Evaluation of email alerts in practice: Part 2. Validation of the information assessment method.

RATIONALE AND OBJECTIVE:. The information assessment method (IAM) permits health professionals to systematically document the relevance, cognitive impact, use and health outcomes of information objects delivered by or retrieved from electronic knowledge resources. The companion review paper (Part 1) critically examined the literature, and proposed a 'Push-Pull-Acquisition-Cognition-Application' evaluation framework, which is operationalized by IAM. The purpose of the present paper (Part 2) is to examine the content validity of the IAM cognitive checklist when linked to email alerts. METHODS: A qualitative component of a mixed methods study was conducted with 46 doctors reading and rating research-based synopses sent on email. The unit of analysis was a doctor's explanation of a rating of one item regarding one synopsis. Interviews with participants provided 253 units that were analysed to assess concordance with item definitions. RESULTS AND CONCLUSION: The content relevance of seven items was supported. For three items, revisions were needed. Interviews suggested one new item. This study has yielded a 2008 version of IAM.

ESCMID* guideline for the diagnosis and management of Candida diseases 2012: developing European guidelines in clinical microbiology and infectious diseases.

The process to develop a guideline in a European setting remains a challenge. The ESCMID Fungal Infection Study Group (EFISG) successfully achieved this endeavour. After two face-to-face meetings, numerous telephone conferences, and email correspondence, an ESCMID task force (basically composed of members of the Society's Fungal Infection Study Group, EFISG) finalized the ESCMID diagnostic and management/therapeutic guideline for Candida diseases. By appreciating various patient populations at risk for Candida diseases, four subgroups were predefined, mainly ICU patients, paediatric, HIV/AIDS and patients with malignancies including haematopoietic stem cell transplantation. Besides treatment recommendations, the ESCMID guidelines provide guidance for diagnostic procedures. For the guidelines, questions were formulated to phrase the intention of a given recommendation, for example, outcome. The recommendation was the clinical intervention, which was graded by a score of A-D for the 'Strength of a recommendation'. The 'level of evidence' received a score of I-III. The author panel was approved by ESCMID, European Organisation for Research and Treatment of Cancer, European Group for Blood and Marrow Transplantation, European Society of Intensive Care Medicine and the European Confederation of Medical Mycology. The guidelines followed the framework of GRADE and Appraisal of Guidelines, Research, and Evaluation. The drafted guideline was presented at ECCMID 2011 and points of discussion occurring during that meeting were incorporated into the manuscripts. These ESCMID guidelines for the diagnosis and management of Candida diseases provide guidance for clinicians in their daily decision-making process.

Quality control and conduct of genome-wide association meta-analyses.

Rigorous organization and quality control (QC) are necessary to facilitate successful genome-wide association meta-analyses (GWAMAs) of statistics aggregated across multiple genome-wide association studies. This protocol provides guidelines for (i) organizational aspects of GWAMAs, and for (ii) QC at the study file level, the meta-level across studies and the meta-analysis output level. Real-world examples highlight issues experienced and solutions developed by the GIANT Consortium that has conducted meta-analyses including data from 125 studies comprising more than 330,000 individuals. We provide a general protocol for conducting GWAMAs and carrying out QC to minimize errors and to guarantee maximum use of the data. We also include details for the use of a powerful and flexible software package called EasyQC. Precise timings will be greatly influenced by consortium size. For consortia of comparable size to the GIANT Consortium, this protocol takes a minimum of about 10 months to complete.

Plasma Level of Mmp-9 as Predictive Factor for Response and Progression Free Survival in Patients Treated with Bevacizumab (Bev) and Pegylated Liposomal Doxorubicin (Pld): Sakk 24/06

Background: There is currently no identified marker predicting benefit from Bev in patients with breast cancer (pts). We monitored prospectively 6 angiogenesis-related factors in the blood of advanced stage pts treated with a combination of Bev and PLD in a phase II trial of the Swiss Group for Clinical Cancer Research, SAKK.Methods: Pts received PLD (20 mg/m2) and Bev (10 mg/kg) every 2 weeks for a maximum of 12 administrations, followed by Bev monotherapy until progression or severe toxicity. Blood samples were collected at baseline, during treatment and at treatment discontinuation. Enzyme-linked immunosorbent assays (Quantikine, R&DSystems and Reliatech) were used to measure vascular endothelial growth factor (VEGF), placental growth factor (PlGF), matrix metalloproteinase 9 (MMP-9) and soluble VEGF receptors -1, -2 and -3. The natural log-transformed (ln) data for each factor was analyzed by analysis of variance (ANOVA) model to investigate differences between the mean values of the subgroups of interest (where a = 0.05), based on the best tumor response by RECIST.Results: 132 samples were collected in 41 pts. The mean of baseline ln MMP-9 levels was significantly lower in pts with tumor progression than those with tumor response (p=0.0202, log fold change=0.8786) or disease control (p=0.0035, log fold change=0.8427). Higher MMP-9 level was a significant predictor of superior progression free survival (PFS): p=0.0417, hazard ratio=0.574, 95% CI=0.336-0.979. In a multivariate cox proportional hazards model, containing performance status, disease free interval, number of tumor sites, visceral involvement and prior adjuvant chemotherapy, using stepwise regression baseline MMP-9 was still a statistically 117P Table 1. SOLTI-0701* AC01B07* NU07B1* SOR+CAP N=20 PL+CAP N=33 SOR+ GEM/CAP N=23 PL+ GEM/CAP N=27 SOR+PAC N=48 PL+PAC N=46 Baseline characteristics Age, median (range), y 49 (32-72) 53 (30-78 54 (32-69) 57 (31-82) 50 (27-80) 52 (23-74) AJCC stage, n (%) IIIB/IIIC 3 (15) 6 (18) 0 (0) 3 (11) 8 (17) 9 (20) IV 17 (85) 27 (82) 23 (100) 24 (89) 40 (83) 37 (80) Metastatic site, n (%) Non-visceral 3 (15) 6 (18) 7 (30) 6 (22) 9 (19) 17 (37) Visceral 17 (85) 27 (82) 16 (70) 21 (78) 39 (81) 29 (63) Prior metastatic chemo, n (%) 8 (40) 15 (45) 21 (91) 25 (93) - - Efficacy PFS, median, mo 4.3 2.5 3.1 2.6 5.6 5.5 HR (95% CI)_ 0.60 (0.31, 1.14) 0.57 (0.30, 1.09) 0.86 (0.50, 1.45) 1-sided P value_ 0.055 0.044 0.281 Overall survival, median, mo 17.5 16.1 Pending 14.7 18.2 HR (95% CI)_ 0.98 (0.50, 1.89) 1.11 (0.64, 1.94) 1-sided P value_ 0.476 0.352 Safety N=20 N=33 N=22 N=27 N=46 N=46 Tx-emergent Grade 3/4, n (%) 15 (75) 16 (48) 20 (91) 17 (63) 36 (78) 16 (35) Grade 3§ hand-foot skin reaction/ syndrome 8 (40) 5 (15) 8 (36) 0 (0) 14 (30) 2 (4) *Efficacy results based on intent-to-treat population and safety results based on safety population (pts who received study drug[s]); _Cox regression within each subgroup; _log-rank test within each subgroup; §maximum toxicity grade for hand-foot skin reaction/syndrome; AJCC, American Joint Committee on Cancer mittedabstractsª The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com Downloaded from annonc.oxfordjournals.org at Bibliotheque Cantonale et Universitaire on June 6, 2011 significant factor (p=0.0266). The results of the other measured factors were presented elsewhere.Conclusions: Higher levels of MMP-9 could predict tumor response and superior PFSin pts treated with a combination of Bev and PLD. These exploratory results justify further investigations of MMP-9 in pts treated with Bev combinations in order to assess its role as a prognostic and predictive factor.Disclosure: K. Zaman: Participation in advisory board of Roche; partial sponsoring ofthe study by Roche (the main sponsor was the Swiss Federation against Cancer (Oncosuisse)). B. Thu¨rlimann: stock of Roche; Research grants from Roche. R. vonMoos: Participant of Advisory Board and Speaker honoraria

Terrestrial Lidar investigation of the 2004 rockslide along Petit Champlain Street, Québec City (Quebec, Canada)

Au cours des 240 dernières années, 53 mouvements de versant se sont produits le long du promontoire de Québec, causant la mort de 88 personnes principalement lors de chutes de blocs. En octobre 2004, un petit éboulement a atteint la route dans une zone proche de l'éboulement de 1889 qui a tué 35 personnes et blessé 30 autres. Une image 3D a été créée par l'utilisation d'un scanner Lidar terrestre (SLT). Les sept familles de joints identifiées sont en accord avec les mesures effectuées dans de précédentes études. L'imagerie SLT a aussi permit d'estimer les volumes des instabilités passées et d'en analyser le mécanisme : un glissement rocheux qui affecte des blocs débités en parallélépipèdes par d'autres familles de joints. De plus la zone étudiée montre qu'elle est favorable aux chutes de blocs.

Usage et utilité clinique de la CRP dans le diagnostic, le pronostic et le suivi de patients hospitalisés pour une pneumonie acquise dans la communauté. Enquête auprès des médecins du CHUV

Introduction: L'utilisation de marqueurs de l'inflammation comme la CRP pour le diagnostic, le pronostic et le suivi lors de pneumonie acquise dans la communauté (PAC) est une méthode rapide et bon marché. Cependant son utilité reste controversée etles avis d'expert divergent. Au CHUV, la CRP est dosée systématiquement chez les patients hospitalisés avec une PAC. L'objectif de ce travail est double: 1) effectuer une revue systématique de la littérature; 2) mieux comprendre l'usage et la perception de l'utilité clinique de la CRP en analysant la pratique des médecins du CHUV. Méthode: Nous avons envoyé un questionnaire par email à 2 reprises à tous les médecins assistants et chefs de clinique du service de médecine interne (SMI) et du centre interdisciplinaire des urgences (CIU) du CHUV. Les questions portaient sur la pratique clinique et sur la perception de l'utilité de la CRP dans le diagnostic, le pronostic et le suivi de patients hospitalisés pour une PAC. Résultats: Les résultats de la revue systématique sont présentés et analysés en intégrant les réponses issues du questionnaire. Nous avons reçu 53 réponses sur les 125 questionnaires envoyés. 62% des médecins interrogés demandent un dosage de la CRP dans >90% des cas lors d'une suspicion de PAC basée sur la clinique contre 45% si en plus la radiologie parle en faveur d'une PAC. 75% des médecins répètent ce dosage 1 à 4 fois durant le suivi. La raison principale évoquée est la suspicion d'une évolution défavorable et, plus rarement, la présence de comorbidités. Quand on questionne les médecins sur l'utilité de la CRP,on observe que seulement 30% pensent que la CRP est utile pour le diagnostic de PAC et 28% pour exclure une PAC lors de suspicion clinique. De même, 25% des médecins pensent qu'elle est utile dans le suivi des patients et 9% pour évaluer le pronostic de la PAC. On ne trouve pas d'association entre le niveau de formation et l'usage ou l'appréciation de l'utilité de la CRP. Conclusion: Les médecins assistants et les chefs de clinique du SMI et du CIU du CHUV dosent très souvent la CRP chez les patients hospitalisés pour une PAC. Leur motivation n'est ni liée à l'éventuelle valeur diagnostique de cet examen biologique,ni à son hypothétique valeur pour le pronostic et le suivi.

Les expériences de vieillissement vécues par des femmes sénégalaises âgées de 60 ans et plus, vivant dans la communauté.

Cette étude vise à mieux comprendre la signification que des femmes sénégalaises âgées de 60 ans et plus donnent au vieillissement. Des entrevues non structurées auprès de dix participantes ont été analysées selon l'approche phénoménologique descriptive de Giorgi. Vingt-quatre sous-thèmes, huit thèmes et une structure générale émergent de l'analyse des données recueillies. Le vieillissement féminin est vécu comme un processus de réflexion existentielle et une expérience d'épanouissement malgré une vulnérabilité physique, psychologique et économique. Ainsi, pour ces femmes, vieillir représente une expérience paradoxale intégrant à la fois des satisfactions et des contraintes. Des recommandations ont été faites dans le sens de la mise en oeuvre d'un programme de recherche visant l'amélioration des conditions de vie et de santé des femmes âgées de 60 ans et plus.

Use of accuracy profile for the validation of a gas chromatography-negative chemical ionization tandem mass spectrometry method: quantification of ethyl glucuronide in hair

Introduction: Ethylglucuronide (EtG) is a direct and specific metabolite of ethanol. Its determination in hair is of increasing interest for detecting and monitoring alcohol abuse. The quantification of EtG in hair requires analytical methods showing highest sensitivity and specificity. We present a fully validated method based on gas chromatography-negative chemical ionization tandem mass spectrometry (GC-NCI-MS/MS). The method was validated using French Society of Pharmaceutical Sciences and Techniques (SFSTP) guidelines which are based on the determination of the total measurement error and accuracy profiles. Methods: Washed and powdered hair is extracted in water using an ultrasonic incubation. After purification by Oasis MAX solid phase extraction, the derivatized EtG is detected and quantified by GC-NCI-MS/MS method in the selected reaction monitoring mode. The transitions m/z 347 / 163 and m/z 347 / 119 were used for the quantification and identification of EtG. Four quality controls (QC) prepared with hair samples taken post mortem from 2 subjects with a known history of alcoholism were used. A proficiency test with 7 participating laboratories was first run to validate the EtG concentration of each QC sample. Considering the results of this test, these samples were then used as internal controls for validation of the method. Results: The mean EtG concentrations measured in the 4 QC were 259.4, 130.4, 40.8, and 8.4 pg/mg hair. Method validation has shown linearity between 8.4 and 259.4 pg/mg hair (r2 > 0.999). The lower limit of quantification was set up at 8.4 pg/mg. Repeatability and intermediate precision were found less than 13.2% for all concentrations tested. Conclusion: The method proved to be suitable for routine analysis of EtG in hair. GC-NCI-MS/MS method was then successfully applied to the analysis of EtG in hair samples collected from different alcohol consumers.

Effects of dopamine on total oxygen consumption and oxygen delivery in healthy men.

The effect of acute intravenous dopamine (DA) administration at three sequential (but randomized) infusion rates was studied in eight young male volunteers. DA was infused at 2.5, 5, and 10 micrograms.kg-1.min-1. O2 consumption (VO2) and CO2 production (VCO2) were measured continuously by means of a computerized indirect calorimeter (blood system). In response to the 5- and 10-micrograms.kg-1.min-1 DA infusion rates, a significant increase (P less than 0.01) in VO2 corresponding to a 6% (range, 3-10) and 15% (range, 12-23) increase, respectively, of preinfusion values was observed. In contrast, at the low dose (2.5 micrograms.kg-1.min-1), DA induced no significant change in VO2. Cardiac output (Qc) increased significantly after the three DA administration rates [19% (range, 0-42), 34% (range, 17-71), and 25% (range, -3 to +47)] for the doses 2.5, 5, and 10 micrograms.-kg-1.min-1, respectively. The increase in O2 delivery (QO2) outweighed VO2 at all administration rates despite the relative drop in QO2 at the maximal DA administration rate. These results indicate that in humans DA improves net O2 supply to tissues proportionally more than it increases VO2 at all doses used in the present study.

Development and evaluation of a shaken baby syndrome prevention program.

OBJECTIVE: To evaluate parents' and nurses' opinions regarding the adequacy of an educational program on shaken baby syndrome: the Perinatal Shaken Baby Syndrome Prevention Program (PSBSPP). DESIGN: Qualitative and quantitative assessments in the form of interviews and questionnaires administered in French. SETTING: Two birthing institutions in Montréal, QC, Canada: a university hospital and a regional center. PARTICIPANTS: Two hundred and sixty-three parents (73.8% mothers, 26.2% fathers) received the intervention after the birth of their child, and 69 nurses administered it. METHODS: Parents' and nurses' assessments of the adequacy and relevance of the program and nurses' assessments of the training they received to administer the program were evaluated. RESULTS: Both parents and nurses supported this initiative. Most parents appreciated the usefulness of the information. Nurses believed the program was adequate, and their training to deliver the program was satisfactory. All participants reported that the program was highly relevant, especially for new parents. CONCLUSION: The Perinatal Shaken Baby Syndrome Prevention Program achieves the goals of (a) increasing parents' knowledge about infant crying, anger, and shaken baby syndrome and (b) helping parents identify coping strategies. The relevance of introducing the PSBSPP in all birthing institutions is supported. Future studies should focus on vulnerable and culturally diverse populations, and longitudinal follow-up could help determine if the PSBSPP reduces the incidence of shaken baby syndrome.

The hematology laboratory in blood doping (bd): 2014 update on the athlete biological passport (APB)

Introduction: Blood doping (BD) is the use of Erythropoietic Stimulating Agents (ESAs) and/or transfusion to increase aerobic performance in athletes. Direct toxicologic techniques are insufficient to unmask sophisticated doping protocols. The Hematological module of the ABP (World Anti-Doping Agency), associates decision support technology and expert assessment to indirectly detect BD hematological effects. Methods: The ABP module is based on blood parameters, under strict pre-analytical and analytical rules for collection, storage and transport at 2-12°C, internal and external QC. Accuracy, reproducibility and interlaboratory harmonization fulfill forensic standard. Blood samples are collected in competition and out-ofcompetition. Primary parameters for longitudinal monitoring are: - hemoglobin (HGB); - reticulocyte percentage (RET); - OFF score, indicator of suppressed erythropoiesis, calculated as [HGB(g/L) * 60-√RET%]. Statistical calculation predicts individual expected limits by probabilistic inference. Secondary parameters are RBC, HCT, MCHC-MCH-MCV-RDW-IFR. ABP profiles flagged as atypical are review by experts in hematology, pharmacology, sports medicine or physiology, and classified as: - normal - suspect (to target) - likely due to BD - likely due to pathology. Results: Thousands of athletes worldwide are currently monitored. Since 2010, at least 35 athletes have been sanctioned and others are prosecuted on the sole basis of abnormal ABP, with a 240% increase of positivity to direct tests for ESA, thanks to improved targeting of suspicious athletes (WADA data). Specific doping scenarios have been identified by the Experts (Table and Figure). Figure. Typical HGB and RET profiles in two highly suspicious athletes. A. Sample 2: simultaneous increases in HGB and RET (likely ESA stimulation) in a male. B. Samples 3, 6 and 7: "OFF" picture, with high HGB and low RET in a female. Sample 10: normal HGB and increased RET (ESA or blood withdrawal). Conclusions: ABP is a powerful tool for indirect doping detection, based on the recognition of specific, unphysiological changes triggered by blood doping. The effect of factors of heterogeneity, such as sex and altitude, must also be considered. Schumacher YO, et al. Drug Test Anal 2012, 4:846-853. Sottas PE, et al. Clin Chem 2011, 57:969-976.

Entretiens phénoménologiques et entretiens focalisés sur l'activité : analyse comparative, similitudes et variations.

Cet article présente une analyse comparative des résultats de deux formes d'entretiens : en 2005, des entretiens phénoménologiques, en 2006 des entretiens centrés sur l'activité. Deux problématiques sont abordées : la perception de la santé au travail et les pratiques de contraception. Nous présentons les premiers résultats de cette analyse comparative : ils montrent que l'adaptation des entretiens centrés sur l'activité au domaine de la santé présente un grand intérêt au niveau des apports de contenus. Le retour du sujet sur le discours concernant son activité concrète facilite la réflexivité et conduit à des transformations personnelles. Des difficultés concernant la position du chercheur et l'adéquation de la technique à la Psychologie de la Santé sont discutées. Cette première exploration ne détermine pas encore ce qui est dû à la différence des techniques. Nos travaux comparatifs vont se poursuivre en vue d'explorer des alternatives méthodologiques applicables en Psychologie de la Santé.

Scientific value of systematic reviews: survey of editors of core clinical journals.

BACKGROUND: Synthesizing research evidence using systematic and rigorous methods has become a key feature of evidence-based medicine and knowledge translation. Systematic reviews (SRs) may or may not include a meta-analysis depending on the suitability of available data. They are often being criticised as 'secondary research' and denied the status of original research. Scientific journals play an important role in the publication process. How they appraise a given type of research influences the status of that research in the scientific community. We investigated the attitudes of editors of core clinical journals towards SRs and their value for publication.¦METHODS: We identified the 118 journals labelled as "core clinical journals" by the National Library of Medicine, USA in April 2009. The journals' editors were surveyed by email in 2009 and asked whether they considered SRs as original research projects; whether they published SRs; and for which section of the journal they would consider a SR manuscript.¦RESULTS: The editors of 65 journals (55%) responded. Most respondents considered SRs to be original research (71%) and almost all journals (93%) published SRs. Several editors regarded the use of Cochrane methodology or a meta-analysis as quality criteria; for some respondents these criteria were premises for the consideration of SRs as original research. Journals placed SRs in various sections such as "Review" or "Feature article". Characterization of non-responding journals showed that about two thirds do publish systematic reviews.¦DISCUSSION: Currently, the editors of most core clinical journals consider SRs original research. Our findings are limited by a non-responder rate of 45%. Individual comments suggest that this is a grey area and attitudes differ widely. A debate about the definition of 'original research' in the context of SRs is warranted.

Evaluation of risk perception related to drug use during pregnancy: a Swiss survey

Introduction Health care professionals' perception of risk mayimpact on therapeutic management of women during pregnancy.Since the thalidomide tragedy, the use of drugs during pregnancygenerates fear. This concern might affect the estimation of the riskassociated with drug intake during pregnancy, leading to prematurediscontinuation of a required treatment, superfluous anxiety orpointless termination of a desired pregnancy. Although data regardingthe security of drugs during pregnancy are still scarce, a few specializedinformation sources exist providing reliable recommendationsfor daily practice. This study aimed at characterizing therisk perception associated with drugs during pregnancy in a sample ofSwiss health care professionals.Materials & Methods An online French and German survey was sentby email to the Swiss professional societies of Pharmacists, Gynecologists,Mid-wives and Pediatricians. The questionnaire wasconstructed to assess (a) the characteristics of the population and theopinion of the professionals regarding the medication use pattern intheir pregnant patients, (b) to evaluate the sources of information usedduring their practice and finally (c) to assess their risk perceptionassociated with drugs during pregnancy. Results were analyzed bydescriptive statistics.Results A total of 1,310 questionnaires were collected (18% responserate). Most health care professionals believe that 30-60% of theirpregnant patients are taking at least one treatment during their pregnancyand that 80% are adherent to it. A large majority think,however, that women are anxious when they must take their medication.More than 80% of health professionals commonly use theSwiss Drug Reference Book (Compendium) to assess the risk associatedwith drugs during pregnancy, despite the uniformly low levelof credibility and utility they express about this reference. Except forsome gynecologists, the majority of professionals are not aware of ordo not use specialized books. The majority of participants thinkwrongly that more than 30% of drugs are teratogenic. About 20% ofthem are not aware of the risk associated with paracetamol intakeduring pregnancy. More than 70% agree that phytotherapeutic mixturesare not safer than conventional drugs, with the exception of midwiveswho tend to overestimate the safety of such drugs. With thenotable exception of gynecologists, the risk related to drug intake wasoverall overestimated.Discussion & Conclusion Swiss professionals differ in their perceptionof the risk associated with drugs during pregnancy and tend tooverestimate it. The differences might be attributed to the level oftraining and awareness of specialized sources offering a realisticestimation of the risk. Further efforts are needed to expand thetraining and the tools for health care professionals to optimize druguse during pregnancy.