bluuebunny/crossref_metadata_2025_split huggingface dataset:
Organizational Research with Impact: Working Backwards
Authors: Fraser Irene 
Published: August 2004

ABSTRACT Background or Rationale: To improve health care, we need to improve the organization of care, along with the payment systems that shape organizational priorities and behavior. The opportunity and challenge for research are to find a way to work with health care leadership so that future management decisions can make use of strong evidence. Aims and Methods: This article uses findings from research on nursing to illustrate the potential for organizational research and management research to improve health care. It then distills recommendations from six focused stakeholder meetings to identify five ways in which we might improve organizational, management, and policy research to maximize its use. Results and Discussion: Hospital, health plan, and other system leaders have five recommendations for research: (1) Design studies that answer user questions, with a focus on the “why” and “what if” rather than just the “what.” (2) Present findings in leaders' time and space, defining evidence as they do and identifying generalizability of findings. (3) Change the incentive system for researchers so that they are rewarded for the activities that maximize impact on decision making. (4) Build user‐researcher collaborations and dialogue. (5) Change the way we disseminate evidence, with dissemination through “early adopters,” trade association meetings, consultants, etc. Implications for Research, Practice, and Policy: System and policy leaders control important levers for improving health care, since they shape organizational structure, processes and culture, payment strategies, program design, and regulation. Just as evidence‐based medicine can improve clinical practice, evidence‐based management and policymaking can change how these powerful levers are used. But for evidence to inform the decisions of system and policy leaders, we will need to rethink and restructure the research enterprise itself, bringing the potential users of evidence into the production process.
Translation Research in Long‐Term Care: Improving Pain Management in Nursing Homes
Authors: Jones Katherine R. , Fink Regina , Vojir Carol , Pepper Ginny , Hutt Evelyn , Clark Lauren , Scott Jill , Martinez Ruby , Vincent Deborah , Mellis B. Karen 
Published: August 2004

ABSTRACT Background: Pain prevalence in nursing homes remains high, with multiple resident, staff, and physician barriers presenting serious challenges to its improvement. Aims: The study aims were to (1) develop and test a multifaceted, culturally competent intervention to improve nursing home pain practices; (2) improve staff, resident, and physician knowledge and attitudes about pain and its management; (3) improve actual pain practices in nursing homes; and (4) improve nursing home policies and procedures related to pain. Methods: A multifaceted, culturally competent intervention was developed and tested in six Colorado nursing homes, with another six nursing homes serving as control sites. Both educational and behavioral change strategies were employed. Findings: The intervention was successful in improving the percentage of residents reporting constant pain in the treatment homes. Contextual factors (implementation of Medicare's Nursing Home Compare report card) appeared to exert a positive influence on pain documentation. There was no reduction in the percentage of residents reporting pain or reporting moderate/severe pain. Discussion: Multiple challenges to quality improvement exist in nursing homes. Turnover of nursing staff reduced actual exposure to the intervention, and turnover of directors of nursing influenced constancy of message and overall facility stability. Residents often failed to report their pain, and physicians were reluctant to alter their prescribing practices. Implications: Any intervention to improve pain management in nursing homes must target explicitly the residents, nursing home staff, and primary care physicians. Implementation strategies need to accommodate the high turnover rates among staff, as well as the changes among the nursing home leadership. Conclusions: Pain is a complex problem in the nursing home setting. Multiple factors must be considered in both the design and implementation of interventions to improve pain practices and reduce pain prevalence in nursing homes.
Outcomes of Adoption: Measuring Evidence Uptake by Individuals and Organizations
Authors: Donaldson Nancy E. , Rutledge Dana N. , Ashley Jeffrey 
Published: August 2004

ABSTRACT Background: The translation and diffusion of findings into health care validate the potential of evidence‐based innovation to improve clinical practice and affirm the benefits of society's investment in advancing science. Aims: This article briefly reviews key concepts in the knowledge use process, considers theoretical implications for measuring outcomes and uptake of innovation, discusses issues to consider in planning for measurement of adoption, and provides an example of confronting those challenges from a project now in progress. Theoretical Perspectives and Translation Outcomes: Four principal conceptual frameworks related to translational science, Lewin, Rogers, Havelock, and Promoting Action on Research Implementation in Health Services (PARIHS), explicate a process that catalyzes new knowledge adoption and use by individuals and systems to solve problems. Each conceptual perspective suggests that translation is not complete until the extent and impact of use is examined and understood. Most perspectives support evaluation of impact of evidence‐based practice using process measures that integrate clinician knowledge, actual performance of the practice, and patient/clinician outcomes. Based on the Agency for Healthcare Research and Quality (AHRQ) framework, additional measures might include changes in patterns of care and changes in policies, procedures, or protocols. Case Example: A description of process and outcome measures used in an in‐progress quality improvement demonstration project, California Nursing Outcomes Coalition (CalNOC) Partners in Quality Translating Research into Practice to Reduce Patient Falls Project, is presented. Implication(s) for Practice, Research, and Policy: Since the adoption of evidence‐based innovation is a process that is often described along a continuum, investigators seeking to measure the impact of an evidence‐based innovation must gather evidence that uptake of the innovation has occurred. The theoretical perspective and practical measurement issues of a given project will drive selection of process and outcome measures. Conclusions: Efforts to change practice in order to enhance evidence‐based patient care must integrate monitoring and evaluation of specific target outcomes of adoption as the basis for validating the impact of the change.
Testing a Collaborative Research Utilization Model to Translate Best Practices in Pain Management
Authors: Dufault Marlene 
Published: August 2004

ABSTRACTWhile millions of dollars are being spent developing the seeds of research to improve the care we give to patients, significant barriers to using empirical evidence by health care professionals and policymakers still exist. The gap between what we know from research and what we use in practice is at the heart of the translation research problem. How do we get empirical knowledge uptake and use by clinicians in the fields of practice? In addition, how do we measure if practice changes are occurring? This article describes a program of translation research in which the intervention, called the Collaborative Research Utilization model, was developed and tested in four clinical studies over 18 years.
Preparing the Next Generation of Scientists in Translation Research
Authors: Williams Carolyn A. 
Published: August 2004

ABSTRACT Aim: Four questions about translation research are considered in this article. (1) Why should there be concern about preparing nurse scientists for translation research? (2) Are current research‐intensive doctoral programs in nursing preparing graduates for translation research? (3) Should targeted efforts be made to systematically prepare nurses in translation research? (4) What strategies would be useful? Question 1: It is argued that translation research is needed in order to increase the odds that interventions found to be efficacious can be effectively translated into practices that will produce desired outcomes. Thus, evidence from translation research is a very important component of the science base needed to guide innovation in practice. Another reason of concern in preparing translation researchers is the growing pace of research into the efficacy of interventions, which accelerates the need for translation research. Furthermore, the emergence of clinical doctoral programs in nursing that will be seeking faculty with expertise in translation research supports the need for preparing scientists in translation research. Question 2: To determine whether translation research was visible in current research‐intensive doctoral programs, a Web‐based review of these programs offered by colleges and universities in the database of the American Association of Colleges of Nursing (AACN) was conducted in the fall of 2003. The search revealed that in the 79 programs surveyed, no school identified an area of emphasis in terms that suggested a component of translation science such as research dissemination or utilization, knowledge transfer, diffusion of innovation, or technology transfer. Less than a dozen courses could be located that focused on topics related to translation research or translation science. Questions 3 and 4: The case is made that more attention should be given to preparing translation scientists in research‐intensive doctoral programs in nursing, and several strategies were suggested for moving toward that goal.
Renal Amyloidosis Is Associated with Increased Mortality in Hemodialysis Patients
Authors: Sengul Sule , Arat Zubeyde , Ozdemir F. Nurhan 
Published: August 2004

Abstract:Aim:  The aim of the study was to investigate the risk factors for mortality of hemodialysis (HD) patients at Baskent University Hospital, HD Center in Ankara, Turkey.Methods:  We prospectively followed 203 stable HD patients for 42 months. Population characteristics (age, gender, duration of HD, causes of end stage renal disease [ESRD]) and biochemical variables were included in the study. Mortality was prospectively monitored.Results:  Sixty‐one patients died over 42 months. Cardiovascular events and infections/septicemia were the most common causes of death. The nonsurvivors had significantly lower hemoglobin (Hb), parathyroid hormone (PTH), creatinine, albumin, and prealbumin levels and higher age and higher C‐reactive protein (CRP) levels. Survival curves as obtained by the Kaplan–Meier method in the groups of causes of ESRD (renal amyloidosis [RA], diabetes mellitus [DM], hypertension [HT] + atherosclerotic kidney disease [AKD], and others) showed that patients with DM and RA had the worst prognosis during the follow‐up period. In the multivariate Cox proportional hazards model, RA and DM were found to be independent risk factors for death in HD patients together with high CRP and low albumin and prealbumin levels. Infection/septicemia is the leading cause of mortality in patients with DM and RA.Conclusion:  The results of this study indicate that the presence of RA and DM as underlying renal diseases are independent predictors of mortality in our HD patients along with poor nutritional status and activated inflammatory response.
Estrogen receptor‐α gene polymorphisms in patients with periodontitis
Authors: Zhang Li , Meng Huanxin , Zhao Hongshan , Li Qiyan , Xu Li , Chen Zhibin , Shi Dong , Feng Xianghui 
Published: August 2004

Background:  Recent studies have shown that estrogen receptor‐α (ER‐α) gene polymorphisms are associated with alterations in bone mineral density and osteoporosis. It is unclear whether ER‐α gene polymorphisms are associated with alveolar bone loss in patients with periodontitis.Objective:  The aim of this study was to investigate the relationship between ER‐α gene polymorphisms and periodontitis.Methods:  Ninety patients with aggressive periodontitis, 34 patients with chronic periodontitis and 91 healthy controls were recruited in this study. All these subjects belonged to the Han Chinese race. DNA was extracted from peripheral blood of each subject. The ER‐α gene was analyzed by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) with PvuII and XbaI restriction endonucleases.Results:  The detection frequency of XX genotype was significantly higher in the chronic periodontitis patients than in the healthy controls (11.8% vs. 4.4%, p < 0.05). The difference between the female chronic periodontitis patients and healthy controls (26.7% vs. 2.1%, p < 0.01) was statistically significant, but no difference was found between the male patients and controls (p > 0.05). The detection frequency of PvuII ER genotypes was not statistically different among the three groups (p > 0.05).Conclusions:  In female Han Chinese population, the XX genotype may be a risk indicator for chronic periodontitis.
Periodontal therapy: a novel non‐drug‐induced experimental model to study human inflammation
Authors: D'Aiuto F. , Nibali L. , Mohamed‐Ali V. , Vallance P. , Tonetti M. S. 
Published: August 2004

Background:  Chronic periodontitis causes a low‐grade systemic inflammatory response; its standard treatment, however, induces an acute inflammatory response. The aim of this study was to describe the systemic inflammatory reactions to an intensive periodontal treatment regimen.Methods:  Fourteen otherwise healthy subjects suffering from severe chronic periodontitis were enrolled in a 1 month pilot single‐blind trial. Intensive periodontal treatment, consisting of full‐mouth subgingival root debridement delivered within a 6‐h period, was performed. Periodontal parameters were recorded before and 1 month after completion of treatment. Blood samples were taken at baseline and 1, 3, 5, 7 and 30 days after treatment. Interleukin‐1 receptor antagonist (IL‐1Ra), Interleukin‐6 (IL‐6) and C‐reactive protein (CRP) serum concentrations were determined by enzyme‐linked immunosorbent assay (ELISA). Complete blood counts were also performed.Results:  One day after treatment, mild neutrophilia and monocytosis (p < 0.05) and lymphopenia (p < 0.01) were accompanied by a sharp increase in inflammatory markers (IL‐1Ra, IL‐6, p < 0.01). A 10‐fold increase in CRP (p < 0.001) was detected on day 1 and its kinetics followed a pattern of a classical acute phase response (significantly raised concentrations up to 1 week, p < 0.01). At 3–7 days after treatment, subjects presented also with a mild tendency towards a normocytic anaemic state (p < 0.01) and a degree of lympho‐thrombocytosis (p < 0.05). The observed changes were similar to those expected following the well‐characterized endotoxin‐challenge model of inflammation.Conclusions:  Intensive periodontal treatment produced an acute systemic inflammatory response of 1 week duration and might represent an alternative to classic endotoxin‐challenge or drug‐induced models to study acute inflammation in humans.
Initial antimicrobial effect of controlled‐release doxycycline in subgingival sites
Authors: Jorgensen M. G. , Safarian A. , Daneshmand N. , Keim R. J. , Slots J. 
Published: August 2004

Objectives:  To determine the ability of a 10% doxycycline hyclate controlled‐release polymer (Atridox®) to suppress periodontopathic bacteria when placed subgingivally following scaling and root planing (Sc/Rp).Methods:  Eight males and seven females, mean age 48 years, with moderate to advanced periodontitis participated in the study. In each patient, bilateral periodontal pockets probing 6–7 mm were randomly assigned to treatment by Sc/Rp + doxycycline polymer or by Sc/Rp alone. Subgingival placement of doxycycline polymer was carried out according to the manufacturer's instructions. Sc/Rp was performed with hand instruments for at least 10 min in each study tooth. Subgingival samples were collected by paper‐points at baseline, at 2 weeks and at 4 weeks post‐treatment. Culture methodology was used to isolate and identify putative periodontal pathogens, including Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Dialister pneumosintes, Tannerella forsythia, Prevotella intermedia/Prevotella nigrescens, Campylobacter species, Eubacterium species, Fusobacterium species, Peptostreptococcus micros, Eikenella corrodens, Staphylococcus species, enteric gram‐negative rods, β‐hemolytic streptococci and yeasts. The microbiologic examination was carried out blindly. Microbiological data were analyzed using a General Linear Model Analysis of Variance for within and between group effects.Results:  Sites receiving Sc/Rp + doxycycline polymer and sites receiving Sc/Rp alone exhibited similar levels of periodontal pathogens at baseline and did not differ significantly in total viable counts and proportional recovery of periodontopathic bacteria post‐treatment.Conclusions:  Controlled‐release doxycycline placed in moderate to deep periodontal pockets caused no significant additional reduction in the subgingival pathogenic microbiota compared to thorough Sc/Rp alone. Since controlled‐release doxycycline may not significantly suppress several subgingival pathogenic microorganisms and seems to possess no distinct advantage over broad‐spectra, safe and inexpensive antiseptics, the rationale for its employment in periodontal therapy remains unclear.
Inhibitory effects of green tea polyphenol (–)‐epigallocatechin gallate on the expression of matrix metalloproteinase‐9 and on the formation of osteoclasts
Authors: Yun Jeong‐Ho , Pang Eun‐Kyoung , Kim Chang‐Sung , Yoo Yun‐Jung , Cho Kyoo‐Sung , Chai Jung‐Kiu , Kim Chong‐Kwan , Choi Seong‐Ho 
Published: August 2004

Background:  Alveolar bone resorption is a characteristic feature of periodontal diseases and involves the removal of both the mineral and organic constituents of the bone matrix, which is caused by either multinucleated osteoclast cells or matrix metalloproteinases (MMPs). The gram‐negative bacterium, Porphyromonas gingivalis has been reported to stimulate the activity and expression of several groups of MMPs, whereas (–)‐epigallocatechin gallate (EGCG), the main constituent of green tea polyphenols, has been reported to have inhibitory effects on the activity and expression of MMPs.Objectives:  In the present study, we investigated the effects of the green tea polyphenol, EGCG, on the gene expression of osteoblast‐derived MMP‐2, ‐9 and ‐13, stimulated by P. gingivalis, and on the formation of osteoclasts.Methods:  The effect of EGCG on the gene expression of MMPs was examined by treating mouse calvarial primary osteoblastic cells with EGCG (20 µm) in the presence of sonicated P. gingivalis extracts. The transcription levels of MMP‐2, ‐9 and ‐13 were assessed by reverse transcription‐polymerase chain reaction (RT‐PCR). The effect of EGCG on osteoclast formation was confirmed by tartrate‐resistant acid phosphatase (TRAP) staining in a co‐culture system of mouse bone marrow cells and calvarial primary osteoblastic cells.Results:  Treatment with the sonicated P. gingivalis extracts stimulated the expression of MMP‐9 mRNA and this effect was significantly reduced by EGCG, whereas the transcription levels of MMP‐2 and MMP‐13 were not affected by either the sonicated P. gingivalis extracts or EGCG. In addition, EGCG significantly inhibited osteoclast formation in the co‐culture system at a concentration of 20 µm.Conclusions:  These findings suggest that EGCG may prevent the alveolar bone resorption that occurs in periodontal diseases by inhibiting the expression of MMP‐9 in osteoblasts and the formation of osteoclasts.
The investigation of glutathione peroxidase, lactoferrin, myeloperoxidase and interleukin‐1β in gingival crevicular fluid: implications for oxidative stress in human periodontal diseases
Authors: Wei Pi‐Fen , Ho Kun‐Yen , Ho Yea‐Pyng , Wu Yi‐Min , Yang Yi‐Hsin , Tsai Chi‐Cheng 
Published: August 2004

Background:  Human periodontal diseases are inflammatory disorders that are the result of complex interactions between periodontopathogens and the host's immune response. Two important and interrelated factors are involved in the pathophysiological progression of periodontal diseases, i.e. the activation of immune system and the production of oxygen radicals and their related metabolites. Increased production of oxygen radicals may contribute to oxidative stress, which is reported to be involved in many diseases, including periodontal diseases.Objectives:  The objective of this study was to investigate glutathione peroxidase, lactoferrin and myeloperoxidase, which play an essential role in free radical production and defenses, and the proinflammatory cytokine interleukin‐1β (IL‐1β), which is important in the regulation of immunological and inflammatory reactions in human periodontal diseases.Methods:  Gingival crevicular fluid (GCF) samples were collected from 27 subjects, 19 periodontitis patients and eight healthy controls, ranging in ages from 24 to 62 years. Clinical parameters were recorded. GCF glutathione peroxidase, lactoferrin, myeloperoxidase and IL‐1β were analyzed by enzyme‐linked immunosorbent assays (ELISA).Results:  The periodontitis sites exhibited significantly greater total amount of glutathione peroxidase, lactoferrin, myeloperoxidase and IL‐1β than healthy sites. Total amount of glutathione peroxidase, lactoferrin, myeloperoxidase and IL‐1β was positively correlated with plaque index, gingival index, probing depth and probing attachment level (p < 0.05).Conclusion:  The imbalance between the levels of myeloperoxidase/IL‐1β and glutathione peroxidase/lactoferrin could result in tissue damage of reactive oxygen species (ROS) in periodontitis which is initiated and perpetuated by the chronic insults of periodontopathogens.