Clinical Evidence: a useful tool for promoting evidence-based practice?

BACKGROUND: Research has shown that many healthcare professionals have problems with guidelines as they would prefer to be given all relevent information relevent to decision-making rather than being told what they should do. This study assesses doctors' judgement of the validity, relevance, clarity and usability of the Italian translation of Clinical Evidence (CE) after its free distribution launched by the Italian Ministry of Health METHODS: Opinions elicited using a standardised questionnaire delivered either by mail or during educational or professional meetings RESULTS: Twenty percent (n = 1350) doctors participated the study. Most of them found CE's content valid, useful and relevant for their clinical practice, and said CE can foster communications among clinicians, particularly among GPs and specialists. Hospital doctors (63%) more often than GPs (48%) read the detailed presentation of individual chapters. Twenty-nine percent said CE brought changes in their clinical practice. Doctors appreciated CE's nature of an evidence-based information compendium and would have not preferred a collection of practice guidelines. CONCLUSIONS: Overall, the pilot initiative launched by the Italian Ministry of Health seems to have been well received and to support the subsequent decision to make the Italian edition of Clinical Evidence concise available to all doctors practising in the country. Local implementation initiatives should be warranted to favour doctor's use of CE

Aplicabilidade do contraponto rítmico no poema O Corvo de Edgar Alan Poe: motivo, variação e tradução

The “counterpoint rhythm” phenomenon is this way called in the study of poetry by borrowing of the term as applied in music, describing an effect in which two rhythmical patterns would coexist simultaneously. However, it receives controversial denominations and meanings in literature, coming to be recently qualified as inherent to canon meters of Portuguese language poetry. That said, the present work had as its objective to comprehend this phenomenon as it in fact occurs, how it could be adequately denominated and if it is applicable in the study of poetry. To that end, the first part consisted of a critical review of the literature concerning the object, having as principle the objective definition of the borrowed musical concepts, while the second sought the applicability of the phenomenon through the comparison of the rhythmical analysis by multiple levels of intensive distribution in the poem The Raven by Edgar Allan Poe and in its translations by Fernando Pessoa and Milton Amado. It was concluded that the various meanings consist in similar phenomena which can be grouped under the adequate denomination of “variation of rhythmic motif” and that, since the phenomenon was observed in the poem by Poe, doubtfully reproduced by Pessoa and predominantly reproduced by Amado, this concept presents applicability to the analysis and interpretation of poetry.O fenômeno “contraponto rítmico” é assim chamado no estudo da poesia por empréstimo do termo como aplicado em música, descrevendo um efeito em que dois padrões rítmicos coexistiriam simultaneamente. No entanto, recebe controversas denominações e acepções na literatura, chegando a ser recentemente qualificado como inerente a metros cânones da tradição da poesia em língua portuguesa. Diante disso, o presente trabalho teve por objetivo compreender se um tal fenômeno de fato ocorre, como poderia ser adequadamente denominado e se é aplicável ao estudo da poesia. Para isso, a primeira parte tratou de uma revisão crítica da literatura tocante ao objeto, tendo por princípio a definição objetiva dos conceitos musicais tomados por empréstimo, enquanto a segunda buscou a aplicabilidade do fenômeno realizando a comparação da análise rítmica em múltiplos níveis de distribuição intensiva no poema The Raven de Edgar Allan Poe e nas suas traduções por Fernando Pessoa e Milton Amado. Concluiu-se que as diversas acepções tratam de fenômenos semelhantes que podem ser agrupados sob a adequada denominação de “variação de motivo rítmico” e que, observado o fenômeno no poema de Poe, duvidosamente reproduzido por Pessoa e preponderantemente reproduzido por Amado, este conceito apresenta aplicabilidade para a análise e interpretação de poesia

Clinical evidence continuous medical education: a randomised educational trial of an open access e-learning program for transferring evidence-based information – ICEKUBE (Italian Clinical Evidence Knowledge Utilization Behaviour Evaluation) – study protocol

<p>Abstract</p> <p>Background</p> <p>In an effort to ensure that all physicians have access to valid and reliable evidence on drug effectiveness, the Italian Drug Agency sponsored a free-access e-learning system, based on <it>Clinical Evidence</it>, called ECCE. Doctors have access to an electronic version and related clinical vignettes. Correct answers to the interactive vignettes provide Continuing Medical Education credits. The aims of this trial are to establish whether the e-learning program (ECCE) increases physicians' basic knowledge about common clinical scenarios, and whether ECCE is superior to the passive diffusion of information through the printed version of <it>Clinical Evidence</it>.</p> <p>Design</p> <p>All Italian doctors naïve to ECCE will be randomised to three groups. Group one will have access to ECCE for <it>Clinical Evidence </it>chapters and vignettes lot A and will provide control data for <it>Clinical Evidence </it>chapters and vignettes lot B; group two vice versa; group three will receive the concise printed version of <it>Clinical Evidence</it>. There are in fact two designs: a before and after pragmatic trial utilising a two by two incomplete block design (group one versus group two) and a classical design (group one and two versus group three). The primary outcome will be the retention of <it>Clinical Evidence </it>contents assessed from the scores for clinical vignettes selected from ECCE at least six months after the intervention. To avoid test-retest effects, we will randomly select vignettes out of lot A and lot B, avoiding repetitions. In order to preserve the comparability of lots, we will select vignettes with similar, optimal psychometric characteristics.</p> <p>Trial registration</p> <p>ISRCTN27453314</p

A novel point mutation in the CYBB gene promoter leading to a rare X minus chronic granulomatous disease variant — Impact on the microbicidal activity of neutrophils

AbstractThis article reports an atypical and extremely rare case of X-linked CGD in an Italian family characterized by a low expression of gp91phox (X91− CGD). A novel point mutation in the CYBB gene's promoter (insertion of a T at position −54T to −56T) appeared to prevent the full expression of this gene in the patient's neutrophils and correlated with a residual oxidase activity in the whole cells population. The expression and functional activity of the oxidase in eosinophils appeared to be almost normal. Gel shift assays indicated that the mutation led to decreased interactions with DNA-binding proteins. The total O2− production in the patient's granulocytes (5–7% of normal) supported no microbicidal power after 45 min and 60 min of contact with S. aureus and C. albicans, respectively. Despite this residual oxidase activity, the patients suffered from severe and life-threatening infections. It was concluded that in these X91− CGD neutrophils, the O2− production per se was not sufficient to protect the patient against severe infections

Agreement on classification of clinical photographs of pigmentary lesions: exercise after a training course with young dermatologists.

Smartphone apps may help promoting the early diagnosis of melanoma. The reliability of specialist judgment on lesions should be assessed. Hereby, we evaluated the agreement of 6 young dermatologists, after a specific training. Clinical judgment was evaluated during 2 online sessions, 1 month apart, on a series of 45 pigmentary lesions. Lesions were classified as highly suspicious, suspicious, non-suspicious or not assessable. Cohen's and Fleiss' kappa were used to calculate intra- and inter-rater agreement. The overall intra-rater agreement was 0.42 (95% confidence interval - CI: 0.33-0.50), varying between 0.12-0.59 on single raters. The inter-rater agreement during the first phase was 0.29 (95% CI: 0.24-0.34). When considering the agreement for each category of judgment, kappa varied from 0.19 for not assessable to 0.48 for highly suspicious lesions. Similar results were obtained in the second exercise. The study showed a less than satisfactory agreement among young dermatologists. Our data point to the need for improving the reliability of the clinical diagnoses of melanoma especially when assessing small lesions and when dealing with thin melanomas at a population level

Chloride movements in human neutrophils during phagocytosis: Characterization and Relationship to Granule Release

Chloride ion efflux is an early event occurring after exposure of human neutrophils to several soluble agonists. Under these circumstances, a rapid and reversible fall in the high basal intracellular chloride (Cl\u2013i) levels is observed. This event is thought to play a crucial role in the modulation of several critical neutrophil responses including activation and up-regulation of adhesion molecules, cell attachment and spreading, cytoplasmic alkalinization, and activation of the respiratory burst. At present, however, no data are available on chloride ion movements during neutrophil phagocytosis. In this study, we provide evidence that phagocytosis of Candida albicans opsonized with either whole serum, complement-derived opsonins, or purified human IgG elicits an early and long-lasting Cl\u2013 efflux accompanied by a marked, irreversible loss of Cl\u2013i. Simultaneous assessment of Cl\u2013 efflux and phagocytosis in cytochalasin D-treated neutrophils indicated that Cl\u2013 efflux occurs without particle ingestion. These results suggest that engagement of immune receptors is sufficient to promote chloride ion movements. Several structurally unrelated chloride channel blockers inhibited phagocytosis-induced Cl\u2013 efflux as well as the release of azurophilic\u2014but not specific\u2014granules. It implicates that different neutrophil secretory compartments display distinct sensitivity to Cl\u2013i modifications. Intriguingly, inhibitors of Cl\u2013 exchange inhibited cytosolic Ca2+ elevation, whereas Cl\u2013 efflux was not impaired in Ca2+-depleted neutrophils. We also show that Fc\u3b3R(s)- and CR3/CR1-mediated Cl\u2013 efflux appears to be dependent on protein tyrosine phosphorylation but independent of PI3K and phospholipase C activation

IMPATTO DI UN CORSO DI FORMAZIONE A DISTANZA SULLA SEGNALAZIONE SPONTANEA DI REAZIONI AVVERSE DA FARMACI

Obiettivo del lavoro: verificare l'eventuale impatto di un corso di formazione a distanza accreditato sul sistema della segnalazione spontanea di reazioni avverse da farmac

Heterogeneity of macrophages as revealed by studies on their oxidative metabolism

We have examined the ability of macrophages and polymorhs (PMN), from different sources and from different animal species, to release superoxide anion and H2O2 during phagocytosis of serum opsonized heat killed B. mycoides