Best practice guidelines on publishing ethics: a publisher's perspective, 2nd edition

Wiley has updated its publishing ethics guidelines, first published in 2006. The new guidelines provide guidance, resources and practical advice on ethical concerns that arise in academic publishing for editors, authors and researchers, among other audiences. New guidance is also included on whistle blowers, animal research, clinical research and clinical trial registration, addressing cultural differences, human rights and confidentiality. The guidelines are uniquely interdisciplinary, and were reviewed by 24 editors and experts chosen from the wide range of communities that Wiley serves. They are also published in Advanced Materials, Headache, Annals of the New York Academy of Sciences, Social Science Quarterly, and on the website http://exchanges.wiley.com/ethicsguidelines.     

Welchen Beitrag liefern funktional definierte Populationen zur Erklärung regionaler Unterschiede in der medizinischen Versorgung?

Geographic variation in health care is increasingly subject to analysis and health policy aiming at the suitable allocation of resources and the reduction of unwarranted variation for the patient populations concerned. As in the case of area-level indicators, in most cases populations are geographically defined. The concept of geographically defined populations, however, may be self-limiting with respect to identifying the potential for improvement. As an alternative, we explored how a functional definition of populations would support defining the scope for reducing unwarranted geographical variations. Given that patients in Germany have virtually no limits in accessing physicians of their choice, we adapted a method that has been developed in the United States to create virtual networks of physicians based on commonly treated patients. Using the physician claims data under statutory insurance, which covers 90?% of the population, we defined 43,006 populations—and networks—in 2010. We found that there is considerable variation between the population in terms of their risk structure and the share of the primary care practice in the total services provided. Moreover, there are marked differences in the size and structure of networks between cities, densely populated regions, and rural regions. We analyzed the variation for two area-level indicators: the proportion of diabetics with at least one HbA1c test per year for diabetics, and the proportion of patients with low back pain undergoing computed tomography and/or magnetic resonance imaging. Variation at the level of functionally defined populations proved to be larger than for geographically defined populations. The pattern of distribution gives evidence on the degree to which consensus targets could be reached and which networks need to be addressed in order to reduce unwarranted regional variation. The concept of functionally defined populations needs to be further developed before implementation.     

Healthcare provider knowledge,attitudes and practices in patients on the Victorian Spleen Registry

Objective: This study aimed to evaluate the knowledge, attitudes and practices of healthcare providers regarding asplenic patients and to assess their satisfaction with the Victorian Spleen Registry (VSR) service. Methods: Survey forms were sent to 992 healthcare providers listed as caring for at least one patient registered on the VSR. Results: A total of 223 completed questionnaires were returned. Healthcare providers heard about the VSR mainly from another healthcare professional or through a healthcare institution (31.7%), via online or printed resources (30.8%) or from their patients (24.4%). Most respondents valued the work of the VSR in providing information to healthcare professionals (71.4%), providing a reminder service for vaccinations (66.7%) and providing education to patients (60.5%). Most of those surveyed correctly identified high‐risk infections for asplenic and hyposplenic patients with encapsulated organisms, but less than one‐third identified a risk with malarial infections (32.9%). Providers always recommended influenza vaccinations, emergency standby antibiotics and an alert medallion or card in 92.8%, 63.6% and 36.4% of cases, respectively. Conclusions: Healthcare providers value and are satisfied with the service provided by the VSR. Patients can play a valuable role in communicating with their health providers. This survey may have been of value to healthcare providers by heightening awareness of the VSR website as well as knowledge of the registry. Implications: The results positively reflect the functioning of the VSR, although better promotion of the VSR among healthcare professionals and consideration of expansion is needed.     

Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism

Background

Plasma levels of brain natriuretic peptide (BNP) are increased in patients with left heart failure. In patients with severe pulmonary embolism (PE), primary right ventricular (RV) dysfunction is frequent. Little is known about BNP secretion in acute RV failure.

Methods

We prospectively studied 50 consecutive patients with confirmed PE (age range, 57 ± 19 years; 36 men). PE was confirmed with pulmonary angiography, spiral computed tomography, or echocardiography and subsidiary analyses. On admission, echocardiography and BNP measurements were performed in all patients.

Results

Patients without RV dysfunction had significantly lower BNP levels than patients with RV dysfunction (55 ± 69 pg/mL vs 340 ± 362 pg/mL, P <.001). There was a significant correlation between RV end-diastolic diameter and BNP (r = 0.43, P <.05). BNP discriminated patients with or without RV dysfunction (area under the receiver operating characteristic curve, 0.78; 95% CI, 0.64-0.92). A BNP >90 pg/mL was associated with a risk ratio of 28.4 (95% CI, 3.22-251.12) for the diagnosis of RV dysfunction. All patients without LV systolic dysfunction who had syncope necessitating cardiopulmonary resuscitation had normal BNP levels. Patients with RV dysfunction had significantly more in-hospital complications (cardiogenic shock, inotropic therapy, mechanical ventilation). However, BNP levels were not predictive of mortality or in-hospital complications.

Conclusions

BNP levels are frequently increased in patients with PE who have RV dysfunction, whereas patients without RV dysfunction show reference range BNP levels in the absence of left ventricular dysfunction. In acute PE, BNP elevation is highly predictive of RV dysfunction, but not of in-hospital complications and mortality.     

Host-derived amino acids support the proliferation of symbiotic bacteria

Animals are typically colonized by diverse bacterial symbionts, many of which are commensal and, in numerous cases, even essential for their host’s proper development and growth. In exchange, the host must supply a sufficient array and quantity of nutrients to support the proliferation and persistence of its microbial community. In this investigation, we have examined such a nutritional environment by determining the symbiotic competence of auxotrophic mutants of the bioluminescent bacterium Vibrio fischeri, and have demonstrated that the host squid Euprymna scolopes provides at least 9 aa to the growing culture of symbiotic V. fischeri present in its light-emitting organ. We also collected and analyzed the extracellular fluid from this organ, in which the symbionts reside, and confirmed that it contained significant amounts of amino acids. The combined results suggested that host-derived free amino acids, as well as peptides or proteins, are a source of the amino acids that support the growth of the symbionts. This work describes a technique to sample the symbionts and their surrounding environment without contamination by host tissue components and, in combination with molecular genetic studies, allows the characterization of the nutritional conditions that support a cooperative animal–bacterial symbiosis.     

Evaluation of the Paradoxical Sphincter Contraction by a Strain/Squeeze Index in Constipated Patients

PURPOSE One finding in patients with constipation is the paradoxical puborectalis contraction, i.e. , activation of the sphincter muscles during straining instead of relaxation. The aims of this study were to evaluate the importance of needle placement in sphincter-electromyography and to evaluate a strain/squeeze index in constipated patients and control subjects. METHODS We investigated consecutively 194 constipated patients and 16 control subjects with integrated electromyography during straining and squeezing and calculated a strain/squeeze index. The examination was performed in the puborectalis and in the external anal sphincter muscle through hook-electrodes. RESULTS There was a strong correlation between indices in the puborectalis muscle and in the external anal sphincter muscle (r = 0.70–0.80, P < 0.001). Forty-seven patients (24 percent) had a mean index of greater than 50 compared with none in the control group (P = 0.01). Mean overall index in patients was 24 (range, 0–306) vs. 18 (range, 0–45) in controls (P = 0.12). Patients with an index greater than 50 had impaired rectal evacuation (P < 0.001), increased threshold for urge (P < 0.05), and tended to have fewer stools (P = 0.06). CONCLUSION Quantification of paradoxical contraction in the puborectalis and external anal sphincter with a strain/squeeze index differentiates patients in whom paradoxical activity may be a cause of constipation. An index above 50 may be of pathologic significance. Correlations between activity in the puborectalis and external anal sphincter muscle were strong which suggests that investigation in one of them is sufficient. Reprints are not available.