Background and objective The WHO emphasises the importance of integrating advice on physical activity(PA)into primary care of patients with chronic ischaemic heart disease(IHD).Similarly,the German treatment guideline...Background and objective The WHO emphasises the importance of integrating advice on physical activity(PA)into primary care of patients with chronic ischaemic heart disease(IHD).Similarly,the German treatment guideline‘Chronic Coronary Heart Disease’recommends that general practitioners(GPs)provide advice on PA to IHD patients.However,the provision of PA advice seems to be inadequately implemented in general practice.One reason is the lack of medical training in providing PA advice effectively and efficiently.International guidelines recommend such training for health professionals.This study aims to explore experiences,perceptions and attitudes,including barriers and facilitators of GPs towards the routine delivery of PA advice to IHD patients.Methods Between March and June 2023,12 face-to-face problem-centred interviews and six focus group discussions(n=37)with GPs were conducted.Interview and discussion guides were developed and pilot tested by the multi-professional study team.We used a purposive sampling strategy,and data were collected in an iterative process.Audio-recorded data were transcribed verbatim and analysed using a content structuring procedure(deductive and inductive approach).GPs were involved throughout the entire research process,for example,in multi-professional analysis groups.Results Although GPs are mostly aware of the health benefits of PA for patients with IHD,PA advice is not routinely provided.Conversations on PA tend to be rather unstructured,and advice is often addressed more generally than customised to the patients’needs and preferences.Priority is given to other lifestyle issues,such as smoking cessation.PA advice is perceived as time-consuming and rather ineffective with regard to the target behaviour.GPs frequently express frustration in this context.GPs express a lack of and simultaneously a need for communication strategies(structure and tools)that can be integrated into everyday GP practice to motivate patients to PA.Conclusion The results provide relevant insights into the current practice of GPs with regard to their attitudes on,experiences with,and requirements for the provision of PA advice to IHD patients.These results are helpful to inform the development of appropriate GP training in the provision of very brief PA advice to IHD patients.展开更多
The liquid cooling system(LCS)of fuel cells is challenged by significant time delays,model uncertainties,pump and fan coupling,and frequent disturbances,leading to overshoot and control oscillations that degrade tempe...The liquid cooling system(LCS)of fuel cells is challenged by significant time delays,model uncertainties,pump and fan coupling,and frequent disturbances,leading to overshoot and control oscillations that degrade temperature regulation performance.To address these challenges,we propose a composite control scheme combining fuzzy logic and a variable-gain generalized supertwisting algorithm(VG-GSTA).Firstly,a one-dimensional(1D)fuzzy logic controler(FLC)for the pump ensures stable coolant flow,while a two-dimensional(2D)FLC for the fan regulates the stack temperature near the reference value.The VG-GSTA is then introduced to eliminate steady-state errors,offering resistance to disturbances and minimizing control oscillations.The equilibrium optimizer is used to fine-tune VG-GSTA parameters.Co-simulation verifies the effectiveness of our method,demonstrating its advantages in terms of disturbance immunity,overshoot suppression,tracking accuracy and response speed.展开更多
BACKGROUND Thirst management in convalescent patients recovering from a digestive surgery performed under general anesthesia requires attention.A simple,practical,and safe method can effectively relieve thirst symptom...BACKGROUND Thirst management in convalescent patients recovering from a digestive surgery performed under general anesthesia requires attention.A simple,practical,and safe method can effectively relieve thirst symptoms in such patients.AIM To evaluate the enhanced recovery after surgery(ERAS)-based evidence-based care(EBC)plus ice stimulation therapy for thirst management of convalescent patients following digestive surgery performed under general anesthesia.METHODS A total of 191 patients convalescing after digestive surgery performed under general anesthesia between March 2020 and February 2023 and experiencing thirst were selected.In total,89 patients and 102 patients in the control and research groups received routine care and ERAS-based EBC plus ice stimulation therapy,respectively.The following data were comparatively analyzed:(1)Thirst degree(thirst intensity numerical rating scale)and thirst distress(TD)degree(TD scale);(2)Oral mucosal wetness;(3)Unstimulated whole salivary flow rate(UWSFR);(4)Adverse reactions(palpitation,fatigue,chapped lips,and nausea and vomiting);and(5)Nursing satisfaction.RESULTS After nursing,thirst degree and distress were statistically lower in the research group than in the control group.Additionally,compared with the control group,the research group exhibited a lower degree of oral mucosal wetness,higher UWSFR,fewer adverse reactions,and more total nursing satisfaction.CONCLUSION ERAS-based EBC plus ice stimulation therapy can effectively alleviate thirst in convalescent patients recovering from a digestive surgery performed under general anesthesia.It can alleviate xerostomia symptoms,reduce adverse reactions,and improve patient comfort.展开更多
Introduction This study aimed to either identify or develop and validate a patient-reported outcome measure(PROM)to assess treatment burden related to general practice for patients with multimorbidity,which can be use...Introduction This study aimed to either identify or develop and validate a patient-reported outcome measure(PROM)to assess treatment burden related to general practice for patients with multimorbidity,which can be used alongside the MultiMorbidity Questionnaire part 1(MMQ1)without overwhelming the target population with redundant items.Methods We conducted a systematic literature review to identify all existing PROMs measuring treatment burden.If no suitable PROM was found,our plan was to:(1)develop a draft PROM using items from existing instruments,(2)carry out group and individual interviews with patients with multimorbidity to ensure the PROM’s understandability,clarity,completeness and relevance and(3)undertake psychometric validation with a diverse sample of primary care patients with chronic conditions.Results We did not identify an eligible PROM in the literature review.The draft PROM consisted of 30 items divided into six domains;Information about treatment,Challenges with medication,Medical appointments,Self-monitoring,Health behaviour and Challenges in the contact to the health system.In the psychometric validation,neither these domains nor any other theoretical constellation of items had adequate psychometric properties.Individual items had good criterion validity and sensitivity to change.Conclusions In this study,we developed a 30-item PROM with high content validity where various individual items showed adequate criterion validity and sensitivity to change,making these items useful as a supplemental measure to the MMQ1.Trial registration number NCT05676541 Registration Date:16 December 2022.展开更多
Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Desi...Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Design A retrospective cohort study using routinely collected general practice data.Logistic regression was used to compare odds of allied health referrals,adjusting for age,sex and socioeconomic status.Setting De-identified patient and episode activity data from 537 GP practices across two PHNs in Australia between 2018 and 2023.Participants Data from 1153304 patients and 28667517 GP episodes of care were analysed.After merging records,693328 unique patients were identified,including 16610 patients with dementia.Subcohorts included patients with dementia,stroke,Parkinson’s disease and combinations of these conditions.Results The dementia cohort(n=16610)had a similar overall allied health referral rate(36.1%)to the control cohort(n=48977)(35.4%).Patients with dementia only were significantly less likely to receive any allied health referral compared with those with stroke(adjusted OR(aOR)0.76,95%CI 0.72 to 0.80;p<0.001)or Parkinson’s disease(aOR 0.72,95%CI 0.66 to 0.78;p<0.001).Those with dementia and stroke were also less likely to receive referrals than those with stroke only(aOR 0.71,95%CI 0.61 to 0.82;p<0.001).No significant difference was found between dementia with Parkinson’s and Parkinson’s only groups(p=0.48).Patients with dementia were consistently less likely to be referred to key allied health services(p<0.05).Conclusion Despite strong evidence supporting allied health interventions for dementia,referral rates remain comparatively low.Enhancing GP referral resources and education,integrating dementia-specific care pathways and implementing supportive policy changes are needed to improve access and equity in dementia care.展开更多
Artificial intelligence,especially large language models(LLMs),is reshaping how we learn,communicate,and create.These systems provide students and professionals immediate access to fluent,context-aware language that c...Artificial intelligence,especially large language models(LLMs),is reshaping how we learn,communicate,and create.These systems provide students and professionals immediate access to fluent,context-aware language that can support learning,increase productivity,and spark creativity.But what happens when their use becomes excessive?This paper explores the potential long-term consequences of over-relying on LLMs-particularly memory,critical thinking,creativity,and motivation.Drawing on research in cognitive psychology,education,neuroscience,and media studies,it argues that LLMs are best understood as cognitive prostheses:incredibly valuable when used wisely,but risky when they replace rather than support human imagination.展开更多
BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclea...BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclear.AIM To clarify the impact of relevant factors,particularly perirenal fat,on postoperative hypertension resolution.METHODS In this retrospective single-center study,a total of 138 patients with obesity and hypertension were included,all of whom underwent LSG in the hospital and were followed up for one year.Multivariate logistic regression models were used to identify independent risk factors for postoperative hypertension resolution.Generalized additive models were employed to clarify the nonlinear relationships between these factors and hypertension resolution,and their predictive values were compared using fivefold cross-validation.RESULTS After LSG,107 patients(77.5%)experienced hypertension resolution,while 31 patients(22.5%)did not achieve resolution.Both the preoperative perirenal fat area(PrFA)and perirenal fat thickness were independent risk factors for postoperative hypertension resolution(P<0.001 vs P=0.002).These factors are curvilinearly correlated with the hypertension resolution rate,but PrFA has a better predictive value than perirenal fat thickness dose(area under the curve=0.846 vs 0.809).Compared with those with PrFA≥18 cm2,patients with PrFA<18 cm2 had a higher hypertension resolution rate[87%vs 68.1%;odds ratio(95%confidence interval)=3.513(1.367-9.902),P=0.012].CONCLUSION PrFA is a preoperative predictor of postoperative hypertension resolution.It is curvilinearly associated with the resolution rate,and patients with PrFA<18 cm²have better hypertension resolution outcomes after LSG.展开更多
AIM:To evaluate the demographics,clinical characteristics,treatments,and outcomes of patients with ocular surface squamous neoplasia(OSSN)at the Philippine General Hospital.METHODS:This was a single-center,11-year ret...AIM:To evaluate the demographics,clinical characteristics,treatments,and outcomes of patients with ocular surface squamous neoplasia(OSSN)at the Philippine General Hospital.METHODS:This was a single-center,11-year retrospective,cross sectional case series on 18 cases of OSSN seen between January 2012 to June 2023.The patient’s demographics,presenting symptoms,tumor characteristics,histopathologic diagnosis,treatment,outcomes,and duration of follow-up were reviewed.RESULTS:Out of 33 identified cases of OSSN,only 18 were eligible for inclusion in the study.Mean age was 60.78y(range 31 to 80),with male predominance(66.67%).The left eye was most commonly affected(61.11%)with most presenting with fleshy mass(83.33%).Most tumors were located nasally(66.67%)and were predominantly papilliform(44.44%)in morphology with associated hyperpigmentation(38.89%).Squamous cell carcinoma(SCCA)was the most common histopathologic diagnosis(72.22%).The main primary treatment was surgical excision(94.44%)with or without adjunctive therapy,with only 1 patient undergoing first-line topical chemotherapy.Only 3 recurrences(16.67%)were noted with a median followup of 7.5mo.A statistically significant recurrence-free odds leaning towards the utilization of cryotherapy was noted.CONCLUSION:OSSN seen at the Philippine General Hospital is presented as a limbal papilliform mass,most commonly affecting elderly males.Surgical excision with adjuvant cryotherapy and/or chemotherapy is the preferred mode of treatment.展开更多
Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due...Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due to the frequency of other types of joint diseases and the existence of degenerative and dystrophic valve disease. In adults, the initial rheumatic attack is marked by the predominance of joint damage over cardiac damage. However, it is often at this age that rheumatic valve disease is discovered. The revised Jones criteria also find their place in the diagnosis of AAR in adults. Objective: To study the demographic, clinical, and biological characteristics of acute rheumatic fever (ARF) in the General Medicine Department of the Siguiri Prefectural Hospital. Materials and Methods: This descriptive observational study examined the demographic, clinical and biological characteristics of acute rheumatic fever (ARF) at the Siguiri Prefectural Hospital, Guinea, between April 1 and September 31, 2021 according to Jones criteria. The data were collected on a form containing sociodemographic variables (age, sex, profession), rheumatological, cardiac, pulmonary and neurological clinical signs, biological variables and treatment. Results: Figure 1 shows the flow of the hospital frequency of the RAA in the General Medicine Department of the Prefectural Hospital of Siguiri. During the study period, 420 patients were hospitalized, of whom 161 patients had AAR, a frequency of 38.33%. Table 1 shows the distribution of patients diagnosed with ARB, by sociodemographic characteristics. The average age was 44.7 ± 19.78 years and the extremes of 14 and 90 years, the female sex dominated with a ratio of 0.75. The informal sector was in the majority in 45.34% of cases and most were illiterate, i.e. 53.42%. In our study, the incidence was lower during the dry season than during the rainy season, a hot season with high rainfall and humidity, the rainy period was a provider with a peak in August and September. The lifestyle was characterized by overcrowding in 87.58% of patients. The main complaint was fever, i.e. 88.82%. Rheumatological manifestations such as arthritis were 98.14%, chest pain was 37.89% (61 cases). The diagnosis was confirmed by ASLO titration in 85.71% of patients and 98.55% (136 cases) had a titration greater than 400 U/ml. Conclusion: The results obtained from our study show a high prevalence of acute rheumatic fever, which makes it a worrying health problem in the Siguiri health district. Young female adult patients, married with an informal profession and not in school residing in Siguiri were the most encountered in our study. The main functional signs mentioned by the patients were fever, cough and abdominal pain;osteoarticular pain and chest pain dominated the clinical picture. Almost all of our patients had an ASLO titer greater than 400 U/ml and a positive C-reactive protein. Our results show a high risk of spread of acute rheumatic fever within the population of Siguiri. Due to the serious complications caused by acute rheumatic fever, particular attention must be paid to it by carrying out other, much larger studies in order to identify the problem of RAA.展开更多
Objective This study describes acceptance and attitudes towards genetic cancer testing among German primary care patients.Design Cross-sectional survey.Setting Primary care.Participant Systematically recruited patient...Objective This study describes acceptance and attitudes towards genetic cancer testing among German primary care patients.Design Cross-sectional survey.Setting Primary care.Participant Systematically recruited patients aged≥18 years from six general practices in Mecklenburg-Western Pomerania participated in an anonymous self-administered survey on familial cancer prevention(n=479 and 67.0%participation rate).Those with complete data were analysed(n=424;mean age 53.7,SD 16.6 years;men 34.4%).Linear regression analyses were used to examine potential disparities in general acceptance of genetic testing and attitudes towards genetic cancer testing according to sociodemographics and familial cancer knowledge.Result General acceptance of genetic testing was high,particularly among younger,higher-educated individuals and those with a family history of cancer and higher familial cancer knowledge.For example,83.3%either agreed or strongly agreed that it should be available to anybody.The most important benefits of genetic cancer testing were to guide check-up frequency(81.4%),to inform medical decision-making(80.2%)and to understand children’s risk(75.2%).The most important concerns included the potential burden on the family(44.6%)and the belief that cancer cannot be prevented(39.2%).More favourable attitudes were found among younger,higher-educated individuals,those with a personal history of cancer and those with fewer children or no partner.For example,higher age was linked to lower benefit(regression coefficient(RC)−0.01,95%CI−0.01 to−0.001)and higher concern ratings(RC 0.01,95%CI 0.002 to 0.01).About a third(34.7%)rated not wanting to know about genetic alterations that increase their cancer risk as a(very)important reason against testing.Information avoidance was higher among older individuals(RC 0.02,95%CI 0.01 to 0.02),women(RC 0.40,95%CI 0.11 to 0.69),those with lower education(RC−0.64,95%CI−0.91 to−0.36)and those with more children(RC 0.21,95%CI 0.09 to 0.33).Conclusion Acceptance of genetic testing was high,but barriers remain,particularly among older adults,women,the less educated and those with more children.Targeted educational efforts to improve health literacy,emphasise the preventive potential of genetic testing and emotional support through genetic counselling are essential to overcome these barriers and promote informed decision-making.展开更多
The initial boundary value problem for a viscoelastic equation ｜ u t ｜ ρ u tt △u-△u tt ＋ t 0 g（ts）△u（s）ds ＋ ｜ u t ｜ m u t = ｜ u ｜ p u in a bounded domain is considered, where ρ, m, p 〉 0 and g is a n...The initial boundary value problem for a viscoelastic equation ｜ u t ｜ ρ u tt △u-△u tt ＋ t 0 g（ts）△u（s）ds ＋ ｜ u t ｜ m u t = ｜ u ｜ p u in a bounded domain is considered, where ρ, m, p 〉 0 and g is a nonnegative and decaying function. The general uniform decay of solution energy is discussed under some conditions on the relaxation function g and the initial data by adopting the method of [14, 15, 19]. This work generalizes and improves earlier results in the literature.展开更多
A viscoelastic equation with Balakrishnan-Taylor damping and nonlinear boundary/interior sources is considered in a bounded domain. Under appropriate assumptions ira- posed on the source and the damping, we establish ...A viscoelastic equation with Balakrishnan-Taylor damping and nonlinear boundary/interior sources is considered in a bounded domain. Under appropriate assumptions ira- posed on the source and the damping, we establish uniform decay rate of the solution energy in terms of the behavior of the nonlinear feedback and the relaxation function, without setting any restrictive growth assumptions on the damping at the origin and weakening the usual assumptions on the relaxation function.展开更多
AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality ...AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.展开更多
AIM： To evaluate the association between gastroesophageal reflux diseases （GERD） and coronary heart diseases. METHODS： One thousand nine hundred and seventy consecutive patients who attended our hospital were enro...AIM： To evaluate the association between gastroesophageal reflux diseases （GERD） and coronary heart diseases. METHODS： One thousand nine hundred and seventy consecutive patients who attended our hospital were enrolled. All of the patients who first attend our hospital were asked to respond to the F-scale questionnaire regardless of their chief complaints. All patients had a careful history taken, and resting echocardiography （ECG） was performed by physicians if the diagnostic necessity arose. Patients with ECG signs of coronary artery ischemia were defined as ST- segment depression based on the Minnesota code. RESULTS： Among 712 patients （36%） with GERD, ECG was performed in 171 （24%）, and ischemic changes were detected in eight （5%）. Four （50%） of these patients with abnormal findings upon ECG had no chest symptoms such as chest pain, chest oppression, or palpitations. These patients （0.6%; 4/712） were thought to have non-GERD heartburn, which may be related to ischemic heart disease. Of 281 patients who underwent ECG and did not have GERD symptoms, 20 （7%） had abnormal findings upon ECG. In patients with GERD symptoms and ECG signs of coronary artery ischemia, the prevalence of linked angina was considered to be 0.4% （8/1970 patients）.CONCLUSION： The present study suggested that ischemic heart disease might be found although a patient was referred to the hospital with a complaint of GERD symptoms. Physicians have to be concerned about missing clinically important coronary artery disease while evaluating patients for GERD symptoms.展开更多
BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy,the outcomes of such procedure under regional anesthesia(RA)have been evaluated.In the context of cholecyst...BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy,the outcomes of such procedure under regional anesthesia(RA)have been evaluated.In the context of cholecystectomy,combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIM To evaluate comparative outcomes of RA and general anesthesia(GA)in patients undergoing laparoscopic cholecystectomy.METHODS A comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTS Thirteen randomized controlled trials enrolling 1111 patients were included.The study populations in the RA and GA groups were of comparable age(P=0.41),gender(P=0.98)and body mass index(P=0.24).The conversion rate from RA to GA was 2.3%.RA was associated with significantly less postoperative pain at 4 h[mean difference(MD):-2.22,P<0.00001],8 h(MD:-1.53,P=0.0006),12 h(MD:-2.08,P<0.00001),and 24 h(MD:-0.90,P<0.00001)compared to GA.Moreover,it was associated with significantly lower rate of nausea and vomiting[risk ratio(RR):0.40,P<0.0001].However,RA significantly increased postoperative headaches(RR:4.69,P=0.03),and urinary retention(RR:2.73,P=0.03).The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes,with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSION Our findings indicate that RA may be an attractive anesthetic modality for daycase laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA.However,its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy.展开更多
In more recent times, health-related quality of life (HRQOL) measurements have formed an important part of as- sessing the quality of routine care in general practice. For a measure to have clinical usefulness it must...In more recent times, health-related quality of life (HRQOL) measurements have formed an important part of as- sessing the quality of routine care in general practice. For a measure to have clinical usefulness it must not only be valid, appro- priate, reliable, responsive, and capable of being interpreted, but it must also be simple, fast to complete, easy to score, and provide useful clinical data. The Two-step method of choosing appropriate measures is introduced. Then through comparison of generic instruments with disease-specific instruments, we can conclude that sometimes a combination of generic and disease-specific HRQOL measures may be more appropriate for monitoring changes in a patient’s health status due to an intervention.展开更多
The purpose of this article is to introduce a general split feasibility problems for two families of nonexpansive mappings in Hilbert spaces. We prove that the sequence generated by the proposed new algorithm converge...The purpose of this article is to introduce a general split feasibility problems for two families of nonexpansive mappings in Hilbert spaces. We prove that the sequence generated by the proposed new algorithm converges strongly to a solution of the general split feasibility problem. Our results extend and improve some recent known results.展开更多
To accurately assess the prevalence of GERD symptoms in general practice. METHODS： 4139 consecutive patients （2025 men and 2114 women with a mean age of 43 years）, who first attended the Outpatient Department of Ge...To accurately assess the prevalence of GERD symptoms in general practice. METHODS： 4139 consecutive patients （2025 men and 2114 women with a mean age of 43 years）, who first attended the Outpatient Department of General Medicine and Emergency Care at Toho University Omori Hospital, were asked to respond to the F-scale questionnaire regardless of their chief complaints. The questionnaire is a self-report instrument, written in a simple and easy-to- understand language, containing 12 questions. RESULTS： Of 4139 subjects, 1554 patients （37.6%） were identified as GERD according to their F-scale score （〉 7）. However, there were only 45 consultations （1.1%） for typical GERD symptoms. Although GERD symptoms are common in adults of all ages, the prevalence of GERD was highest in the 20-29 years age group and the age group 70-79 years had the lowest prevalence for both males and females. CONCLUSION： Although there was a high rote indicating GERD in our primary care population, only 1.1% of outpatients attended our hospital with a chief complaint of GERD symptoms. Since about one-third of GERD patients are affected by atypical symptoms, general physicians need to be cautious about extrapolating these results to patients with a chief complaint other than typical GERD symptoms.Watanabe T, Urita Y, Sugimoto M, Miki K. Gastro-esophagea reflux disease symptoms are more common in genera practice in Japan. World J Gastroenterol 2007; 13（31） 4219-4223展开更多
BACKGROUND Gastroesophageal reflux(GER)affects up to 20%of the adult population and is defined as troublesome and frequent symptoms of heartburn or regurgitation.GER produces significantly harmful impacts on quality o...BACKGROUND Gastroesophageal reflux(GER)affects up to 20%of the adult population and is defined as troublesome and frequent symptoms of heartburn or regurgitation.GER produces significantly harmful impacts on quality of life and precipitates poor mental well-being.However,the potential risk factors for the incidence and extent of GER in adults undergoing general anesthesia remain unclear.AIM To explore independent risk factors for the incidence and extent of GER during general anesthesia induction.METHODS A retrospective study was conducted,and 601 adult patients received general anesthesia intubation or laryngeal mask surgery between July 2016 and January 2019 in Shanghai General Hospital of Nanjing Medical University.This study recruited a total of 601 adult patients undergoing general anesthesia,and the characteristics of patients and the incidence or extent of GER were recorded.The potential risk factors for the incidence of GER were explored using multivariate logistic regression,and the risk factors for the extent of GER were evaluated using multivariate linear regression.RESULTS The current study included 601 adult patients,82 patients with GER and 519 patients without GER.Overall,we noted significant differences between GER and non-GER for pharyngitis,history of GER,other digestive tract diseases,history of asthma,and the use of sufentanil(P<0.05),while no significant differences between groups were observed for sex,age,type of surgery,operative time,body mass index,intraoperative blood loss,smoking status,alcohol intake,hypertension,diabetes mellitus,psychiatric history,history of respiratory infection,history of surgery,the use of lidocaine,palliative strategies,propofol,or rocuronium bromide,state anxiety inventory,trait anxiety inventory,and selfrating depression scale(P>0.05).The results of multivariate logistic regression indicated that female sex[odds ratio(OR):2.702;95%confidence interval(CI):1.144-6.378;P=0.023],increased age(OR:1.031;95%CI:1.008-1.056;P=0.009),pharyngitis(OR:31.388;95%CI:15.709-62.715;P<0.001),and history of GER(OR:11.925;95%CI:4.184-33.989;P<0.001)were associated with an increased risk of GER,whereas the use of propofol could protect against the risk of GER(OR:0.942;95%CI:0.892-0.994;P=0.031).Finally,age(P=0.004),operative time(P<0.001),pharyngitis(P<0.001),history of GER(P=0.024),and hypertension(P=0.017)were significantly associated with GER time.CONCLUSION This study identified the risk factors for GER in patients undergoing general anesthesia including female sex,increased age,pharyngitis,and history of GER.展开更多
BACKGROUND： Hepatitis B virus（HBV） infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-relate...BACKGROUND： Hepatitis B virus（HBV） infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-related patients has not been well controlled in China. With the development of general practitioner（GP） system in this country, GPs may greatly improve the management of the patients with HBV infection. However, the role of GPs in controlling HBV infection has been rarely studied.DATA SOURCES： A literature search of PubMed, CNKI,Wanfang data and VIP was performed with the following key words： ＂general practitioner＂, ＂family physician＂, ＂community management＂, ＂community health care workers＂, ＂family practice＂, ＂hepatitis B virus＂, ＂HBV＂, ＂HBV vaccination＂, ＂HBV prevention＂, ＂HBV management＂, ＂HBV treatment＂, ＂antiviral therapy＂ and ＂chronic hepatitis B（CHB）＂. The information about the GPs-involved prevention, diagnosis and treatment of CHB was reviewed.RESULTS： The reports on the role of GPs in the prevention,diagnosis and treatment of HBV infection are few. But the experiences from Western countries demonstrated that GPs could play a significant role in the management of patients withCHB. The importance of GPs is obvious although there are some difficulties in China. GPs and health officials at different levels should work together in the management of patients with CHB.CONCLUSIONS： The involvement of GPs in the management of patients with HBV infection is effective in China. But GPs＇ knowledge and skills for the control of HBV infection have to be improved currently. GPs＇ involvement will enforce the management of CHB in China in the near future.展开更多
基金funded as a junior research group in health services research by the German Ministry of Education and Research(BMBF)(funding period:05/2022-04/2027,grant number:01GY2103).
文摘Background and objective The WHO emphasises the importance of integrating advice on physical activity(PA)into primary care of patients with chronic ischaemic heart disease(IHD).Similarly,the German treatment guideline‘Chronic Coronary Heart Disease’recommends that general practitioners(GPs)provide advice on PA to IHD patients.However,the provision of PA advice seems to be inadequately implemented in general practice.One reason is the lack of medical training in providing PA advice effectively and efficiently.International guidelines recommend such training for health professionals.This study aims to explore experiences,perceptions and attitudes,including barriers and facilitators of GPs towards the routine delivery of PA advice to IHD patients.Methods Between March and June 2023,12 face-to-face problem-centred interviews and six focus group discussions(n=37)with GPs were conducted.Interview and discussion guides were developed and pilot tested by the multi-professional study team.We used a purposive sampling strategy,and data were collected in an iterative process.Audio-recorded data were transcribed verbatim and analysed using a content structuring procedure(deductive and inductive approach).GPs were involved throughout the entire research process,for example,in multi-professional analysis groups.Results Although GPs are mostly aware of the health benefits of PA for patients with IHD,PA advice is not routinely provided.Conversations on PA tend to be rather unstructured,and advice is often addressed more generally than customised to the patients’needs and preferences.Priority is given to other lifestyle issues,such as smoking cessation.PA advice is perceived as time-consuming and rather ineffective with regard to the target behaviour.GPs frequently express frustration in this context.GPs express a lack of and simultaneously a need for communication strategies(structure and tools)that can be integrated into everyday GP practice to motivate patients to PA.Conclusion The results provide relevant insights into the current practice of GPs with regard to their attitudes on,experiences with,and requirements for the provision of PA advice to IHD patients.These results are helpful to inform the development of appropriate GP training in the provision of very brief PA advice to IHD patients.
基金Supported by the Major Science and Technology Project of Jilin Province(20220301010GX)the International Scientific and Technological Cooperation(20240402071GH).
文摘The liquid cooling system(LCS)of fuel cells is challenged by significant time delays,model uncertainties,pump and fan coupling,and frequent disturbances,leading to overshoot and control oscillations that degrade temperature regulation performance.To address these challenges,we propose a composite control scheme combining fuzzy logic and a variable-gain generalized supertwisting algorithm(VG-GSTA).Firstly,a one-dimensional(1D)fuzzy logic controler(FLC)for the pump ensures stable coolant flow,while a two-dimensional(2D)FLC for the fan regulates the stack temperature near the reference value.The VG-GSTA is then introduced to eliminate steady-state errors,offering resistance to disturbances and minimizing control oscillations.The equilibrium optimizer is used to fine-tune VG-GSTA parameters.Co-simulation verifies the effectiveness of our method,demonstrating its advantages in terms of disturbance immunity,overshoot suppression,tracking accuracy and response speed.
文摘BACKGROUND Thirst management in convalescent patients recovering from a digestive surgery performed under general anesthesia requires attention.A simple,practical,and safe method can effectively relieve thirst symptoms in such patients.AIM To evaluate the enhanced recovery after surgery(ERAS)-based evidence-based care(EBC)plus ice stimulation therapy for thirst management of convalescent patients following digestive surgery performed under general anesthesia.METHODS A total of 191 patients convalescing after digestive surgery performed under general anesthesia between March 2020 and February 2023 and experiencing thirst were selected.In total,89 patients and 102 patients in the control and research groups received routine care and ERAS-based EBC plus ice stimulation therapy,respectively.The following data were comparatively analyzed:(1)Thirst degree(thirst intensity numerical rating scale)and thirst distress(TD)degree(TD scale);(2)Oral mucosal wetness;(3)Unstimulated whole salivary flow rate(UWSFR);(4)Adverse reactions(palpitation,fatigue,chapped lips,and nausea and vomiting);and(5)Nursing satisfaction.RESULTS After nursing,thirst degree and distress were statistically lower in the research group than in the control group.Additionally,compared with the control group,the research group exhibited a lower degree of oral mucosal wetness,higher UWSFR,fewer adverse reactions,and more total nursing satisfaction.CONCLUSION ERAS-based EBC plus ice stimulation therapy can effectively alleviate thirst in convalescent patients recovering from a digestive surgery performed under general anesthesia.It can alleviate xerostomia symptoms,reduce adverse reactions,and improve patient comfort.
基金supported by the public agreement between the Danish Regions and the General Practitioners’Organization 2022–2024.
文摘Introduction This study aimed to either identify or develop and validate a patient-reported outcome measure(PROM)to assess treatment burden related to general practice for patients with multimorbidity,which can be used alongside the MultiMorbidity Questionnaire part 1(MMQ1)without overwhelming the target population with redundant items.Methods We conducted a systematic literature review to identify all existing PROMs measuring treatment burden.If no suitable PROM was found,our plan was to:(1)develop a draft PROM using items from existing instruments,(2)carry out group and individual interviews with patients with multimorbidity to ensure the PROM’s understandability,clarity,completeness and relevance and(3)undertake psychometric validation with a diverse sample of primary care patients with chronic conditions.Results We did not identify an eligible PROM in the literature review.The draft PROM consisted of 30 items divided into six domains;Information about treatment,Challenges with medication,Medical appointments,Self-monitoring,Health behaviour and Challenges in the contact to the health system.In the psychometric validation,neither these domains nor any other theoretical constellation of items had adequate psychometric properties.Individual items had good criterion validity and sensitivity to change.Conclusions In this study,we developed a 30-item PROM with high content validity where various individual items showed adequate criterion validity and sensitivity to change,making these items useful as a supplemental measure to the MMQ1.Trial registration number NCT05676541 Registration Date:16 December 2022.
基金funded by the Australian Government Medical Research Future Fund(MRFF),Grant number 2015947.
文摘Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Design A retrospective cohort study using routinely collected general practice data.Logistic regression was used to compare odds of allied health referrals,adjusting for age,sex and socioeconomic status.Setting De-identified patient and episode activity data from 537 GP practices across two PHNs in Australia between 2018 and 2023.Participants Data from 1153304 patients and 28667517 GP episodes of care were analysed.After merging records,693328 unique patients were identified,including 16610 patients with dementia.Subcohorts included patients with dementia,stroke,Parkinson’s disease and combinations of these conditions.Results The dementia cohort(n=16610)had a similar overall allied health referral rate(36.1%)to the control cohort(n=48977)(35.4%).Patients with dementia only were significantly less likely to receive any allied health referral compared with those with stroke(adjusted OR(aOR)0.76,95%CI 0.72 to 0.80;p<0.001)or Parkinson’s disease(aOR 0.72,95%CI 0.66 to 0.78;p<0.001).Those with dementia and stroke were also less likely to receive referrals than those with stroke only(aOR 0.71,95%CI 0.61 to 0.82;p<0.001).No significant difference was found between dementia with Parkinson’s and Parkinson’s only groups(p=0.48).Patients with dementia were consistently less likely to be referred to key allied health services(p<0.05).Conclusion Despite strong evidence supporting allied health interventions for dementia,referral rates remain comparatively low.Enhancing GP referral resources and education,integrating dementia-specific care pathways and implementing supportive policy changes are needed to improve access and equity in dementia care.
文摘Artificial intelligence,especially large language models(LLMs),is reshaping how we learn,communicate,and create.These systems provide students and professionals immediate access to fluent,context-aware language that can support learning,increase productivity,and spark creativity.But what happens when their use becomes excessive?This paper explores the potential long-term consequences of over-relying on LLMs-particularly memory,critical thinking,creativity,and motivation.Drawing on research in cognitive psychology,education,neuroscience,and media studies,it argues that LLMs are best understood as cognitive prostheses:incredibly valuable when used wisely,but risky when they replace rather than support human imagination.
基金Supported by the National Natural Science Foundation of China,No.82270914 and No.82401043.
文摘BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclear.AIM To clarify the impact of relevant factors,particularly perirenal fat,on postoperative hypertension resolution.METHODS In this retrospective single-center study,a total of 138 patients with obesity and hypertension were included,all of whom underwent LSG in the hospital and were followed up for one year.Multivariate logistic regression models were used to identify independent risk factors for postoperative hypertension resolution.Generalized additive models were employed to clarify the nonlinear relationships between these factors and hypertension resolution,and their predictive values were compared using fivefold cross-validation.RESULTS After LSG,107 patients(77.5%)experienced hypertension resolution,while 31 patients(22.5%)did not achieve resolution.Both the preoperative perirenal fat area(PrFA)and perirenal fat thickness were independent risk factors for postoperative hypertension resolution(P<0.001 vs P=0.002).These factors are curvilinearly correlated with the hypertension resolution rate,but PrFA has a better predictive value than perirenal fat thickness dose(area under the curve=0.846 vs 0.809).Compared with those with PrFA≥18 cm2,patients with PrFA<18 cm2 had a higher hypertension resolution rate[87%vs 68.1%;odds ratio(95%confidence interval)=3.513(1.367-9.902),P=0.012].CONCLUSION PrFA is a preoperative predictor of postoperative hypertension resolution.It is curvilinearly associated with the resolution rate,and patients with PrFA<18 cm²have better hypertension resolution outcomes after LSG.
文摘AIM:To evaluate the demographics,clinical characteristics,treatments,and outcomes of patients with ocular surface squamous neoplasia(OSSN)at the Philippine General Hospital.METHODS:This was a single-center,11-year retrospective,cross sectional case series on 18 cases of OSSN seen between January 2012 to June 2023.The patient’s demographics,presenting symptoms,tumor characteristics,histopathologic diagnosis,treatment,outcomes,and duration of follow-up were reviewed.RESULTS:Out of 33 identified cases of OSSN,only 18 were eligible for inclusion in the study.Mean age was 60.78y(range 31 to 80),with male predominance(66.67%).The left eye was most commonly affected(61.11%)with most presenting with fleshy mass(83.33%).Most tumors were located nasally(66.67%)and were predominantly papilliform(44.44%)in morphology with associated hyperpigmentation(38.89%).Squamous cell carcinoma(SCCA)was the most common histopathologic diagnosis(72.22%).The main primary treatment was surgical excision(94.44%)with or without adjunctive therapy,with only 1 patient undergoing first-line topical chemotherapy.Only 3 recurrences(16.67%)were noted with a median followup of 7.5mo.A statistically significant recurrence-free odds leaning towards the utilization of cryotherapy was noted.CONCLUSION:OSSN seen at the Philippine General Hospital is presented as a limbal papilliform mass,most commonly affecting elderly males.Surgical excision with adjuvant cryotherapy and/or chemotherapy is the preferred mode of treatment.
文摘Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due to the frequency of other types of joint diseases and the existence of degenerative and dystrophic valve disease. In adults, the initial rheumatic attack is marked by the predominance of joint damage over cardiac damage. However, it is often at this age that rheumatic valve disease is discovered. The revised Jones criteria also find their place in the diagnosis of AAR in adults. Objective: To study the demographic, clinical, and biological characteristics of acute rheumatic fever (ARF) in the General Medicine Department of the Siguiri Prefectural Hospital. Materials and Methods: This descriptive observational study examined the demographic, clinical and biological characteristics of acute rheumatic fever (ARF) at the Siguiri Prefectural Hospital, Guinea, between April 1 and September 31, 2021 according to Jones criteria. The data were collected on a form containing sociodemographic variables (age, sex, profession), rheumatological, cardiac, pulmonary and neurological clinical signs, biological variables and treatment. Results: Figure 1 shows the flow of the hospital frequency of the RAA in the General Medicine Department of the Prefectural Hospital of Siguiri. During the study period, 420 patients were hospitalized, of whom 161 patients had AAR, a frequency of 38.33%. Table 1 shows the distribution of patients diagnosed with ARB, by sociodemographic characteristics. The average age was 44.7 ± 19.78 years and the extremes of 14 and 90 years, the female sex dominated with a ratio of 0.75. The informal sector was in the majority in 45.34% of cases and most were illiterate, i.e. 53.42%. In our study, the incidence was lower during the dry season than during the rainy season, a hot season with high rainfall and humidity, the rainy period was a provider with a peak in August and September. The lifestyle was characterized by overcrowding in 87.58% of patients. The main complaint was fever, i.e. 88.82%. Rheumatological manifestations such as arthritis were 98.14%, chest pain was 37.89% (61 cases). The diagnosis was confirmed by ASLO titration in 85.71% of patients and 98.55% (136 cases) had a titration greater than 400 U/ml. Conclusion: The results obtained from our study show a high prevalence of acute rheumatic fever, which makes it a worrying health problem in the Siguiri health district. Young female adult patients, married with an informal profession and not in school residing in Siguiri were the most encountered in our study. The main functional signs mentioned by the patients were fever, cough and abdominal pain;osteoarticular pain and chest pain dominated the clinical picture. Almost all of our patients had an ASLO titer greater than 400 U/ml and a positive C-reactive protein. Our results show a high risk of spread of acute rheumatic fever within the population of Siguiri. Due to the serious complications caused by acute rheumatic fever, particular attention must be paid to it by carrying out other, much larger studies in order to identify the problem of RAA.
基金supported by the research networks Community Medicine,Molecular Medicine,GANI_MED and Digital Health Lab of the University Medicine Greifswald(grant number FOVB-2024-04).
文摘Objective This study describes acceptance and attitudes towards genetic cancer testing among German primary care patients.Design Cross-sectional survey.Setting Primary care.Participant Systematically recruited patients aged≥18 years from six general practices in Mecklenburg-Western Pomerania participated in an anonymous self-administered survey on familial cancer prevention(n=479 and 67.0%participation rate).Those with complete data were analysed(n=424;mean age 53.7,SD 16.6 years;men 34.4%).Linear regression analyses were used to examine potential disparities in general acceptance of genetic testing and attitudes towards genetic cancer testing according to sociodemographics and familial cancer knowledge.Result General acceptance of genetic testing was high,particularly among younger,higher-educated individuals and those with a family history of cancer and higher familial cancer knowledge.For example,83.3%either agreed or strongly agreed that it should be available to anybody.The most important benefits of genetic cancer testing were to guide check-up frequency(81.4%),to inform medical decision-making(80.2%)and to understand children’s risk(75.2%).The most important concerns included the potential burden on the family(44.6%)and the belief that cancer cannot be prevented(39.2%).More favourable attitudes were found among younger,higher-educated individuals,those with a personal history of cancer and those with fewer children or no partner.For example,higher age was linked to lower benefit(regression coefficient(RC)−0.01,95%CI−0.01 to−0.001)and higher concern ratings(RC 0.01,95%CI 0.002 to 0.01).About a third(34.7%)rated not wanting to know about genetic alterations that increase their cancer risk as a(very)important reason against testing.Information avoidance was higher among older individuals(RC 0.02,95%CI 0.01 to 0.02),women(RC 0.40,95%CI 0.11 to 0.69),those with lower education(RC−0.64,95%CI−0.91 to−0.36)and those with more children(RC 0.21,95%CI 0.09 to 0.33).Conclusion Acceptance of genetic testing was high,but barriers remain,particularly among older adults,women,the less educated and those with more children.Targeted educational efforts to improve health literacy,emphasise the preventive potential of genetic testing and emotional support through genetic counselling are essential to overcome these barriers and promote informed decision-making.
文摘The initial boundary value problem for a viscoelastic equation ｜ u t ｜ ρ u tt △u-△u tt ＋ t 0 g（ts）△u（s）ds ＋ ｜ u t ｜ m u t = ｜ u ｜ p u in a bounded domain is considered, where ρ, m, p 〉 0 and g is a nonnegative and decaying function. The general uniform decay of solution energy is discussed under some conditions on the relaxation function g and the initial data by adopting the method of [14, 15, 19]. This work generalizes and improves earlier results in the literature.
文摘A viscoelastic equation with Balakrishnan-Taylor damping and nonlinear boundary/interior sources is considered in a bounded domain. Under appropriate assumptions ira- posed on the source and the damping, we establish uniform decay rate of the solution energy in terms of the behavior of the nonlinear feedback and the relaxation function, without setting any restrictive growth assumptions on the damping at the origin and weakening the usual assumptions on the relaxation function.
文摘AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.
文摘AIM： To evaluate the association between gastroesophageal reflux diseases （GERD） and coronary heart diseases. METHODS： One thousand nine hundred and seventy consecutive patients who attended our hospital were enrolled. All of the patients who first attend our hospital were asked to respond to the F-scale questionnaire regardless of their chief complaints. All patients had a careful history taken, and resting echocardiography （ECG） was performed by physicians if the diagnostic necessity arose. Patients with ECG signs of coronary artery ischemia were defined as ST- segment depression based on the Minnesota code. RESULTS： Among 712 patients （36%） with GERD, ECG was performed in 171 （24%）, and ischemic changes were detected in eight （5%）. Four （50%） of these patients with abnormal findings upon ECG had no chest symptoms such as chest pain, chest oppression, or palpitations. These patients （0.6%; 4/712） were thought to have non-GERD heartburn, which may be related to ischemic heart disease. Of 281 patients who underwent ECG and did not have GERD symptoms, 20 （7%） had abnormal findings upon ECG. In patients with GERD symptoms and ECG signs of coronary artery ischemia, the prevalence of linked angina was considered to be 0.4% （8/1970 patients）.CONCLUSION： The present study suggested that ischemic heart disease might be found although a patient was referred to the hospital with a complaint of GERD symptoms. Physicians have to be concerned about missing clinically important coronary artery disease while evaluating patients for GERD symptoms.
文摘BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy,the outcomes of such procedure under regional anesthesia(RA)have been evaluated.In the context of cholecystectomy,combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIM To evaluate comparative outcomes of RA and general anesthesia(GA)in patients undergoing laparoscopic cholecystectomy.METHODS A comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTS Thirteen randomized controlled trials enrolling 1111 patients were included.The study populations in the RA and GA groups were of comparable age(P=0.41),gender(P=0.98)and body mass index(P=0.24).The conversion rate from RA to GA was 2.3%.RA was associated with significantly less postoperative pain at 4 h[mean difference(MD):-2.22,P<0.00001],8 h(MD:-1.53,P=0.0006),12 h(MD:-2.08,P<0.00001),and 24 h(MD:-0.90,P<0.00001)compared to GA.Moreover,it was associated with significantly lower rate of nausea and vomiting[risk ratio(RR):0.40,P<0.0001].However,RA significantly increased postoperative headaches(RR:4.69,P=0.03),and urinary retention(RR:2.73,P=0.03).The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes,with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSION Our findings indicate that RA may be an attractive anesthetic modality for daycase laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA.However,its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy.
文摘In more recent times, health-related quality of life (HRQOL) measurements have formed an important part of as- sessing the quality of routine care in general practice. For a measure to have clinical usefulness it must not only be valid, appro- priate, reliable, responsive, and capable of being interpreted, but it must also be simple, fast to complete, easy to score, and provide useful clinical data. The Two-step method of choosing appropriate measures is introduced. Then through comparison of generic instruments with disease-specific instruments, we can conclude that sometimes a combination of generic and disease-specific HRQOL measures may be more appropriate for monitoring changes in a patient’s health status due to an intervention.
基金Supported by the Scientific Research Fund of Sichuan Provincial Department of Science and Technology(2015JY0165,2011JYZ011)the Scientific Research Fund of Sichuan Provincial Education Department(14ZA0271)+2 种基金the Scientific Research Project of Yibin University(2013YY06)the Natural Science Foundation of China Medical University,Taiwanthe National Natural Science Foundation of China(11361070)
文摘The purpose of this article is to introduce a general split feasibility problems for two families of nonexpansive mappings in Hilbert spaces. We prove that the sequence generated by the proposed new algorithm converges strongly to a solution of the general split feasibility problem. Our results extend and improve some recent known results.
文摘To accurately assess the prevalence of GERD symptoms in general practice. METHODS： 4139 consecutive patients （2025 men and 2114 women with a mean age of 43 years）, who first attended the Outpatient Department of General Medicine and Emergency Care at Toho University Omori Hospital, were asked to respond to the F-scale questionnaire regardless of their chief complaints. The questionnaire is a self-report instrument, written in a simple and easy-to- understand language, containing 12 questions. RESULTS： Of 4139 subjects, 1554 patients （37.6%） were identified as GERD according to their F-scale score （〉 7）. However, there were only 45 consultations （1.1%） for typical GERD symptoms. Although GERD symptoms are common in adults of all ages, the prevalence of GERD was highest in the 20-29 years age group and the age group 70-79 years had the lowest prevalence for both males and females. CONCLUSION： Although there was a high rote indicating GERD in our primary care population, only 1.1% of outpatients attended our hospital with a chief complaint of GERD symptoms. Since about one-third of GERD patients are affected by atypical symptoms, general physicians need to be cautious about extrapolating these results to patients with a chief complaint other than typical GERD symptoms.Watanabe T, Urita Y, Sugimoto M, Miki K. Gastro-esophagea reflux disease symptoms are more common in genera practice in Japan. World J Gastroenterol 2007; 13（31） 4219-4223
基金the ethics committee of Shanghai General Hospital(2019KY037).
文摘BACKGROUND Gastroesophageal reflux(GER)affects up to 20%of the adult population and is defined as troublesome and frequent symptoms of heartburn or regurgitation.GER produces significantly harmful impacts on quality of life and precipitates poor mental well-being.However,the potential risk factors for the incidence and extent of GER in adults undergoing general anesthesia remain unclear.AIM To explore independent risk factors for the incidence and extent of GER during general anesthesia induction.METHODS A retrospective study was conducted,and 601 adult patients received general anesthesia intubation or laryngeal mask surgery between July 2016 and January 2019 in Shanghai General Hospital of Nanjing Medical University.This study recruited a total of 601 adult patients undergoing general anesthesia,and the characteristics of patients and the incidence or extent of GER were recorded.The potential risk factors for the incidence of GER were explored using multivariate logistic regression,and the risk factors for the extent of GER were evaluated using multivariate linear regression.RESULTS The current study included 601 adult patients,82 patients with GER and 519 patients without GER.Overall,we noted significant differences between GER and non-GER for pharyngitis,history of GER,other digestive tract diseases,history of asthma,and the use of sufentanil(P<0.05),while no significant differences between groups were observed for sex,age,type of surgery,operative time,body mass index,intraoperative blood loss,smoking status,alcohol intake,hypertension,diabetes mellitus,psychiatric history,history of respiratory infection,history of surgery,the use of lidocaine,palliative strategies,propofol,or rocuronium bromide,state anxiety inventory,trait anxiety inventory,and selfrating depression scale(P>0.05).The results of multivariate logistic regression indicated that female sex[odds ratio(OR):2.702;95%confidence interval(CI):1.144-6.378;P=0.023],increased age(OR:1.031;95%CI:1.008-1.056;P=0.009),pharyngitis(OR:31.388;95%CI:15.709-62.715;P<0.001),and history of GER(OR:11.925;95%CI:4.184-33.989;P<0.001)were associated with an increased risk of GER,whereas the use of propofol could protect against the risk of GER(OR:0.942;95%CI:0.892-0.994;P=0.031).Finally,age(P=0.004),operative time(P<0.001),pharyngitis(P<0.001),history of GER(P=0.024),and hypertension(P=0.017)were significantly associated with GER time.CONCLUSION This study identified the risk factors for GER in patients undergoing general anesthesia including female sex,increased age,pharyngitis,and history of GER.
基金supported by a grant from the National Scientific and Technological Major Project of China(2013ZX10004904-001-005)
文摘BACKGROUND： Hepatitis B virus（HBV） infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-related patients has not been well controlled in China. With the development of general practitioner（GP） system in this country, GPs may greatly improve the management of the patients with HBV infection. However, the role of GPs in controlling HBV infection has been rarely studied.DATA SOURCES： A literature search of PubMed, CNKI,Wanfang data and VIP was performed with the following key words： ＂general practitioner＂, ＂family physician＂, ＂community management＂, ＂community health care workers＂, ＂family practice＂, ＂hepatitis B virus＂, ＂HBV＂, ＂HBV vaccination＂, ＂HBV prevention＂, ＂HBV management＂, ＂HBV treatment＂, ＂antiviral therapy＂ and ＂chronic hepatitis B（CHB）＂. The information about the GPs-involved prevention, diagnosis and treatment of CHB was reviewed.RESULTS： The reports on the role of GPs in the prevention,diagnosis and treatment of HBV infection are few. But the experiences from Western countries demonstrated that GPs could play a significant role in the management of patients withCHB. The importance of GPs is obvious although there are some difficulties in China. GPs and health officials at different levels should work together in the management of patients with CHB.CONCLUSIONS： The involvement of GPs in the management of patients with HBV infection is effective in China. But GPs＇ knowledge and skills for the control of HBV infection have to be improved currently. GPs＇ involvement will enforce the management of CHB in China in the near future.
