Northwest Network. Participants: Fifty‐one of 64 individuals (physicians, nurses, pharmacists, dieticians, quality managers, and other clinical and nonclinical staff) who participated in planning and/or implementing pilot interventions. Main Findings: Barriers to successful implementation related primarily to the intervention process and secondarily to characteristics of the intervention context. Interview responses indicated that planning, including identification of resources and assessment of potential barriers and facilitators, was a critical and universally underutilized step in the intervention process. Conclusions: Organized team process, documented plans for intervention activities, and ongoing evaluation are essential for sustaining intervention activities. A top priority for facilitating interventions should be the development of educational materials, such as “how to” guides, that teach intervention teams how to anticipate barriers and make plans to address them, as well as identifying and fostering local experts in planning and implementing interventions.
In Vitro Interactions between Amphotericin B, Itraconazole, and Flucytosine against 21 Clinical
Aspergillus
Isolates Determined by Two Drug Interaction Models
Authors: Te Dorsthorst D. T. A. , Verweij P. E. , Meis J. F. G. M. , Punt N. C. , Mouton J. W. 
Published: May 2004

ABSTRACT

Combination therapy of flucytosine (5FC) with other antifungal agents could be of use for the treatment of invasive aspergillosis. However, interpretation of the results of in vitro interactions is problematic. The fractional inhibitory concentration (FIC) index is the most commonly used method, but it has several major drawbacks in characterizing antifungal drug interaction. Alternatively, a response surface approach using the concentration-effect relationship over the whole concentration range instead of just the MIC can be used. We determined the in vitro interactions between amphotericin B (AMB), itraconazole, and 5FC against 21
Aspergillus
isolates with a broth microdilution checkerboard method that employs the dye MTT [3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2
H
-tetrazolium bromide]. FIC indices based on three different MIC endpoints (MIC-0, MIC-1, and MIC-2) and the interaction coefficient alpha were determined, the latter by estimation from the response surface approach described by Greco et al. (W. R. Greco, G. Bravo, and J. C. Parsons, Pharmacol. Rev. 47:331-385, 1995). The value obtained for the FIC index was found to be dependent on the MIC endpoint used and could be either synergistic, indifferent, or antagonistic. The response surface approach gave more consistent results. Of the three combinations tested, the AMB-5FC combination was the most potent in vitro against
Aspergillus
spp. We conclude that the use of the response surface approach for the interpretation of in vitro interaction studies of antifungals may be helpful in order to predict the nature and intensity of the drug interaction. However, the correlation of these results with clinical outcome remains difficult and needs to be further investigated.
Effects of Voriconazole on
Cryptococcus neoformans
Authors: van Duin David , Cleare Wendy , Zaragoza Oscar , Casadevall Arturo , Nosanchuk Joshua D. 
Published: May 2004

ABSTRACT

Voriconazole is a broad-spectrum triazole that offers extended activity against molds and yeasts that are not susceptible to earlier azole-type drugs. Recent studies indicate that melanization can severely reduce the susceptibility of certain antifungal drugs, but there is no information as to whether voriconazole is vulnerable to this effect. The activity of voriconazole on
C. neoformans
was assessed by MIC analysis and time-kill assays for melanized and nonmelanized cells. Cell morphology, capsule release, and phagocytosis of
C. neoformans
were studied in the presence or absence of subinhibitory concentrations of voriconazole. Voriconazole was fungicidal at concentrations of ≥8 μg/ml in vitro against the strains of
C. neoformans
examined, and its efficacy was not diminished by melanization. Cells grown in subinhibitory concentrations of voriconazole had smaller cellular and capsular volumes than cells grown in the absence of drug. The induction of the capsule by serum was not affected by voriconazole. Cells grown in subinhibitory concentrations of voriconazole released their capsule and were phagocytosed at rates comparable with yeast grown without the antifungal. The high activity of voriconazole against both melanized and nonmelanized cells results suggest that voriconazole may be a particularly valuable drug for cryptococcosis.
In Vitro Activities of Garenoxacin and Levofloxacin against
Chlamydia pneumoniae
Are Not Affected by Presence of
Mycoplasma
DNA
Authors: Smith Raymond P. , Baltch Aldona L. , Ritz William J. , Carpenter Andrea N. , Halse Tanya A. , Bopp Lawrence H. 
Published: May 2004

ABSTRACT

We studied 20
Chlamydia pneumoniae
isolates obtained from respiratory sites and atheroma tissue of patients from various geographic areas to determine the susceptibilities of these isolates to a new des-fluoroquinolone, garenoxacin, and to levofloxacin. In addition, we assessed the cultures with these isolates by PCR for the presence or absence of
Mycoplasma
sp. DNA. Both the MIC at which 90% of isolates are inhibited (MIC
90
) and the minimal bactericidal concentration at which 90% of isolates are killed (MBC
90
) for garenoxacin were 0.06 μg/ml, and both the MIC
90
and the MBC
90
for levofloxacin were 2.0 μg/ml. The activity of garenoxacin against
C. pneumoniae
was 32-fold greater than that of levofloxacin.
Mycoplasma
sp. DNA was detected by PCR in 17 of 20 cultures.
Mycoplasma
amplicons from five
Mycoplasma
DNA-positive
C. pneumoniae
cultures were sequenced and found to represent four
Mycoplasma
species. Our data demonstrate that
C. pneumoniae
cultures frequently contain
Mycoplasma
DNA and that its presence in
C. pneumoniae
cultures does not appear to affect the susceptibility results for the two fluoroquinolones that we tested.
Effects of Efflux Transporter Genes on Susceptibility of
Escherichia coli
to Tigecycline (GAR-936)
Authors: Hirata Takahiro , Saito Asami , Nishino Kunihiko , Tamura Norihisa , Yamaguchi Akihito 
Published: May 2004

ABSTRACT

The activity of tigecycline, 9-(
t
-butylglycylamido)-minocycline, against
Escherichia coli
KAM3 (
acrB
) strains harboring plasmids encoding various tetracycline-specific efflux transporter genes,
tet
(B),
tet
(C), and
tet
(K), and multidrug transporter genes,
acrAB
,
acrEF
, and
bcr
, was examined. Tigecycline showed potent activity against all three Tet-expressing, tetracycline-resistant strains, with the MICs for the strains being equal to that for the host strain. In the Tet(B)-containing vesicle study, tigecycline did not significantly inhibit tetracycline efflux-coupled proton translocation and at 10 μM did not cause proton translocation. This suggests that tigecycline is not recognized by the Tet efflux transporter at a low concentration; therefore, it exhibits significant antibacterial activity. These properties can explain its potent activity against bacteria with a Tet efflux resistance determinant. Tigecycline induced the Tet(B) protein approximately four times more efficiently than tetracycline, as determined by Western blotting, indicating that it is at least recognized by a TetR repressor. The MICs for multidrug efflux proteins AcrAB and AcrEF were increased fourfold. Tigecycline inhibited active ethidium bromide efflux from intact
E. coli
cells overproducing AcrAB. Therefore, tigecycline is a possible substrate of AcrAB and its close homolog, AcrEF, which are resistance-modulation-division-type multicomponent efflux transporters.
Regulatory Regions of
smeDEF
in
Stenotrophomonas maltophilia
Strains Expressing Different Amounts of the Multidrug Efflux Pump SmeDEF
Authors: Sanchez Patricia , Alonso Ana , Martinez Jose L. 
Published: May 2004

ABSTRACT

The
smeT-smeDEF
region and the
smeT
gene, which encodes
the
smeDEF
repressor, are highly polymorphic. Few changes in
smeT
might be associated with
smeDEF
overexpression.
The results obtained with cellular extracts suggest that mutant SmeT
proteins cannot bind to the operator and that other transcription
factors besides SmeT are involved in the regulation of
smeDEF
expression.
Nosocomial Outbreak of Extended-Spectrum β-Lactamase SHV-5-Producing Isolates ofPseudomonas aeruginosain Athens, Greece
Authors: Poirel Laurent , Lebessi Evangelia , Castro Marisa , Fèvre Cindy , Foustoukou Maria , Nordmann Patrice 
Published: May 2004

ABSTRACTSeven nonrepetitivePseudomonas aeruginosaisolates producing the clavulanic acid-inhibited extended-spectrum β-lactamase SHV-5 were isolated in the same hospital in Athens, Greece, from 1998 to 2002. All isolates except one were clonally related, and theblaSHV-5gene was chromosomally located. This study underlined that this gene, which is widespread inEnterobacteriaceaein Greece, may disseminate also inP. aeruginosa.
ELVIRA HSV, a Yield Reduction Assay for Rapid Herpes Simplex Virus Susceptibility Testing
Authors: Stránská Růžena , Schuurman Rob , Scholl David R. , Jollick Joseph A. , Shaw Carl J. , Loef Caroline , Polman Merjo , van Loon Anton M. 
Published: May 2004

ABSTRACT
A colorimetric yield reduction assay, ELVIRA (enzyme-linked virus inhibitor reporter assay) HSV, was developed to determine the antiviral drug susceptibilities of herpes simplex virus (HSV). It uses an HSV-inducible reporter cell line. This simple and rapid assay has an objective readout, low inoculum size, and good reproducibility. The results correlate well with those of the plaque reduction assay.
Strong correlation of maximal squat strength with sprint performance and vertical jump height in elite soccer players: Figure 1
Authors: Wisløff U , Castagna C , Helgerud J , Jones R , Hoff J 
Published: May 2004

Background:A high level of strength is inherent in elite soccer play, but the relation between maximal strength and sprint and jumping performance has not been studied thoroughly.Objective:To determine whether maximal strength correlates with sprint and vertical jump height in elite male soccer players.Methods:Seventeen international male soccer players (mean (SD) age 25.8 (2.9) years, height 177.3 (4.1) cm, weight 76.5 (7.6) kg, and maximal oxygen uptake 65.7 (4.3) ml/kg/min) were tested for maximal strength in half squats and sprinting ability (0–30 m and 10 m shuttle run sprint) and vertical jumping height.Result:There was a strong correlation between maximal strength in half squats and sprint performance and jumping height.Conclusions:Maximal strength in half squats determines sprint performance and jumping height in high level soccer players. High squat strength did not imply reduced maximal oxygen consumption. Elite soccer players should focus on maximal strength training, with emphasis on maximal mobilisation of concentric movements, which may improve their sprinting and jumping performance.
Effects of prolonged strenuous exercise (marathon running) on biochemical and haematological markers used in the investigation of patients in the emergency department
Authors: Smith J E , Garbutt G , Lopes P , Pedoe D Tunstall 
Published: May 2004

Objectives:To investigate the effects of strenuous exercise on commonly used biochemical and haematological variables in subjects running the 2002 London marathon.Methods:34 healthy volunteers (7 female, 27 male) were recruited for the study. Blood was taken before the start (at registration) and immediately after completion of the marathon. Samples were analysed for urea and electrolytes, liver function tests, creatine kinase (CK), CK-MB isoenzyme, myoglobin, troponin I, full blood count, a clotting screen, and D-dimers. The results before and after exercise were compared. Pearson’s correlation coefficients were calculated for all variables.Results:Significant increases were found in CK, CK-MB, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and myoglobin following the marathon. However, there was no significant change in the level of troponin I. There was also evidence of activation of the coagulation and fibrinolytic cascades following the marathon, with a reduction in activated partial thromboplastin time, a reduction in fibrinogen, and an increase in D-dimers.Conclusions:The results confirm previous individual studies on marathon running and the biochemical and haematological tests routinely carried out in hospital. These are affected by prolonged exercise, and “abnormal” results in these tests may be normal after prolonged exercise and therefore not diagnostic of a disease process. The results of investigations in patients who have been exercising should be interpreted with caution.
Quadriceps atrophy: to what extent does it exist in patellofemoral pain syndrome?
Authors: Callaghan M J , Oldham J A 
Published: May 2004

Background:Quadriceps atrophy is a commonly cited accompaniment to patellofemoral pain syndrome (PFPS), yet there is little valid, objective evidence for its existence.Objective:To investigate atrophy and weakness of the quadriceps femoris muscle group in patients with PFPS using measures of cross-sectional area and peak extension torque.Methods:A total of 57 patients with insidious onset of PFPS and 10 healthy control subjects had ultrasound scanning of the quadriceps femoris. The scans were analysed using computerised planimetry to estimate the cross-sectional area of the quadriceps femoris. Lower limb peak torque was also measured using a Biodex dynamometer.Results:The mean of % differences revealed a 3.38% (95% confidence interval (CI) 1.3 to 5.45) difference in cross-sectional area (CSA) between the affected and unaffected limb in PFPS patients and a 1.31% (95% CI 0.06 to 2.55) difference in the dominant and non-dominant limb of the control group; the between-groups difference was not significant (p = 0.409). There was a 18.4% (95% CI 13 to 23.8) difference between the affected and unaffected limb in peak torque in PFPS patients and a 7.6% (95% CI 3.2 to 12) difference between the dominant and non-dominant limb in the control group; the between-groups difference was significant (p = 0.002).Conclusions:The mean of % differences of 3.38% quadriceps atrophy between limbs was considerably less than the only other study using ultrasound scanning on the quadriceps in PFPS and was not significant between the groups. There were greater and more significant between-group differences in lower limb peak torque indicating that muscle strength may not be related to muscle size. These results help to re-appraise of the amount of quadriceps atrophy in PFPS.
Pharmacokinetic and Pharmacodynamic Evaluation of Two Dosing Regimens for Piperacillin‐Tazobactam
Authors: Kim Myo‐Kyoung , Capitano Blair , Mattoes Holly M. , Xuan Dawei , Quintiliani Richard , Nightingale Charles H. , Nicolau David P. 
Published: May 2004

Study Objective. To compare the pharmacokinetic and pharmacodynamic profiles of two dosing regimens for piperacillin‐tazobactam against commonly encountered pathogens. The regimens compared were piperacillin 4.0 g‐tazobactam 0.5 g administered every 8 hours, and piperacillin 3.0 g‐tazobactam 0.375 g administered every 6 hours.Design. Multiple‐dose, open‐label, randomized, crossover study.Setting. Clinical research center at Hartford Hospital.Subjects. Twelve healthy volunteers.Intervention. The two dosing regimens for piperacillin‐tazobactam were administered intravenously in crossover design. Blood was sampled after the third dose.Measurements and Main Results. Drug concentrations were determined by a validated high‐performance liquid chromatography assay. The percentage of time above minimum inhibitory concentration (%T>MIC) for piperacillin was calculated for a range of MIC values. The maximum concentration (Cmax), area under the concentration‐time curve (AUC0‐τ), and total clearance of piperacillin differed significantly between the two study regimens, as did the Cmax, AUC0‐τ, volume of distribution, and total clearance of tazobactam (p<0.05). The piperacillin 4.0 g‐tazobactam 0.5 g regimen provided 40–50% T>MIC for MIC values 8–16 μg/ml; a similar value for the piperacillin 3.0 g‐tazobactam 0.375 g regimen was 16–32 μg/ml.Conclusion. Although statistically significant differences in the pharmaco‐dynamic profile were noted for the regimens, both provide adequate T>MIC against commonly encountered pathogens considered susceptible to piperacillin‐tazobactam. However, for treatment of Pseudomonas aeruginosa infection, combination therapy or higher‐dosage regimens (e.g., piperacillin 3.0 g‐tazobactam 0.375 g every 4 hours, piperacillin 4.0 g‐tazobactam 0.5 g every 6 hours, or continuous‐infusion piperacillin 12 g‐tazobactam 1.5 g/day) may be a prudent option when full MIC data are unavailable.
Macrolide Therapy for Chlamydia pneumoniae in the Secondary Prevention of Coronary Artery Disease: A Meta‐Analysis of Randomized Controlled Trials
Authors: Etminan Mahyar , Carleton Bruce , Delaney J. A. C. , Padwal Raj 
Published: May 2004

Study Objective. As recent studies have shown that antibiotic therapy to eradicate Chlamydia pneumoniae may be beneficial in the secondary prevention of coronary artery disease, and studies to date may have lacked statistical power, we conducted a meta‐analysis of randomized controlled trials to determine the role of antibiotic therapy in this patient population.Design. Systematic review and meta‐analysis of randomized controlled trials.Patients. A total of 12,032 patients from nine studies.Measurements and Main Results. We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and abstracts of conference proceedings to identify pertinent studies. The random effects model was used to estimate a pooled relative risk. Heterogeneity was assessed using the bootstrap version of the Q statistic with 1000 replications. In total, we reviewed nine randomized controlled trials enrolling 12,032 patients; six enrolled patients with acute coronary syndrome, two enrolled patients with stable coronary artery disease, and one enrolled a mixed population. Compared with placebo, macrolide therapy was not associated with a significant reduction in any coronary event (relative risk [RR] 0.98, 95% confidence interval [CI] 0.88–1.08), myocardial infarction or angina (RR 0.89, 95% CI 0.68–1.16), or overall mortality (RR 0.95, 95% CI 0.81–1.12).Conclusion. Our results do not support routine use of antichlamydial therapy for secondary prevention of coronary events.
Greater Effect of Enhanced Pharmacist Care on Cholesterol Management in Patients with Diabetes Mellitus: A Planned Subgroup Analysis of the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP)
Authors: Simpson Scot H. , Johnson Jeffrey A. , Biggs Rosemarie S. , Tsuyuki Ross T. 
Published: May 2004

Study Objective. To determine the effect of enhanced pharmacist care on cholesterol management in patients with and without diabetes mellitus.Methods. We conducted a planned subgroup analysis of the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP), a 54‐center randomized trial of pharmacist intervention compared with usual care in patients at high risk for cardiovascular events. The patients involved had atherosclerotic disease or diabetes. We compared the effect of pharmacist intervention in patients with and without diabetes. The primary end point was a composite of performing a fasting cholesterol profile, or adding or increasing the dosage of a cholesterol‐lowering drug. Secondary end points were individual components of the primary end point and change in 10‐year risk for cardiovascular events, using the Framingham risk equation.Results. Of the 675 patients enrolled in the SCRIP study, 294 (44%) had diabetes. Enhanced pharmacist care had a more beneficial effect on cholesterol management in those with diabetes (odds ratio [OR] 4.8) than without diabetes (OR 2.1), p=0.01. Secondary end points showed similar trends, and reduction in Framingham risk was greater in patients with diabetes than without.Conclusion. Pharmacist intervention for dyslipidemia appears to have a greater impact in patients with diabetes. Results of this substudy suggest that pharmacists should target this patient group for interventions in cholesterol risk management.