Systematic review of economic evaluations and cost analyses of guideline implementation strategies

Objectives To appraise the quality of economic studies undertaken as part of evaluations of guideline implementation strategies; determine their resources use; and recommend methods to improve future studies. Methods Systematic review of economic studies undertaken alongside robust study designs of clinical guideline implementation strategies published (1966-1998). Studies assessed against the BMJ economic evaluations guidelines for each stage of the guideline process (guideline development, implementation and treatment). Results 235 studies were identified, 63 reported some information on cost. Only 3 studies provided evidence that their guideline was effective and efficient. 38 reported the treatment costs only, 12 implementation and treatment costs, 11 implementation costs alone, and two guideline development, implementation and treatment costs. No study gave reasonably complete information on costs. Conclusions Very few satisfactory economic evaluations of guideline implementation strategies have been performed. Current evaluations have numerous methodological defects and rarely consider all relevant costs and benefits. Future evaluations should focus on evaluating the implementation of evidence based guidelines. Keywords: Cost-effectiveness analysis, physician (or health care professional) behaviour, practice guidelines, quality improvement, systematic review.Peer reviewedAuthor versio

Room temperature magnetic stabilization of buried cobalt nanoclusters within a ferromagnetic matrix studied by soft x-ray magnetic circular dichroism

Single dusting layers of size-selected Co nanoclusters (NCs) of sizes ranging from 1.5–5.5 nm have been deposited by a gas-phase aggregation method in ultrahigh vacuum, and embedded within a NiFe matrix. Magnetic hysteresis loops have been obtained using soft x-ray magnetic circular dichroism, which shows that these Co NCs embedded in NiFe exhibit room temperature ferromagnetism with identical coercivity to the surrounding NiFe film. The strong local exchange field at the interface between NiFe and Co NCs, combined with the magnetic anisotropy of the NiFe film, allows stabilization of NC ferromagnetism which persists to room temperature

Salicylic acid, a multifaceted hormone to combat disease.

For more than 200 years, the plant hormone salicylic acid (SA) has been studied for its medicinal use in humans. However, its extensive signaling role in plants, particularly in defense against pathogens, has only become evident during the past 20 years. This review surveys how SA in plants regulates both local disease resistance mechanisms, including host cell death and defense gene expression, and systemic acquired resistance (SAR). Genetic studies reveal an increasingly complex network of proteins required for SA-mediated defense signaling, and this process is amplified by several regulatory feedback loops. The interaction between the SA signaling pathway and those regulated by other plant hormones and/or defense signals is also discussed