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Fluoroscopic gastric peroral endoscopic pyloromyotomy(G-POEM)in patients with a failed gastric electrical stimulator

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Gastroenterology Report 2018年第2期6卷 122-126,I0002页

作者： Abhinav Koul Sunil Dacha Parit Mekaroonkamol Xiaoyu Li Lianyong Li Nikrad Shahnavaz Steven Keilin Field F.Willingham jennifer christie Qiang Cai Department of Gastroenterology University of California Davis Medical CenterSacramentoUSA Division of Digestive Diseases Emory University School of MedicineAtlantaUSA Department of Gastroenterology Qingdao University First Affiliated HospitalQingdaoChina Division of Digestive Diseases PLA 306 HospitalBeijingChina

Background:Gastric electrical stimulators(GESs)have been used to treat refractory gastroparesis in patients who fail initial therapies such as dietary modifications,control of psychological stressors and pharmacologic *** recently,gastric peroral endoscopic pyloromyotomy(G-POEM)has emerged as a novel endoscopic technique to treat refractory *** present a case series of patients with refractory gastroparesis who failed treatment with an implanted GES that were safely treated with G-POEM performed under fluoroscopy as a salvage ***:Cases of G-POEM performed on patients with refractory gastroparesis who failed treatment with a GES were retrospectively *** G-POEM procedures were performed under fluoroscopic guidance with the GES still in *** Cardinal Symptoms Index(GCSI)and gastric emptying scintigraphy were assessed before and after the *** were followed up for up to 18 months post ***:Five patients underwent G-POEM after failing treatment with a *** fluoroscopy,the GES and their leads were visualized in different parts of the *** GES lead was observed at the antrum near the myotomy *** procedures were successfully completed without ***’GCSI decreased by an average of 62%1 month post *** also had notable improvements in gastric emptying 2 months post ***:In patients with refractory gastroparesis who have failed treatment with a GES,G-POEM can be safe and effective without removing the *** visualize the GES and avoid cutting GES leads during myotomy,the procedure should be performed under fluoroscopy.

关键词： gastroparesis G-POEM pyloromyotomy gastric electrical stimulator fluoroscopy

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Implementation of cancer screening in rural primary care practices after joining an accountable care organisation:a multiple case study

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Family Medicine and Community Health 2021年第4期9卷 42-49,I0013,I0014,I0015页

作者： Heather Nelson-Brantley Edward F Ellerbeck Stacy McCrea-Robertson jennifer Brull jennifer Bacani McKenney K Allen Greiner christie Befort School of Nursing University of Kansas Medical CenterKansas CityKansasUSA University of Kansas Cancer Center University of Kansas Medical CenterKansas CityKansasUSA Population Health University of Kansas Medical CenterKansas CityKansasUSA Family Medicine University of Kansas Medical CenterKansas CityKansasUSA

Objective To describe common strategies and practice-specific barriers,adaptations and determinants of cancer screening implementation in eight rural primary care practices in the Midwestern United States after joining an accountable care organisation(ACO).Design This study used a multiple case study *** sampling was used to identify a diverse group of practices within the *** were collected from focus group interviews and workflow *** Consolidated Framework for Implementation Research(CFIR)was used to guide data collection and *** were cross-analysed by clinic and CFIR domains to identify common themes and practice-specific determinants of cancer screening *** The study included eight rural primary care practices,defined as Rural-Urban Continuum Codes 5-9,in one ACO in the Midwestern United *** Providers,staff and administrators who worked in the primary care practices participated in focus groups.28 individuals participated including 10 physicians;one doctor of osteopathic medicine;three advanced practice registered nurses;eight registered nurses,quality assurance and licensed practical nurses;one medical assistant;one care coordination manager;and four *** With integration into the ACO,practices adopted four new strategies to support cancer screening:care gap lists,huddle sheets,screening via annual wellness visits and information ***-case analysis revealed that all practices used both visit-based and population-based cancer screening strategies,although workflows varied widely across *** of the four strategies was adapted for fit to the local context of the *** shared that joining the ACO provided a strong external incentive for increasing cancer screening *** predominant determinants of cancer screening success at the clinic level were use of the electronic health record(EHR)and fully engaging nurses in the screening ***

关键词： nurse joining screening

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