Ongoing Gaps Research Articles

Genome size and base composition of Bromeliaceae species assessed by flow cytometry

Flow cytometry (FCM) has been used to estimate the nuclear DNA content of Bromeliaceae species, which constitutes relevant information for studies of taxonomy, evolution, genetic diversity, and reproductive biology in bromeliads. Nevertheless, C values have only been estimated for 58 out of the 3,140 existing Bromeliaceae species. Aiming to contribute to the genome database of Bromeliaceae, the current study was carried out to measure the nuclear DNA content and base composition of Bromelioideae and Tillandsioideae species occurring in the Atlantic Rainforest. The most adequate FCM procedure provided histograms exhibiting G0/G1 peaks with coefficients of variation below 5%, so that these histograms were used to measure the mean 2C and AT% values for all collected Bromelioideae and Tillandsioideae species. These values were statistically compared, and dendrograms were plotted. A second comparison was performed among all mean 2C values reported for Pitcairnioideae, Tillandsioideae, and Bromelioideae species. In accordance with previous statistical comparisons, two groups were formed: cluster 1, composed by Tillandsia loliacea, Tillandsia usneoides, and Tillandsia cyanea, and cluster 2, gathering other 69 species. Based on these results, we concluded that FCM was a rapid, accurate, and reliable technique to assess genome size and base composition. Furthermore, the FCM data reported here will contribute to the Monocot and Bromeliaceae database, which still displays several ongoing gaps, especially for endemic species.

W3.1 The epidemiology of preeclampsia: use of population data for research

W5.1 – Table 1. Comparison of outcomes in Cochrane Reviews and this systematic review Outcome Cochrane Review RR (95% CI) This systematic review Odds Ratio (95% CI) MgS04 None/other anti convulsant Preeclampsia (MgS04 vs none) Death RR 0.54 (0.26,1.10) N/A 0/214 7/383 Seizure RR 0.41 (0.29,0.58) N/A 2.7/10000 4.9/10000 5%£ 1.6%* Eclampsia (MgS04 vs other) Death RR 0.60 (0.36,1.00) = 0.31 (0.01, 8.28) to 0.80 (0.03, 20.62) 0-8.6% 2.5-16% RR 0.50 (0.24,1.05) Recurrent seizure RR 0.45 (0.35,0.58) = 0.30 (0.06, 1.62) to 1.07 (0.09, 12.71) 4.8-12.5% 6-32% RR 0.31 (0.20,0.47) Stillbirth RR 0.89 (0.63,1.26) = 0.43 (0.08, 2.37) to 0.69 (0.07, 7.19) 6-15% 3-23% RR 0.83 (0.61,1.13) Neonatal death RR 1.34 (0.84,2.14) = 0.62 (0.09, 4.32) to 1.07 (0.17, 6.56) 12% 12-22% RR 0.95 (0.59,1.53) CI = confidence interval, =diazepam, phenytoin, £high risk unit, *excluding MgS04 recipients. systematic review of randomised trials, involving over 11,000 women with pre-eclampsia, the use of magnesium sulphate compared with placebo or no anticonvulsant more than halved the risk of eclampsia. Antenatal magnesium sulphate has now been evaluated for fetal, infant and childhood neuroprotection prior to very preterm birth. The Cochrane systematic review included five randomised trials, involving over 4400 babies. In women at risk of very preterm birth, antenatal magnesium sulphate compared with placebo reduced the risk in the fetus, infant or risk of death or cerebral palsy, or cerebral palsy alone. The research evidence-base for the use of magnesium sulphate for neuroprotection of the mother and neonate has been used to prepare and update clinical practice guidelines worldwide. The clinical challenge is to ensure optimal, local implementation with removal of any research knowledgeimplementation barriers. The completed systematic reviews and clinical practice guidelines on the use of magnesium sulphate for neuroprotection highlight on-going research gaps and make recommendations for further research. These should become our priority for research, whether a health professional, consumer, policy maker or funder. W5.1 Maternal and infant outcomes on magnesium sulphate for preeclampsia/eclampsia: a systematic review comparing outcomes within trials with outcomes outside of trials Sarah McDonald1, Nancy Dzaja2, Olha Lutsiv3, Lelia Duley4. 1Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine and Department of Diagnostic Imaging, and Department of Clinical Epidemiology & Biosatistics, McMaster University, Hamilton, Ontario, Canada; 2Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada; 3Health Sciences, McMaster University, Hamilton, Ontario, Canada; 4University of Leeds, Centre for Epidemilogy and Biostatistics, Genetics, Health and Therapeutics, West Yorkshire, UK, UK Background: Eclampsia remains a leading cause of maternal mortality worldwide. Randomized trials have shown MgS04 reduces seizures in both preeclampsia and eclampsia, with trends towards decreases in mortality. It has been argued that outcome in trials may not always reflect outcome in similar situations outside of trials. Aim: To assess whether outcomes for women with preeclampsia and eclampsia treated with MgS04 outside of randomized trials differs from those within. Methods: We performed a systematic review of cohort, before-and-after and serial cross-sectional studies in 1) preeclamptic women who received either MgS04 or no anticonvulsant or 2) eclamptic women who received either MgS04 or another anticonvulsant. Primary outcomes were death (maternal, fetal, neonatal) or eclampsia/further seizures. Embase and Medline were searched from 1990 onwards (5 years before the Collaborative Eclampsia Trial publication). Results: Ten studies met inclusion criteria, mainly based in academic centres in Bangladesh, India, Pakistan, Saudi Arabia and Turkey (see Table 1 below). Conclusions: Outcomes outside RCTs are comparable to those within. This supports the view that results of RCTs are a reliable basis for clinical care.

Enhancing continuity of care and reducing unnecessary utilization in high-risk and homebound patients: the emerging role of the residentialist in the health care delivery system

As much as 6% of the aging population is severely disabled. A significant portion of Medicare spending is attributable to this population, who frequently use acute services and are prone to acute hospitalizations, hospital readmissions, and futile care. For this high-risk, frail, elderly population, data suggest that many of these episodes of care are compounded by suboptimal postdischarge continuity, and by ongoing gaps in access and continuity. An old model of care is emerging as a reinvention of the traditional house call, using the services of clinicians providing care in the home. This paper discusses the evolution of this practice model into a set of competencies and skills defined as residentialist care . Residentialists offer significant potential to create a disruptive innovation in care delivery, close gaps in care, and improve efficiency and continuity of health care to the high-risk, homebound, frail elderly.

Using evidence to inform clinical practice shortly after traumatic events

Despite ongoing gaps in our knowledge, there is now considerable research evidence available to inform clinical decisions and treatment plans shortly after traumatic events. The author uses two fictional cases to illustrate an evidence-based approach to clinical management following traumatic events. The importance of fully assessing individuals and tailoring management plans to address their specific needs optimally is highlighted by considering two distinct, but familiar types of presentation.

Prospective study of specialist oncology community nursing resulting in improvements in key patient supportive care outcomes

9107 Background: Cancer patients report ongoing significant gaps in supportive care. To date few interventions have been shown to improve supportive care outcomes in cancer. Research in other areas suggests that specialist nursing interventions in the community may address gaps in unmet need, continuity of care and quality of life. This study prospectively studied a community based nursing intervention for cancer patients. Methods: Patients were followed using a longitudinal cohort design, with assessments at baseline (T1), four (T2) and eight (T3) weeks, upon enrollment in a specialist nursing program. The nursing intervention included a comprehensive supportive care assessment and subsequent care delivery or linkage to appropriate services in the community. Validated patient assessment outcomes included: Supportive Cancer Needs Survey Short Form 34, Quality of Life (EORTC QLC-30(v3)), Continuity and Coordination of Care (CCCQ), and a service utilization instrument. Results: 72 of 109 enrolled patients completed all study measures. The majority had advanced stage disease. Median age was 59 years. Disease categories for participants included: breast (33%), gastrointestinal. (18.1%), lung (13.9%), ovarian (9.7%), and head and neck (8.3%). All participants received a baseline comprehensive assessment and had a mean of 1.7 home visits with a mean of 3.9 telephone contacts. We observed significant reductions in most supportive care need domains ( Table ). There were trends to improvement in domains of quality of life and continuity of care. We also observed reductions in acute care services use and increased community agency use. Conclusions: This is one of the first prospective studies in cancer patients that demonstrates improvements in a number of supportive care outcomes through a community based specialist nursing intervention. A randomized study to confirm these findings is currently underway. [Table: see text] No significant financial relationships to disclose.

From research methods to clinical practice in psychiatry: Challenges and opportunities in the developing world

Psychiatric disorders are amongst the most prevalent, burdensome, and costly of all medical disorders. Several factors make this an exciting time for research on these conditions; these include relevant advances in (1) nosology and epidemiology; (2) neuroscience, including neurogenetics, molecular neurobiology, cognitive-affective neuroscience, and brain imaging; (3) psychopharmacological and psychotherapeutic interventions; (4) systems research in mental health, including evaluation of evidence and of costs; and (5) patient advocacy and mental health literacy. At the same time, there are important challenges facing psychiatry researchers; these include (1) limitations of current diagnostic systems; (2) problems in attracting talented researchers to neuroscience and in obtaining sufficient funding for the vast amount of needed work; (3) a relative lack of controlled pharmacotherapeutic and psychotherapeutic studies undertaken outside the context of tertiary centres in the developed world; (4) ongoing gaps in systems research, including a relative lack of research on the effects of mental health policy; and (5) stigmatization of mental illness and anti-scientific beliefs in the community. These opportunities and challenges exist in both the developed and the developing world, but their scope may differ qualitatively and quantitatively; here we present a perspective from the developing world. We conclude with a wish list for the way forwards.

Renewing the model employer. Changing employment relations and "partnership" in the health and private sectors.

Drawing from original empirical data this paper compares the changing nature of employment relations in the health and private sectors. A key concern is to assess the extent to which the emergence of partnership-type arrangements between employers and trade unions lays the basis for the "renewal" of the traditional public sector concept of the model employer. Empirically, the paper draws on a survey of trade union representatives from 238 workplaces and a case study of a hospital trust. The data reveal that employment relations in the NHS are more collectivist when compared with the private sector. However, the development of partnership in the NHS is hamstrung by ongoing training and involvement gaps and widespread work intensification.

Re-fuelling the talent tank. A qualitative study of key deficiencies, future needs, and life-long learning needs of communication management professionals in Europe

This paper originates from the results of the EU financed project, ECOPSI, which advanced understanding about the professional competences of European public relations and communication managers. The paper focuses on deficiencies in competences that practitioners identify for themselves and on the needs for the future generation that will perform four professional roles: chief communication officer (CCO), crisis communication, social media, and internal communication. Questions to understand the roles and their future requirements were defined around: means for achievement of current competences to perform the role, competence gaps, specialized competences, and future needs. They were explored with qualitative methodology through 53 in depth interviews. The analysis of data shows that European professionals understand and evaluate their way of performing the practice through a complex framework of competences. The findings provide evidence of synergies in the understanding and interpretation of the four roles and there is common identification of on-going gaps and future needs, suggesting that public relations is a maturing discipline with an accumulated set of standards in Europe. The study also targets the capacity of intervention for advancing the profession to an approach of knowledge acquisition and supporting the previous academic consensus about the necessity of a body of knowledge and specialized skills for professionalization