Patient reported out come measures in patients with abdominal a ortic a neurysms: a systematic review p rotocol

Background: Abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta, which is usually asymptomatic. However, rupture of the aneurysm can be fatal or require complex surgery with potential complications, leading to a poor quality of life. Patient reported outcome measures (PROMs) are becoming increasing ly important in the current era of healthcare management. PROMs are used to directly assess how patients feel or function in relation to their health condition without any interpretation . Generic, disease - specific and preference - based PROMs ca n be used to assess the quality of life (QoL), symptoms and functional limitations in patients with AAA including those under surveillance or undergoing endovascular or open surgery or screening . However, these tools vary in terms of their reliability, validity and suitability for use in patients with AAA in a clinical setting. Objectives: To identify, summarise and assess PROMs that have been administered to patients with a diagnosis of AAA including those under surveillance or undergoing endovascular or open surgery or screening . Methods: Key electronic databases and research registers will be searched including: MEDLINE and MEDLINE in Process, EMBASE, PsycINFO, PROQOLID, CINAH L, PROMS Bibliography (Oxford University), Web of Science and the Cochrane Library databases from inception. A two - stage search approach will be used. The first stage will utilise general terms for PROMs to identify studies. These will be retrieved and t he title and abstract will be examined for additional PROM terms. Stage 2 will incorporate these terms with the preliminary search strategy and a methodological search filter . Searches will be supplemented by hand - searching reference lists of relevant reviews and included studies. Study selection, data extraction and quality assessment will be performed independently by at least 2 reviewers. All English language instruments identified as PROMs for patients with AAA will be included. Data will be extracted regarding type of PROM, methods and results. Methodological quality of included studies will be assessed using the CO nsensus - based S tandards for the selection of health st atus Measurement IN struments checklist (COSMIN) and the psychometric properties of the PROMs will be assessed on criteria bas ed in published recommendations. Findings will be presented as narrative and tabular summaries. Discussion : This systematic review will identify PROMs that are used to assess QoL , symptoms and functional limitations in patients with AAA and assess their effectiveness for this population and application to clinical practice. The findings of the review will help inform a project examining the re-configuration of vascular services in the UK, and identify targets for future research

Patient-reported outcome measures in patients with peripheral artery disease: Protocol for a systematic review

Peripheral arterial disease (PAD) results in reduced health-related quality of life and significant functional impairment. Patient-reported outcome measures (PROMs) are important when considering the impact of treatments and management strategies in patients with PAD. A variety of studies have reported the use of different PROMs in patients with PAD. However, PROMs should provide valid and reliable findings to help in healthcare decision-making. The aim of this proposed systematic review is to comprehensively evaluate the psychometric properties of PROMs developed and/ or validated in patients with PAD

Detection of Gamma-Ray Emission from the Vela Pulsar Wind Nebula with AGILE

Pulsars are known to power winds of relativistic particles that can produce bright nebulae by interacting with the surrounding medium. These pulsar wind nebulae (PWNe) are observed in the radio, optical, x-rays and, in some cases, also at TeV energies, but the lack of information in the gamma-ray band prevents from drawing a comprehensive multiwavelength picture of their phenomenology and emission mechanisms. Using data from the AGILE satellite, we detected the Vela pulsar wind nebula in the energy range from 100 MeV to 3 GeV. This result constrains the particle population responsible for the GeV emission, probing multivavelength PWN models, and establishes a class of gamma-ray emitters that could account for a fraction of the unidentified Galactic gamma-ray sources.Comment: Accepted by Science; first published online on December 31, 2009 in Science Express. Science article and Supporting Online Material are available at http://www.sciencemag.or

Burkholderia cenocepacia ET12 strain activates TNFR1 signalling in cystic fibrosis airway epithelial cells

Burkholderia cenocepacia is an important pulmonary pathogen in individuals with cystic fibrosis (CF). Infection is often associated with severe pulmonary inflammation, and some patients develop a fatal necrotizing pneumonia and sepsis (‘cepacia syndrome’). The mechanisms by which this species causes severe pulmonary inflammation are poorly understood. Here, we demonstrate that B. cenocepacia BC7, a potentially virulent representative of the epidemic ET12 lineage, binds to tumour necrosis factor receptor 1 (TNFR1) and activates TNFR1-related signalling pathway similar to TNF-α, a natural ligand for TNFR1. This interaction participates in stimulating a robust IL-8 production from CF airway epithelial cells. In contrast, BC45, a less virulent ET12 representative, and ATCC 25416, an environmental B. cepacia strain, do not bind to TNFR1 and stimulate only minimal IL-8 production from CF cells. Further, TNFR1 expression is increased in CF airway epithelial cells compared with non-CF cells. We also show that B. cenocepacia ET12 strain colocaizes with TNFR1 in vitro and in the lungs of CF patients who died due to infection with B. cenocepacia, ET12 strain. Together, these results suggest that interaction of B. cenocepacia , ET12 strain with TNFR1 may contribute to robust inflammatory responses elicited by this organism.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73011/1/j.1462-5822.2007.01029.x.pd

Sources of evidence in HIV/AIDS care: pilot study comparing family physicians and AIDS service organization staff

BACKGROUND: The improvement of the quality of the evidence used in treatment decision-making is especially important in the case of patients with complicated disease processes such as HIV/AIDS for which multiple treatment strategies exist with conflicting reports of efficacy. Little is known about the perceptions of distinct groups of health care workers regarding various sources of evidence and how these influence the clinical decision-making process. Our objective was to investigate how two groups of treatment information providers for people living with HIV/AIDS perceive the importance of various sources of treatment information. METHODS: Surveys were distributed to staff at two local AIDS service organizations and to family physicians at three community health centres treating people living with HIV/AIDS. Participants were asked to rate the importance of 10 different sources of evidence for HIV/AIDS treatment information on a 5-point Likert-type scale. Mean rating scores and relative rankings were compared. RESULTS: Findings suggest that a discordance exists between the two health information provider groups in terms of their perceptions of the various sources of evidence. Furthermore, AIDS service organization staff ranked health care professionals as the most important source of information whereas physicians deemed AIDS service organizations to be relatively unimportant. The two groups appear to share a common mistrust for information from pharmaceutical industries. CONCLUSIONS: Discordance exists between medical "experts" from different backgrounds relating to their perceptions of evidence. Further investigation is warranted in order to reveal any effects on the quality of treatment information and implications in the decision-making process. Possible effects on collaboration and working relationships also warrant further exploration

Effectiveness of acupuncture, special dressings and simple, low-adherence dressings for healing venous leg ulcers in primary healthcare: study protocol for a cluster-randomized open-labeled trial

<p>Abstract</p> <p>Background</p> <p>Venous leg ulcers constitute a chronic recurring complaint that affects 1.0–1.3% of the adult population at some time in life, and which corresponds to approximately 75% of all chronic ulcers of the leg. Multilayer compression bandaging is, at present, the only treatment that has been proved to be effective in treating this type of ulcer. There is no consensus, however, about the dressings that may be applied, beneath the compression, to promote the healing of this type of ulcer, as there does not seem to be any added benefit from using special dressings rather than simple, low-adherence ones. As well as analgesia, acupuncture provokes peripheral vasodilation, in skin and muscles – which has been demonstrated both experimentally and in clinical practice – probably due to the axon reflex, among other mechanisms. The aim of the present study is to measure the effectiveness and cost of compression treatment for venous leg ulcers combined with special dressings, in comparison with low-adherence ones and acupuncture.</p> <p>Methods/design</p> <p>Cluster-randomized open-labeled trial, at 15 primary healthcare clinics in the Sevilla-Sur Healthcare District, with a control group treated with compression bandaging and low-adherence dressings; the experiment will consist, on the one hand, of the compression treatment applied in combination with special dressings (Treatment 1), and on the other, the compression treatment applied in association with low-adherence dressings, together with acupuncture (Treatment 2).</p> <p>Discussion</p> <p>The results will be measured and recorded in terms of the median time elapsed until complete healing of the ulcer, and the rate of complete healing at 3 months after beginning the treatment. An economic analysis will also be made.</p> <p>This study, carried out in the context of real clinical practice, will provide information for decision-taking concerning the effectiveness of special dressings. Moreover, for the first time a high-quality study will evaluate the effectiveness of acupuncture in the process of healing venous leg ulcers.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN26438275.</p

Exploring the role of organizational policies and procedures in promoting research utilization in registered nurses

<p>Abstract</p> <p>Background</p> <p>Policies and procedures (P&Ps) have been suggested as one possible strategy for moving research evidence into practice among nursing staff in hospitals. Research in the area of P&Ps is limited, however. This paper explores: 1) nurses' use of eight specific research-based practices (RBPs) and RBP overall, 2) nurses' use and understanding of P&Ps, and 3) the role of P&Ps in promoting research utilization.</p> <p>Methods</p> <p>Staff nurses from the eight health regions governing acute care services across the Canadian province of Newfoundland and Labrador completed an anonymous questionnaire regarding their use of eight RBPs and associated P&Ps. Data were also obtained from authorities in six of the eight regions about existing relevant P&Ps. We used descriptive statistics and multivariate regression analysis to assess the relationship between key independent variables and self-reported use of RBP.</p> <p>Results</p> <p>Use of the eight RBPs ranged from 7.8% to 88.6%, depending on the practice. Nurses ranked P&P manuals as their number one source of practice knowledge. Most respondents (84.8%) reported that the main reason they consult the P&P manual is to confirm they are practicing according to agency rules. Multivariate regression analysis identified three significant predictors of being a user versus non-user of RBP overall: awareness, awareness by regular use, and persuasion. Six significant predictors of being a consistent versus less consistent user of RBP overall were also identified: perception of P&P existence, unit, nursing experience, personal experience as a source of practice knowledge, number of existing research-based P&Ps, and lack of time as a barrier to consulting P&P manuals.</p> <p>Conclusion</p> <p>Findings suggest that nurses use P&Ps to guide their practice. However, the mere existence of P&Ps is not sufficient to translate research into nursing practice. Individual and organizational factors related to nurses' understanding and use of P&Ps also play key roles. Thus, moving research evidence into practice will require careful interplay between the organization and the individual. P&Ps may be the interface through which this occurs.</p

Autonomy and Its Role in English Language Learning: Practice and Research

This chapter picks up discussion in the previous edition of this handbook of how the concept of autonomy has influenced language education and applied linguistics in recent years. It begins by discussing the philosophical and practical origins of learner autonomy in language education and particularly in English language teaching and how these have developed over the last 10 years. Key practical initiatives and research findings are reviewed to illuminate how autonomy has been interpreted in relation to learners, teachers, and the learning situation; how it has been linked or contrasted with other constructs; and how fostering autonomy has been seen as a part of pedagogy. Recent developments from the earlier edition are discussed regarding metacognition and, in particular, various contextual dimensions of learner autonomy. Other emerging topics are also reviewed, including learner autonomy in the world of digital/social media, learner autonomy in curriculum design and published materials, and the relation of learner autonomy to plurilingual perspectives. The chapter discusses issues in each of these areas, potential strategies for developing autonomy and effective learning, and possible future directions for research and practice

'Why don't you try it again?' A comparison of parent led, home based interventions aimed at increasing children's consumption of a disliked vegetable

Previous research suggests that the use of modelling and non-food rewards may be effective at increasing tasting, and consequential liking and acceptance, of a previously disliked food. Although successful school-based interventions have been developed, there is a lack of research into home-based interventions using these methods. This study aimed to develop and investigate the efficacy of a parent led home-based intervention for increasing children's acceptance of a disliked vegetable. A total of 115 children aged 2-4 years were allocated to one of four intervention groups or to a no-treatment control. The four intervention conditions were: repeated exposure; modelling and repeated exposure; rewards and repeated exposure; or modelling, rewards and repeated exposure. Children in all of the intervention conditions were exposed by a parent to daily offerings of a disliked vegetable for 14 days. Liking and consumption of the vegetable were measured pre and post-intervention. Significant increases in post-intervention consumption were seen in the modelling, rewards and repeated exposure condition and the rewards and repeated exposure condition, compared to the control group. Significant post-intervention differences in liking were also found between the experimental groups. Liking was highest (>60%) in the modelling, rewards and repeated exposure group and the rewards and repeated exposure group, intermediate (>26%) in the modelling and repeated exposure and repeated exposure groups, and lowest in the control group (10%). Parent led interventions based around modelling and offering incentives may present cost efficient ways to increase children's vegetable consumption