The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines

BACKGROUND: This study tested the effects of two organizational support processes, the provision of financial incentives for superior clinical performance and the availability of a patient (smoker) registry and proactive telephone support system for smoking cessation, on provider adherence to accepted practice guidelines and associated patient outcomes. METHODS: Forty clinics of a large multispecialty medical group practice providing primary care services were randomly allocated to study conditions. Fifteen clinics each were assigned to the experimental conditions "control" (distribution of printed versions of smoking cessation guidelines) and "incentive" (financial incentive pay-out for reaching preset clinical performance targets). Ten clinics were randomized to receive financial incentives combined with access to a centralized patient registry and intervention system ("registry"). Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients' smoking cessation behaviors. RESULTS: Patients' tobacco use status was statistically significant (P < 0.01) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition. Patients visiting registry clinics accessed counseling programs statistically significantly more often (P < 0.001) than patients receiving care in the control condition. Other endpoints did not statistically significantly differ between the experimental conditions. CONCLUSIONS: The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practices and patient behaviors was mixed. Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment.     

<Emphasis Type="Italic">Scutellaria baicalensis</Emphasis> extract decreases cisplatin-induced pica in rats

Purpose Nausea/vomiting are significant side effects associated with the use of chemotherapy in cancer patients. Treatment of nausea/vomiting caused by cisplatin, a potent chemotherapeutic agent and one of the most emetogenic stimuli, requires a combination of different antiemetic drugs. In this study, we investigated the effects of Scutellaria baicalensis, an antioxidant herbal medicine, on cisplatin-induced nausea using a rat model.Methods Rats react to emetic/nausea-producing stimuli, such as cisplatin, with altered feeding habits, manifested by pica or increased consumption of kaolin (a type of clay). We measured pica in rats to quantify cisplatin-induced nausea, and to evaluate the antinausea effect of pretreatment with S. baicalensis extract (SbE) given intraperitoneally.Results Cisplatin at 3 mg/kg induced significant pica accompanied by reduced food intake, suggesting the presence of nausea. Hence, this cisplatin dose was selected for testing the antinausea activity of SbE. Cisplatin-induced pica decreased significantly when animals were pretreated with SbE at doses of 1 mg/kg and 3 mg/kg (P<0.01). At a higher SbE dose (10 mg/kg), kaolin consumption increased, rather than further decreased, and was significantly different from that in the groups treated with low SbE doses.Conclusions SbE pretreatment decreased cisplatin-induced kaolin intake in the rat model of simulated nausea, suggesting that SbE and its active constituent(s) may play a therapeutic role in chemotherapy-induced emesis. Absence of therapeutic effect at the highest tested SbE dose could have been a result of prooxidant activity often associated with excess antioxidant concentration.This work was supported in part by NIH grants R01 CA79042, P30 CA14599, and R21 AT00381.     

平喘冲剂治疗小儿哮喘临床观察

为观察平喘冲剂治疗小儿哮喘的临床疗效,将196例患儿随机分为治疗组100例口服中药平喘冲剂,对照组96例静脉滴注青霉素、氨茶碱,疗程1周,观察治疗前后喘憋、咳嗽、紫绀、哮鸣音、肺功能、肺阻抗血流的变化。结果：治疗组总有效率为98．00％,对照组总有效率为93．75％,各项检测指标治疗组均优于对照组。提示平喘冲剂具有平喘止咳、化痰通瘀的作用。     

Dihydropyridines as inhibitors of capacitative calcium entry in leukemic HL-60 cells

A series of 1,4-dihydropyridines (DHPs) were investigated as inhibitors of capacitative calcium influx through store-operated calcium (SOC) channels. Such channels activate after ATP-elicited release of inositol trisphosphate (IP(3))-sensitive calcium stores in leukemia HL-60 cells. The most potent DHPs were those containing a 4-phenyl group with an electron-withdrawing substituent, such as m- or p-nitro- or m-trifluoromethyl (IC(50) values: 3-6 microM). Benzyl esters, corresponding to the usual ethyl/methyl esters of the DHPs developed as L-type calcium channel blockers, retained potency at SOC channels, as did N-substituted DHPs. N-Methylation reduced by orders of magnitude the potency at L-type channels resulting in DHPs nearly equipotent at SOC and L-type channels. DHPs with N-ethyl, N-allyl, and N-propargyl groups also had similar potencies at SOC and L-type channels. Replacement of the usual 6-methyl group of DHPs with larger groups, such as cyclobutyl or phenyl, eliminated activity at the SOC channels; such DHPs instead elicited formation of inositol phosphates and release of IP(3)-sensitive calcium stores. Other DHPs also caused a release of calcium stores, but usually at significantly higher concentrations than those required for the inhibition of capacitative calcium influx. Certain DHPs appeared to cause an incomplete blockade of SOC channel-dependent elevations of calcium, suggesting the presence of more than one class of such channels in HL-60 cells. N-Methylnitrendipine (IC(50) 2.6 microM, MRS 1844) and N-propargylnifrendipine (IC(50) 1.7 microM, MRS 1845) represent possible lead compounds for the development of selective SOC channel inhibitors.     

A comparison of methods to compute the point of force application in handrim wheelchair propulsion: a technical note

Several methods are available for computing the location of the point of force application (PFA) in manual wheelchair propulsion using kinetic data. We compared five different techniques for computing the PFA location in analysis of data from five wheelchair users propelling their own wheelchairs using their normal propulsion style. The effects of the assumptions used in the calculations on the resulting location of the PFA, handrim force and moment components, and mechanical efficiency (e) were quantified. When kinetic data were used to locate the PFA, the most consistent and stable results were obtained using the assumptions that components of the handrim moment about the anteriorly directed and vertically directed axes were negligible. Some assumptions led to unsolvable equations at points during the propulsion cycle, demonstrating that they were inappropriate. All PFA values calculated with kinetic data were unstable at the beginning and end of the propulsion phase. While differences exist due to individual technique, assuming handrim moment components about the anterior-posterior, vertical, and/or both axes resulted in the most representative results.     

The reversal of antagonists facilitates the peak rate of tension development

OBJECTIVE: The present study was designed to test the effects of the reversal of antagonists on the peak rate of tension development (dF/dt(max)) of the elbow extensors. DESIGN: Experimental, with matched controls. SETTING: A biomechanics research laboratory. PARTICIPANTS: Twenty-six healthy women without a history of upper extremity injury or neurologic disorder, randomly assigned to experimental (n = 13) or control (n = 13) groups. INTERVENTIONS: Two groups of healthy subjects followed identical exercise protocols, except that the control group performed maximal isometric contractions of the elbow extensors and the experimental group executed a maximal isometric elbow flexion contraction immediately before a maximal elbow extension contraction. Both groups performed 5 cycles of a 2-second contraction with 22-second rest periods between agonist muscle contractions and were evaluated at 4 test sessions spaced 2 weeks apart. MAIN OUTCOME MEASURES: All measurements were done with the shoulder and elbow at 90 degrees of flexion in the sagittal plane to ensure reproducibility. A load cell was used to measure elbow extension moment and to calculate the peak rate of tension development (dF/dt(max)). Biceps and triceps brachii surface electromyographic activity was monitored concurrently. The electromyographic measures were mean spike (peak-to-peak) amplitude and mean spike frequency of the biceps and triceps brachii activity. RESULTS: Intraclass dF/dt(max) and electromyographic reliability was good (r > or = .72) in both groups. Because biceps electromyographic measures were considerably less reliable (r < or = .53), they were not included in our analysis. While dF/dt(max) increased quadratically in both groups (p <.05), the experimental group was on average 36.1Nm. s(-1) (63%) greater across sessions 2 to 4 (p <.05). In contrast, triceps electromyographic activity did not differ significantly between groups (p >.05). The means averaged across groups exhibited a quadratic increase from session 1 to session 4: 91microV or 48% for mean spike amplitude (p <.05) and 7Hz or 16% for mean spike frequency (p <.05). CONCLUSIONS: The greater dF/dt(max) for the experimental group was not associated with increased electromyographic activity. The experimental group appeared to use the biomechanic properties of the pretensioned extensor muscle-tendon complex, rather than neurologic biasing, to accomplish its power gains.     

Differentiation of rat embryonic neural stem cells promoted by co-cultured Schwann cells

Objective To explore the factors which induce differentiation of embryonic neural stem cells. Methods Rat embryonic neural stem cells were co-cultured with newborn rat Schwann cells in serum-free medium. The phenotype and specific-markers including tubulin-β, glial fibrillary acidic protein (GFAP) and galactorcerebroside (GalC), were domonstrated by phase contrast microscopy and double immunofluorescence staining. Results Overall, 80%±5% of neural stem cells protruded several elongated processes and expressed tubulin-β antigen at high levels, while 20±3% of them protruded several short processes and were GalC or GFAP positive. Conclusion The factors secreted by Schwann cells could induce rat embryonic neural stem cell to differentiate.     

Genetic susceptibility to ischemic cerebrovascular disease in Koreans

Ischemic cerebrovascular disease (ICVD) is a multifactorial disease caused by the interactions of several genetic and environmental factors. Tobacco smoke is a major cause of both cancer and vascular disease. Although its carcinogenic role via induction of DNA damage and mutation is well established, the mechanisms involved in vascular disease remain unclear. One possibility is that DNA damage causes smooth muscle cell proliferation in the intima of arteries, thereby contributing to atherothrombotic processes. The binding of chemicals to DNA is modulated by detoxification enzymes, including glutathione S-transferase (GST). We examined whether polymorphisms in this gene, as well as the angiotensin-converting enzyme (ACE) gene influence the risk of ICVD on smoking status. DNA was analyzed for deletions in the GST M1, T1, and ACE genes by polymerase chain reaction (PCR). No significant association was observed between GST null genotype and ICVD, even in smokers. However, a significant association between ACE and ICVD was observed only in smokers (X ²=0.023, p<0.05). We conclude that GST polymorphism is not a risk factor for the development of ICVD through smoking and suggest a high probability that ACE polymorphism may contribute to the odds of ICVD in smokers.     

Reexamination of the characteristics of the deficit schizophrenia patients

The aim of this study was to reexamine and compare the characteristics of the deficit and nondeficit schizophrenic patients. This cross-sectional study consisted of 62 in- and out-patients, 18–65 years of age, diagnosed with schizophrenia according to DSM-IV. The sociodemographic variables, premorbid adjustment, clinical course and general functioning level in the past five years were evaluated by utilizing the appropriate sections of Comprehensive Assessment of Symptoms and History (CASH). In addition, GAF, the Schedule for the Deficit Syndrome (SDS), Positive and Negative Syndrome Scale (PANSS), Montgomery Äsberg Depression Scale (MADRS), the Neurological Evaluation Scale (NES) and the Simpson Angus Extrapyramidal Side Effects (EPS) Rating Scale, Trail A and B, Verbal Fluency, Stroop, Block Design and Finger Tapper tests were administered. Using the SDS, 19 patients (30.6 %) were categorized as deficit; 43 (69.4 %) were categorized as nondeficit. The deficit patients were worse on the Functioning During Past Five Years score of CASH. The PANSS and MADRS mean scores were not significantly different between the two groups, except a higher level of negative symptoms observed in the deficit group. NES scores were also significantly higher in the deficit group. However, sociodemographic and other clinical variables, neurocognitive measures and EPS symptoms did not show any significant difference between the two groups. Our findings suggest that the deficit schizophrenia is a distinct subgroup comprised of patients who have more negative symptoms, neurological impairment and poor functioning which may have a common underlying pathology.