Colorectal Cancer Screening in High-risk Populations: a Survey of Cognition among Medical Professionals in Jiangsu,China

To investigate the cognition of medical professionals when following screening guidelines for colorectal cancer(CRC) and barriers to CRC screening. Between February 2012 and December 2012, an anonymous survey with19-questions based on several CRC screening guidelines was randomly administered to gastroenterologists,oncologists, general surgeons, and general practitioners in Jiangsu, a developed area in China where the incidenceof CRC is relatively high. The average cognitive score was 26.4% among 924 respondents. Gastroenterologistsand oncologists had higher scores compared with others (p<0.01 and p<0.01, respectively); doctor of medicine(M.D.) with or without doctor of philosophy (Ph.D.) or holders with bachelor of medical science (BMS) achievedhigher scores than other lower degree holders (P<0.05). More importantly, doctors who finished CRC relatededucation in the past year achieved higher scores than the others (p<0.001). The most commonly listed barriersto referring high-risk patients for CRC screening were “anxiety about colonoscopy without anesthesia”, “lackof awareness of the current guidelines” and “lack of insurance reimbursement.” Lack of cognition was detectedamong doctors when following CRC screening guidelines for high-risk populations. Educational programs shouldbe recommended to improve their cognition and reduce barriers to CRC screening.     

Management practices of hepatitis C virus infected alcoholic hepatitis patients: A survey of physicians

AIM: To survey gastroenterologists and hepatologists regarding their current views on treating hepatitis C virus (HCV) infected alcoholic hepatitis (AH) patients. METHODS: A sixteen item questionnaire was electronically mailed to gastroenterologists and hepatologists. A reminder was sent after 2 mo to increase the response rate. Participation of respondents was confidential. Accessing secured web site to respond to the questionnaire was considered as informed consent. Responses received on the secured website were downloaded in an excel sheet for data analysis. RESULTS: Analyzing 416 responses to 1556 (27% response rate) emails, 57% respondents (56% gastroenterologists) reported HCV prevalence > 20% amongst AH patients. Sixty nine percent often treated AH and 46% preferred corticosteroids (CS). Proportion of respondents with consensus (75% or more respondents agreeing on question) on specific management of HCV infected AH were: routine HCV testing (94%), HCV not changing response to CS (80%) or pentoxifylline (91%), no change in approach to treating HCV infected AH (75%). None of respondent variables: age, specialty, annual number of patients seen, and HCV prevalence could predict respondent to be in consensus on any of or all 4 questions. Further, only 4% would choose CS for treating HCV infected AH as opposed to 47% while treating HCV negative AH. CONCLUSION: Gastroenterologists and hepatologists believe that AH patients be routinely checked for HCV. However, there is lack of consensus on choice of drug for treatment and outcome of HCV positive AH patients. Studies are needed to develop guidelines for management of HCV infected AH patients.     

Impact of Lymph Node Metastases in Esophageal Carcinoma Patients is Independent of Patient Age

Objective: The purpose of the present study was to define the clinicopathological features and prognosis ofesophageal cancer. Methods: Between 2004 and 2009, 128 patients with esophageal cancer were enrolled in aretrospective database and divided into two groups on the basis of number positive lymph nodes with the cutoffas four. Results: The findings for 18 patients (14.0%) Group A were compared with those of 110 patientsGroup B. In the group A, there were significantly more women (12/6 vs. 54/56, P < 0.001). In both groups, themost frequent histological morphology was squamous cell carcinoma (83% and 75%, respectively), althoughthe percentages were significantly different (P < 0.005). In the group A, lesions were more frequently located inthe middle one-third of the esophagus than in the group B (61% vs. 28%, P < 0.001). Group A was more likely tobe Stage IIa. Survival rates in group A patients at 5 years after resection were 15.8%, similar to those in groupB patients (12.1%, difference not significant). Local lymph node metastases and microscopic residual tumor atthe line of resection were also more prevalent in the young patients, but not to a statistically significant degree.Conclusions: These findings suggested that the clinical and pathologic features of carcinomas of the esophagusin young patients do not significantly differ from those in older patients.     

Deep brain stimulation for dystonia due to cerebral palsy: A review

Cerebral palsy (CP) is a heterogeneous group of syndromes that cause a non-progressive disorder of early onset, with abnormal control of movement and posture. Various aetiologies can cause the CP clinical spectrum, but all have a disruption of motor control in common. CP can be divided into four major types based on the motor disability: predominant spastic, dyskinetic, ataxic and mixed form. Dyskinetic CP (DCP) is the most common cause of acquired dystonia in children. The treatment of DCP is challenging because most individuals have mixed degrees of chorea, athetosis and dystonia. Pharmacological treatment is often unsatisfactory. Functional neurosurgery, in particular deep brain stimulation targeting the basal ganglia or the cerebellum, is emerging as a promising therapeutic approach in selected patients with DCP. We evaluated herein the effects of DBS on patients with DCP in a review of published patient data in the largest available studies.     

Atrial Septal Defect: Spectrum of Care

Atrial septal defect (ASD) is a common congenital heart defect. Variability in management of this lesion exists among clinicians. A review of the literature reveals that there is lack of standard guidelines for the evaluation and management of patients with different types of ASDs. This survey-based study was conducted to test the uniformity of diagnostic and therapeutic approach to management of children with secundum, sinus venosus, and primum ASDs. Survey questionnaires were prepared to include questions regarding follow-up, diagnosis, and therapeutic intervention of different types and sizes of ASDs. Questions addressed follow-up visitations, type and frequency of investigative studies, pharmacological therapy, and choice of repair method. Surveys were sent out to all pediatric cardiology academic programs in the United States (n=48) and randomly selected international programs from Europe, Asia, and Australia (n=19). A total of 23 programs (34%) responded to the survey (15 from the United States and 8 internationally). A separate questionnaire was prepared for secundum, primum, and sinus venosus ASD. In each questionnaire, lesion types were subdivided into small, moderate, and large defect sizes to address differences of management approaches to each defect type and size. Results indicate that in secundum ASD, most participants use size of the defect and/or evidence of right-sided volume overload as criteria for defining small, moderate, and large defects. Frequency of follow-up does not vary with the type of lesion but is more frequent with larger defects. Most participants see patients with small defects at intervals of 6 months to 1 year and those with large defects at 3- to 6-month intervals. Age of patient and presence of symptoms determined the frequency of follow-up across all defects. Echocardiography was the most frequently used investigative modality in all defect sizes and types during follow-up visits (used by >80% for follow-up), followed by electrocardiography (ECG). There is a striking preference for the use of pharmacological therapy in primum ASD compared with secundum and sinus venosus ASD. The timing of repair was mainly dependent on patient age and symptomatology in different defects, with the presence of associated anomalies contributing to that in primum and sinus venosus ASD. Most participants use percutaneous approach to close secundum ASD (either as a first choice or as one of two choices depending on the presence of certain features). Before repair, participants use MRI or cardiac catheterization to fully evaluate a secundum ASD if it is large. These investigative modalities are not commonly used in primum and sinus venosus ASD. There is agreement on postoperative follow-up in different types of defects, with most participants continuing follow-up indefinitely, especially in larger defects.     

Racial and ethnic disparities in children's oral health: the National Survey of Children's Health

BackgroundThe authors evaluated racial/ethnic differences and their socioeconomic determinants in the oral health status of U.S. children, as reported by parents.MethodsThe authors used interview data from the 2003 National Survey of Children's Health, a large representative survey of U.S. children. They calculated weighted, nationally representative prevalence estimates for non-Hispanic whites, non-Hispanic blacks and Hispanics, and they used logistic regression to explore the association between parents' reports of fair or poor oral health and various socioeconomic determinants of oral health.ResultsThe results showed significant racial/ethnic differences in parental reports of fair or poor oral health, with prevalences of 6.5 percent for non-Hispanic whites, 12.0 percent for non-Hispanic blacks and 23.4 percent for Hispanics. Although adjustments for family socioeconomic status (poverty level and education) partially explained these racial/ethnic disparities, Hispanics still were twice as likely as non-Hispanic whites to report their children's oral health as fair or poor, independent of socioeconomic status. The authors did find differences in preventive-care attitudes among groups. However, in multivariate models, such differences did not explain the disparities.ConclusionsSignificant racial/ethnic disparities exist in parental reports of their children's oral health, with Hispanics being the most disadvantaged group. Disparities appear to exist independent of preventive-care attitudes and socioeconomic status.     

加速康复外科在中国大陆胸外科临床现状——基于胸外科医生及护士调查分析

背景与目的 虽然加速康复外科(enhanced recovery after surgery,ERAS)理念近年来已逐渐被外科医生所熟悉和应用于临床实践中,但目前关于我国大陆胸外科医师对ERAS理念的认知和应用现状如何仍不清楚.本研究基于对参会胸外科医生和护士进行ERAS相关问题的问卷调查结果,分析加速康复外科在胸外科的应用现状和面临的困难.方法对参与第一届胸科ERAS华西论坛代表回复的773份有效问卷进行分析,问卷内容主要包括两部分:一是被调查人单位情况及个人基本情况;二是加速康复外科相关的10个问题.结果①ERAS的临床应用现状为理念大于实践,69.6%的医生和58.7%的护士认同此观点;88.5%的医生和85.7%护士均认为ERAS理念适用于所有外科.②ERAS临床应用依从性差的主要原因是方案不成熟、无共识和规范(55.6%的医生和69.1%的护士).③ERAS临床实施的最佳团队组合是外科为主的学科协作及医护一体(62.1%的医生和70.7%的护士).④73.7%的医生和81.9%的护士认为ERAS的评价标准应为:平均住院日、患者感受和社会满意度进行综合评价.结论加速康复外科在胸外科应用现状仍然是理念大于实践,主要原因是缺乏临床可用的规范和方案.     

Racial/ethnic disparities in the prevalence and awareness of Hepatitis B virus infection and immunity in the United States

Hepatitis B virus (HBV) infection in the United States is the most common among Asians followed by non‐Hispanic blacks. However, there have been few studies that describe HBV infection and immunity by racial group. Our study aimed to assess racial/ethnic disparities in the prevalence and awareness of HBV infection and immunity using nationally representative data. In the National Health and Nutrition Examination Survey 2011‐2014, 14 722 persons had HBV serology testing. We estimated the prevalence of HBV infection, past exposure, and immunity by selected characteristics and calculated adjusted odds ratios using survey‐weighted generalized logistic regression. Awareness of infection and vaccination history was also investigated. The overall prevalence of chronic HBV infection, past exposure and vaccine‐induced immunity was 0.34% [95%CI 0.24‐0.43], 4.30% [95%CI 3.80‐4.81], and 24.4% [95%CI 23.4‐25.4], respectively. The prevalence of chronic infection was 2.74% [95% CI 1.72‐3.76] in Asians, 0.64% [95% CI 0.35‐0.92] in non‐Hispanic blacks, and 0.15% [95% CI 0.06‐0.24] in non‐Asian, non‐blacks. Only 26.2% of those with chronic infection were aware of their infection. The prevalence of the past exposure was 21.5% [95%CI 19.3‐23.7] in Asians, 8.92% [95%CI 7.84‐9.99] in non‐Hispanic blacks, 2.05% [95%CI 1.49‐2.63] in non‐Hispanic whites and 4.47% [95%CI 3.25‐5.70] in Hispanics. Prevalence of vaccine‐induced immunity by each race was 34.1% [95%CI: 32.0‐36.2] in Asians, 25.5% [95%CI: 24.0‐27.0] in non‐Hispanic blacks, 24.0% [95%CI: 22.6‐25.4] in non‐Hispanic whites and 22.2% [95%CI: 21.3‐23.3] in Hispanics. There are considerable racial/ethnic disparities in HBV infection, exposure and immunity. More active and sophisticated healthcare policies on HBV management may be warranted.