A systematic review of the implementation and impact of asthma protocols

BACKGROUND: Asthma is one of the most common childhood illnesses. Guideline-driven clinical care positively affects patient outcomes for care. There are several asthma guidelines and reminder methods for implementation to help integrate them into clinical workflow. Our goal is to determine the most prevalent method of guideline implementation; establish which methods significantly improved clinical care; and identify the factors most commonly associated with a successful and sustainable implementation. METHODS: PUBMED (MEDLINE), OVID CINAHL, ISI Web of Science, and EMBASE. Study Selection: Studies were included if they evaluated an asthma protocol or prompt, evaluated an intervention, a clinical trial of a protocol implementation, and qualitative studies as part of a protocol intervention. Studies were excluded if they had non-human subjects, were studies on efficacy and effectiveness of drugs, did not include an evaluation component, studied an educational intervention only, or were a case report, survey, editorial, letter to the editor. RESULTS: From 14,478 abstracts, we included 101 full-text articles in the analysis. The most frequent study design was pre-post, followed by prospective, population based case series or consecutive case series, and randomized trials. Paper-based reminders were the most frequent with fully computerized, then computer generated, and other modalities. No study reported a decrease in health care practitioner performance or declining patient outcomes. The most common primary outcome measure was compliance with provided or prescribing guidelines, key clinical indicators such as patient outcomes or quality of life, and length of stay. CONCLUSIONS: Paper-based implementations are by far the most popular approach to implement a guideline or protocol. The number of publications on asthma protocol reminder systems is increasing. The number of computerized and computer-generated studies is also increasing. Asthma guidelines generally improved patient care and practitioner performance regardless of the implementation method

Genetic modifiers of radon-induced lung cancer risk: a genome-wide interaction study in former uranium miners

PURPOSE: Radon is a risk factor for lung cancer and uranium miners are more exposed than the general population. A genome-wide interaction analysis was carried out to identify genomic loci, genes or gene sets that modify the susceptibility to lung cancer given occupational exposure to the radioactive gas radon. METHODS: Samples from 28 studies provided by the International Lung Cancer Consortium were pooled with samples of former uranium miners collected by the German Federal Office of Radiation Protection. In total, 15,077 cases and 13,522 controls, all of European ancestries, comprising 463 uranium miners were compared. The DNA of all participants was genotyped with the OncoArray. We fitted single-marker and in multi-marker models and performed an exploratory gene-set analysis to detect cumulative enrichment of significance in sets of genes. RESULTS: We discovered a genome-wide significant interaction of the marker rs12440014 within the gene CHRNB4 (OR = 0.26, 95% CI 0.11-0.60, p = 0.0386 corrected for multiple testing). At least suggestive significant interaction of linkage disequilibrium blocks was observed at the chromosomal regions 18q21.23 (p = 1.2 × 10-6), 5q23.2 (p = 2.5 × 10-6), 1q21.3 (p = 3.2 × 10-6), 10p13 (p = 1.3 × 10-5) and 12p12.1 (p = 7.1 × 10-5). Genes belonging to the Gene Ontology term "DNA dealkylation involved in DNA repair" (GO:0006307; p = 0.0139) or the gene family HGNC:476 "microRNAs" (p = 0.0159) were enriched with LD-blockwise significance. CONCLUSION: The well-established association of the genomic region 15q25 to lung cancer might be influenced by exposure to radon among uranium miners. Furthermore, lung cancer susceptibility is related to the functional capability of DNA damage signaling via ubiquitination processes and repair of radiation-induced double-strand breaks by the single-strand annealing mechanism

EXAFS Spectroscopy of Fractional Mixed-Valence Charge Density Wave Systems

We present extended X-ray absorption fine structure (EXAFS) spectra and modeling of a series of structurally tunable quasi-one-dimensional mixed-valence platinum-halide linear chain materials, [Pt(en2)][Pt(en2)X2](ClO4)4 with X = Cl, Br, I. The materials exhibit a commensurate charge density wave with fractional charge states on alternating platinum ions in the chain, as well as a Peierls distortion with alternating platinum-halide bond lengths. The amplitude of the charge density wave and, correspondingly, the extent of the Peierls distortion are controlled by the identity of the bridging halide ion. We have carried out ab initio multiple scattering calculations using the FEFF9 code to relate the oriented Pt LIII EXAFS spectra to the tunable electronic and structural properties. The spectral modeling reveals distinct photoelectron threshold energy values for the two inequivalent platinum ions in each of the mixed-valence chains, with values that vary systematically with fractional valence state. The difference in the photoelectron threshold energies of the two inequivalent platinum ions within each material correlates directly with the amplitude of the charge density wave, reflecting the decrease in charge density wave strength through the halide series X = Cl, Br, and I. We use dynamical matrix modeling to relate the experimentally determined mean-square relative displacement parameters for the metal-halide bond distances to the chain-axis vibrational modes that modulate the charge density wave structure. In addition, we discuss the EXAFS fitting results for the Pt-I bond lengths in the [Pt(en2)][Pt(en2)I2](ClO4)4 complex in comparison to previous, mutually inconsistent structural determinations for this material