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1.
Br J Cancer ; 2024 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-38969866

RESUMEN

BACKGROUND: Invadopodia facilitate cancer cell extravasation, but the molecular mechanism whereby invadopodia-specific proteases such as MT1-MMP are called to invadopodia is unclear. METHODS: Mass spectrometry and immunoprecipitation were used to identify interactors of MT1-MMP in metastatic breast cancer cells. After identification, siRNA and small molecule inhibitors were used to assess the effect these interactors had on cellular invasiveness. The chicken embryo chorioallantoic membrane (CAM) model was used to assess extravasation and invadopodia formation in vivo. RESULTS: In metastatic breast cancer cells, MT1-MMP was found to associate with plectin, a cytolinker and scaffolding protein. Complex formation between plectin and MT1-MMP launches invadopodia formation, a subtype we termed iplectin (i = invadopodial). iPlectin delivers MT1-MMP to invadopodia and is indispensable for regulating cell surface levels of the enzyme. Genetic depletion of plectin with siRNA reduced invadopodia formation and cell invasion in vitro. In vivo extravasation efficiency assays and intravital imaging revealed iplectin to be a key contributor to invadopodia ultrastructure and essential for extravasation. Pharmacologic inhibition of plectin using the small molecule Plecstatin-1 (PST-1) abrogated MT1-MMP delivery to invadopodia and extravasation efficiency. CONCLUSIONS: Anti-metastasis therapeutic approaches that target invadopodia are possible by disrupting interactions between MT1-MMP and iplectin. CLINICAL TRIAL REGISTRATION NUMBER: NCT04608357.

2.
Org Biomol Chem ; 21(18): 3715-3732, 2023 05 10.
Artículo en Inglés | MEDLINE | ID: mdl-36825573

RESUMEN

Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the two "major cannabinoids". However, their incorporation into clinical and nutraceutical preparations is challenging, owing to their limited bioavailability, low water solubility, and variable pharmacokinetic profiles. Understanding the organic chemistry of the major cannabinoids provides us with potential avenues to overcome these issues through derivatization. The resulting labile pro-drugs offer ready cannabinoid release in vivo, have augmented bioavailability, or demonstrate interesting pharmacological properties in their own right. This review identifies and discusses a subset of these advanced derivatization strategies for the major cannabinoids, where the starting material is the pure phytocannabinoid itself, and the final product either a cannabinoid pro-drug, or a novel pharmacoactive material.


Asunto(s)
Cannabidiol , Cannabinoides , Profármacos , Disponibilidad Biológica , Cannabinoides/farmacología , Dronabinol/química , Dronabinol/farmacocinética , Cannabidiol/química , Cannabidiol/farmacocinética , Administración Oral
3.
Chem Asian J ; 18(6): e202201308, 2023 Mar 14.
Artículo en Inglés | MEDLINE | ID: mdl-36705487

RESUMEN

Weak intermolecular forces are typically very difficult to observe in highly competitive polar protic solvents as they are overwhelmed by the quantity of competing solvent. This is even more challenging for three-component ternary assemblies of pure organic compounds. In this work, we overcome these complications by leveraging the binding of fused aromatic N-heterocycles in an open resorcinarene cavity to template the formation of a three-component halogen-bonded ternary assembly in a protic polar solvent system.

4.
Proc Natl Acad Sci U S A ; 119(4)2022 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-35064078

RESUMEN

Prostate-specific membrane antigen (PSMA) is highly overexpressed in most prostate cancers and is clinically visualized using PSMA-specific probes incorporating glutamate-ureido-lysine (GUL). PSMA is effectively absent from certain high-mortality, treatment-resistant subsets of prostate cancers, such as neuroendocrine prostate cancer (NEPC); however, GUL-based PSMA tracers are still reported to have the potential to identify NEPC metastatic tumors. These probes may bind unknown proteins associated with PSMA-suppressed cancers. We have identified the up-regulation of PSMA-like aminopeptidase NAALADaseL and the metabotropic glutamate receptors (mGluRs) in PSMA-suppressed prostate cancers and find that their expression levels inversely correlate with PSMA expression and are associated with GUL-based radiotracer uptake. Furthermore, we identify that NAALADaseL and mGluR expression correlates with a unique cell cycle signature. This provides an opportunity for the future study of the biology of NEPC and potential therapeutic directions. Computationally predicting that GUL-based probes bind well to these targets, we designed and synthesized a fluorescent PSMA tracer to investigate these proteins in vitro, where it shows excellent affinity for PSMA, NAALADaseL, and specific mGluRs associated with poor prognosis.


Asunto(s)
Antígenos de Superficie/metabolismo , Glutamato Carboxipeptidasa II/metabolismo , Glutamatos , Lisina , Sondas Moleculares , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/metabolismo , Urea , Animales , Antígenos de Superficie/química , Sitios de Unión , Proteínas de Ciclo Celular/genética , Proteínas de Ciclo Celular/metabolismo , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Técnica del Anticuerpo Fluorescente , Colorantes Fluorescentes/síntesis química , Colorantes Fluorescentes/química , Expresión Génica , Glutamato Carboxipeptidasa II/química , Glutamatos/química , Humanos , Inmunohistoquímica , Lisina/química , Masculino , Ratones , Modelos Moleculares , Conformación Molecular , Imagen Molecular/métodos , Sondas Moleculares/química , Neoplasias de la Próstata/genética , Unión Proteica , Receptores de Ácido Kaínico/genética , Receptores de Ácido Kaínico/metabolismo , Relación Estructura-Actividad , Urea/análogos & derivados , Urea/química
5.
Dalton Trans ; 49(26): 9086-9093, 2020 Jul 07.
Artículo en Inglés | MEDLINE | ID: mdl-32572417

RESUMEN

The preparation of a series of 4,4',5,5'-substituted benzo-fused 1,2,5,6-tetrathiocins X2C6H2S4C6H2X2 (1a-1g) were prepared from the reaction of S2Cl2 with 1,2-C6H4X2 (X = OMe, OEt; X2 = OCH2O, OCH2CH2O, OCH2CH2CH2O, MeNC([double bond, length as m-dash]O)NMe, O(CH2CH2O)4). The oxidative addition of 1a-1g to zero-valent Pd2dba3 or Pt2dba3 (dba = dibenzylideneacetone) in the presence of bis (diphenylphosphino)ethane (dppe) resulted in formation of the substituted mononuclear benzenedithiolate complexes M(L)(dppe) [L = dithiolate ligand; 2a-2g (M = Pd) and 3a-3g (M = Pt)] in 37-89% yield based on recrystallized material. Representative examples of M(L)(dppf) [dppf = bis-diphenylphosphinoferrocene; 4a, 4g (M = Pd) and 5g (M = Pt)] were prepared in a similar fashion. The structures of all derivatives were determined by X-ray diffraction, multinuclear NMR and elemental analysis. The reactivity of the two crown ether dithiolate complexes, 2g and 4g, with 1 equivalent of NaBPh4 led to isolation of the 1 : 1 complexes in which the Na+ cation is bound in the macrocyclic crown, [Na(2g)(MeOH)2][BPh4] and [Na(4g)][BPh4] whose structures were determined by X-ray diffraction. Electrochemical studies supported through DFT calculations on the crown ether derivatives revealed a series of ligand-based oxidation waves corresponding to the dithiolate ligand (and dppf for 4g and 5g) whose redox potentials were shifted by ca. +0.1 V on binding to Na+.

6.
Molecules ; 23(12)2018 Dec 14.
Artículo en Inglés | MEDLINE | ID: mdl-30558190

RESUMEN

The heavier chalcogens sulfur and selenium are important in organic and inorganic chemistry, and the role of such chalcogens in biological systems has recently gained more attention. Sulfur and, to a lesser extent selenium, are involved in diverse reactions from redox signaling to antioxidant activity and are considered essential nutrients. We investigated the ability of the DFT functionals (B3LYP, B3PW91, ωB97XD, M06-2X, and M08-HX) relative to electron correlation methods MP2 and QCISD to produce reliable and accurate structures as well as thermochemical data for sulfur/selenium-containing systems. Bond lengths, proton affinities (PA), gas phase basicities (GPB), chalcogen⁻chalcogen bond dissociation enthalpies (BDE), and the hydrogen affinities (HA) of thiyl/selenyl radicals were evaluated for a range of small polysulfur/selenium compounds and cysteine per/polysulfide. The S⁻S bond length was found to be the most sensitive to basis set choice, while the geometry of selenium-containing compounds was less sensitive to basis set. In mixed chalcogens species of sulfur and selenium, the location of the sulfur atom affects the S⁻Se bond length as it can hold more negative charge. PA, GPB, BDE, and HA of selenium systems were all lower, indicating more acidity and more stability of radicals. Extending the sulfur chain in cysteine results in a decrease of BDE and HA, but these plateau at a certain point (199 kJ mol-1 and 295 kJ mol-1), and PA and GPB are also decreased relative to the thiol, indicating that the polysulfur species exist as thiolates in a biological system. In general, it was found that ωB97XD/6-311G(2d,p) gave the most reasonable structures and thermochemistry relative to benchmark calculations. However, nuances in performance are observed and discussed.


Asunto(s)
Polímeros/química , Selenio/química , Azufre/química , Cisteína/química , Compuestos de Selenio/química , Termodinámica
7.
J Phys Chem B ; 122(3): 1092-1101, 2018 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-29281289

RESUMEN

Archaeal threonyl-tRNA synthetase (ThrRS) possesses an editing active site wherein tRNAThr that has been misaminoacylated with serine (i.e., Ser-tRNAThr) is hydrolytically cleaved to serine and tRNAThr. It has been suggested that the free ribose sugar hydroxyl of Ado76 of the tRNAThr (Ado762'OH) is the mechanistic base, promoting hydrolysis by orienting a nucleophilic water near the scissile Ser-tRNAThr ester bond. We have performed a computational study, involving molecular dynamics (MD) and hybrid ONIOM quantum mechanics/molecular mechanics (QM/MM) methods, considering all possible editing mechanisms to gain an understanding of the role played by Ado762'OH group. More specifically, a range of concerted or stepwise mechanisms involving four-, six-, or eight-membered transition structures (total of seven mechanisms) were considered. In addition, these seven mechanisms were fully optimized using three different DFT functionals, namely, B3LYP, M06-2X, and M06-HF. The M06-HF functional gave the most feasible energy barriers followed by the M06-2X functional. The most favorable mechanism proceeds stepwise through two six-membered ring transition states in which the Ado762'OH group participates, overall, as a shuttle for the proton transfer from the nucleophilic H2O to the bridging oxygen (Ado763'O) of the substrate. More specifically, in the first step, which has a barrier of 25.9 kcal/mol, the Ado762'-OH group accepts a proton from the attacking nucleophilic water while concomitantly transferring its proton onto the substrates C-Ocarb center. Then, in the second step, which also proceeds with a barrier of 25.9 kcal/mol, the Ado762'-OH group transfers its proton on the adjacent Ado763'-oxygen, cleaving the scissile Ccarb-O3'Ado76 bond, while concomitantly accepting a proton from the previously formed C-OcarbH group.


Asunto(s)
Adenosina Difosfato Ribosa/metabolismo , Treonina-ARNt Ligasa/metabolismo , Adenosina Difosfato Ribosa/química , Conformación Molecular , Simulación de Dinámica Molecular , Teoría Cuántica , Treonina-ARNt Ligasa/química
8.
Phys Chem Chem Phys ; 19(37): 25598-25609, 2017 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-28905057

RESUMEN

Glutaminyl-tRNA synthetase (GlnRS) catalyzes the aminoacylation of glutamine to the corresponding tRNAGln. However, most bacteria and all archaea lack GlnRS and thus an indirect noncanonical aminoacylation is required. With the assistance of a non-discriminating version of Glutamyl-tRNA synthetases (ND-GluRS) the tRNAGln is misaminoacylated by glutamate. In this study, we have computationally investigated the aminoacylation mechanism in GlnRS and ND-GluRS employing Molecular Dynamics (MD) simulations, Quantum Mechanics (QM) cluster and Quantum Mechanics/Molecular Mechanics (QM/MM) calculations. Our investigations demonstrated the feasibility of a water-mediated, substrate-assisted catalysis pathway with rate limiting steps occurring at energy barriers of 25.0 and 25.4 kcal mol-1 for GlnRS and ND-GluRS, respectively. A conserved lysine residue participates in a second proton transfer to facilitate the departure of the adenosine monophosphate (AMP) group. Thermodynamically stable (-29.9 and -9.3 kcal mol-1 for GlnRS and ND-GluRS) product complexes are obtained only when the AMP group is neutral.


Asunto(s)
Aminoacil-ARNt Sintetasas/metabolismo , Aminoacilación , Simulación de Dinámica Molecular , Archaea , Glutamato-ARNt Ligasa , Ácido Glutámico , Glutamina , Agua
9.
J Org Chem ; 81(22): 10930-10941, 2016 11 18.
Artículo en Inglés | MEDLINE | ID: mdl-27690149

RESUMEN

A second-generation approach to the synthesis of hydromorphone by oxidative dearomatization/Diels-Alder cycloaddition was investigated. Detailed analysis of the stereochemical outcome of the [4 + 2] cycloaddition was performed first on a truncated model system as well as on the material leading to ent-hydromorphone. The stereochemical assignments were made by NMR and X-ray methods. The second-generation synthesis of hydromorphone was completed in both enantiomeric series. Improvements in the dearomatization conditions were attained using hypervalent iodine reagents instead of Pb(OAc)4. Electrochemical methods of oxidative dearomatization were also investigated. New conditions enabling the rearomatization of ring A from the methoxyketal were developed, and a formal synthesis of the natural enantiomer of hydromorphone was completed. Experimental and spectral data are provided for all new compounds.

10.
PLoS One ; 11(8): e0161726, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27579865

RESUMEN

The recent establishment of a minimum age estimate of 39.9 ka for the origin of rock art in Sulawesi has challenged claims that Western Europe was the locus for the production of the world's earliest art assemblages. Tantalising excavated evidence found across northern Australian suggests that Australia too contains a wealth of ancient art. However, the dating of rock art itself remains the greatest obstacle to be addressed if the significance of Australian assemblages are to be recognised on the world stage. A recent archaeological project in the northwest Kimberley trialled three dating techniques in order to establish chronological markers for the proposed, regional, relative stylistic sequence. Applications using optically-stimulated luminescence (OSL) provided nine minimum age estimates for fossilised mudwasp nests overlying a range of rock art styles, while Accelerator Mass Spectrometry radiocarbon (AMS 14C) results provided an additional four. Results confirm that at least one phase of the northwest Kimberley rock art assemblage is Pleistocene in origin. A complete motif located on the ceiling of a rockshelter returned a minimum age estimate of 16 ± 1 ka. Further, our results demonstrate the inherent problems in relying solely on stylistic classifications to order rock art assemblages into temporal sequences. An earlier than expected minimum age estimate for one style and a maximum age estimate for another together illustrate that the Holocene Kimberley rock art sequence is likely to be far more complex than generally accepted with different styles produced contemporaneously well into the last few millennia. It is evident that reliance on techniques that produce minimum age estimates means that many more dating programs will need to be undertaken before the stylistic sequence can be securely dated.


Asunto(s)
Arqueología , Arte , Cultura , Fósiles , Australia , Humanos
11.
Inorg Chem ; 54(19): 9384-6, 2015 Oct 05.
Artículo en Inglés | MEDLINE | ID: mdl-26371499

RESUMEN

The outcome of the oxidative addition reactions of bis(4',5'-dimethoxybenzo)-1,2,5,6-tetrathiocin to Pd2dba3 under microwave conditions is sensitive to the nature of the phosphine coreagent; the bidentate phosphines dppm, dppe, and dppf afford the mononuclear dithiolates (dmobdt)Pd(dppm) (4), (dmobdt)Pd(dppe) (2), and (dmobdt)Pd(dppf) (5), whereas more labile monodentate phosphines lead to aggregation; Ph3P afforded the dinuclear dithiolate (dmobdt)2Pd2(PPh3)2 (6), whereas (t)Bu3P generated the phosphine-free hexanuclear edge-capped octahedral complex Pd6(dmobdt)6 (7) [dmobdt = 4,5-dimethoxybenzenedithiolate, (MeO)2C6H2S2(2-)].

12.
Dalton Trans ; 44(12): 5284-7, 2015 Mar 28.
Artículo en Inglés | MEDLINE | ID: mdl-25708496

RESUMEN

Treatment of the imine PhC(=NSiMe3)py with Et2BOMe or BF3·Et2O afforded bicyclic ketiminoboranes and via intramolecular N-coordination. The basicity of the imine N is evidenced by their reactivity towards Brønsted and Lewis acids and the structures of ·HCl and ·BF3 are reported as well as the dipyridyl imine derivative ·HCl.

13.
Dalton Trans ; 44(5): 2071-4, 2015 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-25563651

RESUMEN

Cu(II)-promoted aerial oxidation of a series of benzothiadiazines () under ambient conditions affords the first structurally characterised examples of thiadiazine S-oxides (). The isolation of the homoleptic Cu(II) 3-(2'-pyridyl)benzothiadiazide-S-oxide complex provides insight into the reaction mechanism.

14.
Dalton Trans ; 43(34): 12996-3005, 2014 Sep 14.
Artículo en Inglés | MEDLINE | ID: mdl-25030211

RESUMEN

Reaction of the novel ligand 3-(2'-pyridyl)-benzo-1,2,4-thiadiazine (L) with the transition metal chloride salts MCl2·xH2O (M(II) = Mn, Fe, Co, Cu and Zn) in a 2 : 1 mole ratio afforded the mononuclear octahedral (high spin) complexes L2MCl2 (1a-1e respectively) in which L binds in a chelate fashion via N(2) and the pyridyl N atoms. In the case of CuCl2 the intermediate 1 : 1 four-coordinate complex LCuCl2 (2) was also isolated which adopts a polymeric structure with pseudo-square planar molecules linked via long Cu···S contacts (d(Cu···S) = 2.938(1) Å) in the apical position. In the presence of non-interacting ions, 3 : 1 complexes are isolated, exemplified by the reaction of L with Fe(CF3SO3)2 in a 3 : 1 ratio which affords the low spin complex [L3Fe][CF3SO3]2 (3). Reaction of L with VCl3 in a 2 : 1 mole ratio under aerobic conditions afforded the vanadyl complex [L2V(=O)Cl][Cl] (4).

15.
Inorg Chem ; 53(16): 8610-23, 2014 Aug 18.
Artículo en Inglés | MEDLINE | ID: mdl-25073110

RESUMEN

The syntheses, structures, and magnetic properties of three new coordination complexes, tetranuclear [Zn2L(3)(OAc)(OMe)]2·3MeOH·H2O (3), trinuclear [Ni3(L(3))3]·6H2O (4), and a 1-D chain {[Cu2L(3)(OAc)2]2·H2O}n (6), of a polydentate, doubly deprotonated, 3,3'-disubstituted bipyridine ligand [L(3)](2-) are reported. The X-ray crystal structures demonstrate that the ditopic ligand provides a flexible N3 donor set for transition metal ions where each binding pocket shifts from fac to intermediate fac/mer to the mer isomer affording a Ni3 triangle, a Zn4 tetramer, and a 1-D Cu(II) polymer, respectively. This variation in coordination preference is rationalized with the aim of designing future ligands with controlled coordination modes. Magnetic susceptibility studies on 4 reveal it belongs to the rare family of ferromagnetically coupled [Ni3] clusters. In contrast, magnetic studies of the 1-D chain 6 reveal weak antiferromagnetic interactions due to the poor orbital overlap of the singly occupied Cu(II) d(x(2)-y(2)) orbitals with the one-atom bridge that connects them along the Jahn-Teller distortion axis.

16.
Dalton Trans ; 43(3): 1332-7, 2014 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-24196875

RESUMEN

High loading of the radical PhCNSSN˙ (1) into faujasite has been achieved via gas phase diffusion. Whilst the large 12 Å pores can accommodate the enthalpically preferred dimer, the smaller pores dictate inclusion as a paramagnetic monomer. Powder X-ray diffraction studies reveal the host framework is unchanged whilst TGA reveal that the void space has high radical loadings. SQUID magnetometry coupled with EPR spectroscopy indicate that the majority of radicals adopt diamagnetic π*-π* dimers consistent with predominant location of 1 as dimers within the large cavities.

17.
Dalton Trans ; 43(6): 2352-5, 2014 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-24352526

RESUMEN

A unique octanuclear copper(II) cluster with a saddle-shaped structural topology has been prepared from a large, flexible polydentate ligand comprising a 4,4'-bipyridine linker bearing four pendant pyrazolate heterocycles.


Asunto(s)
Cobre/química , Compuestos Organometálicos/química , Modelos Moleculares , Estructura Molecular , Piridinas/química
18.
Dalton Trans ; 43(5): 2134-9, 2014 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-24287761

RESUMEN

Oxidative addition of the electron-rich tetra-methoxy-dibenzo-1,2,5,6-tetrathiocine [(MeO)2C6H2S2]2 to zero-valent group 10 transition metal complexes in the presence of diphenylphosphinoethane (dppe) affords the corresponding dithiolate complexes, [(DMOBD)M(dppe)] (DMOBD = dimethoxybenzenedithiolato, (MeO)2C6H2S2(2-); M = Ni, Pd, Pt) in high yield which were characterized by single crystal X-ray diffraction. Whereas the Pd and Pt complexes exhibit two quasi-reversible 1e(-) oxidation processes, the nickel species undergoes a quasi-reversible 1e(-) reduction.

19.
Artif Intell Med ; 49(3): 187-95, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20483571

RESUMEN

OBJECTIVE: We consider predictive models for clinical performance of pancreatic cancer patients based on machine learning techniques. The predictive performance of machine learning is compared with that of the linear and logistic regression techniques that dominate the medical oncology literature. METHODS AND MATERIALS: We construct predictive models over a clinical database that we have developed for the University of Massachusetts Memorial Hospital in Worcester, Massachusetts, USA. The database contains retrospective records of 91 patient treatments for pancreatic tumors. Classification and regression targets include patient survival time, Eastern Cooperative Oncology Group (ECOG) quality of life scores, surgical outcomes, and tumor characteristics. The predictive performance of several techniques is described, and specific models are presented. RESULTS: We show that machine learning techniques attain a predictive performance that is as good as, or better than, that of linear and logistic regression, for target attributes that include tumor N and T stage, survival time, and ECOG quality of life scores. Bayesian techniques are found to provide the best performance overall. For tumor size as the target attribute, however, logistic regression (respectively linear regression in the case of a numerical as opposed to discrete target) performs best. Preprocessing in the form of attribute selection and supervised attribute discretization improves predictive performance for most of the predictive techniques and target attributes considered. CONCLUSION: Machine learning provides techniques for improved prediction of clinical performance. These techniques therefore merit consideration as valuable alternatives to traditional multivariate regression techniques in clinical medical studies.


Asunto(s)
Inteligencia Artificial , Sistemas de Administración de Bases de Datos , Neoplasias Pancreáticas/cirugía , Algoritmos , Humanos , Neoplasias Pancreáticas/fisiopatología , Calidad de Vida , Resultado del Tratamiento
20.
Public Health ; 122(6): 602-12, 2008 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-18222510

RESUMEN

BACKGROUND: This paper presents the methods and findings of a survey of current service configuration in tuberculosis screening, treatment and prevention in England and Wales, which was conducted as part of the development of the National Institute for Health and Clinical Excellence guidelines on tuberculosis for the country. METHODS: A random sample of health protection units (HPUs) was surveyed (stratified geographically) in England. For Wales, National Health Service boundaries were used. There was a 100% sample of HPUs (33 clinics) in London and a 50% sample (81 clinics) outside London. The survey was completed by nurses in tuberculosis clinics. The questionnaire asked for details of caseload in terms of active disease (notified cases) and latent infection (screening and chemoprophylaxis), and the different types of specialist tuberculosis services offered. RESULTS: Completed surveys were obtained from 67 of 81 clinics outside London and all 33 clinics in London. An association was found between the number of notifications and personnel, in line with previous British Thoracic Society guidelines. Higher notification areas, especially in London, provide additional specialist services such as human immunodeficiency virus/tuberculosis clinics and specialist paediatric clinics. Clinics in London also reported higher usage of incentives, directly observed therapy (DOT) and free prescriptions. Low notification areas outside London tend to see more patients at home for contact tracing and treatment review. However, there is considerable variation in the use of DOT and chemoprophylaxis that is not entirely explained by differences in caseload. CONCLUSIONS: The survey showed that service configuration was organized in different ways in both high and low incidence areas. There is a need to share good practice and explore ways to configure services effectively in line with local needs.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Tuberculosis/terapia , Atención a la Salud , Inglaterra , Encuestas de Atención de la Salud , Humanos , Medicina Estatal , Encuestas y Cuestionarios , Tuberculosis/diagnóstico , Gales , Recursos Humanos
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