Improving Delivery of Evidence-Based Prenatal Care in a Family Medicine Clinic

Background: According to the Institute of Medicine, using evidence-based decision-making is one of the key principles that will enable the health care system to provide consistent, high-quality medical care to all people. This can be a challenge when providing care to pregnant women, as ethical issues regarding research in this population have resulted in a relative dearth of high quality randomized control trials providing evidence for prenatal issues. The challenge of providing evidence-based prenatal care is further compounded in a busy Family Medicine teaching practice where pregnant women represent a relatively small fraction of the patients seen on a daily basis. Purpose: The purpose of this project was to develop concise, evidence-based protocols for the management of several common prenatal problems and implement them in a Family Medicine clinic in order to improve the quality of care provided to pregnant women in this practice. Methods: First, four common prenatal problems were identified: 1) Obesity in Pregnancy; 2) Prior Preterm Labor; 3) Gestational Diabetes; and 4) Chronic Hypertension in Pregnancy. For each of these problems, a comprehensive review of the literature was performed. Priority was given to guidelines from professional organizations, meta-analyses and randomized control trials. Using the strongest evidence from all of these sources, a one-page protocol was developed for each condition. The protocols then underwent a review process by the physicians at the clinic. In areas where no strong evidence existed, medico-legal considerations and consensus-derived provider preferences were incorporated into the protocols. Results: In each of the four problems of interest, there existed at least one recommendation that had strong evidence to support it. These recommendations included screening tools, counseling topics and pharmacologic interventions. Conclusions: The first phase of this project has resulted in the development of concise, evidence-based protocols for care of patients with four common prenatal problems that can now be instituted in the Family Medicine clinic. These protocols incorporate the strongest evidence available, and on issues where no strong evidence is available, they take into consideration medico-legal issues and provider preferences derived from a consensus process. We hope that the availability of these protocols will result in more consistent, evidence-based prenatal care. The next steps will be to assess provider utilization of and satisfaction with the protocols, as well as gather outcomes data to see if the implementation of these protocols results in better patient outcomes

Care that Matters: Quality Measurement and Health Care

Barry Saver and colleagues caution against the use of process and performance metrics as health care quality measures in the United States

Psychological and demographic predictors of undergraduate non-attendance at university lectures and seminars

Absenteeism from university teaching sessions is increasingly becoming a common phenomenon and remains a major concern to universities. Poor attendance has significant and detrimental effects on students themselves, their peers and teaching staff. There is, however, a lack of previous research investigating demographic and psychological predictors of non-attendance alongside salient reasons students offer for their absence; it is this ‘gap’ that the present study attempts to fill. We approached 618 undergraduate university students from a single UK university studying various courses to complete a bespoke questionnaire assessing their estimated percentage attendance at lectures and seminars over the academic year. Students answered demographic questions, completed psychometric tests of perceived confidence (Perceived Confidence for Learning) and university belongingness (Psychological Sense of School Membership), and rated the degree to which possible reasons for non-attendance applied to themselves. Multiple regression analyses were carried out separately for estimated attendance at lectures and seminars. Results demonstrated that significant predictors of poorer attendance for both scenarios were experiencing a lower sense of belongingness to university; working more hours in paid employment; having more social life commitments; facing coursework deadlines; and experiencing mental health issues. Improving a sense of belonging to university and targeting interventions at students working in paid employment may be effective means of increasing attendance. Providing support for students with mental health issues, structuring courses around coursework deadlines and helping students to organise their attendance around social activities could also be advantageous

The capabilities and limitations of conductance-based compartmental neuron models with reduced branched or unbranched morphologies and active dendrites

Conductance-based neuron models are frequently employed to study the dynamics of biological neural networks. For speed and ease of use, these models are often reduced in morphological complexity. Simplified dendritic branching structures may process inputs differently than full branching structures, however, and could thereby fail to reproduce important aspects of biological neural processing. It is not yet well understood which processing capabilities require detailed branching structures. Therefore, we analyzed the processing capabilities of full or partially branched reduced models. These models were created by collapsing the dendritic tree of a full morphological model of a globus pallidus (GP) neuron while preserving its total surface area and electrotonic length, as well as its passive and active parameters. Dendritic trees were either collapsed into single cables (unbranched models) or the full complement of branch points was preserved (branched models). Both reduction strategies allowed us to compare dynamics between all models using the same channel density settings. Full model responses to somatic inputs were generally preserved by both types of reduced model while dendritic input responses could be more closely preserved by branched than unbranched reduced models. However, features strongly influenced by local dendritic input resistance, such as active dendritic sodium spike generation and propagation, could not be accurately reproduced by any reduced model. Based on our analyses, we suggest that there are intrinsic differences in processing capabilities between unbranched and branched models. We also indicate suitable applications for different levels of reduction, including fast searches of full model parameter space

Refining associations between TAS2R38 diplotypes and the 6-n-propylthiouracil (PROP) taste test: findings from the Avon Longitudinal Study of Parents and Children

<p>Abstract</p> <p>Background</p> <p>Previous investigations have highlighted the importance of genetic variation in the determination of bitter tasting ability, however have left unaddressed questions as to within group variation in tasting ability or the possibility of genetic prescription of intermediate tasting ability. Our aim was to examine the relationships between bitter tasting ability and variation at the <it>TAS2R38 </it>locus and to assess the role of psychosocial factors in explaining residual, within group, variation in tasting ability.</p> <p>Results</p> <p>In a large sample of children from the Avon Longitudinal Study of Parents and Children, we confirmed an association between bitter compound tasting ability and <it>TAS2R38 </it>variation and found evidence of a genetic association with intermediate tasting ability. Antisocial behaviour, social class and depression showed no consistent relationship with the distribution of taste test scores.</p> <p>Conclusion</p> <p>Factors which could influence a child's chosen taste score, extra to taste receptor variation, appeared not to show relationships with test score. Observed spread in the distribution of the taste test scores <it>within </it>hypothesised taster groups, is likely to be, or at least in part, due to physiological differentiation regulated by other genetic contributors. Results confirm relationships between genetic variation and bitter compound tasting ability in a large sample, and suggest that <it>TAS2R38 </it>variation may also be associated with intermediate tasting ability.</p

STrengthening the REporting of Genetic Association Studies (STREGA)— An Extension of the STROBE Statement

Julian Little and colleagues present the STREGA recommendations, which are aimed at improving the reporting of genetic association studies

Characterization of α₂-adrenergic receptor localization and functional responses

The three α₂-adrenergic receptors (α₂-ARs) were studied in both recombinant and endogenous systems. It was my general hypothesis that the three α₂-adrenergic receptor (AR) subtypes exhibit differential tissue and subcellular localization and couple to physiological pathways to directly elicit functional responses. It was our hope, that in identifying differences between the α₂-ARs we may elucidate their physiological roles and provide a potential means for the rational development of therapeutic drugs or models of such pathologies as atherosclerosis, hypertension and glaucoma. Subtype selective antibodies have been generated and these have provided a tool with which to study the receptors on a molecular and cellular level. Utilizing a number of biochemical, pharmacological, molecular and cellular techniques, I have identified differences between the three receptors with respect to the tissues in which they are expressed, the subcellular domains in which they localize and their patterns of sequestration and down-regulation. In addition, I have demonstrated the expression and co-localization of the α₂-ARs in a variety of native tissues, and a number of functional responses these receptors mediate. These functional responses may have ramifications relevant to tissue healing mechanisms as well as may play a role in a number of pathologies