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81.
82.
SR Majumdar FA McAlister JA Johnson D Bellerose K Siminoski DA Hanley I Qazi DA Lier RG Lambert AS Russell BH Rowe 《The American journal of medicine》2012,125(9):929-936
BackgroundMost vertebral compression fractures are not recognized or treated. We conducted a controlled trial in older patients with vertebral fractures incidentally reported on chest radiographs, comparing usual care with osteoporosis interventions directed at physicians (opinion-leader-endorsed evidence summaries and reminders) or physicians+patients (adding activation with leaflets and telephone counseling).MethodsPatients aged >60 years who were discharged home from emergency departments and who had vertebral fractures reported but were not treated for osteoporosis were allocated to usual care (control) or physician intervention using alternate-week time series. After 3 months, untreated controls were re-allocated to physician+patient intervention. Allocation was concealed, outcomes ascertainment blinded, and analyses intent-to-treat. Primary outcome was starting osteoporosis treatment within 3 months.ResultsThere were 1315 consecutive patients screened, and 240 allocated to control (n = 123) or physician intervention (n = 117). Groups were similar at baseline (average age 74 years, 45% female, 58% previous fractures). Compared with controls, physician interventions significantly (all P <.001) increased osteoporosis treatment (20 [17%] vs 2 [2%]), bone mineral density testing (51 [44%] vs 5 [4%]), and bone mineral density testing or treatment (57 [49%] vs 7 [6%]). Three months after controls were re-allocated to physician+patient interventions, 22% had started treatment and 65% had bone mineral density testing or treatment (P <.001 vs controls). Physician+patient interventions increased bone mineral density testing or treatment an additional 16% compared with physician interventions (P = .01).ConclusionsAn opinion-leader-based intervention targeting physicians substantially improved rates of bone mineral density testing and osteoporosis treatment in patients with incidental vertebral fractures, compared with usual care. Even better osteoporosis management was achieved by adding patient activation to physician interventions [NCT00388908]. 相似文献
83.
David Ryder Katalin Kraszlan Debbie Lien Elizabeth Allen Tanya Chiplin Suzanne Dick 《Psychiatry, Psychology and Law》2013,20(1):65-75
The Western Australian Court Diversion Service (CDS) is a post‐conviction / pre‐sentence program that aims to divert substance‐using offenders from the prison system and into treatment programs. It has been in operation since 1988, though a formal evaluation has not been conducted. The present study evaluated the outcomes for offenders referred to the program in relation to program completion, sentencing and re‐offending. It utilised a quasi‐experimental within groups design using data from client files from January 1998 to June 1999. Offenders who had higher motivation, attended treatment regularly and had less than 20 prior convictions were more likely to complete the program. A custodial sentence was more likely if the offender was male, had committed a serious offence, had more than 30 prior convictions, had lower motivation and had not completed the CDS program. Predictors of re‐offending included lower motivation and a previous custodial sentence. The offender's level of motivation to change and number of prior convictions were significant predictors of all three outcomes: program completion, sentencing and re‐offending. The findings highlight the importance of considering offender characteristics when assessing eligibility for diversion programs, addressing offender motivation within diversion programs and considering issues of which offenders are most likely to benefit from which programs. 相似文献
84.
Katrina Tatton‐Brown Anne Murray Sandra Hanks Jenny Douglas Ruth Armstrong Siddharth Banka Lynne M. Bird Carol L. Clericuzio Valerie Cormier‐Daire Tom Cushing Frances Flinter Marie‐Line Jacquemont Shelagh Joss Esther Kinning Sally Ann Lynch Alex Magee Vivienne McConnell Ana Medeira Keiichi Ozono Michael Patton Julia Rankin Debbie Shears Marleen Simon Miranda Splitt Volker Strenger Kyra Stuurman Clare Taylor Hannah Titheradge Lionel Van Maldergem I. Karen Temple Trevor Cole Sheila Seal Childhood Overgrowth Consortium Nazneen Rahman 《American journal of medical genetics. Part A》2013,161(12):2972-2980
85.
Salas-Lopez D Deitrick L Mahady ET Moser K Gertner EJ Sabino JN 《Journal of general internal medicine》2012,27(1):113-116
Expressed barriers to writing for publication include lack of time, competing demands, anxiety about writing and a lack of
knowledge about the submission process. These limitations can be magnified for practitioners in non-university environments
in which there are fewer incentives or expectations regarding academic publication productivity. However, as members of professional
disciplines, practitioners have both the responsibility and, oftentimes, the insights to make valuable contributions to the
professional literature. Collaborative writing groups can be a useful intervention to overcome barriers, provide the necessary
skills and encouragement as well as produce publications and conference presentations that make worthy additions to the professional
body of knowledge. This article discusses the evolution and outcomes of writing groups at Lehigh Valley Health Network and
describes how this strategy can be adopted by other academic community hospitals to promote professional development and publication. 相似文献
86.
Schwarz EB Postlethwaite D Hung YY Lantzman E Armstrong MA Horberg MA 《Journal of general internal medicine》2012,27(2):196-201
BACKGROUND
Women with diabetes mellitus who delay pregnancy until glycemic control is achieved experience lower rates of adverse pregnancy outcomes. 相似文献87.
Allensworth-Davies D Cheng DM Smith PC Samet JH Saitz R 《The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions》2012,21(3):257-262
Primary care physicians can help drug-dependent patients mitigate adverse drug use consequences; instruments validated in primary care to measure these consequences would aid in this effort. This study evaluated the validity of the Short Inventory of Problems-Alcohol and Drugs modified for Drug Use (SIP-DU) among subjects recruited from a primary care clinic (n= 106). SIP-DU internal consistency was evaluated using Cronbach's alphas, convergent validity by correlating the total SIP-DU score with the DAST-10, and construct validity by analyzing the factor structure. The SIP-DU demonstrated high internal consistency (Cronbach's alpha for overall scale .95, subscales .72-.90) comparable with other SIP versions and correlated well with the DAST-10 (r= .70). Confirmatory factor analysis suggested an unacceptable fit of previously proposed factors; exploratory factor analyses suggested a single factor of drug use consequences. The SIP-DU offers primary care clinicians a valid and practical assessment tool for drug use consequences. 相似文献
88.
Johnson LF Dorrington RE Bradshaw D Coetzee DJ 《Tropical medicine & international health : TM & IH》2012,17(2):161-168
Objectives To assess the extent to which sexually transmitted infections (STIs) have contributed to the spread of HIV in South Africa and to estimate the extent to which improvements in STI treatment have reduced HIV incidence. Methods A mathematical model was used to simulate interactions between HIV and six other STIs (genital herpes, syphilis, chancroid, gonorrhoea, chlamydial infection and trichomoniasis) as well as bacterial vaginosis and vaginal candidiasis. The effects of STIs on HIV transmission probabilities were assumed to be consistent with meta‐analytic reviews of observational studies, and the model was fitted to South African HIV prevalence data. Results The proportion of new HIV infections in adults that were attributable to curable STIs reduced from 39% (uncertainty range: 24–50%) in 1990 to 14% (8–18%) in 2010, while the proportion of new infections attributable to genital herpes increased. Syndromic management programmes are estimated to have reduced adult HIV incidence by 6.6% (3.3–10.3%) between 1994 and 2004, by which time syndromic management coverage was 52%. Had syndromic management been introduced in 1986, with immediate achievement of 100% coverage and a doubling of the rate of health seeking, HIV incidence would have reduced by 64% (36–82%) over the next decade, but had the same intervention been delayed until 2004, HIV incidence would have reduced by only 5.5% (2.8–9.0%). Conclusions Sexually transmitted infections have contributed significantly to the spread of HIV in South Africa, but STI control efforts have had limited impact on HIV incidence because of their late introduction and suboptimal coverage. 相似文献
89.
As understanding of the mechanisms driving and regulating insulin secretion from pancreatic beta cells grows, there is increasing and compelling evidence that nitric oxide (?NO) and other closely-related reactive nitrogen species (RNS) play important roles in this exocytic process. ?NO and associated RNS, in particular peroxynitrite, possess the capability to effect signals across both intracellular and extracellular compartments in rapid fashion, affording extraordinary signaling potential. It is well established that nitric oxide signals through activation of guanylate cyclase-mediated production of cyclic GMP. The intricate intracellular redox environment, however, lends credence to the possibility that ?NO and peroxynitrite could interact with a wider variety of biological targets, with two leading mechanisms involving 1) Snitrosylation of cysteine, and 2) nitration of tyrosine residues comprised within a variety of proteins. Efforts aimed at delineating the specific roles of ?NO and peroxynitrite in regulated insulin secretion indicate that a highly-complex and nuanced system exists, with evidence that ?NO and peroxynitrite can contribute in both positive and negative regulatory ways in beta cells. Furthermore, the ultimate biochemical outcome within beta cells, whether to compensate and recover from a given stress, or not, is likely a summation of contributory signals and redox status. Such seeming regulatory dichotomy provides ample opportunity for these mechanisms to serve both physiological and pathophysiologic roles in onset and progression of diabetes. This review focuses attention upon recent accumulating evidence pointing to roles for nitric oxide induced post-translational modifications in the normal regulation as well as the dysfunction of beta cell insulin exocytosis. 相似文献
90.
Caroline Straatmann Rose Ayoob Rasheed Gbadegesin Keisha Gibson Michelle N. Rheault Tarak Srivastava Cheryl L. Tran Debbie S. Gipson Larry A. Greenbaum William E. Smoyer V. Matti Vehaskari 《Pediatric nephrology (Berlin, Germany)》2013,28(8):1235-1241