The value of formal clinical research training in initiating a career as a clinical investigator.

The aim of this study was to determine whether formal clinical research training is of value in the initiation of a successful career as a clinical investigator. We conducted a retrospective review of the career choices of all 25 fellows who entered the Academic Clinical Research Track at Brigham and Women's Hospital since its inception in 1995 and examined the impact of formal clinical research training during their fellowship on their career choice. The primary measure of a successful career as a clinical investigator was the obtainment of external funding for clinical research within 3 years of completion of fellowship.

Strain specific transcriptional response in Mycobacterium tuberculosis infected macrophages.

Background: Tuberculosis (TB), a bacterial infection caused by Mycobacterium tuberculosis (Mtb) remains a significant health problem worldwide with a third of the world population infected and nearly nine million new cases claiming 1.1 million deaths every year. The outcome following infection by Mtb is determined by a complex and dynamic host-pathogen interaction in which the phenotype of the pathogen and the immune status of the host play a role.

Sympathetic neural hyperalgesia edema syndrome, a frequent cause of pelvic pain in women, mistaken for Lyme disease with chronic fatigue.

Purpose: To show that chronic fatigue syndrome can be mistakenly attributed to Lyme disease rather than considering sympathetic neural hyperalgesia edema syndrome. This common disorder of women, frequently, but not always causing pelvic pain, can present simply as chronic fatigue.

Methods: A water load test was performed in a woman reactive for B-Burgdorferi with chronic fatigue whose symptoms did not improve despite three months of treatment with doxycycline.

Successful pregnancy following a single fresh embryo transfer in a 45-year-old woman whose early follicular phase serum follicle stimulating hormone was 29 mIU/ml.

Purpose: To determine if a successful pregnancy is possible following in vitro fertilization embryo transfer (IVF-ET) in a woman of advanced reproductive age with diminished egg reserve.

Methods: In vitro fertilization-embryo transfer with intracytoplasmic sperm injection (ICSI) was performed for a 45-year-old woman with a peak serum follicle stimulating hormone (FSH) level of 29 mIU/ml and a history of failing to conceive in five previous IVF-ET cycles at a younger age. A minimal FSH stimulation protocol was used.

Speculum retention during embryo transfer does not improve pregnancy rates following embryo transfer--a randomized study.

Purpose: To corroborate or refute two previous studies that suggested that a technique using prolonged speculum retention may improve pregnancy rates per embryo transfer.

Methods: Women undergoing day 3 embryo transfer were randomly assigned to the conventional transfer technique vs the speculum retention technique. The speculum retention technique involves following the embryo transfer not to withdraw the speculum but to loosen the screw in order to exert gentle pressure on the portiovaginalis of the cervix and leave it in for seven minutes.

Live fetus following embryo transfer in a woman with diminished egg reserve whose maximal endometrial thickness was less than 4 mm.

Purpose: To report the thinnest peak endometrial thickness to date resulting in a viable fetus following embryo transfer.

Methods: Mild ovarian hyperstimulation was given to a 35-year-old woman with not only a family history of premature ovarian failure but she also had diminished egg reserve.

Results: She consistently could not attain more than a 4 mm endometrial thickness in graduated estrogen replacement cycles or IVF-ET cycles.

Successful twin pregnancy in a donor oocyte recipient despite a maximum endometrial thickness in the late proliferative phase of 4 mm.

Purpose: To show that even a twin pregnancy is possible following embryo transfer despite a very thin endometrium.

Methods: Two embryos derived from donor oocytes were transferred into a 47-year-old woman despite a peak endometrial thickness of 4 mm.

Results: She delivered viable dichorionic twins at 30 weeks in a pregnancy complicated by HELLP syndrome.

Evidence that the main adverse effect of ganirelix on pregnancy and implantation rates is on the embryo rather than the endometrium.

Purpose: To compare pregnancy rates following the transfer of thawed frozen embryos according to the type of GnRH antagonist or agonist used during controlled ovarian hyperstimulation (COH).

Methods: Retrospective review of frozen embryo transfers according to whether a GnRH agonist or antagonist was used. Furthermore to determine if a specific antagonist/agonist resulted in higher pregnancy rates than the other.

Effect of multiple source vs single source of donor embryos on pregnancy and implantation rates per transfer.

Purpose: To evaluate whether using donated embryos from more than one source has a negative impact on pregnancy rates compared to a single source.

Methods: Retrospective review of all donor embryo transfers that occurred in our IVF center over a 10-year period. Embryos were all from our own patient pool.

Effect of serum progesterone level on the day of human chorionic gonadotropin injection on outcome following in vitro fertilization-embryo transfer in women using gonadotropin releasing hormone antagonists.

Purpose: To determine if there is any association of serum progesterone (P) level at the time of human chorionic gonadotropin (hCG) injection and pregnancy outcome in in vitro fertilization (IVF) cycles using gonadotropin releasing hormone (GnRH) antagonists for controlled ovarian hyperstimulation (COH).

Methods: A retrospective analysis of IVF cycles over a six and a half-year period where either cetrorelix or ganirelix was used with COH and at least two embryos were transferred. Female partners were < or = 35.

Blastomere number and pregnancy rates in the succeeding in vitro fertilization cycle in women who formed all embryos with < or = 5 blastomeres.

Purpose: To determine the likelihood of pregnancy following the transfer of embryos all with slow cleavage to day 3. Furthermore to determine the likelihood that if slow cleavage happens once, it is likely to repeat.

Methods: A 10-year retrospective review of in vitro fertilization-embryo transfer (IVF-ET) cycles was performed to identify day 3 embryo transfers where none of the embryos had > 5 blastomeres.

Evaluation of the importance of late follicular phase endometrial echo patterns and pregnancy outcome following embryo transfer by evaluating infertile donor/recipient pairs.

Purpose: To investigate if the late follicular phase echo pattern is associated with pregnancy outcome in donors vs recipients.

Methods: Infertile donors sharing eggs with recipients were retrospectively evaluated. The endometrial echo pattern was evaluated on the day of human chorionic gonadotropin injection in donors and on the day before progesterone was given to recipients.

The effectiveness of delegation interventions by the registered nurse to the unlicensed assistive personnel and their impact on quality of care, patient satisfaction, and RN staff satisfaction: a systematic review.

Background: Delegation by the registered nurse is a decision making process that includes assessment, planning, implementation, and evaluation. Due to an ever-expanding global shortage of nurses, registered nurses are increasingly dependent on unlicensed assistive personnel to assist in the provision of safe patient care. Delegation is recognised as a fundamental nursing skill that can be utilised effectively to improve quality care.

Effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia: A systematic review.

Background: Hospital readmission soon after discharge is common and costly. To date, published studies of effectiveness of structured discharge process addressing reduction of hospital readmission have focused on patients with chronic conditions and complex needs, but not in adult patients with community acquired pneumonia.

Objectives: To examine and synthesise the best available evidence related to effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.

The effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: A systematic review.

Review Objective: The objective of this review is to synthesise the best available evidence on the effectiveness of web-based programs on the reduction of childhood obesity in school age children.

Background: Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings.

The Effectiveness of Motivational Interviewing on Glycemic Control for Adults with Type 2 Diabetes Mellitus (DM2): A Systematic Review.

Review Question/objective: The objective of this systematic review is to synthesize the best available evidence on the effects of motivational interviewing (MI) interventions (including adaptions of motivational interviewing [AMIs]) on the improvement of glycemic control in adults with type 2 diabetes.

Background: Worldwide, 346 million people have diabetes. With the growing prevalence of diabetes, controlling modifiable risk factors is essential to preventing complications and disease progression.

The effectiveness of computer system tools on potentially inappropriate medications ordered at discharge for adults older than 65 years of age: a systematic review.

Background: Prescribing potentially inappropriate medications to the elderly leads to adverse health outcomes. The use of computer systems decision making tools has been shown to decrease the incidence of prescribing potentially inappropriate medications for the elderly; however, these results are often dependent upon other variables, such as provider compliance.

Objective: To examine and synthesize the best available evidence related to the effect of computer systems clinical decision making tools on frequency of ordering potentially inappropriate medications at discharge and related unplanned emergency room visits or hospital readmissions in community dwelling patients older than 65 years of age.

Smoking and cancer: a review of public health and clinical implications.

The cultivation of tobacco dates backwards to 6000 BC. Use of tobacco for spiritual, euphoric, and medicinal purposes, and its ultimate spread to the 4 corners of the globe, lay at the heart of the current pandemic of tobacco-related disease, including lung, head and neck, and many other forms of cancer. While evidence for the carcinogenic properties of tobacco was documented as early as the 1800s, it was not until the 20th century that the role of tobacco use and smoke exposure in the growing pandemic of lung and other cancers was fully appreciated.

Serum adiponectin levels are significantly reduced during the second half of normal pregnancy.

Purpose: To demonstrate the physiologic changes in adiponectin levels during the first vs second half of pregnancy.

Methods: Sixty-six females with uncomplicated pregnancies and normal pre-gestational BMI had serum adiponectin levels obtained at various gestational ages. Thirty-one samples were obtained during the first half of their pregnancy vs 35 in the second half.

Successful pregnancy following in vitro fertilization embryo transfer in a 46-year-old woman with diminished oocyte reserve as evidenced by a high day 3 serum estradiol.

Purpose: To establish a precedent that a successful pregnancy is possible following in vitro fertilization-embryo transfer (IVF-ET) even in a 46-year-old woman with diminished egg reserve.

Methods: Mild ovarian stimulation was used to stimulate multiple follicles in a woman whose diminished oocyte reserve was manifested by elevated day 3 serum estradiol and top normal serum follicle stimulating hormone (FSH).

Results: She conceived on her third IVF-ET attempt.

Matched controlled study to evaluate the effect of endometrial polyps on pregnancy and implantation rates following in vitro fertilization-embryo transfer (IVF-ET).

Purpose: To determine if endometrial polyps negatively effect outcome following in vitro fertilization-embryo transfer (IVF-ET) and whether hysteroscopic resection improves pregnancy and implantation rates and/or decreases miscarriage rates.

Methods: Retrospective study with two matched controlled groups (polyps vs no polyps) based on age and previous number of IVF failures. The polyp group was further stratified by whether polypectomy was performed or not.

Effect of method of oocyte fertilization on fertilization, pregnancy and implantation rates in women with unexplained infertility.

Purpose: To determine if intracytoplasmic sperm injection (ICSI) offers an advantage over conventional oocyte insemination for women undergoing in vitro fertilization (IVF) and embryo transfer for unexplained infertility.

Methods: A retrospective seven-year review of outcome following IVF with conventional insemination vs ICSI for the category of unexplained infertility. The decision on which method of insemination to use was made by the couple after hearing pros and cons with the consulting physician.

A case whose outcome is consistent with the possibility that if slow embryo cleavage is related to a male factor the prognosis is far greater than if it was related to an egg factor.

Purpose: To determine if the male partner's sperm can be the cause of embryos with slow cleavage.

Methods: Retrospective evaluation of shared donor oocyte pairs where two women shared one pool of oocytes from an oocyte donor.

Results: Only one woman formed embryos that were all < 6 blastomeres in 376 paired cycles (total 752).

Phosphodiesterase-4 inhibition alters gene expression and improves isoniazid-mediated clearance of Mycobacterium tuberculosis in rabbit lungs.

Tuberculosis (TB) treatment is hampered by the long duration of antibiotic therapy required to achieve cure. This indolent response has been partly attributed to the ability of subpopulations of less metabolically active Mycobacterium tuberculosis (Mtb) to withstand killing by current anti-TB drugs. We have used immune modulation with a phosphodiesterase-4 (PDE4) inhibitor, CC-3052, that reduces tumor necrosis factor alpha (TNF-α) production by increasing intracellular cAMP in macrophages, to examine the crosstalk between host and pathogen in rabbits with pulmonary TB during treatment with isoniazid (INH).