Primary care management for optimized antithrombotic treatment [PICANT]: study protocol for a cluster-randomized controlled trial

ABSTRACT: BACKGROUND: Antithrombotic treatment is a continuous therapy that is often performed in general practice and requires careful safety management. The aim of this study is to investigate whether a best practice model that applies major elements of case management, including patient education, can improve antithrombotic management in primary health care in terms of reducing major thromboembolic and bleeding events. METHODS: This 24-month cluster-randomized trial will be performed in 690 adult patients from 46 practices. The trial intervention will be a complex intervention involving general practitioners, health care assistants and patients with an indication for oral anticoagulation. To assess adherence to medication and symptoms in patients, as well as to detect complications early, health care assistants will be trained in case management and will use the Coagulation-Monitoring-List (Co-MoL) to regularly monitor patients. Patients will receive information (leaflets and a video), treatment monitoring via the Co-MoL and be motivated to perform self-management. Patients in the control group will continue to receive treatment-as-usual from their general practitioners. The primary endpoint is the combined endpoint of all thromboembolic events requiring hospitalization, and all major bleeding complications. Secondary endpoints are mortality, hospitalization, strokes, major bleeding and thromboembolic complications, severe treatment interactions, the number of adverse events, quality of anticoagulation, health-related quality of life and costs. Further secondary objectives will be investigated to explain the mechanism by which the intervention is effective: patients' assessment of chronic illness care, self-reported adherence to medication, general practitioners' and health care assistants' knowledge, patients' knowledge and satisfaction with shared decision making. Practice recruitment is expected to take place between July and December 2012. Recruitment of eligible patients will start in July 2012. Assessment will occur at three time points: baseline (T0), follow-up after 12 (T1) and after 24 months (T2). DISCUSSION: The efficacy and effectiveness of individual elements of the intervention, such as antithrombotic interventions, self-management concepts in orally anticoagulated patients and the methodological tool, case-management, have already been extensively demonstrated. This project foresees the combination of several proven instruments, as a result of which we expect to profit from a reduction in the major complications associated with antithrombotic treatment.     

Microconstriction Arrays for High-Throughput Quantitative Measurements of Cell Mechanical Properties

We describe a method for quantifying the mechanical properties of cells in suspension with a microfluidic device consisting of a parallel array of micron-sized constrictions. Using a high-speed charge-coupled device camera, we measure the flow speed, cell deformation, and entry time into the constrictions of several hundred cells per minute during their passage through the device. From the flow speed and the occupation state of the microconstriction array with cells, the driving pressure across each constriction is continuously computed. Cell entry times into microconstrictions decrease with increased driving pressure and decreased cell size according to a power law. From this power-law relationship, the cell elasticity and fluidity can be estimated. When cells are treated with drugs that depolymerize or stabilize the cytoskeleton or the nucleus, elasticity and fluidity data from all treatments collapse onto a master curve. Power-law rheology and collapse onto a master curve are predicted by the theory of soft glassy materials and have been previously shown to describe the mechanical behavior of cells adhering to a substrate. Our finding that this theory also applies to cells in suspension provides the foundation for a quantitative high-throughput measurement of cell mechanical properties with microfluidic devices.     

Sexual maturation in female gray short-tailed opossums, Monodelphis domestica, is dependent upon male stimuli.

The development of physiological responsiveness to male stimuli in peripubertal female gray short-tailed opossums was examined in this study. Prepubertal females were exposed directly or indirectly to male chemicals (odors) or to no male stimuli. All females exposed directly to deposited male stimuli (22/22) showed estrus at a mean (+/- SEM) age of 127 +/- 2 days. Only 59% (13/22) of females exposed indirectly showed estrus, and at an older mean age of 162 +/- 5 days (p less than 0.01). Vaginal estrus was not observed in any of the females isolated from male stimuli (0/11). Direct exposure of prepubertal females to male odors was associated with higher uterine weights compared to those of indirectly exposed and isolated females. Reproductive success, measured as litter production, of peripubertal females greater than 140 days old was comparable to adult reproductive success. This study has shown that reproductive maturation in pubertal female opossums requires male stimuli, that this stimulus appears to be pheromonal, and that direct exposure to deposited male odors is the most effective stimulus for female reproductive maturation.     

Uses,nutritional composition,and ecogeography of four species ofPsophocarpus (fabaceae,phaseoleae) in Zaire

In Zaire the distribution of four of the wild species in the genusPsophocarpus ranges from humid, evergreen, Guinea-Congolian rainforests to high altitude woodlands, dry semi-deciduous forests, and savanna. Material ofPsophocarpus scandens, P. grandiflorus, P. lancifolius, P. lecomtei, andP. lancifolius (yellow-seeded form) were collected from wild and naturalized populations in Zaire. Various organs ofP. scandens, P. grandiflorus, andP. lancifolius are used as food sources, medicinals, and as sources of tannins.Psophocarpus lancifolius andP. lecomtei have reportedly been used as a food source and fish poison, respectively. The various organs were analyzed for carbohydrate, lipid, N, S, P, K, Mg, Ca, Na, Fe, Al, Mn, B, Cu, and Zn. In their own right, these species have potential for wider use as food sources and genetic material for improvement breeding with the cultivated winged bean, Local names, phenological notes, presence of pests and diseases, and ecogeographical information are presented.