Changing clinical practice. Prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism

OBJECTIVE: To determine the effect of continuing medical education (CME) with and without a quality assurance component (CME+QA) on physician practices in the prevention of venous thromboembolism. METHODS: A communitywide study was performed in 15 short-stay hospitals in central Massachusetts. The study population included 3158 patients in acute-care hospitals with multiple risk factors for venous thromboembolism. Study hospitals were randomly assigned to one of two educational strategies or to a control group that received no intervention. RESULTS: The proportion of patients at high risk for venous thromboembolism who received effective methods of prophylaxis increased significantly from 29% in 1986 to 52% in 1989 (P < .001). This increase was seen in all study groups: control hospitals, 40% to 51% (P < .001); CME hospitals, 21% to 49% (P < .0001); and CME+QA hospitals, 27% to 55% (P < .0001). The increase in prophylaxis use from 1986 to 1989 was significantly greater among patients cared for in hospitals whose physicians participated in a formal CME program (an increase of 28%) than in control hospitals (an increase of 11%) (P < .001). There was no significant difference in the use of prophylaxis in hospitals whose physicians received CME+QA interventions compared with hospitals whose physicians received CME interventions alone (identical increases of 28%). CONCLUSION: A formal CME program significantly increased the frequency with which physicians prescribed prophylaxis for venous thromboembolism. We believe the key factor in our CME interventions that motivated clinicians to change their practices was the provision of hospital-specific data demonstrating a compelling need for improvement. Despite the substantial investment by hospitals in QA, traditional QA intervention appeared to provide no additional benefit. Even after extensive CME/QA interventions, prophylaxis for venous thromboembolism remained underutilized, suggesting the need to develop new approaches to changing clinical practice.     

Mild traumatic brain injury--the Fife perspective

Excretion was studied of catecholamines and diphenilamine (DOPA) in 310 patients with carcinoma of the stomach and large intestine and 43 patients with non-malignant diseases. The oncological patients showed decrease in activity of the mediator link of the sympathoadrenal system (SAS) as well as its reserves but there was no association with sex, age, location or histological structure. Three types of SAS functioning were identified, such as compensation, overstrain and emaciation. Surgical intervention led to activation of the hormonal link and exhaustion of the system's reserves. Two kinds of sympathoadrenal response to stress were described--adequate and inadequate. In the former type, phases of stress remain as they are, unchanged, as are time periods of formation thereof, while under the latter one time periods of the phases formation or formation thereof get disordered.     

Bioethics in the medical subspecialty literature

The high affinity growth hormone-binding protein (GHBP) circulates in human blood and represents the extracellular domain of the growth hormone (GH) receptor. It is well known that repetitive bouts of endurance type exercise result in increased integrated GH secretion. As the effects of chronic exercise on plasma GHBP levels have never been studied systematically, we investigated the effect of 2 weeks of intense endurance training on plasma GHBP as well as on plasma insulin-like growth factor (IGF)-I levels in 10 healthy, young, non-obese men. IGF-I was measured as an indicator of the effects of GH release. We also studied 10 control subjects matched for sex, age and activity, who were instructed not to change their customary activities. GHBP was determined by FPLC size exclusion chromatography and subsequent Scatchard plot analysis of the binding data; IGF-I levels were measured by RIA. The results showed that plasma IGF-I and GHBP levels were increased in the subjects who followed the training program. IGF-I and GHBP changed from 252 +/- 56 ng/ml and 912 +/- 59 pmol/l before training, to 344 +/- 61 ng/ml (p < 0.01) and 1020 +/- 48 pmol/l (p < 0.01), respectively. Another effect of the training was that the aerobic capacity of these subjects was better utilized and endurance was improved. In contrast, plasma IGF-I, GHBP, utilization of aerobic capacity and endurance did not change significantly in the control subjects. We conclude that two weeks of strenuous endurance training lead to increased plasma IGF-I and high affinity GHBP levels.     

Recycling carbon fiber composites using microwave irradiation: Reinforcement study of the recycled fiber in new composites

With increasing use of carbon fiber reinforced polymer (CFRP) composites in transportation, sports, and many other industries, recycling of the scrap and end‐of‐life composites has presented both great challenges and opportunities. In this work, we report our study on reclaiming carbon fibers from CFRP using energy efficient microwave irradiation. Different irradiation conditions were used and the optimal conditions were determined based on the surface morphology of the recycled fiber. Polypropylene (PP) and Nylon, representing nonpolar and polar polymers, respectively, were reinforced using the recycled fiber through extrusion and injection molding. For comparison, PP and Nylon reinforced by virgin carbon fiber were also prepared using the same processing conditions. Tensile, flexural, and impact test results showed that, while both carbon fibers could improve these properties, they exhibited different reinforcing effects on the two polymers. The recycled fiber outperformed the virgin fiber in reinforcing PP whereas the virgin fiber performed better in Nylon. This was due to the differences in surface roughness, surface bonding, and fiber aspect ratio between the two fibers. This study shows the great potential of recycled carbon fiber and microwave irradiation as an effective recycling technique. © 2015 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2015 , 132, 42658.     

Fenton试剂氧化处理含丙烯腈废水

采用Fenton试剂氧化法处理自制的含丙烯腈(AN)废水(质量浓度为100 mg/L),通过气相色谱法、离子色谱法、元素分析等研究了处理废水产物的组成,并探讨了氧化反应机理。结果表明,在H2O2用量为1～4 mL、FeSO4.7 H2O质量浓度为600 mg/L、初始pH值为1.3～7.0的条件下处理200 mL废水时,AN可以被氧化生成不同状态的产物,其中绝大部分为气体产物,还有一定量的液体产物(含有一定量草酸和少量乙酸、乙醇酸、硝酸根和铵根离子)和固体产物(含C、N等元素的物质),AN转化率超过95%。     

硫酸法钛白生产中的废硫酸治理

探讨了硫酸法钛白生产中的废硫酸治理。采用一次浓缩和化学方法将２０ ％ 废硫酸制备相关的化工产品;采用石灰中和法治理１ ％ 废硫酸,达到较为理想的治理效果。     

Structural characterization of atomically regulated nanocrystals formed within single-walled carbon nanotubes using electron microscopy

The structural chemistry of nanoscale materials encapsulated within single-walled carbon nanotubes (SWNTs) is reviewed. SWNTs form atomically thin channels within a restricted diameter range, and their internal van der Waals surfaces regulate the growth behavior of encapsulated crystals in a precise fashion, leading to atomically regulated growth. The structural properties of these systems are largely dictated by the structural chemistry of the bulk material, although significant deviations from bulk structures are often observed, with lower surface coordinations and substantial lattice distortions.     

Solution structure of the sodium channel inactivation gate

The sodium channel initiates action potentials by opening in response to membrane depolarization. Fast channel inactivation, which is required for proper physiological function, is mediated by a cytoplasmic loop proposed to occlude the ion pore via a hinged lid mechanism with the triad IFM serving as a hydrophobic "latch". The NMR solution structure of the isolated inactivation gate reveals a stably folded core comprised of an alpha-helix capped by an N-terminal turn, supporting a model in which the tightly folded core containing the latch motif pivots on a more flexible hinge region to occlude the pore during inactivation. The structure, in combination with substituted cysteine mutagenesis experiments, indicates that the IFM triad and adjacent Thr are essential components of the latch and suggests differing roles for the residues of the IFMT motif in fast inactivation.     

Synthesis and biological evaluation of certain new thiazolopyrimidines

A series of 5-methyl-3-phenyl thiazolo[5,4-e][1,2,4]triazolo[1,5-c] pyrimidin-2-thiones and 5-methyl-3-phenyl thiazolo[5,4-e]pyrimidino[3,4-b][1,2,4]triazin-2-thiones were prepared as potential antimicrobial and antitumor agents. Some of the tested compounds showed promising activity. The detailed synthesis, spectroscopic and biological data are reported.