Implementing a guideline for the treatment of type 2 diabetics: results of a Cluster- Randomized Controlled Trial (C-RCT)

<p>Abstract</p> <p>Background</p> <p>In Italy many diabetics still lack adequate care in general practice. We assessed the effectiveness of different strategies for the implementation of an evidence-based guideline for the management of non-complicated type 2 diabetes among General Practitioners (GPs) of Lazio region.</p> <p>Methods</p> <p>Three-arm cluster-randomised controlled trial with GPs as units of randomisation (clusters). 252 GPs were randomised either to an active strategy (training module with administration of the guideline), or to a passive dissemination (administration of the guideline only), or to usual care (control). Data on prescriptions of tests and drugs were collected by existing information systems, whereas patients' data came from GPs' databases. Process outcomes were measured at the cluster level one year after the intervention. Primary outcomes concerned the measurement of glycosilated haemoglobin and the commissioning of micro- and macrovascular complications assessment tests. In order to assess the physicians' drug prescribing behaviour secondary outcomes were also calculated.</p> <p>Results</p> <p>GPs identified 6395 uncomplicated type 2 patients with a high prevalence of cardiovascular risk factors. Data on GPs baseline performance show low proportions of glycosilated haemoglobin assessments. Results of the C-RCT analysis indicate that the active implementation strategy was ineffective relating to all primary outcomes (respectively, OR 1.06 [95% IC: 0.76–1.46]; OR 1.07 [95% IC: 0.80–1.43]; OR 1.4 [95% IC:0.91–2.16]. Similarly, passive dissemination of the guideline showed no effect.</p> <p>Conclusion</p> <p>In our region compliance of GPs with guidelines was not enhanced by a structured learning programme. Implementation through organizational measures appears to be essential to induce behavioural changes.</p> <p>Trial registration</p> <p>ISRCTN80116232</p

The Current State of Proteomics in GI Oncology

Proteomics refers to the study of the entire set of proteins in a given cell or tissue. With the extensive development of protein separation, mass spectrometry, and bioinformatics technologies, clinical proteomics has shown its potential as a powerful approach for biomarker discovery, particularly in the area of oncology. More than 130 exploratory studies have defined candidate markers in serum, gastrointestinal (GI) fluids, or cancer tissue. In this article, we introduce the commonly adopted proteomic technologies and describe results of a comprehensive review of studies that have applied these technologies to GI oncology, with a particular emphasis on developments in the last 3 years. We discuss reasons why the more than 130 studies to date have had little discernible clinical impact, and we outline steps that may allow proteomics to realize its promise for early detection of disease, monitoring of disease recurrence, and identification of targets for individualized therapy

Space/time tectono-sedimentary evolution of the Umbria-Romagna-Marche Miocene Basin (Northern Apennines, Italy): a foredeep model.

The space/time evolution of the Umbria-Romagna-Marche domains of the northern Apennine Miocene foredeep is proposed. In this period, the turbidite siliciclastic sedimentation is represented mainly by the Miocene Marnoso-Arenacea Formation, which generally ends with mainly marly deposits. From the internal Apennine sectors (Umbria-Romagna domain) to the external Adriatic Margin (Marche domain) the siliciclastic succession overlies hemipelagic marly deposits (Schlier Formation). The whole depositional area can be considered as a single wide basin with depocenter or main sedimentation areas progressively migrating eastwards. This basin is characterized by some morphological highs which did not constitute real dams for the sedimentary flow(turbidity currents). Multiple feeding (arkose, litharenites, calcarenites) from different sources is related to palaeogeographical and palaeotectonic reorganization of the most internal, previously deformed, Apennine areas. The activation of the foredeep stage is marked by the beginning of the siliciclastic sedimentation (Late Burdigalian in the most internal sector). This sedimentation ends in the most external sector in the Early Messinian, pointing to a depositional cycle of about 9–10 Ma. The diachronism of the base of the siliciclastic deposition proves to be almost 5 Ma. The syn-depositional compressional deformation, which shows a marked diachronism, affected the internal area of the foredeep in the Early-Middle Serravallian, and progressively migrated up to Late Miocene, involving more and more external sectors. The deformed siliciclastic sedimentary wedge constitutes an orogenic pile incorporated in the Apennine Chain, represented by different tectonic elements superimposed by means of NE-vergent thrusts. The main stratigraphic and tectonic events of the Toscana-Romagna-Marche Apennines are presented in a general framework,resulting also in a terminological revision