Towards Understanding Apparent South Australian GP Resistance to Adopting Health Informatics Systems

This paper reports on a qualitative study of the attitudes of 23 South Australian practitioners in General Practice (GP) towards adopting an unspecified data amalgamating Health Informatics (HI) system. Findings suggest key areas of concern are associated with the potential for diminution of control over change and adoption was primarily influenced by a perceived need to protect the role and value of GPs. If change was seen as involuntary, uncertain or without demonstrable benefit to relevant patient outcomes, the prospect of change tended to manifest as passive or active GP resistance. Findings suggest increased exposure to use of HI systems influences GP perception of both the importance and certainty of potential implementation outcomes. It was concluded that discrete attitudes towards the use of HIS technology could be identified. Determined by contextual GP perceptions of competing managerial, technological and political factors, they are not mutually exclusive and more appropriately seen as a series of developmental and co-existing perspectives

Understanding South Australian GP Attitudes Towards Health Informatics Systems

This paper reports on the attitudes of 20 practitioners in South Australian General Practice towards adopting Health Informatics (HI) systems. HI systems are aimed at improving the overall quality and management of healthcare, but adoption of the technology may require a change in the General Practitioner’s (GP) approach to the way they perform their healthcare delivery role. This qualitative study found HI adoption was primarily influenced by the perceived potential for change in the professional’s value and role. While GPs were generally reluctant to consider technological innovation that was not perceived to demonstrate potential for improvement in patient health outcomes, increased exposure to HI systems positively influenced perceptions of both the importance and the certainty of potential implementation outcomes. It was concluded that GP attitudes could be characterised by four different perspectives of HI systems use in general practice medicine delivery

Neuregulin-1 attenuates mortality associated with experimental cerebral malaria.

BackgroundCerebral Malaria (CM) is a diffuse encephalopathy caused by Plasmodium falciparum infection. Despite availability of antimalarial drugs, CM-associated mortality remains high at approximately 30% and a subset of survivors develop neurological and cognitive disabilities. While antimalarials are effective at clearing Plasmodium parasites they do little to protect against CM pathophysiology and parasite-induced brain inflammation that leads to seizures, coma and long-term neurological sequelae in CM patients. Thus, there is urgent need to explore therapeutics that can reduce or prevent CM pathogenesis and associated brain inflammation to improve survival. Neuregulin-1 (NRG-1) is a neurotrophic growth factor shown to protect against brain injury associated with acute ischemic stroke (AIS) and neurotoxin exposure. However, this drug has not been tested against CM-associated brain injury. Since CM-associated brain injuries and AIS share similar pathophysiological features, we hypothesized that NRG-1 will reduce or prevent neuroinflammation and brain damage as well as improve survival in mice with late-stage experimental cerebral malaria (ECM).MethodsWe tested the effects of NRG-1 on ECM-associated brain inflammation and mortality in P. berghei ANKA (PbA)-infected mice and compared to artemether (ARM) treatment; an antimalarial currently used in various combination therapies against malaria.ResultsTreatment with ARM (25 mg/kg/day) effectively cleared parasites and reduced mortality in PbA-infected mice by 82%. Remarkably, NRG-1 therapy (1.25 ng/kg/day) significantly improved survival against ECM by 73% despite increase in parasite burden within NRG-1-treated mice. Additionally, NRG-1 therapy reduced systemic and brain pro-inflammatory factors TNFalpha, IL-6, IL-1alpha and CXCL10 and enhanced anti-inflammatory factors, IL-5 and IL-13 while decreasing leukocyte accumulation in brain microvessels.ConclusionsThis study suggests that NRG-1 attenuates ECM-associated brain inflammation and injuries and may represent a novel supportive therapy for the management of CM

Heme Mediated STAT3 Activation in Severe Malaria

The mortality of severe malaria [cerebral malaria (CM), severe malaria anemia (SMA), acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)] remains high despite the availability associated with adequate treatments. Recent studies in our laboratory and others have revealed a hitherto unknown correlation between chemokine CXCL10/CXCR3, Heme/HO-1 and STAT3 and cerebral malaria severity and mortality. Although Heme/HO-1 and CXCL10/CXCR3 interactions are directly involved in the pathogenesis of CM and fatal disease, the mechanism dictating how Heme/HO-1 and CXCL10/CXCR3 are expressed and regulated under these conditions is still unknown. We therefore tested the hypothesis that these factors share common signaling pathways and may be mutually regulated.We first clarified the roles of Heme/HO-1, CXCL10/CXCR3 and STAT3 in CM pathogenesis utilizing a well established experimental cerebral malaria mouse (ECM, P. berghei ANKA) model. Then, we further determined the mechanisms how STAT3 regulates HO-1 and CXCL10 as well as mutual regulation among them in CRL-2581, a murine endothelial cell line.The results demonstrate that (1) STAT3 is activated by P. berghei ANKA (PBA) infection in vivo and Heme in vitro. (2) Heme up-regulates HO-1 and CXCL10 production through STAT3 pathway, and regulates CXCL10 at the transcriptional level in vitro. (3) HO-1 transcription is positively regulated by CXCL10. (4) HO-1 regulates STAT3 signaling.Our data indicate that Heme/HO-1, CXCL10/CXCR3 and STAT3 molecules as well as related signaling pathways play very important roles in the pathogenesis of severe malaria. We conclude that these factors are mutually regulated and provide new opportunities to develop potential novel therapeutic targets that could be used to supplement traditional prophylactics and treatments for malaria and improve clinical outcomes while reducing malaria mortality. Our ultimate goal is to develop novel therapies targeting Heme or CXCL10-related biological signaling molecules associated with development of fatal malaria

Pharmacologic inhibition of CXCL10 in combination with anti-malarial therapy eliminates mortality associated with murine model of cerebral malaria.

Despite appropriate anti-malarial treatment, cerebral malaria (CM)-associated mortalities remain as high as 30%. Thus, adjunctive therapies are urgently needed to prevent or reduce such mortalities. Overproduction of CXCL10 in a subset of CM patients has been shown to be tightly associated with fatal human CM. Mice with deleted CXCL10 gene are partially protected against experimental cerebral malaria (ECM) mortality indicating the importance of CXCL10 in the pathogenesis of CM. However, the direct effect of increased CXCL10 production on brain cells is unknown. We assessed apoptotic effects of CXCL10 on human brain microvascular endothelial cells (HBVECs) and neuroglia cells in vitro. We tested the hypothesis that reducing overexpression of CXCL10 with a synthetic drug during CM pathogenesis will increase survival and reduce mortality. We utilized atorvastatin, a widely used synthetic blood cholesterol-lowering drug that specifically targets and reduces plasma CXCL10 levels in humans, to determine the effects of atorvastatin and artemether combination therapy on murine ECM outcome. We assessed effects of atorvastatin treatment on immune determinants of severity, survival, and parasitemia in ECM mice receiving a combination therapy from onset of ECM (day 6 through 9 post-infection) and compared results with controls. The results indicate that CXCL10 induces apoptosis in HBVECs and neuroglia cells in a dose-dependent manner suggesting that increased levels of CXCL10 in CM patients may play a role in vasculopathy, neuropathogenesis, and brain injury during CM pathogenesis. Treatment of ECM in mice with atorvastatin significantly reduced systemic and brain inflammation by reducing the levels of the anti-angiogenic and apoptotic factor (CXCL10) and increasing angiogenic factor (VEGF) production. Treatment with a combination of atorvastatin and artemether improved survival (100%) when compared with artemether monotherapy (70%), p<0.05. Thus, adjunctively reducing CXCL10 levels and inflammation by atorvastatin treatment during anti-malarial therapy may represent a novel approach to treating CM patients

Primer sequences used.

<p>Primer sequences used.</p

mRNA expression of HO-1 (A), CXCL10 (B), and CXCR3 (C) in whole brain homogenates of control, ARM, ATV, ATV/ARM-treated<i> P. berghei</i>ANKA-infected mice ( = 5 per group).

<p>Expression, measured by real-time PCR on day 11 post infection, is relative to the mean expression value in untreated mice day 5 post-infection brain samples and normalized on HPRT values. Treatment with ATV or ATV/ARM increased HO-1 expression and decreased CXCL10 expression in <i>P. berghei</i> ANKA-infection mice brain tissue. Columns and bars represent means standard error. Mean expression values were determined to be significantly different using one-way ANOVA with Holm-Sidak post-tests method for all pairwise multiple comparison. A p value of<0.05 was considered significant. Asterisks denote statistically significant change compared with ctrl D5 and section sign (§) denote statistically significant change compared with ctrl D11. Note the different scales used on each graph. Ctrl = control; D = day; ARM = artemether; ATV = atorvastatin.</p