The effect of provider- and workflow-focused strategies for guideline implementation on provider acceptance

<p>Abstract</p> <p>Background</p> <p>The effective implementation of clinical practice guidelines (CPGs) depends critically on the extent to which the strategies that are deployed for implementing the guidelines promote provider acceptance of CPGs. Such implementation strategies can be classified into two types based on whether they primarily target providers (<it>e.g.</it>, academic detailing, grand rounds presentations) or the work context (<it>e.g.</it>, computer reminders, modifications to forms). This study investigated the independent and joint effects of these two types of implementation strategies on provider acceptance of CPGs.</p> <p>Methods</p> <p>Surveys were mailed to a national sample of providers (primary care physicians, physician assistants, nurses, and nurse practitioners) and quality managers selected from Veterans Affairs Medical Centers (VAMCs). A total of 2,438 providers and 242 quality managers from 123 VAMCs participated. Survey items measured implementation strategies and provider acceptance (<it>e.g.</it>, guideline-related knowledge, attitudes, and adherence) for three sets of CPGs--chronic obstructive pulmonary disease, chronic heart failure, and major depressive disorder. The relationships between implementation strategy types and provider acceptance were tested using multi-level analytic models.</p> <p>Results</p> <p>For all three CPGs, provider acceptance increased with the number of implementation strategies of either type. Moreover, the number of workflow-focused strategies compensated (contributing more strongly to provider acceptance) when few provider-focused strategies were used.</p> <p>Conclusion</p> <p>Provider acceptance of CPGs depends on the type of implementation strategies used. Implementation effectiveness can be improved by using both workflow-focused as well as provider-focused strategies.</p

Effect of Zirconium on the Densification of Reactively Hot-Pressed Zirconium Carbide

Densification mechanisms involved during reactive hot pressing (RHP) of zirconium carbide (ZrC) have been studied. RHP has been carried out using zirconium (Zr) and graphite (C) powders in the molar ratios 1:0.5, 1:0.67, 1:0.8, and 1:1 at 40 MPa, 800°C–1200°C for different durations. The volume fractions of phases formed, including porosity, are determined from the measured density and from Rietveld analysis. Increased densification with an increasing nonstoichiometry in carbon has been observed. Microstructural and X-ray diffraction observations coupled with the predictions of a model based on the constitutive laws governing plastic flow of zirconium suggest that the better densification of nonstoichiometric compositions arise from the higher amount of starting Zr and also the longer duration of its availability for plastic flow during RHP. Volume shrinkage due to reaction between Zr and C and the gradual elimination of the soft metal phase limit the final density achievable. Based on these observations, a twostep RHP carried out at 800°C and 1200°C leads to a better densification than a single RHP at 1200°C

On the Low Temperature Densification of Reactively Hot Pressed Non-Stoichiometric ZrC and (Zr,Ti)C

Reactive hot pressing (RHP) as a low temperature processing route is explored in the present work. For this purpose, metal-carbide mixtures, 1:1 molar ratio of zirconium (Zr): zirconium carbide (ZrC) and titanium (Ti): ZrC, are chosen, along with a temperature of 900°C and 50 MPa pressure. Further, pressureless reaction sintering (RS) is done at 1300-1600°C temperature. It has been found that after 1400°C RS, both the compositions reach almost full density. Ti, ZrC composition shows higher hardness (13 vs 11 GPa) than the Zr, ZrC composition. This process would allow dense products to be made by RHP more economically at lower temperature

Study of the Seed Production of Eggplant (Solanum melongea L.)

The objective of this study is to understand the factors and the conditions cause the dormancy of the eggplant seed.The level of fruit maturity, ripening treatments, the dehydration temperatures will affect the germination of fresh seeds of eggplant.It will be proposed to suggest that the suitable fruit maturity and seed conditioning method for reduced the seed dormancy and increased seed germination under constant temperature.計畫目標: 研究不同茄子果實成熟度及後熟處理, 不同回乾溫度使種子以不同失水速度至10%~12%種子含水量, 處理種子於變溫及恆溫下發芽, 以瞭解影響種子發芽休眠性之因素.架構( 重要工作項目 ): 1.果實成熟度: 高雄選一號茄子分別於春、秋季選取開花後70、80天之果實, 搓洗出 種子.2.果實後熟處理: 採收後果實置於室溫下後熟7天或10天.3.種子含水量: 以二種溫度使種子含水量以不同速度降低至12-10%.4.種子發芽溫度: 將調製好種子於25℃及30/25℃下進行發芽實驗.預期效益: 瞭解茄子種子發芽休眠性與果實成熟度、種子調製方法及發芽溫度之關係, 以建議果實採收適合條件、種子調製方法, 以減少種子休眠性及提高種子發芽品質

Rapid Identification and Differentiation of Candida albicans and Candida dubliniensis by Capillary-Based Amplification and Fluorescent Probe Hybridization

We developed a rapid genotypic assay to differentiate the germ tube-positive yeasts Candida albicans and Candida dubliniensis. Fluorescently labeled nucleic acid probe binding and subsequent denaturation from the target site in the PCR amplicons produced characteristic peak melting temperatures (T(m)) that identified each species. Peak T(m)s of C. albicans (n = 69) and C. dubliniensis (n = 28) isolates produced in the presence of their respective probes were 61.04 ± 0.64°C and 60.52 ± 1.01°C (averages ± standard deviations). No signal was generated when the C. albicans or C. dubliniensis probes were tested against DNA from their counterparts. Both probes reacted with Candida tropicalis DNA, but the T(m) was 51.85 ± 0.05°C with the C. albicans probe and 51.92 ± 0.10°C with the C. dubliniensis probe, differentiating C. tropicalis DNA from C. albicans and C. dubliniensis. A novel hybrid probe was designed to identify both species in a single reaction based on a 4°C difference in peak T(m)s. Our assay is rapid (≤2 h) and allows reliable detection and differentiation of the two germ tube-positive Candida spp

Original Article - Physical growth and psychomotor development of infants exposed to antiepileptic drugs in utero

Objective: To evaluates the physical growth and psychomotor development of infants born to women with epilepsy on regular Anti Epileptic Drugs (AEDs). Setting: Govt. Stanley Medical College and Hospital, Tertiary care referral centre, Chennai. Design: Open prospective cohort study with a control group. Materials and Methods: Consecutive women with epilepsy who were on regular anticonvulsants were followed up from their first trimester. Their babies were examined at birth and anthropometric measurements including anterior fontanelle size were noted. They were followed up till one year and periodically evaluated at 1st, 6th and 12th month of age. Development testing using Griffith scale was done at 2nd, 6th and 12th month. An equal number of control babies were also studied using the same scale for one year at the specified intervals. The results in both the groups were compared. Results : 30 babies were enrolled in the case and control group. The AEDs received by the mothers with epilepsy were Phenytoin, Carbamazepine, and Sodium valproate. At birth and 1st month the weight, head circumference and length of case and control babies were equal. At 6th and 12th month reduction in the above 3 parameters were noted in the case babies ( P < 0.01). Area of anterior fontanelle (AF) was larger in the study group particularly in those exposed to phenytoin in utero( P < 0.001). In the case babies reduction in the sitting, prone and erect progression of the locomotor scores was observed at 2nd month ( P < 0.001). Prone progression alone improved by 12th month and other two remained less than the control ( P < 0.001). No difference was observed in reaching behaviour and personal/social scores in both groups. Infants exposed to Phenytoin monotherapy had a negative impact on sitting progression. Conclusion : Among infants exposed to AEDs in utero physical growth was equal to that of control at birth but reduced at 6th and 12th month probably due to extraneous factors. The Locomotor scores showed reduction in all areas in 2nd, 6th and 12th month except prone progression which alone improved by 12th month. Phenytoin exposure in utero resulted in large AF and it had a negative impact on sitting progression in comparison with Carbamazepine and Sodium valproate

Original Article - Nonepileptic attack disorder among married women

Aim : To study the clinical features, precipitating stressful life events and prognosis of nonepileptic attack disorder (NEAD) among married women. Design: Prospective cohort study with 1-year follow-up. Setting: A tertiary care teaching hospital. Subjects: Of the 1020 patients with epilepsy referred to the epilepsy clinic during 2002-2003, 30 were married women with NEAD. Materials and Methods: The diagnostic criteria for NEAD included normal EEG during ictal and post-ictal phase of the generalized ′attack.′ The data collected included clinical characteristics, semiology of the attacks, precipitating stressful events, and co-morbid psychiatric disorders. The control group included 30 age-matched married women with generalized tonic-clonic seizures. The long-term outcome and factors influencing the outcomes were analyzed. Results: The mean duration of illness was 18 months, and the pattern of the attack was ′fall and lying still′ in 53% and ′fall with generalized motor movements′ in 47%. The frequency was one or more per week in 57% and occasionally in 43%. The important stressful events were matrimonial discord following illegal relationship of the husband with another woman (χ2 = 9.02, P = 0.003) and constant quarrel with other family members (χ2 = 5.19, P = 0.02). The prevalence of sexual abuse was low (7%). Co-morbid psychiatric disorder was observed in 70%. At the end of 1 year, 39% were free from the attack. Resolution of the stressful life events (χ2 = 4.52, P = 0.03) and lower frequency of attack at the time of reporting (χ2 = 3.88, P = 0.05) correlated with good outcomes. Conclusion : Among patients with NEAD in India, the major precipitating factors were matrimonial discord following illegal relationship of the husband with another woman and constant quarrel with other family members and not sexual abuse. Women with low frequency of attack at the time of reporting and the remission of the stressful events had better outcomes