Practice facilitation for improving cardiovascular care: secondary evaluation of a stepped wedge cluster randomized controlled trial using population-based administrative data

BackgroundPractice facilitation (PF), a multifaceted approach in which facilitators (external health care professionals) help family physicians to improve their adoption of best practices, has been highly successful. Improved Delivery of Cardiovascular Care (IDOCC) was an innovative PF trial designed to improve evidence-based care for people who have, or are at risk of, cardiovascular disease (CVD). The intervention was found to be ineffective as assessed by a patient-level composite score based on chart reviews from a subsample of patients (N = 5292). Here, we used population-based administrative data to examine IDOCC’s effect on CVD-related hospitalizations.MethodsIDOCC used a pragmatic, stepped wedge cluster randomized controlled design involving primary care providers recruited across Eastern Ontario, Canada. IDOCC’s effect on CVD-related hospitalizations was assessed in the 2 years of active intervention and post-intervention years. Marginal and mixed-effects regression analyses were used to account for the study design and to control for patient, physician, and practice characteristics. Secondary and subgroup analyses investigated robustness.ResultsOur sample included 262,996 patient/year observations representing 54,085 unique patients who had, or were at risk of, CVD, from 70 practices. There was a strong decreasing secular trend in CVD-related hospitalizations but no statistically significant effect of IDOCC. Relative to patients in the control condition, patients in the intervention condition were estimated to have 4 % lower odds of CVD-related hospitalizations (adjOR = 0.96, 99 % CI 0.83 to 1.11). The nonsignificant result persisted across robustness analyses.ConclusionsClinical outcomes from administrative databases were examined to form a more complete picture of the (in)effectiveness of a large-scale quality improvement intervention. IDOCC did not have a significant effect on CVD hospitalizations, suggesting that the results from the primary composite adherence score analysis were neither due to choice of outcome nor relatively short follow-up period.

Trial registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00574808","term_id":"NCT00574808"}}NCT00574808, registered on 14 December 2007.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1547-2) contains supplementary material, which is available to authorized users.     

Serum and supplement optimization for EU GMP‐compliance in cardiospheres cell culture

Cardiac progenitor cells (CPCs) isolated as cardiospheres (CSs) and CS-derived cells (CDCs) are a promising tool for cardiac cell therapy in heart failure patients, having CDCs already been used in a phase I/II clinical trial. Culture standardization according to Good Manufacturing Practices (GMPs) is a mandatory step for clinical translation. One of the main issues raised is the use of xenogenic additives (e.g. FBS, foetal bovine serum) in cell culture media, which carries the risk of contamination with infectious viral/prion agents, and the possible induction of immunizing effects in the final recipient. In this study, B27 supplement and sera requirements to comply with European GMPs were investigated in CSs and CDCs cultures, in terms of process yield/efficiency and final cell product gene expression levels, as well as phenotype. B27− free CS cultures produced a significantly reduced yield and a 10-fold drop in c-kit expression levels versus B27+ media. Moreover, autologous human serum (aHS) and two different commercially available GMP AB HSs were compared with standard research-grade FBS. CPCs from all HSs explants had reduced growth rate, assumed a senescent-like morphology with time in culture, and/or displayed a significant shift towards the endothelial phenotype. Among three different GMP gamma-irradiated FBSs (giFBSs) tested, two provided unsatisfactory cell yields, while one performed optimally, in terms of CPCs yield/phenotype. In conclusion, the use of HSs for the isolation and expansion of CSs/CDCs has to be excluded because of altered proliferation and/or commitment, while media supplemented with B27 and the selected giFBS allows successful EU GMP-complying CPCs culture.     

Estimating Water Quality Guidelines for Environmental Contaminants Using Multimodal Species Sensitivity Distributions: A Case Study with Atrazine

Species sensitivity distributions (SSDs) are used globally to generate water quality guidelines (WQGs). In Canada, a suite of models has been endorsed for describing SSDs. However, these models may not be suitable for substances with multiple modes of toxic action such as pesticides. Pesticides can produce multimodal SSDs where sensitive target organisms comprise one mode of the SSD and non-target organisms comprise the remaining mode(s). Guidelines from this type of SSD might be estimated using only the most sensitive taxa or using a multimodal distribution. The multimodal method presented here uses all data meeting data quality criteria and is thus in keeping with the concept that data comprising an SSD are a random sample from the population of interest rather than a subset thereof. The bimodal method can simultaneously emphasize the more sensitive portion of the dataset by allowing estimation of WQGs using a statistical subset of the data. In the case of the atrazine dataset example, this allowed estimating a WQG emphasizing more sensitive taxa whereas no parametric models fit only the more sensitive data and the small sample size (5) precluded the use of nonparametric methods.     

A strategic approach for the design and operation of two‐phase partitioning bioscrubbers for the treatment of volatile organic compounds

A strategic approach for the design of two‐phase partitioning bioscrubbers (TPPBs) has been formulated using, as a basis, a re‐evaluation of extensive literature data available for the degradation of benzene by Achromobacter xylosoxidans Y234 in TPPBs with n‐hexadecane as the partitioning phase. Using a previously determined maintenance coefficient for benzene, we determined that an inlet benzene loading rate of 100 mg/h requires 5,928 mg cell mass at biological steady state and 243.0 mg O₂/h. The total oxygen‐transfer rates (TOTRs) into the TPPB increased by 83.5% with 33.3% of organic phase compared with a single aqueous phase and were significantly influenced by gas flow rate, whereas agitation has a minor affect. The fraction of organic phase used was suggested to be the primary parameter with which the TOTR into the TPPB may be altered. Although the presence of an organic solvent in the TPPB remarkably increased the TOTR, the total benzene transfer rate into the TPPB remained largely insensitive due to the intrinsic low Henry's law constant (or relatively high solubility) of benzene in water. Finally, we have integrated the elements of this analysis into a set of heuristic criteria that can serve as a guideline for the design of TPPB systems for future volatile organic compound treatment applications. © 2010 American Institute of Chemical Engineers Biotechnol. Prog., 2010     

Microbiological condition and shelf life of meat from hunted game birds

Hunted game birds (eight partridges, nine wood pigeons, 25 quails, 16 chilled and 16 frozen–thawed pheasants) were processed according to “Good Manufacturing Practice” rules. Microflora of skin, intestinal content and meat cuts (breast and thigh, both fresh and stored in vacuum package) was analysed. Listeria monocytogenes, Salmonella sp. and Campylobacter sp. were not recovered from any sample. Log microbial numbers on skin or in intestines were not significantly related to those on meat cuts. With the exception of pigeons, microbial numbers of the two meat cuts did not differ significantly (p > 0.05), and no significant increase in microbial numbers in vacuum-stored meat was found; the same applied to frozen–thawed compared to chilled pheasants. On meat, average total viable counts were <4.00 log cfu/cm² with a maximum of 6.48 log cfu/cm². Median Escherichia coli numbers were <2.00 log cfu/cm², maximum was 4.48 log cfu/cm². Meat cuts obtained from partridges, quails and pheasants demonstrated a shelf life of 1 week, provided they were kept vacuum-packaged at 0°C to 1°C.     

检验医学专业临床实习管理存在的问题及对策

临床实习是医学理论和临床实践工作有机结合的连接点,是医学生走向临床工作必不可少的重要环节。临床实习教学是医学生教育中一个重要的组成部分,是从课堂到临床、从理论到实践、从理性到感性的重要过程,也是巩固基础知识、理论联系实际、走向独立工作岗位的重要一步。在临床实践过程中,教职人员要培养学生获取、分析和处理疾病信息的能力,正确书写病历、熟练掌握诊疗技术以及与患者及家属和谐沟通的能力。医学检验学是运用现代物理化学方法、手段进行医学诊断的一门学科,通俗的说,就是利用仪器、试剂、CT扫描等检测人的各项指标是否正常,为临床诊断提供依据。因此,加强临床检验医学专业的实习管理工作至关重要。本文从建立合理的教学管理体系、加强临床实习考核制度、完善实习管理、加强教师队伍建设等几个方面,探讨临床检验学实习管理存在的问题,并提出相应的对策,为高等医学院校教学管理工作提供思路。     

Straits in the Russian Arctic

The issues surrounding the regimes of international straits, noninternational straits, and ice-covered areas are analyzed for the purpose of looking at Russian practices in its Arctic straits. It is concluded that the Russian practice exceeds that permitted to states bordering straits under the traditional regime for straits. Nevertheless, viewing the U.S. practice as a coastal state, as well as the coastal state practice of Canada, substantial similarities are found with the Russian practice. Conflicting claims and practices result in a confused Arctic legal regime. An international conference is recommended to discuss and perhaps settle the issues.     

提高医院传染病管理的实践

目的：总结解放军第302医院在防控传染病方面所践采取的措施,提高医院传染病管理相关工作。方法：完善传染病管理组织,明确责任;认真落实传染病管理相关制度;加强相关知识培训,强化医护人员责任意识,提高能动性、自觉性。总结分析以上相关措施实施后,2005年-2010年期间传染病报告情况。结果：2005年-2010年每年传染病疫情报告卡填写完整率逐渐提高,医院传染病报告漏报率呈逐年下降趋势,近两年呈现填写完整无漏报的情况。结论：提高医院传染病管理的相关措施的实施,使医护人员对的传染病防控意识有所提高,做到早发现、早报告、早隔离、早治疗,降低传染病传播风险,有效减少了医院交叉感染的发生,保障人们的生命健康和社会的发展稳定。     

A Proposed Set of Ethical Practice Guidelines in the Assessment and Treatment of Pelvic Floor Disorders

The treatment of pelvic floor disorders using biofeedback, behavioral therapies, and other applied psychophysiological treatments has been well documented as effective. Practitioners must take due care to ensure that they practice within the boundaries of what is common practice for their discipline and within the scope of practice allowed by their professional license as outlined by the appropriate state licensing law(s), the ethical principles and practice guidelines and standards for their discipline, and those of the Association of Applied Psychophysiology and Biofeedback if using a biofeedback assessment or treatment. Being competent to provide a particular treatment does not necessarily make it legal and/or ethical. This paper provides a set of recommended practice guidelines for use in the assessment and treatment of pelvic floor disorders. Please note that they have not at this time been endorsed as an official position of the Association of Applied Psychophysiology and Biofeedback or any other professional organization.     

Learning new gait patterns is enhanced by specificity of training rather than progression of task difficulty

The use of motor learning strategies may enhance rehabilitation outcomes of individuals with neurological injuries (e.g., stroke or cerebral palsy). A common strategy to facilitate learning of challenging tasks is to use sequential progression – i.e., initially reduce task difficulty and slowly increase task difficulty until the desired difficulty level is reached. However, the evidence related to the use of such sequential progressions to improve learning is mixed for functional skill learning tasks, especially considering situations where practice duration is limited. Here, we studied the benefits of sequential progression using a functional motor learning task that has been previously used in gait rehabilitation. Three groups of participants (N = 43) learned a novel motor task during treadmill walking using different learning strategies. Participants in the specific group (n = 21) practiced only the criterion task (i.e., matching a target template that was scaled-up by 30%) throughout the training. Participants in the sequential group (n = 11) gradually progressed to the criterion task (from 3% to 30% in increments of 3%), whereas participants in the random group (n = 11) started at 3% and progressed in random increments (involving both increases and decreases in task difficulty) to the criterion task. At the end of training, kinematic tracking performance on the criterion task was evaluated in all participants both with and without visual feedback. Results indicated that the tracking error was significantly lower in the specific group, and no differences were observed between the sequential and the random progression groups. The findings indicate that the amount of practice in the criterion task is more critical than the difficulty and variations of task practice when learning new gait patterns during treadmill walking.