Is the involvement of opinion leaders in the implementation of research findings a feasible strategy?

Background

Although numerous therapies have been shown to be beneficial in the prevention of myocardial infarction and/or death in patients with coronary disease, these therapies are under-used and this gap contributes to sub-optimal patient outcomes. To increase the uptake of proven efficacious therapies in patients with coronary disease, we designed a multifaceted quality improvement intervention employing patient-specific reminders delivered at the point-of-care, with one-page treatment guidelines endorsed by local opinion leaders ("Local Opinion Leader Statement"). This trial is designed to evaluate the impact of these Local Opinion Leader Statements on the practices of primary care physicians caring for patients with coronary disease. In order to isolate the effects of the messenger (the local opinion leader) from the message, we will also test an identical quality improvement intervention that is not signed by a local opinion leader ("Unsigned Evidence Statement") in this trial.

Methods

Randomized trial testing three different interventions in patients with coronary disease: (1) usual care versus (2) Local Opinion Leader Statement versus (3) Unsigned Evidence Statement. Patients diagnosed with coronary artery disease after cardiac catheterization (but without acute coronary syndromes) will be randomly allocated to one of the three interventions by cluster randomization (at the level of their primary care physician), if they are not on optimal statin therapy at baseline. The primary outcome is the proportion of patients demonstrating improvement in their statin management in the first six months post-catheterization. Secondary outcomes include examinations of the use of ACE inhibitors, anti-platelet agents, beta-blockers, non-statin lipid lowering drugs, and provision of smoking cessation advice in the first six months post-catheterization in the three treatment arms. Although randomization will be clustered at the level of the primary care physician, the design effect is anticipated to be negligible and the unit of analysis will be the patient.

Discussion

If either the Local Opinion Leader Statement or the Unsigned Evidence Statement improves secondary prevention in patients with coronary disease, they can be easily modified and applied in other communities and for other target conditions.     

Clinical implementation of guidelines for cardioverter defibrillator implantation: lost in translation?

Purpose: Guidelines for implantation of cardioverter defibrillators (ICD) are increasingly including indications for primary prevention of sudden cardiac death in high-risk groups, where ICDs were traditionally implanted for secondary prevention. We performed a single-centre audit to evaluate adherence to the recent Dutch guidelines. Methods: All 1886 patients visiting a large regional Dutch teaching hospital (attending 1.8 to 2.0% of the Dutch population) in November 2005 were screened using the recently updated Dutch guidelines. Patients fulfilling these criteria were categorised as having an ICD indication for primary or secondary prevention. Results: 135 patients had an indication for ICD, 19 of whom had one or received one. Of the remaining 116 patients, 14 were ‘new’ to the department of cardiology. The 102 ‘known’ patients had 466 doctor-patient contacts in the previous year, which averages 4.57 cardiology contacts per patient per year. Patients were more likely to receive an ICD for the secondary prevention of SCD (10/11, 91%) than for primary prevention (9/124, 7%). Conclusion: In a large regional teaching hospital in the Netherlands, only a small proportion of patients eligible for ICD implantation actually receive one. Cardiologists tend to implant ICDs for secondary prevention of SCD. The low ICD implantation rate for primary prevention of SCD may relate to logistics (e.g. permission to implant ICDs, the presence of an electrophysiology lab) or the perceived low cost-benefit ratio. Our results indicate that once the substantial backlog (13,500 ICDs) has been addressed, the annual implantation of new ICDs should rise from the current 125 to at least 510 per million inhabitants per year in the Netherlands. (Neth Heart J 2007;15:129-32.)     

Urinary proteomic biomarkers in oncology: ready for implementation?

Introduction: Biomarkers are expected to improve the management of cancer patients by enabling early detection and prediction of therapeutic response. Proteins reflect a molecular phenotype, have high potential as biomarkers, and also are key targets for intervention. Given the ease of collection and proximity to certain tumors, the urinary proteome is a rich source of biomarkers and several proteins have been already implemented.

Areas covered: We examined the literature on urine proteins and proteome analysis in oncology from reports published during the last 5 years to generate an overview on the status of urine protein and peptide biomarkers, with emphasis on their actual clinical value.

Expert commentary: A few studies report on biomarkers that are ready to be implemented in patient management, among others in bladder cancer and cholangiocarcinoma. These reports are based on multi-marker approaches. A high number of biomarkers, though, has been described in studies with low statistical power. In fact, several of them have been consistently reported across different studies. The latter should be the focus of attention and be tested in properly designed confirmatory and ultimately, prospective investigations. It is expected that multi-marker classifiers for a specific context-of-use, will be the preferred path toward clinical implementation.     

Phage display: a useful tool for malaria research?

Defining the molecular intricacies of malaria pathogenesis is a vital area of medical and scientific research. Sophisticated methods have been developed to identify and characterise host-parasite interactions that are important in infection. Phage display involves the combinatorial display of proteins or peptides on the surface of bacteriophage. The technology provides an invaluable tool for screening diverse libraries for polypeptides that have a high affinity for a given target. Phage display in malaria research has proven successful, not only in mapping the protein-protein interactions that are important in Plasmodium biology, but also in the identification of molecules that might be exploited in the design of therapeutic agents or vaccines.     

Spotlight surveys for white-tailed deer: Monitoring panacea or exercise in futility?

Many monitoring programs for white-tailed deer (Odocoileus virginianus) on both private and public lands across the United States have long relied on the use of road-based spotlight surveys for monitoring population size and trends. Research has suggested spotlight surveys are ineffective and that road-based surveys for deer are biased because of highly variable detection rates. To evaluate variability in detection rates relative to the assumption that repeated surveys along roads will provide reliable trend data for use in calculating deer density estimates, we collected 5 years of thermal-imager and spotlight survey data using a multiple-observer, closed-capture approach. Using a Huggin's closed capture model, data bootstrapping, and variance components analyses, our results suggest that density estimates for white-tailed deer generated from data collected during road-based spotlight surveys are likely not reflective of the standing deer population. Detection probabilities during individual spotlight surveys ranged from 0.00 to 0.80 (median = 0.45) across all surveys, and differed by observer, survey, management unit, and survey transect replicate. Mean spotlight detection probability (0.41) and process standard deviation (0.12) estimates indicated considerable variability across surveys, observers, transects, and years, which precludes the generation of a correction factor or use of spotlight data to evaluate long-term trends at any scale. Although recommended by many state, federal, and non-governmental agencies, our results suggest that the benefit of spotlight survey data for monitoring deer populations is limited and likely represents a waste of resources with no appreciable management information gained. © 2012 The Wildlife Society.     

Compassion for animals in the laboratory: impairment or refinement of research methodology?

There are now signs in the United States as well as in Europe that the importance of a positive human-nonhuman animal relationship in research laboratories is appreciated more seriously. In addition to knowledge and skills, primary attributes of animal research personnel must be feelings of compassion and sensitivity toward animals to safeguard the reliability of scientific research data.     

Microtubule-bundling studies revisited: is there a role for MAPs?

The molecular mechanism of microtubule bundling has been enveloped in controversy for the past few years. At the centre of the debate are MAPs: are they necessary for the formation of microtubule bundles? In this article, Gloria Lee and Roland Brandt weigh the evidence and propose that microtubule stability might be the crucial factor in microtubule bundling. Perhaps then MAPs might act as spacer molecules between microtubules.     

Variability in APOE genotype status in human-derived cell lines: a cause for concern in cell culture studies?

Although cell culture studies have provided landmark discoveries in the basic and applied life sciences, it is often under-appreciated that cells grown in culture are prone to generating artifacts. Here, we introduce the genotype status (exemplified by apolipoprotein E) of human-derived cells as a further important parameter that requires attention in cell culture experiments. Epidemiological and clinical studies indicate that variations from the main apolipoprotein E3/E3 genotype might alter the risk of developing chronic diseases, especially neurodegeneration, cardiovascular disease, and cancer. Whereas the apolipoprotein E allele distribution in human populations is well characterized, the apolipoprotein E genotype of human-derived cell lines is only rarely considered in interpreting cell culture data. However, we find that primary and immortalized human cell lines show substantial variation in their apolipoprotein E genotype status. We argue that the apolipoprotein E genotype status and corresponding gene expression level of human-derived cell lines should be considered to better avoid (or at least account for) inconsistencies in cell culture studies when different cell lines of the same tissue or organ are used and before extrapolating cell culture data to human physiology in health and disease.     

Consequences of protecting flowers in a fig: a one-way trip for pollinators?

Abstract. Fig trees ( Ficus ) have closed inflorescences. Closure is an efficient protection of flowers against non-specialist predators and harsh external environmental conditions. Each Ficus species is pollinated by a single insect species, an agaonid wasp, capable of forcing its way through a bract-covered pore, the ostiole, to gain access to the flowers. Figs also provide oviposition sites for the wasps. The fig/pollinator interaction is a classic example of mutualism. It has been widely assumed that, once pollinators have entered a fig, oviposited and pollinated, they die trapped within the fig. In this paper, we present observations under natural conditions and results of field experiments on three very different fig species ( Ficus aurea Nutt., F. carica L. and F. microcarpa L.) showing that some pollinators do exit or try to exit from the fig after pollination and oviposition. Moreover, experimental results demonstrate that in at least one species ( F. carica ), the pollinator is able to oviposit successively in two different figs.
The frequency of re-emergences from figs after pollination varies among species and this may be related to variations in pollination dynamics depending on environmental constraints such as the abundance of trees and tree phenology. Several factors that may favour pollinators that leave figs after pollination and oviposition are discussed. They include competition between pollinators for oviposition sites, and minimising of the risk of vertical transmission of parasites and pathogens.     

The role of ecotourism in conservation: panacea or Pandora’s box?

Does ecotourism contribute towards conservation of threatened species and habitats or is it just a marketing ploy of the tourism industry? Using 251 case studies on ecotourism from the literature, I looked at the distribution of case studies over continents, habitats and flagship species types and what factors influenced whether an ecotourism regime was perceived as ecologically sustainable by authors. Over 50% of ecotourism case studies were reported from Africa and Central America. The overall distribution of ecotourism case studies did not reflect vertebrate endemism, nor overall tourism distribution in terms of tourist numbers and receipts. There were significant differences between continents and habitats with regard to the proportion of sustainable case studies: ecotourism is perceived to be less sustainable in South America and Asia, and in island and mountain habitats. The type of flagship species also influenced whether ecotourism was classified as sustainable or not: ecotourism with no flagship species was rarely classified as sustainable while charismatic bird and mammal species were associated with a higher probability of sustainability. In a multivariate analysis, flagship species type and local community involvement were important predictors of sustainability in ecotourism. Detailed a priori planning, local involvement and control measures were perceived by authors of case studies to increase the success of ecotourism in conservation. They also perceived that ecotourism can only be an effective conservation tool under certain conditions. If these are met, the evidence indicates that ecotourism can make a contribution to conservation.     

Graduate students in conservation biology: Bridging the research–implementation gap

There is a growing consensus that a gap exists between research conducted at academic institutions and information available to practitioners that implement research into conservation policy and practice. Here, I review common recommendations for bridging the Research–Implementation Gap in conservation biology, highlight the unique abilities of graduate students to contribute solutions to this problem, and propose ways research institutions and professionals can encourage graduate students to participate in this process. While some appropriately point out that the main purpose of graduate school is to focus on research, I argue that being exposed early to the broader issues of research and implementation enhances the graduate research experience, helps train students to become leaders in conservation science, and contributes both immediate and long-term solutions to the research–implementation problem.