Sphingomyelin-enriched microdomains at the Golgi complex.

Sphingomyelin- and cholesterol-enriched microdomains can be isolated as detergent-resistant membranes from total cell extracts (total-DRM). It is generally believed that this total-DRM represents microdomains of the plasma membrane. Here we describe the purification and detailed characterization of microdomains from Golgi membranes.

Proof and policy from medical research evidence.

When judging the benefits and harms of health care and predicting patient prognosis, clinicians, researchers, and others must consider many types of evidence. Medical research evidence is part of the required knowledge base, and practitioners of evidence-based medicine must attempt to integrate the best available clinical evidence from systematic research with health professionals' expertise and patients' rights to be informed about diagnostic and therapeutic options available to them. Judging what constitutes sound evidence can be difficult because of, among other things, the sheer quantity, diversity, and complexity of medical evidence available today; the various scientific methods that have been advanced for assembling, evaluating, and interpreting such information; and the guides for applying medical research evidence to individual patients' situations.

Screening and treating adults for lipid disorders.

Context: Screening and treatment of lipid disorders in people at high risk for future coronary heart disease (CHD) events has gained wide acceptance, especially for patients with known CHD, but the proper role in people with low to medium risk is controversial.

Objective: To examine the evidence about the benefits and harms of screening and treatment of lipid disorders in adults without known cardiovascular disease for the U.S.

Current methods of the US Preventive Services Task Force: a review of the process.

The U.S. Preventive Services Task Force (USPSTF/Task Force) represents one of several efforts to take a more evidence-based approach to the development of clinical practice guidelines.

Health outcomes methodology symposium: summary and recommendations.

Background: Interest in the philosophy and techniques of the assessment of health outcomes has burgeoned, prompting research funding agencies and others to examine traditional and emerging methods for outcome measurement.

Objectives: This report summarizes the presentations and discussions at and research recommendations stemming from an invitational symposium on health outcomes methodology convened in September 1999.

Research Design: The summary is based on the preliminary drafts of all formal reports and discussions, transcripts of all presentations and plenary discussions, and notes from breakout groups.

Applying cognitive design principles to formatting HRQOL instruments.

Researchers developing or using health-related quality of life (HRQOL) instruments can benefit from knowledge of state-of-the-art formatting methods for self-administered questionnaires. Three objectives in formatting design are: (1) to reduce errors in respondent navigation through the questionnaire that lead to item non-response and question misinterpretation; (2) to reduce respondent and administrative burden; and (3) to enhance respondent motivation in question answering and compliance with the request to participate. Based on an extensive literature review to identify techniques that have been shown to meet these objectives, we developed specific guidelines for HRQOL instruments concerning all aspects of questionnaire formatting.

Evidence-based practice and nursing: commentary.

With changes in health care, it has become clear that nurses need data to establish evidence for their decisions and interventions. Evidence-based practice involves the use of the best evidence available for making clinical decisions about patient care. The identification of the knowledge base for nursing practice contributes to achieving patient outcomes and making nursing practice credible.

Assessing "best evidence": issues in grading the quality of studies for systematic reviews.

Background: Evidence-based medicine, clinical practice guidelines, quality and value of health services, and science-based decision making are becoming mainstays of the health care sector. As part of the evidence-based movement, systematic reviews of the literature on clinical questions are becoming increasingly common. Part of the structured approach to evaluating the literature involves assessing the quality of individual studies included in systematic reviews.

Lack of efficacy of oral bovine type II collagen added to existing therapy in rheumatoid arthritis.

Objective: To investigate the efficacy of oral type II collagen (CII) in the treatment of rheumatoid arthritis (RA), when added to existing therapy.

Methods: Patients with active RA (n = 190) were randomized into a 6-month, double-blind, placebo-controlled trial. Patients continued to take their current arthritis medications.

Pharmacological treatment of alcohol dependence: a review of the evidence.

Context: Alcoholism affects approximately 10% of Americans at some time in their lives. Treatment consists of psychosocial interventions, pharmacological interventions, or both, but which drugs are most effective at enhancing abstinence and preventing relapse has not been systematically reviewed.

Objective: To evaluate the efficacy of 5 categories of drugs used to treat alcohol dependence--disulfiram, the opioid antagonists naltrexone and nalmefene, acamprosate, various serotonergic agents (including selective serotonergic reuptake inhibitors), and lithium.

Health policy issues and applications for evidence-based medicine and clinical practice guidelines.

Evidence-based medicine and clinical practice guidelines have become increasingly salient to the international health care community in the 1990s. Key issues in health policy in this period can be categorised as costs and access to care, quality of and satisfaction with care, accountability for value in health care, and public health and education. This paper presents a brief overview of evidence-based medicine and clinical practice guidelines and describes how they are likely to influence health policy.

Measuring and improving quality and performance in an evolving health-care sector.

How can the challenges of quality measurement, assurance, and improvement be met at the national, state, and community levels? Can we sustain high levels of quality of care in an evolving health sector that wants to control costs and needs to extend access to millions of people? Can we find new ways to measure clinical practice performance and improve quality that will work more effectively in both the private and public sectors? All these questions demand answers in the context of contemporary circumstances.

Improving health care outcomes through geriatric rehabilitation. Conference summary.

The Boston Working Group on Improving Health Care Outcomes Through Geriatric Rehabilitation was structured around four major themes: (1) defining disability or disablement; (2) the patient's experience of the processes and outcomes of care; (3) the role and value of clinical practice guidelines; and (4) the need for casemix and severity or risk adjustment procedures and measures. These discussions produced opening statements of policy or empiric issues and recommendations about the best means of demonstrating the benefits of geriatric rehabilitation and, in particular, how to measure, ensure, and improve the quality of rehabilitation services, especially for the elderly. This article summarizes the reports from the work groups and identifies some common themes.

Evaluating quality-of-life and health status instruments: development of scientific review criteria.

The Medical Outcomes Trust is a depository and distributor of high-quality, standardized, health outcomes measurement instruments to national and international health communities. Every instrument in the Trust library is reviewed by the Scientific Advisory Committee against a rigorous set of eight attributes. These attributes consist of the following: (1) conceptual and measurement model; (2) reliability; (3) validity; (4) responsiveness; (5) interpretability; (6) respondent and administrative burden; (7) alternative forms; and (8) cultural and language adaptations.