Identifying and prioritizing strategies for comprehensive liver cancer control in Asia

<p>Abstract</p> <p>Background</p> <p>Liver cancer is both common and burdensome in Asia. Effective liver cancer control, however, is hindered by a complex etiology and a lack of coordination across clinical disciplines. We sought to identify strategies for inclusion in a comprehensive liver cancer control for Asia and to compare qualitative and quantitative methods for prioritization.</p> <p>Methods</p> <p>Qualitative interviews (N = 20) with international liver cancer experts were used to identify strategies using Interpretative Phenomenological Analysis and to formulate an initial prioritization through frequency analysis. Conjoint analysis, a quantitative stated-preference method, was then applied among Asian liver cancer experts (N = 20) who completed 12 choice tasks that divided these strategies into two mutually exclusive and exhaustive subsets. Respondents' preferred plan was the primary outcome in a choice model, estimated using ordinary least squares (OLS) and logistic regression. Priorities were then compared using Spearman's Rho.</p> <p>Results</p> <p>Eleven strategies were identified: <it>Access to treatments; Centers of excellence; Clinical education; Measuring social burden; Monitoring of at-risk populations; Multidisciplinary management; National guidelines; Public awareness; Research infrastructure; Risk-assessment and referral</it>; and <it>Transplantation infrastructure</it>. Qualitative frequency analysis indicated that <it>Risk-assessment and referral </it>(85%), <it>National guidelines </it>(80%) and <it>Monitoring of at-risk populations </it>(80%) received the highest priority, while conjoint analysis pointed to <it>Monitoring of at-risk populations </it>(p < 0.001), <it>Centers of excellence </it>(p = 0.002), and <it>Access to treatments </it>(p = 0.004) as priorities, while <it>Risk-assessment and referral </it>was the lowest priority (p = 0.645). We find moderate concordance between the qualitative and quantitative methods (rho = 0.20), albeit insignificant (p = 0.554), and a strong concordance between the OLS and logistic regressions (rho = 0.979; p < 0.0001).</p> <p>Conclusions</p> <p>Identified strategies can be conceptualized as the ABCs of comprehensive liver cancer control as they focus on <it>Antecedents</it>, <it>Better care </it>and <it>Connections </it>within a national strategy. Some concordance was found between the qualitative and quantitative methods (e.g. <it>Monitoring of at-risk populations</it>), but substantial differences were also identified (e.g. qualitative methods gave highest priority to risk-assessment and referral, but it was the lowest for the quantitative methods), which may be attributed to differences between the methods and study populations, and potential framing effects in choice tasks. Continued research will provide more generalizable estimates of priorities and account for variation across stakeholders and countries.</p

Relatório de estágio em farmácia comunitária

Relatório de estágio realizado no âmbito do Mestrado Integrado em Ciências Farmacêuticas, apresentado à Faculdade de Farmácia da Universidade de Coimbr

Development of non-alcoholic fatty liver disease scoring system among adult medical check-up patients: a large cross-sectional and prospective validation study

Cosmas Rinaldi A Lesmana,1,2 Levina S Pakasi,1 Sri Inggriani,3 Maria L Aidawati,3 Laurentius A Lesmana1 1Digestive Disease and GI Oncology Centre, Medistra Hospital, 2Department of Internal Medicine, Hepatobiliary Division, Cipto Mangunkusumo Hospital, University of Indonesia, 3Radiology Department, Medistra Hospital, Jakarta, IndonesiaBackground: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the community. However, NAFLD remains undiagnosed in most people with limited access to imaging facilities in most developing countries.Objective: To examine the prevalence of NAFLD and to develop the risk scoring model for predicting the presence of NAFLD among adult medical check-up patients.Method: A large prospective cross-sectional study was conducted among medical check-up patients who underwent transabdominal ultrasound examination between January and December 2013 in Medistra Hospital, Jakarta. Data were obtained from the patients&#39; medical records. Logistic regression analyses were undertaken to identify the best combination of risk factors for predicting fatty liver using the backward (likelihood ratio) approach. The adjusted odds ratio and 95% confidence interval were estimated using the logistic regression coefficient. The prediction model was assessed using the receiver operating characteristic curve and the Hosmer&ndash;Lemeshow goodness-of-fit test and was validated on a new, prospective cohort. Statistical analysis was done using SPSS version 17.Results: A total of 1,054 cases was included in this study. Fatty liver was present in 538 (51.0%) patients. Bivariate analyses found associations among fatty liver and several risk factors. Six risk factors were incorporated to build the final prediction model. All scores were summed up to obtain the total score. A probability equation was developed by applying linear regression analysis on the total score. The prediction model had good diagnostic performance with an area under the receiver operating characteristic curve =0.833 (95% confidence interval =0.809&ndash;0.857). The Hosmer&ndash;Lemeshow goodness-of-fit P-value was 0.232, which indicated the appropriateness of the logistic regression model to predict fatty liver. On the validation set, the scoring system proved to be moderately accurate and can potentially be applied to larger population setting.Conclusion: The presence of fatty liver in NAFLD patients can be predicted using our proposed fatty liver scoring system.Keywords: fatty liver, scoring model, ultrasound, community, developing countries, diagnostic performanc

Alat Penukar Kalor Untuk Mesin Pengering RDF

Abstrak &nbsp; Penelitian ini memiliki tujuan melakukan analisis, rancang bangun dan pengujian APK plat datar yang akan digunakan pada mesin pengering RDF. Berdasarkan hasil analisis dan uji coba alat pengering surya yang telah dilakukan oleh daud heru bahwa temperatur udara yang dibutuhkan untuk mengeringkan RDF yang berada dalam ruang pengering adalah 60oC, sedamgkan&nbsp; pemanfaatan energi surya saja sebagai sumber energi pengeringan, menghasilkan tempearatur udara pengering di bawah 60 oC. Oleh karena itu dibutuhkan energi panas tambahan dari pembakaran bahan bakar batu bara yang mampu meningkatkan tempeatur udara dalam ruang pengering. Peningkatan temperatur udara dalam ruang pengering ini membutuhkan energi panas yang keluar alat penukar kalor plat datar sebesar qAPK = 23.3 kJ/s dan hasil yang diperoleh melalui perngujian memperlihatkan bahwa temperatur udara rata-rata dalam ruang pengering sebesar Trg = 59.6 oC. Sedangkan jenis alat penukar kalor yang digunakan adalah alat penukar kalor plat datar yang memiliki panjang 40 cm, lebar 60 cm, tinggi 30 cm yang terbuat dari material aluminium dengan ketebalan plat masing-masing sebesar 1 mm. Tungku bahan bakar diletakkan dibawah alat penukar kalor dan dilengkapi dengan peralatan manual yang dapat menaikkan dan menurunkan letak bahan bakar sehingga temperatur yang bervariasi dalam ruang pengering selama percobaan berlangsung dapat diperkecil

Is there an influence of hepatic steatosis on fibrosis and necroinflammation in young patients with chronic viral hepatitis B?

Objectives: Our aim was to investigate the association of liver fibrosis and necroinflammation with HS in untreated young patients with chronic hepatitis B (CHB)

Liver transplantation for patients with acute-on-chronic liver failure in Asia

Poster Presentation: P-0213This journal suppl. entitled: Conference Abstracts: 25th Annual Conference of APASL, February 20–24, 2016, Tokyo, JapanAIM: Acute-on-chronic liver failure (ACLF) is characterized by high mortality. Liver transplantation (LT) is effective in patients who do not improve with supportive measures. This study examines the outcome of ACLF patients who underwent LT in Asia. METHODS: Prospectively collected data from 17 Asian countries in the APASL ACLF Research Consortium was analyzed. 43 patients who underwent LT for ACLF were compared with 1657 non-transplanted ACLF patients. The variables analyzed include patient demographics, acute insult, background liver disease, severity scores (MELD and SOFA scores) and post-LT outcome. RESULTS: Mean age of LT patients was 42.1 years and non-transplanted patients was 43.7 years. 74.4 % of LT patients and 85.1 % of non-LT patients were male. The most common acute liver insult was HBV reactivation (24.4 %) in LT patients, compared with alcohol (49.5 %) in non-LT patients. Three-month survival rate was 76.7 % in LT group, and 52.6 % in non-LT group. Mean MELD scores prior to transplant was (27.7 ± 4.7) and (30.5 ± 8.3) in non-transplant group. In LT patients, baseline renal dysfunction predicted mortality (mean urea: 1.4 vs. 0.84 mg/dL, p = 0.015) (mean creatinine: 61 vs. 27 lmol/l, p = 0.042). High SOFA score was significantly associated with mortality in both LT (12.5 vs. 8, P = 0.015) and non-LT (8.3 vs. 10.9, p\0.001) patients. In non-LT patients, baseline urea (68.5 vs. 41.2 lmol/l, p\0.001), MELD (33.8 vs. 27.5, p\0.001) and Child-Pugh score (12 vs. 11, p\0.001) were independently associated with mortality. CONCLUSION: Baseline renal dysfunction and higher SOFA score predict poorer LT outcome in ACLF patients