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参与质量改进协作对员工组织可持续性感知的影响。
BACKGROUND:Sustainability capacity (SC), which is an organization's ability to implement and maintain change, is influenced by internal attributes, environmental contextual influencers, and intervention attributes. Temporal changes in staff SC perceptions, as well as the influence of quality improvement collaborative (QIC) participation, has generally not been explored. This project addresses this gap, measuring staff SC perceptions at four time points (baseline and every 9 months) for clinics participating in an intervention - the Network for the Improvement of Addiction Treatment QIC initiative (called NIATx200). METHODS:A mixed linear model repeated measures analysis was applied to matched staff members (n = 908, representing 2329 total cases) across the evaluation timeframe. Three separate statistical models assessed potential predictors of SC perceptions: Time (Models I-III); NIATx200 intervention, staff job function, and tenure (Models II &III); and NIATx200 participation hours and four organizational variables (Model III). RESULTS:For Model I, staff perceptions of total SC increased throughout most of the study (t1,4 = - 6.74, p < .0001; t2,4 = - 3.100, p < .036; t3,4 = - 0.23, p = ns). Model II did not change Model I's overall Time effect, but combined NIATx200 services (t = - 2.23, p = .026), staff job function (t = - 3.27, p = .001), and organizational administrators (t = - 3.50, p = .001) were also significantly associated with greater perceptions of total SC. Inclusion of additional variables in Model III demonstrated the importance of a higher participation level (t = - 3.09, p < .002) and being in a free-standing clinic (t = - 2.06, p < .04) on staff perceptions of total SC. CONCLUSION:Although staff exposure to sustainability principals was minimal in NIATx200, staff perceptions about their organization's SC significantly differed over time. However, an organization's participation level in a QIC became the principal predictor of staff SC perceptions, regardless of other factors' influence. Given these findings, it is possible to develop and introduce specific sustainability content within the structure of a QIC to assess the impact on staff SC perceptions over time and the sustainment of organizational change. TRIAL REGISTRATION:ClinicalTrials.gov , NCT00934141 . Registered July 6, 2009. Retrospectively registered.
背景: 可持续性能力 (SC) 是组织实施和维持变革的能力,受内部属性、环境背景影响者和干预属性的影响。员工SC感知的时间变化,以及质量改进协作 (QIC) 参与的影响,通常还没有被探索。该项目解决了这一差距,在四个时间点 (基线和每9个月) 测量工作人员对参与干预的诊所的SC感知 -- 改善成瘾治疗的网络QIC倡议 (称为NIATx200)。 方法: 在整个评估时间范围内,将混合线性模型重复测量分析应用于匹配的工作人员 (n = 908,代表2329个总案例)。三个独立的统计模型评估了SC感知的潜在预测因子: 时间 (模型i-iii); NIATx200干预、员工工作职能和任期 (模型II和III); NIATx200参与时间和四个组织变量 (模型III)。 结果: 对于模型I,员工对总SC的感知在大部分研究中增加 (t1,4 = - 6.74,p < 。0001; t2,4 = - 3.100,p < 。036; t3,4 = - 0.23,p = ns ns)。模型II没有改变模型I的整体时间效应,而是结合了NIATx200服务 (t = - 2.23,p = .026) 、员工工作职能 (t = - 3.27,p = .001) 和组织管理员 (t = - 3.50,P = .001) 也与对总SC的更大感知显著相关。在模型III中包含额外变量证明了更高的参与水平 (t = - 3.09,p < .002) 和在独立诊所 (t = - 2.06,p < .04) 对员工对总SC的看法的重要性。 结论: 尽管在NIATx200中,员工对可持续发展原则的接触很少,但随着时间的推移,员工对其组织SC的看法显著不同。然而,一个组织在QIC中的参与水平成为员工SC感知的主要预测因素,而不管其他因素的影响。鉴于这些调查结果,有可能在QIC的结构中制定和引入具体的可持续性内容,以评估随着时间的推移对工作人员SC看法的影响以及组织变革的维持。 试验注册: clinicaltrials.Gov,NCT00934141。2009年7月6日注册。回顾性登记。
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METHODS::The ATP binding-cassette superfamily corresponds the mostly transmembrane transporters family found in humans. These proteins actively transport endogenous and exogenous substrates through biological membranes in body tissues, so they have an important role in the regulation of many physiological functions necessary for human homeostasis, as well as in response regulation to several pharmacological substrates. The development of multidrug resistance has become one of the main troubles in conventional chemotherapy in different illnesses including cancer, being the increased efflux of antineoplastic drugs the main reason for this multidrug resistance, with a key role of the ABC superfamily. Likely, the interindividual variability in the pharmacological response among patients is well known, and may be due to intrinsically factors of the disease, genetic and environmental ones. Thus, the understanding of this variability, especially the genetic variability associated with the efficacy and toxicity of drugs, can provide a safer and more effective pharmacological treatment, so ABC genes are considered as important regulators due to their relationship with the reduction in pharmacological response. In this review, updated information about transporters belonging to this superfamily was collected, the possible role of these transporters in cancer, the role of genetic variability in their genes, as well as some therapeutic tools that have been tried to raise against main transporters associated with chemoresistance in cancer.
METHODS:BACKGROUND:Cholinergic neurotransmission regulates neuroinflammation in Parkinson disease (PD). RESEARCH DESIGN AND METHODS:The authors conducted a delayed-start study of donepezil for cognitive decline in non-demented PD patients. The study consisted of a 96-week randomized placebo-controlled double-blind phase 1, followed by a 24-week donepezil extension phase 2. The primary outcome measure was a change in the Mini-Mental State Examination (MMSE) at week 120. RESULTS:A total of 98 patients were randomly allocated to the early-start (donepezil-to-donepezil) and delayed-start (placebo-to-donepezil) groups. Mean (SD) of the baseline MMSE was 27.6 (2.0) and 28.0 (2.1), respectively. MMSE change at week 120 was better in the early-start group than in the delayed-start group, but the difference was not significant. The MMSE declined in apolipoprotein ε4 carriers, but not in non-carriers, and the factor interaction (intervention × ε4 genotype) was highly significant (P < 0.001). Analyzed with the interaction, the difference was significant (group difference 1.95 [0.33 to 3.57], P = 0.018). The MMSE decline slope in phase 1 was significantly better in the early-start group than in the delayed-start group (P = 0.048). CONCLUSIONS:Cognitive function deteriorated in ε4 carriers, but not in non-carriers, and early-start donepezil may postpone cognitive decline in the former.
METHODS::Since the discovery of dental pulp stem cells, a lot of teams have expressed an interest in dental pulp regeneration. Many approaches, experimental models and biological explorations have been developed, each including the use of stem cells and scaffolds with the final goal being clinical application in humans. In this review, the authors' objective was to compare the experimental models and strategies used for the development of biomaterials for tissue engineering of dental pulp with stem cells. Electronic queries were conducted on PubMed using the following terms: pulp regeneration, scaffold, stem cells, tissue engineering and biomaterial. The extracted data included the following information: the strategy envisaged, the type of stem cells, the experimental models, the exploration or analysis methods, the cytotoxicity or viability or proliferation cellular tests, the tests of scaffold antibacterial properties and take into account the vascularization of the regenerated dental pulp. From the 71 selected articles, 59% focused on the "cell-transplantation" strategy, 82% used in vitro experimentation, 58% in vivo animal models and only one described an in vivo in situ human clinical study. 87% used dental pulp stem cells. A majority of the studies reported histology (75%) and immunohistochemistry explorations (66%). 73% mentioned the use of cytotoxicity, proliferation or viability tests. 48% took vascularization into account but only 6% studied the antibacterial properties of the scaffolds. This article gives an overview of the methods used to regenerate dental pulp from stem cells and should help researchers create the best development strategies for research in this field.
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