Virginia Commonwealth University

About: Virginia Commonwealth University is a education organization based out in Richmond, Virginia, United States. It is known for research contribution in the topics: Population & Health care. The organization has 23822 authors who have published 49587 publications receiving 1787046 citations. The organization is also known as: VCU.

Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement

Abstract: Importance Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States, accounting for 1 of every 3 deaths among adults. Objective To update the 2008 US Preventive Services Task Force (USPSTF) recommendation on screening for lipid disorders in adults. Evidence Review The USPSTF reviewed the evidence on the benefits and harms of screening for and treatment of dyslipidemia in adults 21 years and older; the benefits and harms of statin use in reducing CVD events and mortality in adults without a history of CVD events; whether the benefits of statin use vary by subgroup, clinical characteristics, or dosage; and the benefits of various treatment strategies in adults 40 years and older without a history of CVD events. Conclusions and Recommendations The USPSTF recommends initiating use of low- to moderate-dose statins in adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater (B recommendation). The USPSTF recommends that clinicians selectively offer low- to moderate-dose statins to adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5% to 10% (C recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older (I statement).

Continuing medical education and the physician as a learner: Guide to the evidence

Abstract: One faculty member in a professional school referred to continuing education as “shouting out of windows,” and an analysis of the programs at his institution shows the aptness of his metaphor: Faculty members who can be persuaded to do so give lectures on subjects of their own choosing to audiences they do not know, who have assembled only because they want to put in enough hours of classroom attendance so that they can meet a relicensure requirement. As a result, every profession now has members who vigorously oppose what they regard as the excessive promotion of continuing education. Cyril O. Houle, 1980 RESEARCHERS OF THE PAST DEcade produced systematic reviews of continuing medical education (CME) and other strategies intended to change physician behavior and improve patient outcomes. The subjects of the reviews included such concepts as audit and feedback, chart-based reminders, clinical practice guidelines, and formal lectures. Defined as interventions to change the behavior of physicians, the effects of those strategies were inconsistent across practitioners, settings, and behaviors. As a result, in the midst of contemporary discussions about quality improvement and the effects of continuing education, there is no singularly effective method for improving physician performance. Physicians must accept responsibility for their own continuous learning: setting goals and selecting educational activities to achieve those goals. We searched the Research and Development Resource Base in Continuing Medical Education and the Specialised Register of the Cochrane Effective Practice and Organization of Care group, supplemented by searches of MEDLINE from 1992 to February 2002 for systematic reviews and evidence of CME and its effect on both physicians and CME planners.

Survival from in-hospital cardiac arrest during nights and weekends.

Abstract: Context Occurrence of in-hospital cardiac arrest and survival patterns have not been characterized by time of day or day of week Patient physiology and process of care for in-hospital cardiac arrest may be different at night and on weekends because of hospital factors unrelated to patient, event, or location variables Objective To determine whether outcomes after in-hospital cardiac arrest differ during nights and weekends compared with days/evenings and weekdays Design and Setting We examined survival from cardiac arrest in hourly time segments, defining day/evening as 7:00 AM to 10:59 PM, night as 11:00 PM to 6:59 AM, and weekend as 11:00 PM on Friday to 6:59 AM on Monday, in 86 748 adult, consecutive in-hospital cardiac arrest events in the National Registry of Cardiopulmonary Resuscitation obtained from 507 medical/surgical participating hospitals from January 1, 2000, through February 1, 2007 Main Outcome Measures The primary outcome of survival to discharge and secondary outcomes of survival of the event, 24-hour survival, and favorable neurological outcome were compared using odds ratios and multivariable logistic regression analysis Point estimates of survival outcomes are reported as percentages with 95% confidence intervals (95% CIs) Results A total of 58 593 cases of in-hospital cardiac arrest occurred during day/evening hours (including 43 483 on weekdays and 15 110 on weekends), and 28 155 cases occurred during night hours (including 20 365 on weekdays and 7790 on weekends) Rates of survival to discharge (147% [95% CI, 143%-151%] vs 198% [95% CI, 195%-201%], return of spontaneous circulation for longer than 20 minutes (447% [95% CI, 441%-453%] vs 511% [95% CI, 507%-515%]), survival at 24 hours (289% [95% CI, 284%-294%] vs 354% [95% CI, 350%-358%]), and favorable neurological outcomes (110% [95% CI, 106%-114%] vs 152% [95% CI, 149%-155%]) were substantially lower during the night compared with day/evening (all P values < 001) The first documented rhythm at night was more frequently asystole (396% [95% CI, 390%-402%] vs 335% [95% CI, 332%-339%], P < 001) and less frequently ventricular fibrillation (198% [95% CI, 193%-202%] vs 229% [95% CI, 226%-232%], P < 001) Among in-hospital cardiac arrests occurring during day/evening hours, survival was higher on weekdays (206% [95% CI, 203%-21%]) than on weekends (174% [95% CI, 168%-18%]; odds ratio, 115 [95% CI, 109-122]), whereas among in-hospital cardiac arrests occurring during night hours, survival to discharge was similar on weekdays (146% [95% CI, 141%-152%]) and on weekends (148% [95% CI, 141%-152%]; odds ratio, 102 [95% CI, 094-111]) Conclusion Survival rates from in-hospital cardiac arrest are lower during nights and weekends, even when adjusted for potentially confounding patient, event, and hospital characteristics

The genome of Cryptosporidium hominis

Abstract: Cryptosporidium species cause acute gastroenteritis and diarrhoea worldwide. They are members of the Apicomplexa--protozoan pathogens that invade host cells by using a specialized apical complex and are usually transmitted by an invertebrate vector or intermediate host. In contrast to other Apicomplexans, Cryptosporidium is transmitted by ingestion of oocysts and completes its life cycle in a single host. No therapy is available, and control focuses on eliminating oocysts in water supplies. Two species, C. hominis and C. parvum, which differ in host range, genotype and pathogenicity, are most relevant to humans. C. hominis is restricted to humans, whereas C. parvum also infects other mammals. Here we describe the eight-chromosome approximately 9.2-million-base genome of C. hominis. The complement of C. hominis protein-coding genes shows a striking concordance with the requirements imposed by the environmental niches the parasite inhabits. Energy metabolism is largely from glycolysis. Both aerobic and anaerobic metabolisms are available, the former requiring an alternative electron transport system in a simplified mitochondrion. Biosynthesis capabilities are limited, explaining an extensive array of transporters. Evidence of an apicoplast is absent, but genes associated with apical complex organelles are present. C. hominis and C. parvum exhibit very similar gene complements, and phenotypic differences between these parasites must be due to subtle sequence divergence.