Disseminated coxsackievirus B fulminant myocarditis in an immunocompetent adult: A case report: Case of disseminated coxsackievirus myocarditis

Coxsackieviral myocarditis is associated with systemic involvement in neonates; however, fulminant coxsackieviral myocarditis is rare in adults, and its dissemination with fatal myocarditis involving kidneys, liver, and adrenal is further rarely reported. We report a case of fulminant myocarditis along with dissemination of coxsackievirus, which was clinically unrecognized.     

Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial

The prevention of child maltreatment necessitates a public health approach. In the U.S. Triple P System Population Trial, 18 counties were randomly assigned to either dissemination of the Triple P—Positive Parenting Program system or to the services-as-usual control condition. Dissemination involved Triple P professional training for the existing workforce (over 600 service providers), as well as universal media and communication strategies. Large effect sizes were found for three independently derived population indicators: substantiated child maltreatment, child out-of-home placements, and child maltreatment injuries. This study is the first to randomize geographical areas and show preventive impact on child maltreatment at a population level using evidence-based parenting interventions.     

Diffuse intrahepatic recurrence after percutaneous radiofrequency ablation for solitary and small hepatocellular carcinoma

Two patients developed segmental, diffuse intrahepatic recurrence after percutaneous radiofrequency ablation (RFA) to treat a primary, solitary, and small (2.5 cm) hepatocellular carcinoma (HCC). Despite the size of the HCC, levels of the tumor markers (α-fetoprotein, α-fetoprotein-L3%, and des-γ-carboxyprothrombin) were all elevated before RFA, and tumors in both patients were contiguous with a major branch of the portal vein. Tumor biopsies of both patients revealed moderately differentiated HCC but diagnostic imaging showed an area of reduced tumor blood flow, suggesting a poorly differentiated component. Since early detection of post-RFA malignancies by standard ultrasonography and contrast-enhanced computed tomography was difficult, the most sensitive indicator of recurrence in these two patients was the elevated tumor markers. The diffuse intrahepatic recurrence was thought to be caused by increased intratumoral pressure during RFA, resulting in the dissemination of cancer cells through the contiguous portal vein. The clinical course of these tumors indicate that the choice of RFA should be carefully considered when treating specific subtype of HCC that is adjacent to main portal vein branch and involves a possible poorly differentiated component and that surgical resection or combinations of RFA with other treatment modalities such as transcatheter arterial chemoembolization should be considered as alternative treatment strategies.     

Disseminating contingency management to increase attendance in two community substance abuse treatment centers: Lessons learned

Although contingency management (CM) has been shown to be effective in substance use treatments, community adoption has been slow. To increase dissemination of CM into community practice, two community treatment programs collaborated with university faculty investigators to design, implement, and evaluate low-cost, prize-based CM interventions delivered by treatment staff using Petry's (2000) fishbowl technique. A pre–post study design was used to evaluate the impact of CM on outpatient group attendance. All clients attending the targeted outpatient groups at both treatment programs were eligible to participate. Group attendance was significantly positively impacted after intervention implementation. This is one of the first studies demonstrating successful implementation of CM by community treatment program counselors within their existing treatment groups. The discussion focuses on practical lessons learned during the planning and implementation of the interventions.     

Unintended effects of training on clinicians’ interest,confidence, and commitment in using motivational interviewing

Background

Improving clinicians’ interest, confidence, and commitment in using evidence-based treatment (EBT) is often an aim of training clinicians in EBT. However, the degree to which these areas actually improve through training and what their relationship is to treatment integrity is unknown.

Method

Using data from a multi-site study (Martino et al., 2010) comparing three methods of clinician training in motivational interviewing (MI), changes in interest, confidence, and commitment over time and their relationship to MI adherence and competence were assessed using mixed-effects regression models. Individual patterns of change were examined through cluster analysis.

Results

Interest, confidence, and commitment declined over time across training conditions with two distinct patterns: 76% clinicians largely maintained strong interest in MI over time with only slight decreases in confidence and commitment (the “maintainers”), while 24% began with lower initial interest, confidence, and commitment, which subsequently declined over time (the “decliners”). Interest and commitment were not associated with MI adherence and competence; confidence was associated with increased competence in the use of advanced MI strategies. However, decliners demonstrated greater use of MI-inconsistent techniques than maintainers overall (d = 0.28).

Conclusions

Training in MI may have an unintended consequence of diminishing clinicians’ interest, confidence, or commitment in using MI in practice. While attitudinal variables in this study show mixed relationships to MI integrity, they may have some utility in identifying less enthusiastic participants, better preparing them for training, or tailoring training approaches to meet individual training needs.     

促进科学与伦理的良性互动——国家人类基因组南方研究中心伦理学部工作体会

介绍了国家人类基因组南方研究中心伦理学部自成立以来开展的主要工作：开展生命伦理前沿研究,为主管部门制订政策和规范提供参考;普及生命伦理知识和理念;参与伦理评审,推进伦理委员会建设;开展国内外学术交流。并表达了工作体会,科学家与伦理学家需要携手合作,共同促进科学技术与伦理道德的良性互动。在伦理审查和监督中,尽可能地把科学与伦理统一起来,确保研究的科学性。     

Retrospective cohort study highlighted outcome reporting bias in UK publicly funded trials

Objective

To assess outcome reporting bias and dissemination bias in trials funded by the National Health System (NHS) Health Technology Assessment (HTA) program.

Study Design and Setting

A retrospective cohort study of HTA monographs and corresponding journal publications including all clinical effectiveness randomized controlled trials published as HTA monographs between 1999 and 2005 by the NHS HTA program.

Results

There was a higher median P-value (P = 0.33, interquartile range [IQR]: 0.02-0.54) among trials without a journal publication compared with those with a journal publication (P = 0.14, IQR: 0.007-0.43), although the difference was not statistically significant (Mann-Whitney U test, z = −0.70; P = 0.48). A higher proportion of statistically significant findings were reported in journal articles when compared with the outcomes reported in the HTA monographs. Trials published in general medical journals tended to have smaller P-values (median: 0.05, IQR: 0.001-0.22) than those published in more specialist journals (median: 0.33 IQR: 0.008-0.58), although this result was not significant (Mann-Whitney U test, z = −1.63; P = 0.10).

Conclusions

Among journal-published trials, there were a greater proportion of statistically significant findings included in the journal reports compared with those in the HTA monographs.