Strengthening primary care: The role of clinical practice guidelines

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What do Hong Kong's family physicians think of clinical guidelines? - A questionnaire survey

Objective: To study the current use of and attitude towards clinical guidelines (CGs) among Hong Kong's family physicians, and to explore the attributes that may enhance implementation. Design: Postal questionnaire survey. Subjects: A questionnaire was posted to all 1427 members of the Hong Kong College of Family Physicians (HKCFP) in the period from March to July, 2010. Main outcome measures: Response to a questionnaire on the current usage of and attitude towards CGs, respondents' demographic data. Results: 617 completed questionnaires were received (response rate 43.2%). Ninety-one percent of respondents had used CGs in patient care and 85% had used them within a month. Sixty-three percent of respondents gave the internet as the first answer to the question of where they found the clinical guidelines. "Contradicting recommendations" was ranked highest as a barrier to guideline use (82%), followed by "CGs not tailored for individual patient's needs" (77%), and "mistrust guidelines sponsored by pharmaceutical companies" (75%). There was a very high degree of agreement on what constituted a good CG: evidence-based (99%), simple and easy to use (99%), applicable to the local population (99%) and the primary care setting (98%), regularly updated (98%) and with cost effective recommendations (93%). On strategies thought to be useful in promoting the use of CGs, 96% of respondents agreed on effective dissemination, 93% on a central system for adoption of CGs, 90% on involving primary care doctors in drafting CGs and 71% on providing financial incentives. Conclusion: Most respondents were using and supportive of CGs, and would like to have a central system for guideline adoption and effective dissemination. They wished to be more involved in the development process. They thought a good CG should be evidence-based, simple and easy to use and applicable in the local setting. Family physicians' views about CGs are important and relevant for Hong Kong's guideline development policy.published_or_final_versio

Sox9 confers stemness properties in hepatocellular carcinoma through Frizzled-7 mediated Wnt/β-catenin signaling

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Down-regulation of TIMP2 by HIF-1α/miR-210/HIF-3α regulatory feedback circuit enhances cancer metastasis in hepatocellular carcinoma

Cancer metastasis is a multistep process that involves a series of tumor-stromal interaction, including extracellular matrix (ECM) remodeling, which requires a concerted action of multiple proteolytic enzymes and their endogenous inhibitors. This study investigated the role of tissue inhibitor of metalloproteinases (TIMP) 2 in the context of hepatocellular carcinoma (HCC) metastasis. We found that TIMP2 was the most significantly down-regulated member among the TIMP family in human HCCs. Moreover, TIMP2 underexpression was frequent (41.8%; 23 of 55) in human HCCs and was significantly associated with liver invasion and poorer survival outcomes of HCC patients. Furthermore, stable silencing of TIMP2 in HCC cell lines enhanced cell invasive ability and ECM degradation associated with formation of invadopodia-like feature, suggesting that TIMP2 is a negative regulator of HCC metastasis. Using an orthotopic tumor xenograft model, we demonstrated that ectopic expression of TIMP2 open reading frame in the highly metastatic HCC cell line, MHCC-97L, significantly reduced HCC progression as well as pulmonary metastasis. Mechanistically, TIMP2 suppression, in a hypoxic environment, was induced through a regulatory feedback circuit consisting of hypoxia-inducible factor (HIF) 1 alpha, microRNA-210 (miR-210), and HIF-3alpha. CONCLUSION: TIMP2 is frequently down-regulated in human HCCs and its down-regulation is associated with aggressive tumor behavior and poorer patient outcome. Its suppression is under the regulation of a novel feedback circuit consisting of HIF-1alpha/miR-210/HIF-3alpha. TIMP2 is an important regulator of ECM degradation and HCC metastasis. (Hepatology 2016;64:473-487).published_or_final_versio

Viral Replication in the Nasopharynx Is Associated with Diarrhea in Patients with Severe Acute Respiratory Syndrome

The role of severe acute respiratory syndrome (SARS) coronavirus as an enteric pathogen was investigated in a cohort of 142 patients with SARS who were treated with a standard treatment protocol. Data from daily hematological, biochemical, radiological, and microbiological investigations were prospectively collected, and the correlation of these findings with diarrhea was retrospectively analyzed. Sixty-nine patients (48.6%) developed diarrhea at a mean (± standard deviation [SD]) of 7.6 ± 2.6 days after the onset of symptoms. The diarrhea was most severe at a mean (± SD) of 8.8 ± 2.4 days after onset, with a maximum frequency of 24 episodes per day (median, 5 episodes; range, 3-24 episodes). A higher mean virus load in nasopharyngeal specimens obtained on day 10 after the onset of symptoms was significantly associated with the occurrence of diarrhea (3.1 log 10 vs. 1.8 log 10 copies/mL; P = .01) and mortality (6.2 vs. 1.7 log 10 copies/mL; P<.01). However, diarrhea was not associated with mortality. The lung and the gastrointestinal tract may react differently to SARS coronavirus infection. Additional investigation of the role of SARS coronavirus in the pathogenesis of diarrhea in patients with SARS should be conducted.published_or_final_versio

SENP1 promotes hypoxia-induced cancer stemness by HIF-1α deSUMOylation and SENP1/HIF-1α positive feedback loop

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Serious Gaming and Gamification interventions for health professional education

This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effectiveness of Serious Gaming and Gamification interventions for delivering pre- and post-registration health professional education compared with traditional learning, other types of eLearning, or other Serious Gaming and Gamification interventions. We will primarily assess the impact of these interventions on students' knowledge, skills, professional attitudes and satisfaction

User-Based Channel Assignment Algorithm in a Load-Balanced IEEE 802.11 WLAN

This article discusses a user-based channel assignment algorithm in a load-balanced IEEE 802.11 WLAN

User-Based Channel Assignment Algorithm in a Load-Balanced IEEE 802.11 WLAN

This article discusses a user-based channel assignment algorithm in a load-balanced IEEE 802.11 WLAN

Channel Assignment and Load Distribution in a Power-Managed Wlan

This paper discusses a proposed algorithm