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Primary care providers practice patterns regarding female pelvic floor disorders

Family Medicine and Community Health 2024年第1期12卷 9-15页

作者： Anna Weimer Jennifer L Hallock Chi Chiung Grace Chen Magee-Women's Hospital of UPMC PittsburghPennsylvaniaUSA kaiser permanente northern california SacramentoCaliforniaUSA Johns Hopkins Medical Institutions Campus BaltimoreMarylandUSA

Introduction Pelvic floor disorders(PFDs)pose substantial physical and psychological burdens for a growing number of *** the ubiquity of these conditions and known patient reluctance to seek care,primary care providers(PCPs)have a unique opportunity to increase treatment and provide appropriate referrals for these *** An online survey was administered to PCPs to assess provider practices,knowledge,comfort managing and ease of referral for *** regression was used to assess the association between demographic/practice characteristics of PCPs and two primary outcomes of interest:discomfort with management and difficulty with referral of *** Of the 153 respondents to the survey,more felt comfortable managing stress urinary incontinence(SUI)and overactive bladder(OAB),compared with pelvic organ prolapse(POP)and faecal incontinence(FI)and were less likely to refer patients with urinary *** providers elicited symptoms for POP and FI as compared with SUI and *** variables that were significantly associated with discomfort with management varied by PFD,but tended to correlate with less exposure to PFDs(eg,those with fewer years of practice,and internal medicine and family physicians as compared with geriatricians);whereas the factors that were significantly associated with difficulty in referral,again varied by PFD,but were related to practice characteristics(eg,specialist network,type of practice,practice setting and quantity of patients).Conclusion These findings highlight the need to increase PCPs awareness of PFDs and develop effective standardised screening protocols,as well as collaboration with pelvic floor specialists to improve screening,treatment and referral for patients with PFDs.

关键词： bladder floor difficulty

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Immunotherapy for gastric cancer and liver metastasis: Is it time to bid farewell

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World Journal of Gastrointestinal Surgery 2024年第8期16卷 2365-2368页

作者： Ahmed Dehal Department of Clinical Sciences Kaiser Permanente School of MedicinePanoramaCA 91402United States

Patients with metastatic gastric cancer have a grim *** che-motherapy offers a limited survival improvement,but recent advancements in immunotherapy have sparked ***,the effectiveness of immunothe-rapy in patients with liver metastases remains *** article reviews a recent study by Liu et al and evaluates conflicting evidence on the impact of liver metastases on response to immunotherapy in metastatic gastric *** some studies suggest no significant difference in treatment response based on liver involvement,others report varied response *** present study,a re-trospective analysis of 48 patients by Liu et al,examines this issue and concludes that immunotherapy is less effective in patients with liver *** methodological limitations and a small sample size,the study contributes to the ongoing *** nuanced response to immunotherapy in certain patients underscores the importance of understanding the tumor microenvironment,immune cell infiltration,and the expression of immune *** than dismissing immunotherapy for patients with gastric cancer and liver metastases,a shift towards personalized treatment strategies and a more profound under-standing of tumor-specific biomarkers is *** unraveling the molecular intricacies of individual cases,clinicians may tailor more effective and customized treatments,offering a glimmer of hope for this challenging patient group.

关键词： Immunotherapy Gastric cancer Liver metastasis Efficacy Prognosis

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Reflections on four decades of physical activity epidemiology

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Journal of Sport and Health Science 2024年第5期13卷 608-610页

作者： Barbara Sternfeld David R.Jacobs Jr. Division of Research Kaiser Permanente Northern CaliforniaOaklandCA 94610USA Division of Epidemiology and Community Health School of Public HealthUniversity of MinnesotaMinneapolisMN 55454USA

In 1985,Public Health Reports published a series of papers prepared for a workshop sponsored by the Centers for Disease Control and Prevention(CDC).1 Building on the seminal work of Jeremy Morris and Ralph Paffenbarger Jr.,who were among the first to use epidemiological methods to study physical activity(PA),2,3 the workshop itself was the result of a growing scientific understanding of the importance of“physical fitness and exercise for improving the health of the public”.

关键词： semi workshop Ralph

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Targeting stroma and tumor,silencing galectin 1 treats orthotopic mouse hepatocellular carcinoma

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Acta Pharmaceutica Sinica B 2024年第1期14卷 292-303页

作者： Tahereh Setayesh Ying Hu Farzam Vaziri Xin Chen Jinping Lai Dongguang Wei Yu-Jui Yvonne Wan Department of Medical Pathology and Laboratory Medicine University of CaliforniaDavisSacramentoCA 95817USA Cancer Biology Program the University of Hawaii Cancer CenterHonoluluHI 96813USA Department of Pathology and Laboratory Medicine Kaiser Permanente Sacramento Medical CenterSacramentoCA 95825USA

This study examines inhibiting galectin 1(Gal1)as a treatment option for hepatocellular carcinoma(HCC).Gal1 has immunosuppressive and cancer-promoting *** data showed that Gal1 was highly expressed in human and mouse *** levels of Gal1 positively correlated with the stages of human HCC and negatively with *** roles of Gal1 in HCC were studied using overexpression(OE)or silencing using Igals1 siRNA delivered by *** to HCC initiation induced by RAS and AKT mutations,lgals1-OE and silencing had opposite impacts on tumor *** treatment effect of lgals1 siRNAwas further demonstrated by intersecting HCC at different time points when the tumor load had already reached 9%or even 42%of the body *** spatial transcriptomic profiles of Gal1 silenced and OE HCC,inhibiting matrix formation and recognition of foreign antigen in CD45t cell-enriched areas located at tumor-margin likely contributed to the anti-HCC effects of Gal1 *** the tumors,silencing Gal1 inhibited translational initiation,elongation,and ***,Gal1 silencing increased immune cells as well as expanded cytotoxic T cells within the tumor,and the anti-HCC effect of lgals1 siRNAwas ***,Gal1 silencing has a promising potential for HCC treatment.

关键词： Liver Hepatocellular carcinoma Carbohydrate-binding lectin Galectin 1 Extracellular matrix Translation Spatial transcriptomics Tumor-margin

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CT Thresholds for Spinal Bone Mineral Attenuation to Prioritize Eligible Older Women for Osteoporosis Screening

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Open Journal of Radiology 2024年第2期14卷 92-101页

作者： Seo Yeon K. Orite Bryn Higuchi Hyo-Chun Yoon Lana H. Gimber St. Elizabeths Medical Center Brighton MA USA University of california Irvine CA USA kaiser permanente Division of Research Oakland CA USA Department of Diagnostic Imaging Hawaii Permanente Medical Group Honolulu HI USA

Introduction: Computed tomography (CT) measurements of bone mineral attenuation may be a useful means to identify older women who should be prioritized for bone mineral density screening. Methods: We compared bone mineral attenuation as measured in the L1 vertebra of CT studies to the results of dual-energy x-ray absorptiometry (DEXA) studies to determine what CT attenuation thresholds might yield a reasonable combination of sensitivity and specificity for the detection of osteoporosis. The study was limited to women between the ages of 65 and 75 years who had a DEXA study and a CT that included the L1 or adjacent vertebra performed within 3 years of the DEXA study. Results: There were 1226 women in this study, of whom 452 (38%) had osteoporosis based on a T-score ≤ −2.5 by DEXA. There were 830 CT studies performed with contrast and 396 studies which were performed without contrast. There was a statistically significant difference in the mean HU of those studies performed without contrast compared to those with contrast (unenhanced mean 103 HU versus 125 HU, p < 0.001). Different CT attenuation thresholds provided the most appropriate combination of sensitivity and specificity for the detection of osteoporosis when comparing CT studies performed without or with IV contrast and when all the CT data were used in aggregate. Conclusion: Different thresholds appear necessary when using the mean CT vertebral attenuation to identify older women for preferential referral for DEXA studies.

关键词： Osteoporosis Bone Mineral Attenuation CT Threshold

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Storylines of family medicine Ⅹ:standing up for diversity,equity and inclusion

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Family Medicine and Community Health 2024年第S3期12卷 89-98页

作者： William B Ventres Leslie A Stone Wayne W Bryant Jr Mario F Pacheco Edgar Figueroa Francis N Chu Shailendra Prasad David N Blane Na'amah Razon Ranit Mishori Robert L Ferrer Garrett S Kneese Family and Preventive Medicine University of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA Family and Community Medicine University of New Mexico School of MedicineAlbuquerqueNew MexicoUSA Medicine Weill Cornell Medical CollegeNew YorkNew YorkUSA San Jose Family Medicine Residency Kaiser PermanenteSan JoseCaliforniaUSA Family Medicine and Community Health University of Minnesota Medical School—Twin Cities CampusMinneapolisMinnesotaUSA School of Health and Wellbeing University of GlasgowGlasgowUK Family and Community Medicine University of CaliforniaDavisSacramentoCaliforniaUSA Family Medicine Georgetown University School of MedicineWashingtonDistrict of ColumbiaUSA Family and Community Medicine UT Health San Antonio Long School of MedicineSan AntonioTexasUSA UC San Diego Family Medicine Residency Program San DiegoCaliforniaUSA

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the ***‘Ⅹ:standing up for diversity,equity and inclusion’,authors address the following themes:‘The power of diversity—why inclusivity is essential to equity in healthcare’,‘Medical education for whom?’,‘Growing a diverse and inclusive workforce’,‘Therapeutic judo—an inclusive approach to patient care’,‘Global family medicine—seeing the world“upside down”’,‘The inverse care law‘,‘Social determinants of health as a lens for care’,‘Why family physicians should care about human rights’and‘Toward health equity—the opportunome’.May the essays that follow inspire readers to promote change.

关键词： illustration education family

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Effect of a region-wide incorporation of an algorithm based on the 2012 international consensus guideline on the practice pattern for the management of pancreatic cystic neoplasms in an integrated health system

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World Journal of Clinical Cases 2018年第13期6卷 624-631页

作者： Andrew Khoi Nguyen Agathon Girgis Timnit Tekeste Karen Chang Mopelola Adeyemo Armen Eskandari Emilio Alonso Priyanka Yaramada Charles Chaya Albert Ko Edmund Burke Isaiah Roggow Rebecca Butler Aniket Kawatkar Brian S Lim School of Medicine University of California Department of Gastroenterology Kaiser Permanente Riverside Medical Center Department of Surgery Kaiser Permanente Riverside Medical Center Department of Research and Evaluation Southern California Permanente Medical Group

AIM To examine the practice pattern in kaiser permanente Southern california(KPSC), i.e., gastroenterology(GI)/surgery referrals and endoscopic ultrasound(EUS), for pancreatic cystic neoplasms(PCNs) after the regionwide dissemination of the PCN management *** Retrospective review was performed; patients with PCN diagnosis given between April 2012 and April 2015(18 mo before and after the publication of the algorithm) in KPSC(integrated health system with 15 hospitals and 202 medical offices in Southern california) were ***2558(1157 pre-and 1401 post-algorithm) received a new diagnosis of PCN in the study period. There was no difference in the mean cyst size(pre-19.1 mm vs post-18.5 mm, P = 0.119). A smaller percentage of PCNs resulted in EUS after the implementation of the algorithm(pre-45.5% vs post-34.8%, P < 0.001). A smaller proportion of patients were referred for GI(pre-65.2% vs post-53.3%, P < 0.001) and surgery consultations(pre-24.8% vs post-16%, P < 0.001) for PCN after the implementation. There was no significant change in operations for PCNs. Cost of diagnostic care was reduced after the implementation by 24%, 18%, and 36% for EUS, GI, and surgery consultations, respectively, with total cost saving of 24%.CONCLUSION In the current healthcare climate, there is increased need to optimize resource utilization. Dissemination of an algorithm for PCN management in an integrated health system resulted in fewer EUS and GI/surgery referrals, likely by aiding the physicians ordering imaging studies in the decision making for the management of PCNs. This translated to cost saving of 24%, 18%, and 36% for EUS, GI, and surgical consultations, respectively, with total diagnostic cost saving of 24%.

关键词： Pancreatic cyst Algorithm incorporation Pancreas Optimization of resource utilization Fukuoka criteria Sendai criteria Pancreatic cancer Intraductal papillary mucinous neoplasm Practice management Algorithm

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Microscopic colitis:A large retrospective analysis from a health maintenance organization experience

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World Journal of Gastroenterology 2009年第25期15卷 3122-3127页

作者： Kevin T Kao Benito A Pedraza Amy C McClune David A Rios Yi-Qiong Mao Robert H Zuch Michael H Kanter Sony Wirio Chris N Conteas Department of Gastroenterology Kaiser PermanenteLos Angeles Medical Center Los Angeles California 90027United States Department of Internal Medicine Kaiser Permanente Los Angeles Medical Center Los Angeles California 90027 United States Department of Pathology Southern California Kaiser Permanente Medical Group California 90027 United States

AIM： To examine the demographic data on a large multi-ethnic population of patients with microscopic colitis （MC） in Southern california and to determine the association of MC with inflammatory bowel disease （IBD） and colorectal cancer. METHODS： All patients diagnosed with MC by co- Ionic biopsy from 1996-2005 were identified utilizing a pathology database. All biopsies were reviewed by experienced pathologists utilizing standard histologic criteria. Patients＇ medical records were reviewed and data regarding patient age, co-morbidities, sex, ethnic- ity, and medications were analyzed. An age- and sex- matched standard control group was also generated. Chi-square test was used to evaluate the associations of co-morbidities between lymphocytic colitis （LC）, col- lagenous colitis （CC） and the control group. RESULTS： A total of 547 cases of MC were identified, 376 patients with LC and 171 patients with CC. The fe- male/male ratio was 3：1 in CC and 2.7：1 in LC patients. Celiac disease （P 〈 0.001）, irritable bowel syndrome （IBS）（P 〈 0.001）, and thyroid diseases （P 〈 0.001） were found to have a higher occurrence in MC com- pared to the control group. No statistical differences in the occurrence of colorectal cancer, diabetes and IBD were found between the MC group and the control group. CONCLUSION： This is the largest group of patients with MC known to the authors that has been studied to date. Conditions such as celiac disease, IBS, and thyroid diseases were found to be related to MC. Fur- thermore, neither an increased risk of colorectal cancer nor IBD was associated with MC in this study.

关键词： Collagenous colitis Inflammatory bowel disease Lymphocytic colitis Microscopic colitis

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Entangled chimeras in nonlocally coupled bicomponent phase oscillators:From synchronous to asynchronous chimeras

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Frontiers of physics 2020年第6期15卷 115-123页

作者： Qiong-Lin Dai Xiao-Xuan Liu Kai Yang Hong-Yan Cheng Hai-Hong Li Fagen Xie Jun-Zhong Yang School of Science Beiing University of Posts and TelecommunicationsBeijing 100876China Department of Research and Eoaluation Kaiser Permanente Southern CaliforniaPasadenaCA 91101USA

Chimera states,a symmetry-breaking spatiotemporal pattern in nonlocally coupled identical dynamical units,have been identified in various systems and generalized to coupled nonidentical *** has been shown that strong heterogeneity in the frequencies of nonidentical oscillators might be harmful to chimera *** this work,we consider a ring of nonlocally coupled bicomponent phase oscillators in which two types of oscillators are randomly distributed along the ring:some oscillators with *** w1 and others with *** this model,the heterogeneity in frequency is measured by frequency mismatch|w1-w2|between the oscillators in these two *** report that the nonlocally coupled bicomponent phase oscillators allow for chimera states no matter how large the frequency mismatch *** bicomponent oscillators are composed of two chimera states,one supported by oscillators with natural frequency wI and the other by oscillators with natural frequency *** two chimera states in two subpopulations are synchronized at weak frequency mismatch,in which the coberent oscillators in thern share similar mean phase velocity,and are desynchronized at large frequency mismatch,in which the coherent oscillators in different subpopulations have distinct mean phase *** synchronization-desynchronization transition between chimera states in these two subpopulations is observed with the increase in the frequency *** observed phenomena are theoretically analyzed by passing to the continuum limit and using the Ott-Antonsen approach.

关键词： chimera states bicomponent phase oscillators nonlocal coupling desynchronization transition

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To scan or not to scan:Use of transient elastography in an integrated health system

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World Journal of Hepatology 2023年第3期15卷 419-430页

作者： Libby Stein Rasham Mittal Hubert Song Joanie Chung Amandeep Sahota Department of Internal Medicine Kaiser Permanente Los Angeles Medical CenterLos AngelesCA 90027United States Department of Transplant Hepatology Kaiser Permanente Los Angeles Medical CenterLos AngelesCA 90027United States Research and Evaluation Kaiser Permanente Southern CaliforniaLos AngelesCA 91101United States

BACKGROUND Non-invasive tests,such as Fibrosis-4 index and transient elastography(com-monly FibroScan),are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease(NAFLD).In 2018,a clinical decision support tool(CDST)was implemented to guide primary care providers(PCPs)on use of FibroScan for *** To analyze how this CDST impacted health care utilization and patient *** We performed a retrospective review of adults who had FibroScan for NAFLD indication from January 2015 to December 2017(pre-CDST)or January 2018 to December 2020(post-CDST).Outcomes included FibroScan result,laboratory tests,imaging studies,specialty referral,patient morbidity and *** We identified 958 patients who had FibroScan,115 before and 843 after the CDST was *** percentage of FibroScans ordered by PCPs increased from 33%to 67.1%.The percentage of patients diagnosed with early F1 fibrosis,on a scale from F0 to F4,increased from 7.8%to 14.2%.Those diagnosed with ad-vanced F4 fibrosis decreased from 28.7%to 16.5%.There were fewer laboratory tests,imaging studies and biopsy after the CDST was *** there were more specialty referrals placed after the CDST was implemented,multivariate analysis revealed that healthcare utilization aligned with fibrosis score,whereby patients with more advanced disease had more *** few patients were hospitalized or *** This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.

关键词： Non-alcoholic fatty liver disease Transient elastography FibroScan Clinical decision support tool Health care utilization Primary care

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