Acute lysine supplementation does not improve hepatic or peripheral insulin sensitivity in older, overweight individuals.

CONTEXT: Lysine supplementation may have a positive influence on the regulation of glucose metabolism but it has not been tested in the geriatric population. OBJECTIVE: We evaluated the impact of acute lysine supplementation using three randomized experimental scenarios: 1) oral glucose alone (control), 2) oral glucose and low-dose lysine (2 grams), and oral glucose and high dose lysine (5 grams) lysine in 7 older (66 ± 1 years/age), overweight/obese (BMI = 28 ± 2 kg/m(2)) individuals. METHODS: We utilized a dual tracer technique (i.e., [6,6-(2)H2] glucose primed constant infusion and 1-[(13)C] glucose oral ingestion) during an oral glucose tolerance test (OGTT) to examine differences in hepatic and peripheral insulin sensitivity under all three scenarios. RESULTS: Post-absorptive plasma glucose and insulin concentrations were not different between the three trials. Similarly, the response of glucose and insulin concentrations during the oral glucose tolerance tests (OGTT) was similar in the three trials. The results of the Matsuda index (ISI/M) were also not different between the three trials. As an index of hepatic insulin sensitivity, there were no significant differences in the endogenous glucose rate of appearance (glucose Ra) for control, 2 g lysine and 5 g lysine (1.2 ± 0.1, 1.1 ± 0.1, 1.3 ± 0.1 mg•kg(-1)•min(-1)), respectively. With respect to peripheral insulin sensitivity, there were no significant differences in the glucose rate of disappearance (glucose Rd) for control, 2 g lysine and 5 g lysine (4.2 ± 0.1, 4.3 ± 0.2, and 4.5 ± 0.4 mg•kg(-1)•min(-1)), respectively. CONCLUSIONS: Previous studies in younger participants have suggested that lysine may have a beneficial effect on glucose metabolism. However, acute lysine supplementation in the older population does not facilitate beneficial changes in glucose Ra or glucose Rd.

Does shifting a physician payment system shift physician priorities? A multi-site evaluation of an alternative payment plan (APP) for gynecologic oncologists in Ontario.

OBJECTIVE: The objective of this study was to attempt to understand how changing the mode of reimbursement alters physician behavior from the physician's perspective. METHOD: Individual interviews were conducted with 14 Ontario gynecologic oncologists. Each interview was analyzed using grounded theory. RESULTS: The move to an alternative payment plan (APP) significantly shifted physician clinical and personal priorities. This resulted in improvements in recruitment and retention. A model was developed to explain the link between the shift in the payment system and physician perceptions of their behavior. The model is comprised of two themes: (a) need for change: site similarities and differences, (b) effects of change: shifting priorities and time management. Even when the same compensation package was offered to four sites, the interpretations and motivations differed from site to site. We identified two types of situations: sites that were operating in 'survival mode' and those that were 'meeting core clinical and academic requirements'. They experienced the APP very differently. CONCLUSION: This study presents a model that depicts how and why a funding shift has variable effects on physician behaviors, depending on the individual physician, site, and multi-site perspectives. It offers one of the few qualitative evaluations of a funding change.

The place for prescribing guidelines and the means of their dissemination.

Practice guidelines are of potential benefit when a physician recognizes that they do not have all the facts required for providing appropriate health care. However, when guidelines for prescribing are known to the prescriber, and the physician chooses to modify or ignore them, their behaviour is being driven by personal and professional value systems that are in conflict with their knowledge base. Thus, providing practice guidelines to these physicians will not reduce suboptimal prescribing practices. In these circumstances, a number of studies suggest that addressing the social and situational involvement of physicians within the guidelines may enhance the promulgation and implementation of guidelines, and lead to more optimal prescribing choices for physicians.

The use of research in local health service agencies.

A critical and often overlooked component of the use and transfer of research in the health care system is the local health and social service delivery agency. There is also very little understanding of the extent to which local community-based agencies conduct research internally to improve their operational capacity. More than ever, these local service organizations require research to guide activity in a rapidly changing health care environment which is characterized by diminishing health and social service budgets, de-institutionalization and concomitant increases and metamorphoses in service demands. This study interviewed 25 executive directors and held a focus group with a group of other directors to examine the use and transfer of research in these organizations. A number of central issues were identified by the directors that affect the contribution of research to the delivery of their programs and services. A conceptual model for developing 'locally-based research transfer' was subsequently outlined that could serve as the basis for enhanced research use and research transfer in other local area contexts.

Evaluating an alternative funding plan.

There have been increasing levels of interest shown across Canada in the potential application of alternative funding arrangements for academic health science centres. This article outlines the approach, and some preliminary results, of the alternative funding plan evaluation at Queen's University. Following a discussion of the AFP itself, the article describes the first phase of the evaluation process. Several studies nearing completion are outlined, as are other pieces of research that will be conducted before the AFP is renegotiated in 1999. Finally, the authors provide a brief discussion of the organizational and methodological issues that emerge when evaluating an AFP.

Modelling acidification at Beacon Hill-a low rainfall, high pollutant deposition site in Central England.

The model MAGIC (Model of Acidification of Groundwater In Catchments) has been applied to the Beacon Hill site, near Loughborough in Central England. This site is heavily impacted by wet and dry deposition of oxides of sulphur and nitrogen. The high acid inputs have caused soil acidification and acid stream waters. Long term simulations suggest that there has been a major decline in alkalinity and pH over the past 50 years. Despite recent reductions in deposition levels, soils and streams are predicted to continue to acidify in the future. For this heavily impacted site, deposition must be reduced by 80-90% to reverse the acidification trend and allow recovery of soil and stream waters.