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PubMed2005

The metabolic syndrome.

The metabolic syndrome is a multifaceted clinical entity resulting from the interaction of genetic, hormonal, and lifestyle factors. Over the past two decades, the number of people diagnosed with the syndrome has steadily increased and is associated with the global epidemic of obesity and diabetes. The metabolic syndrome is characterized by the clustering of disorders which includes high blood pressure, high (pro)insulin concentrations, excess body weight with central obesity, and an altered lipid profile (dyslipidaemia) that increase the likelihood to develop micro- and macrovascular complications, including coronary heart disease or stroke. Each of these disorders is by itself a risk factor for other diseases including diabetes mellitus. In combination, morbidity and mortality are dramatically increased. Because the defining thresholds for establishing the diagnosis of the metabolic syndrome are controversial, the NCEP: ATP III and the WHO have made specific suggestions. The current definitions of the metabolic syndrome can be used as predictors of vascular complications. Risk assessment and subsequent selection of probands for intervention, such as weight reduction and increased physical activity are recommended for the clinical management of the metabolic syndrome.

Albuminuria↗

PubMed2003

Rational Prescribing in Primary Care (RaPP-trial). A randomised trial of a tailored intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs in general practice [ISRCTN48751230].

BACKGROUND: The underlying reasons for differences between clinical practice and systematically developed guidelines vary from one clinical problem to another. It is therefore logical to tailor strategies to support the implementation of guidelines to address identified barriers to change. The objective of this trial is to evaluate the effects of a tailored intervention to support the implementation of systematically developed guidelines for the use of antihypertensive and cholesterol-lowering drugs for the primary prevention of cardiovascular disease. METHODS/DESIGN: Unblinded, cluster-randomised trial. 150 general practices will be recruited from two geographical areas in Norway, and randomised to the intervention or control group (passive dissemination of guidelines). Outcomes will be measured for all eligible patients seen in the participating practices during one year after the intervention. A multifaceted intervention has been tailored to address identified barriers to change. Key components are an educational outreach visit with audit and feedback, and computerised reminders. Pharmacists will conduct the visits. During the outreach visit the main recommendations will be presented and software will be installed that links to the electronic medical record systems used in the participating practices. The software will perform an audit that will be fed back during the visit, present pop-up reminders for patients with high blood pressure or cholesterol, and provide a cardiovascular risk calculator and patient education material. The main outcomes are the proportions of 1) first time prescriptions for hypertension where thiazides are not prescribed, 2) patients not assessed for cardiovascular risk before prescribing antihypertensive or cholesterol-lowering drugs, and 3) patients treated for hypertension or high cholesterol for three months or more who have not achieved recommended treatment goals.

Anticholesteremic Agents↗

PubMed2006

A cluster-randomized educational intervention to reduce inappropriate prescription patterns for elderly patients in general practice--The Prescription Peer Academic Detailing (Rx-PAD) study [NCT00281450].

BACKGROUND: Age-related alterations in metabolism and excretion of medications increase the risk of adverse drug events in the elderly. Inappropriate polypharmacy and prescription practice entails increased burdens of impaired quality of life and drug related morbidity and mortality. The main objective of this trial is to evaluate effects of a tailored educational intervention towards general practitioners (GPs) aimed at supporting the implementation of a safer drug prescribing practice for elderly patients > or = 70 years. METHODS/DESIGN: Approximately 80 peer continuing medical education (CME) groups (about 600 GPs) in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. The control group will not receive any intervention towards prescription patterns in elderly, but will be the target of an educational intervention for prescription of antibiotics for respiratory tract infections. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, a set of quality indicators (QIs), i.e. explicit recommendations for safer prescribing for elderly patients, will be presented and discussed. Software will be handed out for installation in participants' practice computers to enable extraction of pre-defined prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Feedback reports will include QI-scores on individual- and group levels, before and after the intervention. The main outcome of this trial is the change in proportions of inappropriate prescriptions (QIs) for elderly patients > or = 70 years following intervention, compared to baseline levels. DISCUSSION: Improvement of prescription patterns in medical practice is a challenging task. Evidence suggests that a thorough evaluation of diagnostic indications for drug treatment in the elderly and/or a reduction of potentially inappropriate drugs may impose significant clinical benefits. Our hypothesis is that an educational intervention program will be effective in improving prescribing patterns for elderly patients in GP settings.

Aged↗

PubMed1986

The appreciation of affect in alcoholic Korsakoff patients.

The purpose of this study is to assess the appreciation of affective components of words in patients with insult to diencephalic and subcortical brain structures thought to subserve emotional expression. Six alcoholic Korsakoff patients were presented with triadic comparisons composed of names of birds, predators, and birds of prey. The principal findings revealed that normal control subjects associate birds of prey with both birds and predators, but Korsakoff patients associate the birds of prey significantly more often with birds than predators. Three-dimensional spatial representations of patients' associations revealed that normals cluster birds at one extreme of a dimension and predators at the other extreme, with birds of prey lying in an intermediate position. Korsakoff patients also clearly separate the birds from the predators and form tight clusters within each of these groups, but they associate the birds of prey noticeably with the birds. Moreover, Korsakoff patients displayed, on another dimension of the spatial representation, their difficulty appreciating that a word could possess multiple category memberships. The findings are discussed with respect to the multifaceted dementia seen in Korsakoff Syndrome, and are interpreted to provide guarded support for the claim that insult to particular diencephalic and subcortical brain structures interferes with the appreciation of affective material in particular circumstances.

Adult↗

PubMed2006

Rational prescribing in primary care (RaPP): a cluster randomized trial of a tailored intervention.

BACKGROUND: A gap exists between evidence and practice regarding the management of cardiovascular risk factors. This gap could be narrowed if systematically developed clinical practice guidelines were effectively implemented in clinical practice. We evaluated the effects of a tailored intervention to support the implementation of systematically developed guidelines for the use of antihypertensive and cholesterol-lowering drugs for the primary prevention of cardiovascular disease. METHODS AND FINDINGS: We conducted a cluster-randomized trial comparing a tailored intervention to passive dissemination of guidelines in 146 general practices in two geographical areas in Norway. Each practice was randomized to either the tailored intervention (70 practices; 257 physicians) or control group (69 practices; 244 physicians). Patients started on medication for hypertension or hypercholesterolemia during the study period and all patients already on treatment that consulted their physician during the trial were included. A multifaceted intervention was tailored to address identified barriers to change. Key components were an educational outreach visit with audit and feedback, and computerized reminders linked to the medical record system. Pharmacists conducted the visits. Outcomes were measured for all eligible patients seen in the participating practices during 1 y before and after the intervention. The main outcomes were the proportions of (1) first-time prescriptions for hypertension where thiazides were prescribed, (2) patients assessed for cardiovascular risk before prescribing antihypertensive or cholesterol-lowering drugs, and (3) patients treated for hypertension or hypercholesterolemia for 3 mo or more who had achieved recommended treatment goals. The intervention led to an increase in adherence to guideline recommendations on choice of antihypertensive drug. Thiazides were prescribed to 17% of patients in the intervention group versus 11% in the control group (relative risk 1.94; 95% confidence interval 1.49-2.49, adjusted for baseline differences and clustering effect). Little or no differences were found for risk assessment prior to prescribing and for achievement of treatment goals. CONCLUSIONS: Our tailored intervention had a significant impact on prescribing of antihypertensive drugs, but was ineffective in improving the quality of other aspects of managing hypertension and hypercholesterolemia in primary care.

Anticholesteremic Agents↗

PubMed2002

Differential regulation of functional gene clusters in overt coronary artery disease in a transgenic atherosclerosis-hypertensive rat model.

BACKGROUND: Human acute coronary syndrome refers to the spectrum of clinical manifestations of overt coronary artery (CAD) disease characterized by atherosclerotic plaque destabilization and resultant myocardial injury. Typically studied as distinct pathologies, emerging pathogenic paradigms implicate multiple processes beyond thrombosis and ischemic cell injury respectively, with significant pathway overlap involving inflammation, apoptosis, matrix degradation, and oxidative stress. However, all these pathways have also been implicated in still-quiescent coronary plaque progression, thus making it harder to pinpoint the turnkey events leading to overt-CAD. Analysis of transcription profiles could identify a working framework of pathogenesis distinguishing overt-CAD. MATERIALS AND METHODS: We investigated the transcription profile associated with overt-coronary artery disease (CAD), in contrast to quiescent-CAD and attenuated, quiescent-CAD using the Tg 53 transgenic atherosclerosis-hypertensive rat model, which exhibits end-stage coronary heart disease simulating human acute coronary syndromes. Using a rat-specific known-gene oligonucleotide array, twice corroborated transcription profiles from four individual Tg 53 rats exhibiting overt-CAD were analyzed and contrasted to transcription profiles of age-matched Tg 53 rats with quiescent-CAD (pooled n = 4) and attenuated, quiescent-CAD (pooled n = 4). RESULTS: Tg 53 male rats with overt-CAD exhibited distinct transcription profiles compared with both quiescent-CAD control groups. Functional gene cluster analysis detects upregulation of genes involved in inflammation (interleukin-1, interleukin-18, Fc gamma II receptor, thyrotropin releasing hormone), matrix balance (membrane type metalloproteinase, TIMP-1, lysyl oxidase), oxidized LDL entry (endothelial oxLDL receptor), which contrast deinduced gene clusters involved in angiogenesis, proliferation, metabolism, ion transport and adrenergic receptors. CONCLUSION: The data demonstrate that transcriptionally mediated events distinguish the onset of overt-CAD and identify a first list of putative "turnkey" genes. This altered molecular framework implies an altered "hardwiring" which a priori would require multifaceted, targeted intervention- currently not implemented to date. Although more studies are necessary, early concordance with current pathogenic paradigms of human coronary plaque destabilization and post-ischemic myocardial response provides translational significance to observations and hypotheses.

Animals↗

PubMedDate not supplied

Nursing research in HIV/AIDS home care, Part 2: Results and implications.

This study categorized the problems of clients with human immunodeficiency syndrome/acquired immune deficiency syndrome (HIV/AIDS), identified on admission to home care, into nursing diagnoses. The study followed a descriptive retrospective record review of adult men and women (n = 244) admitted to a certified home health care agency in New York City. When all problems were clustered into nursing diagnoses, the principle diagnosis in more than 70% of the sample were impaired home maintenance, high risk for ineffective individual coping, altered nutrition:less than body requirements, feeding self-care deficit, and fatigue. The results indicate that the home healthcare needs of persons with HIV/AIDS are multifaceted in nature and extend beyond the signs and symptoms of advancing disease. Nursing diagnoses serve as a basis for capturing all data that contribute to client problems and are the focus of planning nursing care in the home.

Adult↗

PubMed2005

A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home.

OBJECTIVE: Good hand hygiene may reduce the spread of infections in families with children who are in out-of-home child care. Alcohol-based hand sanitizers rapidly kill viruses that are commonly associated with respiratory and gastrointestinal (GI) infections. The objective of this study was to determine whether a multifactorial campaign centered on increasing alcohol-based hand sanitizer use and hand-hygiene education reduces illness transmission in the home. METHODS: A cluster randomized, controlled trial was conducted of homes of 292 families with children who were enrolled in out-of-home child care in 26 child care centers. Eligible families had > or =1 child who was 6 months to 5 years of age and in child care for > or =10 hours/week. Intervention families received a supply of hand sanitizer and biweekly hand-hygiene educational materials for 5 months; control families received only materials promoting good nutrition. Primary caregivers were phoned biweekly and reported respiratory and GI illnesses in family members. Respiratory and GI-illness-transmission rates (measured as secondary illnesses per susceptible person-month) were compared between groups, adjusting for demographic variables, hand-hygiene practices, and previous experience using hand sanitizers. RESULTS: Baseline demographics were similar in the 2 groups. A total of 1802 respiratory illnesses occurred during the study; 443 (25%) were secondary illnesses. A total of 252 GI illnesses occurred during the study; 28 (11%) were secondary illnesses. The secondary GI-illness rate was significantly lower in intervention families compared with control families (incidence rate ratio [IRR]: 0.41; 95% confidence interval [CI]: 0.19-0.90). The overall rate of secondary respiratory illness was not significantly different between groups (IRR: 0.97; 95% CI: 0.72-1.30). However, families with higher sanitizer usage had a marginally lower secondary respiratory illness rate than those with less usage (IRR: 0.81; 95% CI: 0.65-1.09). CONCLUSIONS: A multifactorial intervention emphasizing alcohol-based hand sanitizer use in the home reduced transmission of GI illnesses within families with children in child care. Hand sanitizers and multifaceted educational messages may have a role in improving hand-hygiene practices within the home setting.

Anti-Infective Agents, Local↗

PubMed2005

Multilevel modelling of hospitalisations for recurrent diarrhoeal disease in Aboriginal and non-Aboriginal infants and young children in Western Australia.

A multilevel proportional hazards model was used to determine the prognostic factors affecting hospitalisations for recurrent diarrhoeal disease in infants and young children. All infants born in 1996 who had index gastroenteritis admission to Western Australian (WA) hospitals during their first year of life were included in our study cohort (n = 486). There were 618 hospital admissions for infectious diarrhoea over the 6-year follow-up period. Aboriginal children stayed significantly longer in hospital than their non-Aboriginal peers, and comorbidities such as dehydration, gastrointestinal sugar intolerance, failure to thrive, iron deficiency anaemia and certain infections (genitourinary, scabies and/or otitis media) were all significantly associated with the delayed discharge of patients. Substantial variations among patients (variance = 0.660) and between health service regions of WA (variance = 0.296) were found. Over 30% of the total variation could be attributed to the heterogeneity between health districts. For any two patients in the same health district, the within-region (intraclass) correlation was estimated to be 0.309. In the absence of detailed socio-demographic data, application of the standard survival procedure may lead to incorrect inferences due to regional clustering and repeated observations on individuals. By accounting for latent patient and regional effects, the multilevel analysis clearly confirmed the high burden of infectious diarrhoea among Aboriginal infants and children, and their much longer hospital stays. Coexisting morbidities contributed to the prolonged and recurrent hospitalisations. Findings of this epidemiological study indicated the need of multifaceted clinical disease prevention and hygiene promotion strategies to control the disease.

Anemia, Iron-Deficiency↗

PubMed2000

Metabolic syndrome X: a review.

Metabolic syndrome X is a multifaceted syndrome, which occurs frequently in the general population. It is more common in men than in women. A large segment of the adult population of industrialized countries develops the metabolic syndrome, produced by genetic, hormonal and lifestyle factors such as obesity, physical inactivity and certain nutrient excesses. This disease is characterized by the clustering of insulin resistance and hyperinsulinemia, and is often associated with dyslipidemia (atherogenic plasma lipid profile), essential hypertension, abdominal (visceral) obesity, glucose intolerance or noninsulin-dependent diabetes mellitus and an increased risk of cardiovascular events. Abnormalities of blood coagulation (higher plasminogen activator inhibitor type 1 and fibrinogen levels), hyperuricemia and microalbuminuria have also been found in metabolic syndrome X. This review summarizes the present knowledge of abnormalities in this syndrome. Each risk factor is reviewed, and potential criteria for diagnosis and therapeutic targets are discussed. Because patients with metabolic syndrome X accumulate cardiac risk factors, they should be given special attention in terms of diagnosis and treatment.

Blood Glucose↗

PubMed2004

Macrovascular complications of metabolic syndrome: an early intervention is imperative.

The metabolic syndrome is a widespread clinical condition and an important cluster of atherothrombotic disease risk factors. The inclusion of this syndrome in the recently published Adult Treatment Panel III (ATP III) guidelines focused the attention of the physicians on this entity. Abdominal obesity, PPAR modulation, insulin resistance (with or without glucose intolerance), atherogenic dyslipidemia, elevated blood pressure, prothrombotic and proinflammatory states are the principal factors of this multifaceted syndrome. There are two major pathways of metabolic syndrome progress: (1) With preserved pancreatic beta cells function and insulin hypersecretion, which can recompense for insulin resistance. This pathway leads mostly to the macrovascular complications of metabolic syndrome. (2) With substantial injure of pancreatic beta cells leading to gradually reduced insulin secretion and to hyperglycemia (e.g. overt type 2 diabetes). This pathway leads to both microvascular and macrovascular complications. Because macrovascular complications of insulin resistance state precede the onset of hyperglycemia, early intervention in patients with metabolic syndrome is particularly important. Since central obesity (accompanied by insulin resistance even in the absence of hyperglycemia) is the key factor leading to development of metabolic syndrome and its future macrovascular complications, we assume that next logical step is the recognition of central obesity itself as a major risk factor for cardiovascular diseases.

Adult↗

PubMed1999

The meaning of quality of life in cancer survivorship.

PURPOSE/OBJECTIVES: To describe the meaning of quality of life (QOL) in long-term cancer survivors, to validate inductively derived QOL themes, and to identify and cluster over-arching themes across long-term cancer survivors. DESIGN: Qualitative study that was part of a larger, cross-sectional survey. SETTING/SAMPLE: 687 (57% response) cancer survivors at an average of 6.7 years after diagnosis. In the sample, 81% were female (with a mean age of 49.6 years), 72% were college educated, 63% were married, and 49% worked full time. METHODS: Mailed survey of three open-ended questions and standard QOL tools. A QOL conceptual model was used to frame the research study, describe the QOL responses of the participants, and explore the meaning of cancer survivorship. Content analysis was used to answer the research questions. Data collection and analysis occurred sequentially. MAIN RESEARCH CONCEPTS: Meaning, QOL cancer survivorship. FINDINGS: 25 of 30 inductively derived QOL themes were validated in this study of long-term cancer survivors; 107 additional QOL themes were identified and clustered into 11 over-arching themes across the entire data set. Over-arching themes included struggle between independence-dependence, balance, wholeness, life purpose, reclaiming life, multiple losses, having control, altered meaning of health, and surviving cancer from a family perspective. IMPLICATIONS FOR NURSING PRACTICE: The meaning of QOL in long-term cancer survivors is multifaceted and complex. CONCLUSIONS: Nurses can use this broader conception of QOL in breast cancer survivors to help patients prepare for and cope with adjustments.

Adaptation, Psychological↗

PubMed1999

Characteristics of sleep disturbance in community-dwelling Alzheimer's disease patients.

This study examined the frequency, predictors, and impact of sleep problems in a population-based sample of 205 Alzheimer's disease (AD) patients. Sleeping more than usual and early morning awakenings were the most common sleep problems reported but were the least disturbing behaviors for caregivers. Night-time awakenings were less common but were most disturbing to caregivers. Using logistic regression analyses, the factors most strongly associated with night awakenings among patients were male gender, greater memory problems, and decreased functional status. Patient depression increased the risk for caregivers to rate patient sleep problems as more disturbing overall. Cluster analyses revealed three characteristic groups of patients who awakened caregivers: one group was inactive during the day but had few other behavior problems; one group had increased levels of fearfulness, fidgeting, and occasional sadness; and the third group had multiple behavior problems, including frequent episodes of sadness, fearfulness, inactivity, fidgeting, and hallucinations. These findings indicate that the nature of sleep problems in AD is multifaceted; future research on the occurrence and treatment of sleep disturbance in dementia patients should consider the patterns of individual differences that may influence its development.

Aged↗

PubMed2005

A cluster randomized controlled trial of a behavioral intervention to facilitate the development and implementation of clinical practice guidelines in Latin American maternity hospitals: the Guidelines Trial: Study protocol [ISRCTN82417627].

BACKGROUND: A significant proportion of the health care administered to women in Latin American maternity hospitals during labor and delivery has been demonstrated to be ineffective or harmful, whereas effective interventions remain underutilized. The routine use of episiotomies and the failure to use active management of the third stage of labor are good examples. METHODS/DESIGN: The aim of this trial is to evaluate the effect of a multifaceted behavioral intervention on the use of two evidence-based birth practices, the selective use of episiotomies and active management of the third stage of labor (injection of 10 International Units of oxytocin). The intervention is based on behavioral and organizational change theories and was based on formative research. Twenty-four hospitals in three urban districts of Argentina and Uruguay will be randomized. Opinion leaders in the 12 intervention hospitals will be identified and trained to develop and implement evidence-based guidelines. They will then disseminate the guidelines using a multifaceted approach including academic detailing, reminders, and feedback on utilization rates. The 12 hospitals in the control group will continue with their standard in-service training activities. The main outcomes to be assessed are the rates of episiotomy and oxytocin use during the third stage of labor. Secondary outcomes will be perineal sutures, postpartum hemorrhages, and birth attendants' opinions.

Journal Article↗

PubMed2025

Nuclear-lamin-guided plastic positioning and folding of the human genome.

The human genome exhibits a highly ordered hierarchical architecture, yet the mechanisms governing its large-scale organization remain poorly understood. Here, we generate lamin single-, double-, and triple-knockout human embryonic and mesenchymal stem cells (hESCs and hMSCs) to investigate the role of lamins in the spatial organization of the human genome. Complete lamin depletion in hMSCs triggers extensive genome repositioning, disrupts chromosome territories, and dissolves long-range compartment clustering and mega-loops. Lamin loss affects both the nuclear periphery and interior, causing partial inversion and dispersion of nuclear speckles, accompanied by reduced global transcription and impaired stem cell homeostasis. Re-expression of wild-type lamin A, which interacts with the speckle scaffold protein SON, partially restores the organizational and transcriptional defects, while the disease-associated E161K mutant disrupts SON binding and shows limited recovery. Our results elucidate the multifaceted roles of lamins in nuclear organization and link their dysfunction to the pathogenesis of laminopathies.

Humans↗

PubMed1998

Growth factor-dependent activation of alphavbeta3 integrin in normal epithelial cells: implications for tumor invasion.

Integrin activation is a multifaceted phenomenon leading to increased affinity and avidity for matrix ligands. To investigate whether cytokines produced during stromal infiltration of carcinoma cells activate nonfunctional epithelial integrins, a cellular system of human thyroid clones derived from normal glands (HTU-5) and papillary carcinomas (HTU-34) was employed. In HTU-5 cells, alphavbeta3 integrin was diffused all over the membrane, disconnected from the cytoskeleton, and unable to mediate adhesion. Conversely, in HTU-34 cells, alphavbeta3 was clustered at focal contacts (FCs) and mediated firm attachment and spreading. alphavbeta3 recruitment at FCs and ligand-binding activity, essentially identical to those of HTU-34, occurred in HTU-5 cells upon treatment with hepatocyte growth factor/scatter factor (HGF/SF). The HTU-34 clone secreted HGF/SF and its receptor was constitutively tyrosine phosphorylated suggesting an autocrine loop responsible for alphavbeta3 activated state. Antibody-mediated inhibition of HGF/SF function in HTU-34 cells disrupted alphavbeta3 enrichment at FCs and impaired adhesion. Accordingly, activation of alphavbeta3 in normal cells was produced by HTU-34 conditioned medium on the basis of its content of HGF/SF. These results provide the first example of a growth factor-driven integrin activation mechanism in normal epithelial cells and uncover the importance of cytokine-based autocrine loops for the physiological control of integrin activation.

Antigens, CD↗

PubMed2003

Continuous quality improvement in medicine: validation of a potential role for medical specialty societies.

A rigorous evaluation of the effects of continuous quality improvement (CQI) on medical practice has not yet been achieved on a large, multicenter scale. The authors sought to test whether a low-intensity CQI intervention could be used to speed the adoption of two coronary artery bypass grafting process-of-care measures on a national level. The infrastructure of the Society of Thoracic Surgeons' National Cardiac Database was used as a CQI Platform in a prospective randomized trial of CQI conducted between January 2001 and July 2002. Preoperative beta-blockade and internal mammary artery grafting in patients aged >75 years were the care processes used. Three hundred fifty-nine National Cardiac Database sites were randomized into two intervention groups (beta blocker, n=124; internal mammary artery grafting, n=114) and one control group (n=114). Each intervention arm received measure-specific information, including a call to action to a physician leader; educational products; and periodic longitudinal, nationally benchmarked, site-specific feedback. Incorporation of the specific care process into everyday clinical practice at the intervention site was the main outcome measure. The analyses included a site-level analysis of differences between pre- and postintervention measure use and a hierarchical analysis using risk-adjustment for patient characteristics and accounting for clustering due to site. Use of beta blockers increased vs. control (Delta=7% vs. Delta=4%), significant at both the site level (p=0.04) and in the hierarchical analyses (p=0.0006). Internal mammary artery graft use also increased vs. control (Delta=9% vs. Delta=5%; p=0.20 and p=0.11, respectively). However, lower volume IMA sites showed significant improvement over lower volume control sites (Delta=14% vs. Delta=8%; p=0.02 for interaction). A multifaceted, physician-led, low-intensity effort can have an impact on the adoption of care processes into national practice. This Society CQI Platform is a potential model for large-scale quality improvement efforts across all disciplines of medicine.

Benchmarking↗

PubMed1998

Women HIV sexual risk takers: related behaviors, interpersonal issues, and attitudes.

HIV and AIDS is a growing health risk for heterosexual women, particularly women of color (Centers for Disease Control and Prevention, 1997). Our research identified 5 types of HIV sexual risk taking in 3 independent samples of adult women from a New England Community: Group A women were noted by low to moderate levels of the 4 risk markers (i.e., unprotected vaginal sex, perceived partner-related risk, number of sexual partners, and unprotected anal sex); Group B women reported very high frequency of unprotected vaginal sex; Group C women were characterized by unprotected anal sex; Group D women had high perceived partner risk; and Group E women reported extremely high levels on all 4 HIV risk markers. Sexual risk groups were validated by demonstrating significant differences among groups on relevant behaviors, interpersonal experiences, and attitudes. Compared to other women, higher risk types reported greater behavioral risk practices (substance use, prostitution, diverse sexual experience), interpersonal risk experiences (sexual abuse, violence), initiation sexual assertiveness, and attitudinal risks (psychosocial distress). They reported less interpersonal assurance (surety of own and partner's HIV status), sexual assertiveness (for condom use and partner communication), psychosocial strengths (sexual self-acceptance), and transtheoretical readiness for change (condom use efficacy, readiness to consider condoms). Results provide additional support for the multifaceted model of HIV risk and the transtheoretical model. Suggestions for specifically focused interventions are given, depending on the pattern of sexual risk taking.

Adolescent↗