BACKGROUND There is an acute need to raise awareness of non-alcoholic fatty liver disease/nonalcoholic steatohepatitis(NAFLD/NASH)among primary care physicians,endocrinologists and diabetologists to improve patient id...BACKGROUND There is an acute need to raise awareness of non-alcoholic fatty liver disease/nonalcoholic steatohepatitis(NAFLD/NASH)among primary care physicians,endocrinologists and diabetologists to improve patient identification and address the current difficulties in NASH clinical trial enrollment.We examined the extent of knowledge and practice regarding NASH diagnosis and management guidelines.A randomized online convenience survey of 12869 physicians drawn from a national physician database of primary care physicians(PCPs),and gastroenterology and endocrinology specialists were queried via online survey.Our results,based on a cohort of 185 respondents,showed gaps in knowledge and practice between these three groups of practitioners,with primary care providers having the lowest adherence to published guidelines for diagnosis of NASH.Without clear knowledge and patient identification at the point of presentation-which is often in primary care or with specialties other than hepatology–many patients with NAFLD and NASH will remain undiagnosed and untreated,and clinical studies will continue to struggle with patient recruitment,hindering clinical development and optimal patient care.AIM To determine knowledge base concerning NASH diagnosis amongst gastroenterologists,endocrinologists and primary care physicians to improve referrals into clinical trials.METHODS A randomized online convenience survey of 12869 physicians drawn from a national physician database of PCPs,and gastroenterology and endocrinology specialists was conducted yielding a sample of 185 respondents.RESULTS The survey revealed that many physicians are either unaware of testing options other than biopsy,or do not use them in practice.Only 46%of endocrinologists and 42%of primary care physicians indicated they would refer a patient for specialist workup if they suspected NASH.Risk(25%)and inconvenience to patients(18%)are given as reasons for not referring those with suspected NASH for biopsy.For standard diagnostic algorithms such as Fibrosis-4 score,18%of PCPs,30%of endocrinologists and 65%gastroenterologists reported using these tests in clinical practice.CONCLUSION Substantial gaps in knowledge of the differences between NAFLD and NASH exist between these physician groups,with knowledge being particularly low among primary care doctors and endocrinologists.The use of a simple noninvasive screening algorithm may help to identify the right patients for clinical trials,which in turn will be vital to the development of effective and welltolerated treatments for this increasingly ubiquitous condition.展开更多
In Hungary, the incidence and mortality from oral cancer is so high, that in the past decades it has attracted international attention. The mortality rates are the highest in Europe. As risk factors, smoking and alcoh...In Hungary, the incidence and mortality from oral cancer is so high, that in the past decades it has attracted international attention. The mortality rates are the highest in Europe. As risk factors, smoking and alcohol drinking have a multiplicative role;in addition, a number of dental factors also play a role. Premalignant conditions and lesions are well known. They should be targeted for early detection and early treatment. The screening tool is simple: inspection and palpation. The physician-patient encounters provide opportunity for screening. This paper looks for the answer to the long debated question: who is responsible for oral screening?展开更多
It is now more than two decades since Nico Pijls and Bernard DeBruyne introduced fractional flow reserve （FFR） as a way to assess stenosis severity in the catheterization laboratory and since Paul Yock invented gray...It is now more than two decades since Nico Pijls and Bernard DeBruyne introduced fractional flow reserve （FFR） as a way to assess stenosis severity in the catheterization laboratory and since Paul Yock invented grayscale intravascular ultrasound （IVUS） that then spawned many second-generation intravascular imaging techniques such as （1） Virtual histology-IVUS （VH-IVUS） that uses both amplitude and radiofrequency ultrasound information to classify plaque as necrotic core,展开更多
France is a country with 67 million inhabitants and is part of the European Union.Antibiotic consumption in humans is higher in France as compared to the European average,especially in outpatient settings(1–2).The bu...France is a country with 67 million inhabitants and is part of the European Union.Antibiotic consumption in humans is higher in France as compared to the European average,especially in outpatient settings(1–2).The burden of antibiotic resistance is also high,as compared to the European average,with an estimated 5,500 deaths per year associated with multidrug-resistant bacterial infections(3).Encouraging results have,however,been observed over the last several years:antibiotic consumption in the community,in nursing homes and in hospitals showed a decreasing trend,as well as certain resistant bacteria,such as 3rd-generation cephalosporin-or fluoroquinolone-resistant Escherichia coli(1–2,4–5).The COVID-19 pandemic has had a dramatic impact on antibiotic consumption and its long-term impact on antibiotic resistance is being carefully monitored(1).展开更多
文摘BACKGROUND There is an acute need to raise awareness of non-alcoholic fatty liver disease/nonalcoholic steatohepatitis(NAFLD/NASH)among primary care physicians,endocrinologists and diabetologists to improve patient identification and address the current difficulties in NASH clinical trial enrollment.We examined the extent of knowledge and practice regarding NASH diagnosis and management guidelines.A randomized online convenience survey of 12869 physicians drawn from a national physician database of primary care physicians(PCPs),and gastroenterology and endocrinology specialists were queried via online survey.Our results,based on a cohort of 185 respondents,showed gaps in knowledge and practice between these three groups of practitioners,with primary care providers having the lowest adherence to published guidelines for diagnosis of NASH.Without clear knowledge and patient identification at the point of presentation-which is often in primary care or with specialties other than hepatology–many patients with NAFLD and NASH will remain undiagnosed and untreated,and clinical studies will continue to struggle with patient recruitment,hindering clinical development and optimal patient care.AIM To determine knowledge base concerning NASH diagnosis amongst gastroenterologists,endocrinologists and primary care physicians to improve referrals into clinical trials.METHODS A randomized online convenience survey of 12869 physicians drawn from a national physician database of PCPs,and gastroenterology and endocrinology specialists was conducted yielding a sample of 185 respondents.RESULTS The survey revealed that many physicians are either unaware of testing options other than biopsy,or do not use them in practice.Only 46%of endocrinologists and 42%of primary care physicians indicated they would refer a patient for specialist workup if they suspected NASH.Risk(25%)and inconvenience to patients(18%)are given as reasons for not referring those with suspected NASH for biopsy.For standard diagnostic algorithms such as Fibrosis-4 score,18%of PCPs,30%of endocrinologists and 65%gastroenterologists reported using these tests in clinical practice.CONCLUSION Substantial gaps in knowledge of the differences between NAFLD and NASH exist between these physician groups,with knowledge being particularly low among primary care doctors and endocrinologists.The use of a simple noninvasive screening algorithm may help to identify the right patients for clinical trials,which in turn will be vital to the development of effective and welltolerated treatments for this increasingly ubiquitous condition.
文摘In Hungary, the incidence and mortality from oral cancer is so high, that in the past decades it has attracted international attention. The mortality rates are the highest in Europe. As risk factors, smoking and alcohol drinking have a multiplicative role;in addition, a number of dental factors also play a role. Premalignant conditions and lesions are well known. They should be targeted for early detection and early treatment. The screening tool is simple: inspection and palpation. The physician-patient encounters provide opportunity for screening. This paper looks for the answer to the long debated question: who is responsible for oral screening?
文摘It is now more than two decades since Nico Pijls and Bernard DeBruyne introduced fractional flow reserve （FFR） as a way to assess stenosis severity in the catheterization laboratory and since Paul Yock invented grayscale intravascular ultrasound （IVUS） that then spawned many second-generation intravascular imaging techniques such as （1） Virtual histology-IVUS （VH-IVUS） that uses both amplitude and radiofrequency ultrasound information to classify plaque as necrotic core,
文摘France is a country with 67 million inhabitants and is part of the European Union.Antibiotic consumption in humans is higher in France as compared to the European average,especially in outpatient settings(1–2).The burden of antibiotic resistance is also high,as compared to the European average,with an estimated 5,500 deaths per year associated with multidrug-resistant bacterial infections(3).Encouraging results have,however,been observed over the last several years:antibiotic consumption in the community,in nursing homes and in hospitals showed a decreasing trend,as well as certain resistant bacteria,such as 3rd-generation cephalosporin-or fluoroquinolone-resistant Escherichia coli(1–2,4–5).The COVID-19 pandemic has had a dramatic impact on antibiotic consumption and its long-term impact on antibiotic resistance is being carefully monitored(1).
基金Center for Patient SafetyDana-Farber Cancer Institute+1 种基金BostonSNW was also supported by a K08 Mentored Clinical Scientist Career Development Award (1 K08 HS 11644) from the US Agency for Healthcare Research and Quality
