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Barriers and facilitators to participating in cardiac rehabilitation and physical activity:A cross-sectional survey

World Journal of Cardiology 2022年第2期14卷 83-95页

作者： Matthew James Fraser Stephen J Leslie Trish Gorely Emma Foster Ronie Walters Division of Biomedical Science University of the Highlands and IslandsInverness IV23JHUnited Kingdom Department of Cardiology NHS HighlandInverness IV23UJUnited Kingdom Department of Nursing and Midwifery University of the Highlands and IslandsInverness IV23JHUnited Kingdom Cardiac Unit NHSH NHS HighlandInverness IV23JHUnited Kingdom

BACKGROUND Cardiovascular diseases(CVD)have been shown to be the greatest cause of death worldwide and rates continue to *** is recommended that CVD patients attend cardiac rehabilitation(CR)following a cardiac event to reduce mortality,improve recovery and positively influence behaviour around CVD risk *** the recognised benefits and international recommendations for exercisebased CR,uptake and attendance remain suboptimal.A greater understanding of CR barriers and facilitators is required,not least to inform service *** understanding current cardiac patients’attitudes and opinions around CR and physical activity(PA)could inform patient-led ***,through understanding aspects of CR and PA that participants like/dislike could provide healthcare providers and policy makers with information around what elements to target in the *** To investigate participants’attitudes and opinions around CR and *** This study employed a cross-sectional survey design on 567 cardiac *** patients who were referred for standard CR classes at a hospital in the Scottish highlands,from May 2016 to May 2017 were *** part of a larger survey,the current study analysed the free-text responses to 5 open-ended questions included within the wider *** were related to the participants’experience of CR,reasons for non-attendance,ideas to increase attendance and their opinions on *** data were analysed using a 6-step,reflexive thematic *** Two main topic areas were explored:“Cardiac rehabilitation experience”and“physical activity”.Self-efficacy was increased as a result of attending CR due to exercising with similar individuals and the safe environment *** ranged from age and health to distance and starting times of the classes which increased travel time and ***,responses demonstrated a lack of information and communication around the *** h

关键词： Cardiovascular disease Cardiac rehabilitation Physical activity Barriers Facilitators Patient experience

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Framework for assessing quality of care for inflammatory bowel disease in Sweden

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World Journal of Gastroenterology 2012年第10期18卷 1085-1092页

作者： Martin Rejler Jrgen Tholstrup Mattias Elg Anna Spngéus Boel Andersson Gre Department of Medicine Highland Hospital S 57533 Eksj Sweden Division of Quality Management and Technology and HELIX Vinn Excellence Centre Linkping University S 58183 Sweden Department of Medical and Health Sciences Faculty of Health Sciences Linkping University S 58183 Sweden Jnkping Academy for Improvement of Health and Welfare The School of Health Sciences Jnkping University Jnkping Academy Box 1026 S 55111 Jnkping Sweden

AIM: To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD) patients. METHODS A framework for quality assessment and improvement was created for IBD based on two generally acknowledged quality models. The model of Donabedian (Df) offers a logistical and productive perspective and the Clinical Value Compass (CVC) model adds a management and service perspective. The framework creates a pedagogical tool to understand the balance between the dimensions of clinical care (CVC) and the components of clinical outcome (Df). The merged models create a framework of the care process dimensions as a whole, reflecting important parts of the IBD care delivery system in a local setting. Clinical and organizational quality measures were adopted from clinical experience and the literature and were integrated into the framework. Data were collected at the yearly check-up for 481 IBD patients during 2008. The application of the quality assessment framework was tested and evaluated in a local clinical IBD care setting in Jnkping County, Sweden. RESULTS: The main outcome was the presentation of how locally-selected clinical quality measures, integrated into two complementary models to develop a frame-work, could be instrumental in assessing the quality of care delivered to patients with IBD. The selected quality measures of the framework noted less anemia in the population than previously reported, provided information about hospitalization rates and the few surgical procedures reported, and noted good access to the clinic. CONCLUSION: The applied local quality framework was feasible and useful for assessing the quality of care delivered to IBD patients in a local setting.

关键词： Quality measures Inflammatory bowel disease Value compass Donabedian Quality improvement

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Gastroenterology in developing countries:Issues and advances

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World Journal of Gastroenterology 2009年第23期15卷 2839-2854页

作者： Kate L Mandeville Justus Krabshuis Nimzing Gwamzhi Ladep Chris JJ Mulder Eamonn MM Quigley Shahid A Khan Centre for Infectious Diseases Epidemiology Department of Primary Care and Population Sciences University College London Hampstead Campus Royal Free Hospital London NW3 2PF United Kingdom highland Data Les Charleix 24390 Tourtoirac Dordogne France Department of Medicine University of Jos and Jos University Teaching Hospital Jos Plateau State P.M.B. 2076 Nigeria Department of Gastroenterology VU University Medical Center Amsterdam 1081 HV Holland World Gastroenterology Organisation and Department of Medicine National University of Ireland Cork University Hospital Clinical Sciences Building Wilton Cork Ireland Department of Hepatology and Gastro-enterology Faculty of Medicine Imperial College London St Mary's Campus London W2 1NY United Kingdom

Developing countries shoulder a considerable burden of gastroenterological disease. Infectious diseases in particular cause enormous morbidity and mortality. Diseases which afflict both western and developing countries are often seen in more florid forms in poorer countries. Innovative techniques continuously improve and update gastroenterological practice. However, advances in diagnosis and treatment which are commonplace in the West, have yet to reach many developing countries. Clinical guidelines, based on these advances and collated in resource-rich environments, lose their relevance outside these settings. In this two-part review, we first highlight the global burden of gastroenterological disease in three major areas： diarrhoeal diseases, hepatitis B, and Helicobacter pylori. Recent progress in their management is explored, with consideration of future solutions. The second part of the review focuses on the delivery of clinical services in developing countries. Inadequate numbers of healthcare workers hamper efforts to combat gastroenterological disease. Reasons for this shortage are examined, along with possibilities for increased specialist training. Endoscopy services, the mainstay of gastroenterology in the West, are in their infancy in many developing countries. The challenges faced by those se^ing up a service are illustrated by the example of a Nigerian endoscopy unit. Finally, we highlight the limited scope of many clinical guidelines produced in western countries. Guidelines which take account of resource limitations in the form of ＂cascades＂ are advocated in order to make these guidelines truly global. Recognition of the different working conditions facing practitioners worldwide is an important step towards narrowing the gap between gastroenterology in rich and poor countries.

关键词： Helicobacter pylori Developing countries Gastrointestinal diseases Health care delivery Practice guidelines

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Tissue inhibitor of metalloproteinase-3 expression affects clinicopathological features and prognosis of aflatoxin B1-related hepatocellular carcinoma

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World Journal of Hepatology 2024年第8期16卷 1131-1144页

作者： Qiu-Ju Liang Qin-Qin Long Feng-Qin Tian Qun-Ying Su Xiao-Ying Zhu Xi-Dai Long Clinicopathological Diagnosis and Research Center The Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000Guangxi Zhuang Autonomous RegionChina Department of Tumor Pathology Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education InstitutesBaise 533000Guangxi Zhuang Autonomous RegionChina

BACKGROUND The dysregulation of tissue inhibitor of metalloproteinase-3(TIMP3)was positively correlated with the progression of hepatocellular carcinoma(HCC).However,it is not clear whether TIMP3 expression is associated with the clinico-pathological features and prognosis of aflatoxin B1(AFB1)-related HCC(AHCC).A retrospective study,including 182 patients with AHCC,was conducted to explore the link between TIMP3 expression in cancerous tissues and the clinico-pathological characteristics and prognosis of ***3 expression was detected by immunohistochemistry and its effects on the clinicopathological features and prognosis of AHCC were evaluated by Kaplan-Meier survival analysis and Cox regression survival *** ratio,hazard ratio(HR),median overall survival time(MST),median tumor recurrence-free survival time(MRT),and corresponding 95%confidential interval(CI)was calculated to RESULTS Kaplan-Meier survival analysis showed that compared with high TIMP3 expression,low TIMP3 expression in tumor tissues significantly decreased the MST(36.00 mo vs 18.00 mo)and MRT(32.00 mo vs 16 mo)of patients with *** Cox regression survival analysis further proved that decreased expression of TIMP3 increased the risk of death(HR=2.85,95%CI:2.04-4.00)and tumor recurrence(HR=2.26,95%CI:1.57-3.26).Furthermore,decreased expression of TIMP3 protein in tissues with AHCC was significantly correlated with tumor clinicopatho-logical features,such as tumor size,tumor grade and stage,tumor microvessel density,and tumor blood ***,TIMP3 protein expression was also negatively associated with amount of AFB1-DNA adducts in tumor *** These findings indicate that the dysregulation of TIMP3 expression is related to AHCC biological behaviors and affects tumor outcome,suggesting that TIMP3 may act as a prognostic biomarker for AHCC.

关键词： Tissue inhibitor of metalloproteinase-3 expression Aflatoxin B1 Hepatocellular carcinoma Clinicopathological feature Prognosis

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Advances in alcoholic liver disease:An update on alcoholic hepatitis

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World Journal of Gastroenterology 2015年第42期21卷 11893-11903页

作者： Randy Liang Andy Liu Ryan B Perumpail Robert J Wong Aijaz Ahmed Department of Medicine Santa Clara Valley Medical Center Albert Einstein College of Medicine Division of Gastroenterology and Hepatology Stanford University School of Medicine Division of Gastroenterology and Hepatology Alameda Health System-Highland Hospital Campus

Alcoholic hepatitis is a pro-inflammatory chronic liver disease that is associated with high short-term morbidity and mortality(25%-35% in one month) in the setting of chronic alcohol use. Histopathology is notable for micro- and macrovesicular steatosis, acute inflammation with neutrophil infiltration, hepatocellular necrosis, perivenular and perisinusoidal fibrosis, and Mallory hyaline bodies found in ballooned hepatocytes. Other findings include the characteristic eosinophilic fibrillar material(Mallory's hyaline bodies) found in ballooned hepatocytes. The presence of focal intense lobular infiltration of neutrophils is what typically distinguishes alcoholic hepatitis from other forms of hepatitis, in which the inflammatory infiltrate is primarily composed of mononuclear cells. Management consists of a multidisciplinary approach including alcohol cessation, fluid and electrolyte correction, treatment of alcohol withdrawal, and pharmacological therapy based on the severity of the disease. Pharmacological treatment for severe alcoholic hepatitis, as defined by Maddrey's discriminant factor ≥ 32, consists of either prednisolone or pentoxifylline for a period of four weeks. The body of evidence for corticosteroids has been greater than pentoxifylline, although there are higher risks of complications. Recently head-to-head trials between corticosteroids and pentoxifylline have been performed, which again suggests that corticosteroids should strongly be considered over pentoxifylline.

关键词： Alcoholic Hepatitis Maddrey discriminant function

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Rising Rate of Liver Transplantation in the Baby Boomer Generation with Non-alcoholic Steatohepatitis in the United States

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Journal of Clinical and Translational Hepatology 2017年第3期5卷 193-196页

作者： Osama Siddique Mairin Joseph-Talreja Eric R.Yoo Ryan B.Perumpail George Cholankeril Stephen A.Harrison Zobair M.Younossi Robert J.Wong Aijaz Ahmed Department of Medicine Memorial Hospital of Rhode Island/Alpert Medical School of Brown University Providence RI USA Division of Gastroenterology and Hepatology Stanford University School of Medicine Stanford CA USA Department of Medicine University of Illinois College of Medicine Chicago IL USA Division of Gastroenterology and Hepatology University of Tennessee Health Sciences Center Memphis TN USA Radcliffe Department of Medicine University of Oxford Oxford United Kingdom Department of Medicine Center for Liver DiseasesInova Fairfax HospitalFalls ChurchVAUSA Division of Gastroenterology and Hepatology Alameda Health SystemHighland HospitalOaklandCAUSA

Background and Aims:Nonalcoholic steatohepatitis (NASH) is the most rapidly growing indication for liver transplantation (LT) in the United States and is on a trajectory to become the leading indication for LT in the next *** aimed to study the trends in NASH-related LT among persons born between 1945 and 1965,the baby boomer (BB) ***:We performed a retrospective cohort analysis using population-based data from the United Network for Organ Sharing/Organ Procurement and Transplantation Network registry from 2004-2015 to evaluate the birth cohort-specific trends in liver transplant waitlist registrations and liver transplant surgeries in patients with *** stratified our study population into three birth cohorts:1) birth before 1945,2) birth between 1945 and 1965,and 3) birth after ***:The overall rates of NASH-related waitlist registrations and liver transplant surgeries steadily increased from 2004 to 2015 and were reflective of a sharp rise noted in the NASH BB *** 2004 to 2015,the proportion of BB patients with NASH added to LT waitlist demonstrated an incremental growth,60.6% in 2004 versus 83.2% in 2015 (p < 0.01).Among the liver transplant recipients with NASH,the proportion represented by the BB cohort increased from 56.3% in 2004 to 80.0% in 2015 (p < 0.01).Conclusion:We report rising rates of waitlist registration and LT for the indication of *** importantly,the BB sub-cohort was mainly responsible for these alarming trends.

关键词： Baby boomers Liver transplantation Non-alcoholic steatohepatitis Waitlist

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Underutilization of Living Donor Liver Transplantation in the United States: Bias against MELD 20 and Higher

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Journal of Clinical and Translational Hepatology 2016年第3期4卷 169-174页

作者： Ryan B.Perumpail Eric R.Yoo George Cholankeril Lupe Hogan Melodie Deis Waldo C.Concepcion C.Andrew Bonham Zobair M.Younossi Robert J.Wong Aijaz Ahmed Division of Gastroenterology and Hepatology Stanford University School of Medicine Stanford CA USA Department of Medicine University of Illinois College of Medicine Chicago IL USA Division of Gastroenterology and Hepatology University of Tennessee Health Sciences Center Memphis TN USA Division of Surgery Division of Abdominal Transplantation Stanford University School of Medicine Stanford CA USA Department of Medicine Center for Liver Diseases Inova Fairfax HospitalFalls Church VA USA Division of Gastroenterology and Hepatology Alameda Health System Highland Hospital CampusOakland CA USA

Background and Aims:Utilization of living donor liver transplantation (LDLT) and its relationship with recipient Model for End-Stage Liver Disease (MELD) needs further evaluation in the United States (U.S.).We evaluated the association between recipient MELD score at the time of surgery and survival following ***:All *** LDLT recipients with MELD< 25 were evaluated using the 1995-2012 United Network for Organ Sharing *** following LDLTwas stratified into three MELD categories (MELD< 15 *** 15-19 *** 20-24) and evaluated using Kaplan-Meier methods and multivariate Cox proportional hazards ***:Overall,2,258 patients underwent *** to patients with MELD< 15,overall 5-year survival following LDLT was similar among patients with MELD 15-19 (80.9% vs.80.3%,p =0.77) and MELD 20-24 (81.2% vs.80.3%,p =0.73).When compared to patients with MELD<15,there was no significant difference in long-term post-LDLT survival among those with MELD 15-19 (HR:1.11,95% CI:0.85-1.45,p =0.45) and a non-significant trend towards lower survival in patients with MELD 20-24 (HR:1.28,95%CI:0.91-1.81,p =0.16).Only 14% of LDLTs were performed in patients with MELD 20-24 and the remaining 86% in patients with MELD< ***:LDLT is underutilized in patients with MELD 20 and higher.

关键词： Living donors Liver transplantation Waitlist Model for End-Stage Liver Disease(MELD)

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Sofosbuvir-based Regimens with Task Shifting Is Cost-effective in Expanding Hepatitis C Treatment Access in the United States

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Journal of Clinical and Translational Hepatology 2017年第1期5卷 16-22页

作者： Channa R.Jayasekera Rachel Beckerman Nathaniel Smith Ryan B.Perumpail Robert J.Wong Zobair M.Younossi Aijaz Ahmed Liver Transplant Program Division of Gastroenterology and HepatologyStanford University Medical CenterStanfordCaliforniaUSA Center for Innovation in Global Health Stanford UniversityStanfordCaliforniaUSA Maple Health Group LLCNew YorkNew YorkUSA Division of Gastroenterology and Hepatology Alameda Health SystemHighland HospitalOaklandCaliforniaUSA Department of Medicine Center for Liver DiseasesInova Fairfax HospitalFalls ChurchVirginiaUSA Betty and Guy Beatty Center for Integrated Research Inova Health SystemFalls ChurchVirginiaUSA

Background and Aims:The current paradigm of specialist physician-managed treatment of chronic hepatitis C virus infection(HCV)is inefficient in absorbing the approximately 3 million patients awaiting treatment in the United *** shifting—whereby specialist physicians screen patients for treatment eligibility but on-treatment monitoring is devolved to more abundant non-physician clinicians—achieves non-inferior treatment outcomes with second generation direct-acting antivirals(2^(nd)Gen DAAs),may increase treatment capacity,and may facilitate greater treatment *** determined the cost effectiveness of 2^(nd)Gen DAAs with respect to interferon-based first-generation DAAs(1^(st)Gen DAAs)within a task-shifted treatment ***:Using a previously described decision-analytic Markov structure,we modeled a hypothetical cohort of 1,000 patients with HCV genotype 1 infection over a lifetime horizon,based upon our outreach clinic's HCV treatment ***-naive and treatment-experienced HCV cohorts were modeled separately,based upon our outr8each clinic's *** response to 2^(nd)Gen DAAs was modeled based on our outreach clinic's *** events,utility,costing,and transition probabilities were sourced from the ***:Driven by improved effectiveness and safety,as well as an expected increase in treatment capacity,2^(nd)Gen DAAs treatment monitored by non-physician clinicians was projected to improve health outcomes and be dominant from a cost-effective perspective versus that of 1^(st)Gen *** were consistent across all assessed patient ***:Based on an assumption of increased treatment capacity accompanying a task-shifted treatment model,2^(nd)Gen DAAs-based treatment was cost effective and cost saving as compared to 1^(st)Gen DAAs-based treatment for all HCV patient subgroups assessed.

关键词： Hepatitis C Treatment access Task shifting Cost effectiveness

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Prehospital identification of sepsis patients and alerting of receiving hospitals:impact on early goal-directed therapy

Prehospital identification of sepsis patients and alerting o...

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国际全身性感染论坛-2011北京

作者： K Halimi J Freeman-Garrick C Agcaoili K Choy F Claridge M Jacobs M Taigman Department of Emergency Medicine and Intensive Care Washington HospitalFremontCAUSA highland hospital OaklandCAUSA Alameda County Emergency Medical Services San LeandroCAUSA American Medical Response Alameda CountyCAUSA

＜正＞Introduction Over the past several years,the early identification and aggressive treatment of sepsis patients has become a standard of care in the hospital setting.A relatively small number of emergency medical service（EMS） systems have started programs to screen for sepsis;an even smaller number provide treatment based on that screening process in the prehospital setting.

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Association of CD14/-260 polymorphism with gastric cancer risk in highland Tibetans

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World Journal of Gastroenterology 2014年第10期20卷 2688-2694页

作者： Kang Li Zeng Dan Xue-Jun Hu Luo-Bu Gesang Yong-Ge Ze Zha-Xi Bianba Cuo-Mu Ciren Yu-Qiang Nie Department of Gastroenterology People’s Hospital of Tibet Autonomous Region Department of Oncology People’s Hospital of Tibet Autonomous Region Department of Gastroenterology Guangzhou First People’s Hospital Guangzhou Medical University

AIM: To investigate the relationship between CD14-260 and -651 polymorphisms and the risk of developing gastric cancer.

关键词： CD14 Single nucleotide polymorphisms Cancer susceptibility Gastric cancer Tibetans

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