Additional Strategies (additional + strategy)

Distribution by Scientific Domains


Selected Abstracts


Can we predict future improvement in glycaemic control?

DIABETIC MEDICINE, Issue 2 2008
R. Singh
Abstract Aims To determine the factors responsible for poor glycaemic control in diabetes and whether any such factors are associated with likely improvement in glycaemic control. Methods A prospective cohort study of 130 diabetic patients with poor glycaemic control (HbA1c , 10.0%) with 1-year follow-up in a teaching hospital Diabetes Clinic. Changes in HbA1c were measured after 1 year. Results Poor glycaemic control was attributed to one of 15 possible causes. Those cases due to recent diagnosis of diabetes, inadequate treatment with diet, oral glucose-lowering agents or insulin, exacerbation of co-existent medical problems, recent stressful life-events and missed clinic appointments were all associated with significant improvement in HbA1c at 12 months. Patients with low mood or alcohol excess, inadequate blood glucose monitoring, poor exercise/sedentary lifestyle, refusal to take tablets or underdosing and refusal to take insulin at all or to increase the dose were all associated with continuing poor glycaemic control at 12 months. The patients were divided almost equally between the two groups. Conclusions In patients with poor glycaemic control, it is possible by simple features identified at clinic to predict which individuals are likely to show improvement in control and which will not. These findings have not been reported previously and suggest that about half of individuals with poor control will improve within our current diabetes clinic practice. Additional strategies will be required to address those individuals who are not likely to respond. [source]


Optimization of in vitro expansion of macaque CD4+ T cells using anti-CD3 and co-stimulation for autotransfusion therapy

JOURNAL OF MEDICAL PRIMATOLOGY, Issue 4-5 2006
Nattawat Onlamoon
Abstract Background, Our laboratory has previously shown that adoptive transfer of in vitro -expanded autologous purified polyclonal CD4+ T cells using anti-CD3/CD28-coated beads induced antiviral responses capable of controlling SIV replication in vivo. Methods, As CD4+ T cells comprise several phenotypic and functional lineages, studies were carried out to optimize the in vitro culture conditions for maximal CD4+ T-cell expansion, survival and delineate the phenotype of these expanded CD4+ T cells to be linked to maximal clinical benefit. Results and Conclusions, The results showed that whereas anti-monkey CD3,/, was able to induce T-cell proliferation and expansion in combination with antibodies against multiple co-stimulatory molecules, monkey CD3, cross reacting antibodies failed to induce proliferation of macaque CD4+ T cells. Among co-stimulatory signals, anti-CD28 stimulation was consistently superior to anti-4-1BB, CD27 or ICOS while the use of anti-CD154 failed to deliver a detectable proliferation signal. Increasing the relative anti-CD28 co-stimulatory signal relative to anti-CD3 provided a modest enhancement of expansion. Additional strategies for optimization included attempts to neutralize free radicals, enhancement of glucose uptake by T cells or addition of T-cell stimulatory cytokines. However, none of these strategies provided any detectable proliferative advantage. Addition of 10 autologous irradiated feeder cells/expanding T cell provided some enhancement of expansion; however, given the high numbers of T cell needed, this approach was deemed impractical and costly, and lower ratios of feeder to expanding T cells failed to provide such benefit. The most critical parameter for efficient expansion of purified CD4+ T cells from multiple monkeys was the optimization of space and culture conditions at culture inception. Finally, anti-CD3/28-expanded CD4+ T cells uniformly exhibited a central memory phenotype, absence of CCR5 expression, marked CXCR4 expression in vitro, low levels of caspase 3 but also of Bcl-2 expression. [source]


Can pediatricians accurately identify maternal depression at well-child visits?

PEDIATRICS INTERNATIONAL, Issue 2 2010
Hiroki Mishina
Abstract Background:, The feasibility of a two-item screening tool for maternal depression in a pediatric setting was recently reported. We assessed whether the accuracy of pediatrician recognition of maternal depression during the one-month well-child visit could be improved by an educational intervention using the two-item screening tool. Methods:, We conducted an educational intervention for pediatric residents in a suburban hospital in Tokyo, Japan, with outcome measurement before and after. Resident education included knowledge about postpartum depression and its impact on children, use of the two-item screening tool and available management strategies. Sixteen pediatric residents examined 267 mother,infant dyads during well-child visits. Residents documented the presence or absence of postpartum depressive symptoms on medical records. Depressive symptoms were also determined using the Edinburgh Postnatal Depression Scale (EPDS) survey; residents were not aware of the results. Using the EPDS as a "gold standard," improvement in sensitivity and specificity of resident recognition of maternal depressive symptoms was determined. Results:, The overall prevalence of postpartum depressive symptoms based on the EPDS was 15.4%. The sensitivity of resident recognition was 8% and specificity 98% before intervention, and 12% and 96% afterwards, respectively. The difference was not statistically significant. Residents indicated fear of maternal stigmatization and mothers' receptiveness to discussing depressive symptoms, as well as lack of time and skills, as major barriers to the identification of maternal depression. Conclusions:, A simple educational intervention using a two-item screening tool did not improve the pediatrician's accuracy in detecting depressive symptoms in mothers. Additional strategies to address perceived barriers may be needed. [source]


Long-term plant community changes in managed fens in Ohio, USA

AQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue 4 2008
Matthew J. Barry
Abstract 1.Long-term studies are necessary to describe effects of restoration efforts on plant communities and invasive species in North American fen communities. In 1986, 1999 and 2000, wetland plant communities and abiotic factors were sampled in two fens in Ohio that were actively managed as a state nature preserve since 1986. The correlation between plant species and environmental conditions was examined in 1986 to 2000, and changes in woody plant cover were measured on aerial photographs from 1938 to 1997 to analyse long-term effects of management practices. 2.142 vascular plant species and 32 bryophyte taxa were found in these rich fens, including 13 rare (i.e. state-listed as endangered, threatened or potentially threatened) and 14 alien species. TWINSPAN analyses identified nine plant community types, and species distributions were correlated with several abiotic factors (groundwater depth, pH, soil organic content, distance from wetland edge and depth of peat). Communities along the wetland edge in deep peat had higher richness, more woody species, more alien species and fewer rare species than communities in areas near sources of flowing groundwater with more marl and less peat. 3.There was little change in species richness, evenness, and Shannon's diversity from 1986 to 2000. However, plant species assemblages changed during the study, and changes were different in unmanipulated transects compared with those where habitat managers removed invasive woody plants. An aerial photograph analysis indicated that woody plant cover increased by about 1% each year during 1938 to 1997 despite current management efforts to remove invasive trees and shrubs. Additional strategies should be directed toward reducing shrub encroachment and invasive species while promoting rare species. Copyright © 2007 John Wiley & Sons, Ltd. [source]


Randomised controlled trial of an educational strategy to increase school,based adolescent hepatitis B vaccination

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2000
S. Rachel Skinner
ABSTRACT OBJECTIVES: This study aimed to evaluate a specifically designed hepatitis B education/promotion curriculum package as part of a successful hepatitis B vaccination delivery system to adolescents. METHODS: A randomised,controlled trial was used to evaluate the effect of the curriculum package (or intervention) on uptake of vaccine. Schools were randomly selected from the metropolitan region of Melbourne to intervention (66 schools or 7,588 students) or control groups (69 schools or 9,823 students). Class teachers administered the intervention to students over 4 class periods before the vaccination course. RESULTS: The difference in mean school uptake between intervention and control was small at 1,2% per dose. 95% confidence intervals around the differences were ,5% to 2% per dose and not significant. Intervention schools taught an average of 7 items out of 12 from the curriculum package. Immunisation rates increased by 4,10% per dose between low and high implementation schools, but this trend was not significant. Impact evaluation demonstrated significantly greater knowledge of hepatitis B and vaccination among students in the intervention than the control group. CONCLUSION: Hepatitis B vaccination of pre,adolescents was not increased by the implementation of a curriculum package that successfully increased knowledge and awareness of hepatitis B in a school,based vaccination program. Additional strategies directed at the education of parents, the cooperative role of schools and pro,active providers might also be required to maximise vaccine uptake in this age group. [source]


Prescription rates of protective co-therapy for NSAID users at high GI risk and results of attempts to improve adherence to guidelines

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009
L. LAINE
Summary Background, Protective co-therapy is recommended in NSAID users with GI risk factors, but adherence is poor. Aim, To assess the proportion of NSAID users receiving co-therapy and strategies to improve adherence. Methods, Arthritis patients ,50 years of age received etoricoxib or diclofenac in a double-blind randomized trial. Reminders that high-risk patients (age , 65; previous ulcer/haemorrhage; corticosteroid, anticoagulant, aspirin use) should receive co-therapy were given at study initiation. Free PPI was provided. An intervention midway through the study included a written reminder and required written response regarding co-therapy. Results, 16 244/23 504 (69%) patients had GI risk factors. Pre-intervention, co-therapy was most common with previous ulcer/haemorrhage [706/1107 (64%)] and 3,4 risk factors [331/519 (64%)]. In the 10 026 patients enrolled pre-intervention and remaining in the study ,6 months after, co-therapy in high-risk patients increased from 2958/6843 (43%) to 4177/6843 (61%) (difference = 18%; 95% CI 16%,19%). The increase was greater outside the US (22%; 19%,24%) than in the US (15%; 13%,17%). Conclusions, Less than 50% of NSAID users with GI risk factors are given protective co-therapy , even if prescribers are given reminders and cost is not an issue. Direct communication requiring written response significantly increased adherence to guidelines, but achieving higher levels of adherence will require additional strategies. [source]


Alternative views of functional protein binding epitopes obtained by combinatorial shotgun scanning mutagenesis

PROTEIN SCIENCE, Issue 9 2005
Gábor Pál
Abstract Combinatorial shotgun scanning mutagenesis was used to analyze two large, related protein binding sites to assess the specificity and importance of individual side chain contributions to binding affinity. The strategy allowed for cost-effective generation of a plethora of functional data. The ease of the technology promoted comprehensive investigations, in which the classic alanine-scanning approach was expanded with two additional strategies, serine- and homolog-scanning. Binding of human growth hormone (hGH) to the hGH receptor served as the model system. The entire high affinity receptor-binding sites (site 1) of wild-type hGH (hGHwt) and of an affinity-improved variant (hGHv) were investigated and the results were compared. The contributions that 35 residue positions make to binding were assessed on each hormone molecule by both serine- and homolog-scanning. The hormone molecules were displayed on the surfaces of bacteriophage, and the 35 positions were randomized simultaneously to allow equal starting frequencies of the wild-type residue and either serine or a homologous mutation in separate libraries. Functional selections for binding to the hGH receptor shifted the relative wild-type/mutant frequencies at each position to an extent characteristic of the functional importance of the side chain. Functional epitope maps were created and compared to previous maps obtained by alanine-scanning. Comparisons between the different scans provide insights into the affinity maturation process that produced hGHv. The serine and homolog-scanning results expand upon and complement the alanine-scanning results and provide additional data on the robustness of the high affinity receptor-binding site of hGH. [source]


Efficacy of Concomitant Chemoradiation and Surgical Salvage for N3 Nodal Disease Associated With Upper Aerodigestive Tract Carcinoma,

THE LARYNGOSCOPE, Issue 11 2000
Khwaja A. Ahmed MD
Abstract Objectives/Hypothesis To determine whether an aggressive approach using trimodality therapy would improve the outcome in head and neck cancer patients with advanced (N3) nodal disease. Study Design In this retrospective, nonrandomized review, we analyzed a subset of patients who were treated in a targeted chemoradiation therapy protocol, consisting of 31 patients who received treatment between June 1993 and June 1997. Methods Patients received selective intra-arterial infusions of cisplatin (150 mg/m2/wk for 4 weeks) and concomitant radiation therapy (2 Gy/fraction × 35 daily fractions over a 7-wk period) to the primary and clinically positive nodal disease. The patients were re-evaluated 2 months later and underwent salvage neck dissections if there was any residual disease. Results Classification of disease in the primary site was as follows: T1 in 2 patients, T2 in 6 patients, T3 in 14 patients, and T4 in 9 patients. Among the 31 patients who were assessed for response at the nodal site, 4 of 31 (13%) had a complete response, 21 of 31 (68%) had a partial response, and 1 of 31 (3%) had no response. Excluding the 5 patients who could not be evaluated, 4 of 26 patients (15%) had a complete response, 21 of 26 (81%) had a partial response, and 1 of 26 (4%) had no response. Nineteen patients subsequently underwent neck dissection, and five patients had histological evidence of residual disease. The remaining seven patients included four who had a complete response in their necks and three who died of intercurrent disease before re-staging. Among the 23 patients who were rendered disease free, there were no recurrences within the neck, whereas 1 patient had recurrence at the primary site and 11 patients had recurrence at distant sites. With a median follow-up of 15 months (range, 4,41 mo), the 3-year overall survival and disease-specific survival were 41% and 43%, respectively. Conclusions Targeted chemoradiation therapy followed by surgical salvage is a highly effective approach for regional control of patients with N3 nodal disease, whereas additional strategies are required to address the problem of distant metastases. [source]


The effect of oral steroids with and without vitamin D3 on early efficacy of immunotherapy in asthmatic children

CLINICAL & EXPERIMENTAL ALLERGY, Issue 12 2009
P. Majak
Summary Background The possibility of additional strategies to enhance the effectiveness of specific immunotherapy (SIT) is highly attractive. Aim The aim of our study was to assess the influence of oral corticosteroids and oral corticosteroids combined with vitamin D3 on the early clinical and immunological effects of SIT. Methods It was a randomized, double-blind, placebo-controlled trial conducted in 54 asthmatic children allergic to house dust mites. Intervention was based on receiving a single dose of oral steroid, with or without vitamin D3, or placebo only on the day of the build-up phase of SIT. Results After 12 months of SIT, the median daily inhaled corticosteroid (ICS) dose, which controls the symptoms of asthma, was reduced by 25% in the steroid group. However, a 50% reduction of the median daily ICS dose was observed in the control group. The clinical effects of SIT were not affected in the steroid+D3 group. Concomitantly, we found that intervention with prednisone significantly impaired the induction of T regulatory lymphocytes. Importantly, the clinical and immunological effects of SIT were not affected by intervention with steroids administered with vitamin D3. Conclusions Our study failed to show a beneficial effect of oral corticosteroids on allergen-specific immunotherapy. We observed that the combined administration of a corticosteroid drug and allergen extract suppressed the early clinical and immunological effects of SIT and that vitamin D3 prevented this ,adverse' influence of steroids. [source]