Implementation of shared decision making by physician training to optimise hypertension treatment. Study protocol of a cluster-RCT

ABSTRACT: BACKGROUND: Hypertension is one of the key factors causing cardiovascular diseases which make up the most frequent cause of death in industrialised nations. However about 60% of hypertensive patients in Germany treated with antihypertensives do not reach the recommended target blood pressure. The involvement of patients in medical decision making fulfils not only an ethical imperative but, furthermore, has the potential of higher treatment success. One concept to enhance the active role of patients is shared decision making. Until now there exists little information on the effects of shared decision making trainings for general practitioners on patient participation and on lowering blood pressure in hypertensive patients. METHODS: In a cluster-randomised controlled trial 1800 patients receiving antihypertensives will be screened with 24 h ambulatory blood pressure monitoring in their general practitioners' practices. Only patients who have not reached their blood pressure target (approximately 1200) will remain in the study (T1 -- T3). General practitioners of the intervention group will take part in a shared decision making-training after baseline assessment (T0). General practitioners of the control group will treat their patients as usual. Primary endpoints are change of systolic blood pressure and change of patients' perceived participation. Secondary endpoints are changes of diastolic blood pressure, knowledge, medical adherence and cardiovascular risk. Data analysis will be performed with mixed effects models. DISCUSSION: The hypothesis underlying this study is that shared decision making, realised by a shared decision making training for general practitioners, activates patients, facilitates patients' empowerment and contributes to a better hypertension control. This study is the first one that tests this hypothesis with a (cluster-) randomised trial and a large sample size.Trial registrationWHO International Clinical Trials: http://apps.who.int/trialsearch/Trial.aspx?TrialID=DRKS00000125.     

Resistance to serine in Bacillus subtilis: identification of the serine transporter YbeC and of a metabolic network that links serine and threonine metabolism

The Gram-positive bacterium Bacillus subtilis uses serine not only as a building block for proteins but also as an important precursor in many anabolic reactions. Moreover, a lack of serine results in the initiation of biofilm formation. However, excess serine inhibits the growth of B. subtilis. To unravel the underlying mechanisms, we isolated suppressor mutants that can tolerate toxic serine concentrations by three targeted and non-targeted genome-wide screens. All screens as well as genetic complementation in Escherichia coli identified the so far uncharacterized permease YbeC as the major serine transporter of B. subtilis. In addition to YbeC, the threonine transporters BcaP and YbxG make minor contributions to serine uptake. A strain lacking these three transporters was able to tolerate 100 mM serine whereas the wild type strain was already inhibited by 1 mM of the amino acid. The screen for serine-resistant mutants also identified mutations that result in increased serine degradation and in increased expression of threonine biosynthetic enzymes suggesting that serine toxicity results from interference with threonine biosynthesis.     

On quantitative effects of RNA shape abstraction

Over the last few decades, much effort has been taken to develop approaches for identifying good predictions of RNA secondary structure. This is due to the fact that most computational prediction methods based on free energy minimization compute a number of suboptimal foldings and we have to identify the native folding among all these possible secondary structures. Using the abstract shapes approach as introduced by Giegerich et al. (Nucleic Acids Res 32(16):4843–4851, 2004), each class of similar secondary structures is represented by one shape and the native structures can be found among the top shape representatives. In this article, we derive some interesting results answering enumeration problems for abstract shapes and secondary structures of RNA. We compute precise asymptotics for the number of different shape representations of size n and for the number of different shapes showing up when abstracting from secondary structures of size n under a combinatorial point of view. A more realistic model taking primary structures into account remains an open challenge. We give some arguments why the present techniques cannot be applied in this case.     

Cold tolerance strategy and cold hardiness of the invasive zigzag elm sawfly Aproceros leucopoda (Hymenoptera: Argidae)

1. The invasive sawfly Aproceros leucopoda causes severe defoliation of various elm species and thus can be a major pest in forest stands and urban environments.
2. The overwintering biology of A. leucopoda has not been investigated so far; therefore, the aim of this study was to determine the cold tolerance strategy and cold hardiness of hibernating A. leucopoda eonymphs.
3. The supercooling points (SCPs) of overwintering individuals varied geographically, monthly and interannually and ranged between ?12.14 °C and ?24.22 °C.
4. As none of the eonymphs survived once the SCP had been reached, A. leucopoda is classified as a freeze‐avoidant species.
5. Survival rates of overwintering eonymphs exposed to different sub‐zero temperatures above the SCP (?1.6 °C and ?4.0 °C for 10, 20 and 30 days and ?10.5 °C for 9 days) ranged between 89.2% and 100%, suggesting that A. leucopoda is not a chill‐susceptible species.
6. Our results suggest that low winter temperatures may not be expected to be an important limiting factor for the overwintering success of A. leucopoda.