GreenPhylDB: a database for plant comparative genomics.

GreenPhylDB (http://greenphyl.cirad.fr) is a comprehensive platform designed to facilitate comparative functional genomics in Oryza sativa and Arabidopsis thaliana genomes. The main functions of GreenPhylDB are to assign O. sativa and A. thaliana sequences to gene families using a semi-automatic clustering procedure and to create 'orthologous' groups using a phylogenomic approach. To date, GreenPhylDB comprises the most complete list of plant gene families, which have been manually curated (6421 families). GreenPhylDB also contains all of the phylogenomic relationships computed for 4375 families. A total of 492 TAIR, 1903 InterPro and 981 KEGG families and subfamilies were manually curated using the clusters created with the TribeMCL software. GreenPhylDB integrates information from several other databases including UniProt, KEGG, InterPro, TAIR and TIGR. Several entry points can be used to display phylogenomic relationships for A. thaliana or O. sativa sequences, using TAIR, TIGR gene ID, family name, InterPro, gene alias, UniProt or protein/nucleic sequence. Finally, a powerful phylogenomics tool, GreenPhyl Ortholog Search Tool (GOST), was incorporated into GreenPhylDB to predict orthologous relationships between O. sativa/A. thaliana protein(s) and sequences from other plant species.

[Difficult patients in primary care: a quantitative and qualitative study]. / Pacientes de trato difícil en atención primaria: una aproximación cuantitativa y cualitativa.

AIM: To identify difficult (heartsink) patients (DP), describe their profile, and report the opinions and experiences they evoke in physicians who see them. DESIGN: Descriptive, cross-sectional study based on quantitative and qualitative methods. SETTING: Urban health care center. PARTICIPANTS: Difficult patients were selected daily from among all patients seen in six primary care practices during the period from March to May 2001. Patients were identified according to the diagnostic criteria of Ellis (patients who cause a knot in the stomach when their name appears on the list of patients with an appointment that day) and O'Dowd (patients who cause distress or discomfort). METHOD: Information was obtained on the number of DP seen, number of visits made by DP, age, sex, type of DP, level of education, occupation, family structure and comorbidity. Type of DP was determined with a modification of the Groves classification (dependent clinger, entitled demander, manipulative help-rejecter, self-destructive denier, somatizer, emotive seducer). We analyzed the opinions DP generated by examining the discourse produced during a discussion group session with 9 physicians from the participating health center and a moderator. RESULTS: A total of 82 DP were identified (prevalence.7%, i.e., 2.3% of all visits). Most (67.1%) were women. Mean age was 57.8 years (standard deviation 15.2 years). Dependent clinger patients predominated (41%). Most patients had primary-level education (62%), about one-third were retired (35%), and about one-third were married and had children (35%). Most had two or more medical diagnoses (74.4%), and many had at least one psychiatric diagnosis (40.2%).The feelings these patients evoked most often in physicians were irritability and frustration. Most physicians agreed that these patients are rare but have a severe emotional impact. Physicians believe that the skills and strategies they have to help them manage these patients are limited, and consider specific training necessary to improve them. CONCLUSIONS: Although DP are not a relevant problem in quantitative terms, they cause considerable emotional distress. Specific training in clinical interviewing is felt to be necessary given the difficulties in managing these patients.

Pacientes de trato difícil en atención primaria: una aproximación cuantitativa y cualitativa / Difficult patients in primary care: a quantitative and qualitative study

Objetivo. Identificar a los pacientes "de trato difícil" (PD), describir su perfil y las opiniones y vivencias que generan en los médicos que los atienden. Diseño. Estudio descriptivo transversal. Metodología cuantitativa-cualitativa. Emplazamiento. Centro de salud urbano. Participantes. Los PD seleccionados diariamente del total de pacientes atendidos en 6 consultas de atención primaria, entre marzo y mayo de 2001. Se identificaron mediante los criterios diagnósticos de Ellis (pacientes que provocan nudo en el estómago al leer su nombre en el listado) y O'Dowd (pacientes capaces de producir distrés, malestar).Método. Se recogió información sobre los PD visitados, número de visitas realizadas por PD, edad, sexo, clasificación, estudios, ocupación, estructura familiar y comorbilidad. Se utilizó la clasificación de Groves modificada (pasivo dependiente, exigente-agresivo, manipulador masoquista, negador-autodestructivo, somatizador, emotivo-seductor). Analizamos las opiniones que generan a partir del discurso producido en un grupo de discusión (9 médicos del centro y un moderador).Diseño. Se seleccionó a 82 pacientes (prevalencia del 0,7 por ciento [el 2,3 por ciento de las consultas realizadas]), de los que el 67,1 por ciento eran mujeres. La edad media era de 57,8 años (DE, 15,2). Predominó la paciente pasiva-dependiente (41 por ciento), con estudios primarios (62 por ciento), jubilada (35 por ciento), casada y con hijos (35 por ciento), con dos o más patologías médicas (74,4 por ciento) y al menos una psiquiátrica (40,2 por ciento).Los sentimientos que predominantemente generan en los médicos son irritabilidad y frustración. La mayoría coincide en que estos pacientes son escasos pero ocasionan un impacto emocional intenso, cree que sus habilidades y estrategias para manejarlos son limitadas y considera necesaria formación específica para mejorarlas. Conclusiones. Aunque cuantitativamente los PD no se consideran un problema relevante, provocan un gran desgaste emocional. Se consideran necesarios formación/entrenamiento específicos en entrevista clínica dadas las dificultades que presenta su manejo (AU)