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1.
Emerg Infect Dis ; 30(3): 591-594, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38407227

ABSTRACT

We report 2 autochthonous feline thelaziosis cases caused by the eyeworm Thelazia callipaeda and discuss the spread among dogs in the northeastern United States. Phylogenetic analysis suggests the parasite was introduced from Europe. Adopting a One Health approach is needed to limit further spread of T. callipaeda eyeworms in North America.


Subject(s)
Cat Diseases , Dog Diseases , Thelazioidea , Cats , Animals , Dogs , Cat Diseases/epidemiology , Phylogeny , Dog Diseases/epidemiology , New England , Loa , Thelazioidea/genetics
2.
Carcinogenesis ; 43(4): 311-320, 2022 05 19.
Article in English | MEDLINE | ID: mdl-35166350

ABSTRACT

Currently, the only definitive method for diagnosing ovarian cancer involves histological examination of tissue obtained at time of surgery or by invasive biopsy. Blood has traditionally been the biofluid of choice in ovarian cancer biomarker discovery; however, there has been a growing interest in exploring urinary biomarkers, particularly as it is non-invasive. In this systematic review, we present the diagnostic accuracy of urinary biomarker candidates for the detection of ovarian cancer. A comprehensive literature search was performed using the MEDLINE/PubMed and EMBASE, up to 1 April 2021. All included studies reported the diagnostic accuracy using sensitivity and/or specificity and/or receiver operating characteristics (ROC) curve. Risk of bias and applicability of included studies were assessed using the QUADAS-2 tool. Twenty-seven studies were included in the narrative synthesis. Protein/peptide biomarkers were most commonly described (n = 18), with seven studies reporting composite scores of multiple protein-based targets. The most frequently described urinary protein biomarker was HE4 (n = 5), with three studies reporting a sensitivity and specificity > 80%. Epigenetic (n = 1) and metabolomic/organic compound biomarkers (n = 8) were less commonly described. Overall, six studies achieved a sensitivity and specificity of >90% and/or an AUC > 0.9. Evaluation of urinary biomarkers for the detection of ovarian cancer is a dynamic and growing field. Currently, the most promising biomarkers are those that interrogate metabolomic pathways and organic compounds, or quantify multiple proteins. Such biomarkers require external validation in large, prospective observational studies before they can be implemented into clinical practice.


Subject(s)
Ovarian Neoplasms , Biomarkers , Biomarkers, Tumor , Carcinoma, Ovarian Epithelial , Female , Humans , Observational Studies as Topic , Ovarian Neoplasms/diagnosis , Proteins , ROC Curve , Sensitivity and Specificity
3.
Pers Individ Dif ; 187: 111393, 2022 Mar.
Article in English | MEDLINE | ID: mdl-34789957

ABSTRACT

The COVID-19 pandemic has taken a massive toll on mental well-being. The unprecedented level of uncertainty associated with the pandemic may be a contributing factor to stress and anxiety, especially among individuals with high intolerance to uncertainty (Rettie & Daniels, 2021). Individual differences in need for cognitive closure have also been linked to mental distress during unpredictable situations (Berenbaum et al., 2008). The present study tested the hypothesis that individuals with a high need for cognitive closure would experience relatively higher stress and anxiety during the COVID-19 pandemic. College students (N = 400) completed an abbreviated Need for Closure Scale (Roets & Van Hiel, 2011), the Generalized Anxiety Disorder Scale (Spitzer et al., 2006), and the short-version of the Perceived Stress Scale (Cohen & Williamson, 1988). Results supported the hypothesized relationship between high need for cognitive closure and higher levels of stress and anxiety. Findings have relevance to college students who are experiencing heightened psychological stress during the COVID-19 pandemic.

4.
Mol Microbiol ; 110(4): 596-615, 2018 11.
Article in English | MEDLINE | ID: mdl-30192418

ABSTRACT

ExoS/ChvI two-component signaling in the nitrogen-fixing α-proteobacterium Sinorhizobium meliloti is required for symbiosis and regulates exopolysaccharide production, motility, cell envelope integrity and nutrient utilization in free-living bacteria. However, identification of many ExoS/ChvI direct transcriptional target genes has remained elusive. Here, we performed chromatin immunoprecipitation followed by microarray analysis (chIP-chip) to globally identify DNA regions bound by ChvI protein in S. meliloti. We then performed qRT-PCR with chvI mutant strains to test ChvI-dependent expression of genes downstream of the ChvI-bound DNA regions. We identified 64 direct target genes of ChvI, including exoY, rem and chvI itself. We also identified ChvI direct target candidates, like exoR, that are likely controlled by additional regulators. Analysis of upstream sequences from the 64 ChvI direct target genes identified a 15 bp-long consensus sequence. Using electrophoretic mobility shift assays and transcriptional fusions with exoY, SMb21440, SMc00084, SMc01580, chvI, and ropB1, we demonstrated this consensus sequence is important for ChvI binding to DNA and transcription of ChvI direct target genes. Thus, we have comprehensively identified ChvI regulon genes and a 'ChvI box' bound by ChvI. Many ChvI direct target genes may influence the cell envelope, consistent with the critical role of ExoS/ChvI in growth and microbe-host interactions.


Subject(s)
Bacterial Proteins/metabolism , Gene Expression Regulation, Bacterial/genetics , Sinorhizobium meliloti/genetics , Sinorhizobium meliloti/metabolism , Transcription Factors/metabolism , Bacterial Proteins/genetics , Binding Sites/genetics , DNA-Binding Proteins/genetics , Genome, Bacterial/genetics , Glucosyltransferases/genetics , Protein Binding/genetics , Signal Transduction , Symbiosis/genetics , Transcription Factors/genetics , Transcription, Genetic/genetics
5.
Yale J Biol Med ; 92(1): 115-120, 2019 03.
Article in English | MEDLINE | ID: mdl-30923478

ABSTRACT

With advances in technology and increases in global urbanization, the complexity of our sensory environment has increased dramatically in the last few hundred years. However, our brains have remained essentially unchanged. The cognitive resources that support complex goal-directed behaviors operate differently in urban versus natural environments. In this short perspective, we consider how the attention system, designed for interacting with nature, is taxed by urban environments and discuss how exposure to nature may support its rejuvenation.


Subject(s)
Attention/physiology , Environment , Nature , Urbanization , Humans
6.
N Z Med J ; 137(1598): 33-43, 2024 Jul 05.
Article in English | MEDLINE | ID: mdl-38963929

ABSTRACT

AIMS: The aims of this research include adapting a patient information tool for whanau (extended family) Maori needs, identifying and reviewing written information provided for the retinopathy of prematurity eye examination (ROPEE) and identifying improvements to ROPEE written information. METHODS: ROPEE patient information (printed leaflets, website, app) was obtained from all tertiary neonatal intensive care units in Aotearoa New Zealand (Aotearoa). Information was reviewed using an adapted "20 good-design principles" guide and given a star rating and Flesch-Kincaid readability score to identify acceptability and usability for patients. RESULTS: Seven ROPEE information materials were reviewed and varied in alignment with the adapted good-design principles tool. Based on the adapted good-design principles, opportunities were identified in many aspects of the written information for improvement, including words and language, tone and meaning, content and design. The Flesch-Kincaid grade level reading scores ranged from 12-22 years reading age. Written information also did not use te reo Maori (Aotearoa Indigenous language) or extensively use Maori imagery. CONCLUSION: Opportunities exist to improve ROPEE whanau information, including making content more readable, understandable and visually appealing. Optimising the clinical information on ROPEE nationally for Aotearoa will support whanau decision making, and aligning written information with Maori (Indigenous peoples of Aotearoa) is a priority.


Subject(s)
Native Hawaiian or Other Pacific Islander , Retinopathy of Prematurity , Humans , New Zealand , Retinopathy of Prematurity/diagnosis , Infant, Newborn , Patient Education as Topic/methods , Pamphlets , Intensive Care Units, Neonatal , Infant, Premature
7.
Pathogens ; 12(11)2023 Oct 26.
Article in English | MEDLINE | ID: mdl-38003748

ABSTRACT

The American Association of Equine Practitioners strongly advocates evidence-based intestinal strongyle control in horses. It recommends targeted treatment of all heavy egg shedders (>500 eggs per gram (EPG) of feces), while the low shedders (0-200 EPG) are left untreated. As 50-75% of adult horses in a herd are low shedders, preventing them from unnecessary anthelmintic exposure is critical for tackling resistance. There are various fecal egg count (FEC) techniques with many modifications and variations in use, but none is identified as a gold standard. The hypothesis of the study was that the diagnostic performance of 12 commonly used quantitation methodologies (three techniques with four variants) differs. In this regard, method comparison studies were performed using polystyrene beads as proxy for intestinal strongyle eggs. Mini-FLOTAC-based variants had the lowest coefficient of variation (CV%) in bead recovery, whereas McMaster variants had the highest. All four variants of Mini-FLOTAC and the NaNO3 1.33 specific gravity variant of modified Wisconsin followed a linear fit with R2 > 0.95. In contrast, the bead standard replicates for modified McMaster variants dispersed from the regression curve, causing a lower R2. The Mini-FLOTAC method seems less influenced by the choice of floatation solution and has better repeatability parameters and linearity for bead standard recovery. For FEC tests with high R2 (>0.95) but that underestimated the true bead count, a correction factor (CF) was determined to estimate the true count. Finally, the validity of CF was analyzed for 5 tests with R2 > 0.95 to accurately quantify intestinal strongyle eggs from 40 different horses. Overall, this study identified FEC methodologies with the highest diagnostic performance. The limitations in standardizing routine FEC tests are highlighted, and the importance of equalization of FEC results is emphasized for promoting uniformity in the implementation of parasite control guidelines.

8.
Article in English | MEDLINE | ID: mdl-37520629

ABSTRACT

To prepare students to address water-related challenges, undergraduate STEM education must provide them with opportunities to learn and reason about water issues. Water in Society is an introductory-level, innovative, and interdisciplinary undergraduate course offered annually at a large midwestern university. The course focuses on both disciplinary concepts and civic engagement, and is designed around a variety of interactive, research-based practices to support students' learning, engagement with authentic data, scientific models and modeling, and collaboration and learning among peers. This study aims to evaluate, "how have student outcomes and perceptions changed over five years of the course?". The results are based on data from students (n = 326) in five consecutive years of the course, during which time the course transitioned from a face-to-face model to fully asynchronous online model due, in part, to impacts of the COVID-19 pandemic. The particularly rapid and abrupt transition between 2020 and 2021 in response to COVID-19 led to many course changes, including modes of communication between instructors and students and opportunities for collaboration. Here, multiple measures are used to evaluate students' learning about water concepts, model-based reasoning about socio-hydrologic systems, and perceptions of the course across all five years. By the end of each iteration of the course, students improved their knowledge of hydrologic concepts, independent of the course format or other student-level variables. However, results also show that students' performance on complex socio-hydrologic systems modeling tasks, as well as their overall satisfaction with the course, decreased in Year 5 when the course was fully online. Results provide insight into efforts to move undergraduate STEM courses online and specific evidence of the COVID-19 pandemic's impacts on undergraduate STEM teaching and learning about water. Supplementary Information: The online version contains supplementary material available at 10.1186/s43031-022-00049-y.

10.
Memory ; 18(3): 265-71, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20209425

ABSTRACT

Research on retrieval-induced forgetting has shown that the selective retrieval of some information can cause the forgetting of other information. Such forgetting is believed to result from inhibitory processes that function to resolve interference during retrieval. The current study examined whether individuals with ADHD demonstrate normal levels of retrieval-induced forgetting. A total of 40 adults with ADHD and 40 adults without ADHD participated in a standard retrieval-induced forgetting experiment. Critically, half of the items were tested using category cues and the other half of the items were tested using category-plus-one-letter-stem cues. Whereas both ADHD and non-ADHD participants demonstrated retrieval-induced forgetting on the final category-cued recall test, only non-ADHD participants demonstrated retrieval-induced forgetting on the final category-plus-stem-cued recall test. These results suggest that individuals with ADHD do have a deficit in the inhibitory control of memory, but that this deficit may only be apparent when output interference is adequately controlled on the final test.


Subject(s)
Attention Deficit Disorder with Hyperactivity/psychology , Cues , Memory , Mental Recall , Analysis of Variance , Female , Humans , Male , Models, Psychological , Psychological Tests , Young Adult
11.
New Phytol ; 182(4): 891-911, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19383098

ABSTRACT

This study compared the leaf transcription profiles, physiological characteristics and primary metabolites of two Populus tremuloides genotypes (clones 216 and 271) known to differ in their responses to long-term elevated [CO2] (e[CO2]) at the Aspen free-air CO2 enrichment site near Rhinelander, WI, USA. The physiological responses of these clones were similar in terms of photosynthesis, stomatal conductance and leaf area index under e[CO2], yet very different in terms of growth enhancement (0-10% in clone 216; 40-50% in clone 271). Although few genes responded to long-term exposure to e[CO2], the transcriptional activity of leaf e[CO2]-responsive genes was distinctly different between the clones, differentially impacting multiple pathways during both early and late growing seasons. An analysis of transcript abundance and carbon/nitrogen biochemistry suggested that the CO2-responsive clone (271) partitions carbon into pathways associated with active defense/response to stress, carbohydrate/starch biosynthesis and subsequent growth. The CO2-unresponsive clone (216) partitions carbon into pathways associated with passive defense (e.g. lignin, phenylpropanoid) and cell wall thickening. This study indicates that there is significant variation in expression patterns between different tree genotypes in response to long-term exposure to e[CO2]. Consequently, future efforts to improve productivity or other advantageous traits for carbon sequestration should include an examination of genetic variability in CO2 responsiveness.


Subject(s)
Carbon Dioxide/pharmacology , Carbon/metabolism , Gene Expression Profiling , Gene Expression Regulation, Plant/drug effects , Plant Leaves/drug effects , Plant Leaves/genetics , Populus/genetics , Clone Cells , Gene Expression Regulation, Plant/radiation effects , Genes, Plant/genetics , Genetic Variation/drug effects , Genetic Variation/radiation effects , Genotype , Light , Nitrogen/metabolism , Organ Size/drug effects , Organ Size/radiation effects , Photosynthesis/drug effects , Photosynthesis/radiation effects , Plant Leaves/radiation effects , Plant Stems/anatomy & histology , Plant Stems/drug effects , Plant Stems/radiation effects , Populus/drug effects , Populus/physiology , Populus/radiation effects , RNA, Messenger/genetics , RNA, Messenger/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Seasons , Transcription, Genetic/drug effects , Transcription, Genetic/radiation effects
13.
J Atten Disord ; 11(2): 141-9, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17494831

ABSTRACT

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is associated with poor inhibition of prepotent responses and deficits in distractor inhibition, but relatively few studies have addressed inhibitory control of proactive interference (PI) in individuals with ADHD. Thus, the goal of the present study was to evaluate resistance to spatial and verbal PI in adults with ADHD. METHOD: Adults with ADHD (n = 32) and adults without ADHD (n = 32) performed a spatial inhibition of return (IOR) task and a semantic IOR task. RESULTS: Adults with and without ADHD showed effective spatial IOR. On the semantic IOR task, adults without ADHD showed semantic inhibition, whereas adults with ADHD showed semantic facilitation (positive priming) instead. CONCLUSION: Adults with ADHD may have domain-specific deficits in resistance to proactive interference. Research has theoretical and clinical implications for adults with ADHD.


Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Color Perception , Orientation , Pattern Recognition, Visual , Proactive Inhibition , Psychomotor Performance , Semantics , Adolescent , Adult , Attention , Attention Deficit Disorder with Hyperactivity/psychology , Female , Humans , Male , Reaction Time
14.
J Atten Disord ; 10(1): 44-53, 2006 Aug.
Article in English | MEDLINE | ID: mdl-16840592

ABSTRACT

OBJECTIVE: Children with ADHD show attention-switching impairment. The present study assessed attention-switching ability in adults with ADHD, the extent to which this ability can be improved via targeted training, and the degree to which training extends to novel tasks of attention-switching. METHOD: Adults with ADHD (n = 16) and adults without ADHD (n = 18) were divided into training and non-training groups. Training groups performed six blocks of four different attention-switching tasks, while non-training groups completed non-switching, "filler" tasks. Lastly, the four groups were tested on two novel attention-switching tasks. RESULTS: Adults with ADHD showed impaired attention-switching, relative to non-ADHD adults, but training significantly improved attention-switching in both ADHD and non-ADHD training groups. Finally, training effects transferred to new tasks of attention-switching. CONCLUSION: Adults with ADHD show attention-switching impairments, but deficits may be ameliorated with short-term, targeted training. Research has implications for cognitive training in ADHD.


Subject(s)
Attention Deficit Disorder with Hyperactivity/therapy , Attention , Cognitive Behavioral Therapy/methods , Teaching/methods , Adult , Female , Humans , Male , Treatment Outcome
15.
Health Policy ; 61(2): 153-71, 2002 Aug.
Article in English | MEDLINE | ID: mdl-12088889

ABSTRACT

In the United Kingdom the election of the 1997-2001 Labour government led to rapid development of drug treatment interventions in the criminal justice sector. One type of drug treatment intervention is arrest referral and this is the most developed and researched form of intervention within the United Kingdom (Arrest referral: emerging lessons from research, paper 23. London: Home Office; 1998). However, much of the published literature reports upon evaluations of working styles and practices of individual arrest referral schemes (ARS). This paper reports a follow-up study on the impact that intervention by an ARS had upon a group of drug-misusing arrestees, 18 months after their initial contact with the ARS. The findings from the follow-up study demonstrate that the intervention had had a positive impact on both drug misuse and offending among the sample. Sixty-four per cent had entered treatment and remained 'clean' following an intervention by the ARS. Analysis of the police national computer records for the sample demonstrated that 88% of those who remained 'clean' also ceased criminal activity. Additionally, the study highlighted other factors relevant to the treatment of drug misusers. Most of the sample had been in contact with health professionals during their misusing careers but the perceived negative attitude on the part of health professionals towards drug misusers and the lack of proactive, health-led interventions indicated that mainstream health care provision had failed this sample of problematic drug misusers. Another key factor to emerge from the study was the relevance of aftercare to the recovery process, which was needed to offer wide-ranging support to drug misusers in recovery, such as help with accommodation, learning basic life skills and constructing a new lifestyle without drugs. The study therefore has a dual outcome in demonstrating the positive impact of the ARS and in turn the rationale for the Government's 10-year anti-drugs strategy but it also highlights the weakness as aftercare is not a prominent feature of the strategy (Tackling drugs to build a better Britain, the government's ten year strategy for tackling drugs. London: The Stationery Office; 1998).


Subject(s)
Criminal Law/trends , Referral and Consultation , Substance Abuse Treatment Centers/organization & administration , Substance-Related Disorders/rehabilitation , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Policy Making , Prisoners/psychology , Program Evaluation , Social Justice , Substance Abuse Treatment Centers/statistics & numerical data , United Kingdom
17.
J Vet Diagn Invest ; 24(3): 572-5, 2012 May.
Article in English | MEDLINE | ID: mdl-22529128

ABSTRACT

Serological testing for toxoplasmosis diagnosis remains the method of choice in human medicine due to the accessibility of the requisite sample, the difficulty in predicting the parasite's location in the host for direct detection, and the availability of established commercial methods. In veterinary medicine, although the first 2 conditions are unchanged, there is a need for commercially produced test methods that are validated for Toxoplasma gondii detection across the range of animal species that can serve as intermediate hosts. The development of such a serological method for animals would allow the diagnosis of toxoplasmosis in individual animals and a higher throughput method for population-level toxoplasmosis surveys. The incorporation of a non-species-specific chimeric protein A/G conjugate into an anti-Toxoplasma immunoglobulin G enzyme-linked immunosorbent assay is described. Serum from potential intermediate hosts was reevaluated using this method and compared with earlier testing using an established agglutination procedure. Very good agreement between the 2 tests was noted (κ = 0.81), establishing the method as a useful option for veterinary diagnostic testing.


Subject(s)
Bacterial Proteins/chemistry , Enzyme-Linked Immunosorbent Assay/veterinary , Immunoglobulin G/blood , Recombinant Fusion Proteins/chemistry , Staphylococcal Protein A/chemistry , Toxoplasma/isolation & purification , Toxoplasmosis, Animal/diagnosis , Animals , Bacterial Proteins/genetics , Bacterial Proteins/immunology , ROC Curve , Recombinant Fusion Proteins/immunology , Sensitivity and Specificity , Staphylococcal Protein A/genetics , Staphylococcal Protein A/immunology , Toxoplasmosis, Animal/immunology , Toxoplasmosis, Animal/parasitology
18.
J Vet Diagn Invest ; 23(2): 297-301, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21398450

ABSTRACT

A challenge faced by veterinary diagnosticians in serologic analysis for exposure to pathogens is the need for a protein conjugate capable of antibody attachment in many animal species. The advent of protein conjugates that are less specific in nature allows diagnosis across many species with little or no modification of technique. Toxoplasma gondii is an organism of veterinary interest that has been demonstrated to infect a plethora of warm-blooded animals. However, the serologic tests available for simultaneous diagnosis in this broad range are limited in number. The current study examined the use of an immunoglobulin G enzyme-linked immunosorbent assay (ELISA) modified by the use of non-species-specific protein conjugates in domestic animal species commonly submitted to diagnostic laboratories for evaluation of Toxoplasma exposure status. Comparison with results from an established indirect hemagglutination technique revealed very good agreement between the 2 test methods. This modification of the ELISA provides a useful method for veterinary diagnosticians to perform rapid and accurate evaluation of multiple animal species for Toxoplasma exposure using a single test.


Subject(s)
Antigens, Protozoan/blood , Enzyme-Linked Immunosorbent Assay/veterinary , Immunoglobulin G/analysis , Toxoplasma/isolation & purification , Toxoplasmosis, Animal/parasitology , Zoonoses/parasitology , Animals , Enzyme-Linked Immunosorbent Assay/methods , Hemagglutination Inhibition Tests/veterinary , ROC Curve , Sensitivity and Specificity , Toxoplasma/immunology , Toxoplasmosis, Animal/blood
19.
Soc Work ; 55(3): 203-12, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20632655

ABSTRACT

There is a growing practice of adoption services on the Internet with varying degrees of regulation, depending on whether it is domestic infant adoption, public foster care adoption, or international adoption. Regulation is particularly lacking in domestic infant adoptions, with Web sites connecting prospective birth and adoptive parents, sometimes through an adoption brokerage service. International adoptions can also be plagued by unethical practices as the Internet has become available in both developed and developing countries. These activities, although offering the benefits of privacy and convenience, also pose serious problems of potential fraud, exploitation, and, most important, lack of professional consideration of the child's best interest. In this article, the authors review the landscape of current Internet-based adoption activities, examine the benefits and risks of Internet-based adoption activities, and call for social work self-regulation and leadership.


Subject(s)
Adoption/legislation & jurisprudence , Government Regulation , Internet , Fraud/prevention & control , Humans , United States
20.
J Nurs Manag ; 12(3): 201-9, 2004 May.
Article in English | MEDLINE | ID: mdl-15089958

ABSTRACT

OBJECTIVES: (1) To determine the acceptability of the Royal College of General Practitioner Guidelines to small samples of nurses, General Practitioners and acute back pain patients, (2) to determine what additional roles for nurses in the management of acute back pain in primary care might be acceptable to these samples, (3) to evaluate the responses of General Practitioners, nurses and patients to a suggested service model based on the RCGP Guidelines, (4) to identify opportunities for and barriers to the further development of such models and to obtain the appraisal of the above by an external group of assessors. METHODOLOGY: Using a qualitative design the pilot study included Primary Care (General Practitioners, Practice Nurses and Patients) with the main outcome measures as: appraisal questionnaires (for RCGP Guideline), qualitative content analysis of focus group narratives, and appraisal of process and outcomes by an external panel. RESULTS: Attitudes towards the RCGP guidelines were positive, but professionals and patients alike did not think their recommendations could be implemented with the current service provision in primary care. There was criticism by professionals of the capacity for a nurse-led service within practices. Access to chiropractors, osteopaths and/or specialist physiotherapists in National Health Service primary care was raised as a need by both groups. All members of the Advisory Panel approved the processes for the recruitment of participants, focus group questions and analysis. DISCUSSION: Barriers to implementation of the RCGP Guideline and to a nurse-led acute back pain service in general practice, were illustrated. These mainly relate to grossly inadequate capacity to deal with multidimensional patient needs, allowing progression to chronic pain states and much higher health care costs. There was a strong desire to include a different group of professionals in primary care. We recommend a local needs assessment and consideration of a national strategy for the implementation of the RCGP Guideline in primary care.


Subject(s)
Attitude of Health Personnel , Attitude to Health , Back Pain , Nurse Practitioners , Physicians, Family , Primary Health Care/standards , Acute Disease , Back Pain/nursing , Back Pain/psychology , Feasibility Studies , Female , Focus Groups , Guideline Adherence/standards , Humans , Male , Needs Assessment , Nurse Practitioners/organization & administration , Nurse Practitioners/psychology , Nurse's Role , Nursing Methodology Research , Physicians, Family/organization & administration , Physicians, Family/psychology , Pilot Projects , Practice Guidelines as Topic , Program Evaluation , Qualitative Research , State Medicine , United Kingdom
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