Role of gut-liver axis and glucagon-like peptide-1 receptor agonists in the treatment of metabolic dysfunction-associated fatty liver disease.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a hepatic manifestation of the metabolic syndrome. It is one of the most common liver diseases worldwide and shows increasing prevalence rates in most countries. MAFLD is a progressive disease with the most severe cases presenting as advanced fibrosis or cirrhosis with an increased risk of hepatocellular carcinoma.

Excitation distribution of the trapezius changes in response to increasing contraction intensity, but not repeated contractions.

Upper trapezius (UT) excitation redistributes with experimentally-induced muscle pain, fatigue, and repeated contractions. Excitation distribution variability is proposed to reduce the likelihood of shoulder pain and pathology by reducing cumulative stress on musculoskeletal structures. While the middle (MT) and lower (LT) trapezius are pivotal in scapular stabilization, it remains unclear whether they display similar excitation distribution variability with repeated or increasing contraction intensity.

Integration of Segmented Ion Fractionation and Differential Ion Mobility on a Q-Exactive Hybrid Quadrupole Orbitrap Mass Spectrometer.

High-field asymmetric waveform ion mobility spectrometry (FAIMS) has gained popularity in the proteomics field for its capability to improve mass spectrometry sensitivity and to decrease peptide co-fragmentation. The recent implementation of FAIMS on Tribrid Orbitrap instruments enhanced proteome coverage and increased the precision of quantitative measurements. However, the FAIMS interface has not been available on older generation Orbitrap mass spectrometers such as the Q-Exactive.

The use of external controls: To what extent can it currently be recommended?

With more and better clinical data being captured outside of clinical studies and greater data sharing of clinical studies, external controls may become a more attractive alternative to randomized clinical trials (RCTs). Both industry and regulators recognize that in situations where a randomized study cannot be performed, external controls can provide the needed contextualization to allow a better interpretation of studies without a randomized control. It is also agreed that external controls will not fully replace RCTs as the gold standard for formal proof of efficacy in drug development and the yardstick of clinical research.

Muscle Activation in Specific Regions of the Trapezius During Modified Kendall Manual Muscle Tests.

Context: Manual muscle tests (MMTs) are often used when assessing shoulder injuries. For the trapezius, individual MMTs are used to selectively test the upper trapezius region (UTR), middle trapezius region (MTR), and lower trapezius region (LTR). The MMTs for each region are assumed to preferentially recruit the corresponding muscle fibers and produce a maximal contraction; however, whether this is true is unknown.

On redesigning public health in Québec: lessons learned from the pandemic.

Over the past few months, our fellow citizens have heard more about public health than ever before. The SARS-CoV-2 pandemic has shed light on the vital role played by public health for health protection and provided telling evidence about current public health capacity as well as the corrective measures to be taken and milestones to be achieved in the future. To this end, we identify several ways forward to re-empower public health in Québec and thus ensure that it can significantly contribute to population health.

Implementing public policy in a non-directive manner: capacities from an intermediary organization.

Setting: We investigate the capacities of an organization responsible for bridging top-down instructions emanating from a law on public health with the bottom-up realities of health service providers working on population-based health. This article traces the implementation of this law, which requires service-provider organizations to base their actions (planning, prevention, and curative activities) upon the expressed and non-expressed needs of the local population. We investigate a case in the province of Québec that took place over more than 10 years.

Effectiveness of a complex intervention on Prioritising Multimedication in Multimorbidity (PRIMUM) in primary care: results of a pragmatic cluster randomised controlled trial.

Objectives: Investigate the effectiveness of a complex intervention aimed at improving the appropriateness of medication in older patients with multimorbidity in general practice.

Design: Pragmatic, cluster randomised controlled trial with general practice as unit of randomisation.

Setting: 72 general practices in Hesse, Germany.

Transforming Regions into High-Performing Health Systems Toward the Triple Aim of Better Health, Better Care and Better Value for Canadians.

A study on the impact of regionalization on the Triple Aim of Better Health, Better Care and Better Value across Canada in 2015 identified major findings including: (a) with regard to the Triple Aim, the Canadian situation is better than before but variable and partial, and Canada continues to underperform compared with other industrialized countries, especially in primary healthcare where it matters most; (b) provinces are converging toward a two-level health system (provincial/regional); (c) optimal size of regions is probably around 350,000-500,000 population; d) citizen and physician engagement remains weak. A realistic and attainable vision for high-performing regional health systems is presented together with a way forward, including seven areas for improvement: 1. Manage the integrated regionalized health systems as results-driven health programs; 2.

A simple heuristic for Internet-based evidence search in primary care: a randomized controlled trial.

Background: General practitioners (GPs) are confronted with a wide variety of clinical questions, many of which remain unanswered.

Methods: In order to assist GPs in finding quick, evidence-based answers, we developed a learning program (LP) with a short interactive workshop based on a simple three-step-heuristic to improve their search and appraisal competence (SAC). We evaluated the LP effectiveness with a randomized controlled trial (RCT).

ACCLAIM: A randomized trial of abatacept (CTLA4-Ig) for relapsing-remitting multiple sclerosis.

Background: Costimulatory blockade of T lymphocytes with the CTLA4-Ig fusion protein abatacept could be an effective treatment for the immune-mediated neuroinflammatory disease relapsing-remitting multiple sclerosis (RRMS).

Objective: To evaluate efficacy and safety of abatacept in RRMS.

Methods: ACCLAIM (A Cooperative Clinical Study of Abatacept in Multiple Sclerosis) was a Phase II, randomized, double-blind, placebo-controlled, multi-center trial.

Pilot study to test the feasibility of a trial design and complex intervention on PRIoritising MUltimedication in Multimorbidity in general practices (PRIMUMpilot).

Objective: To improve medication appropriateness and adherence in elderly patients with multimorbidity, we developed a complex intervention involving general practitioners (GPs) and their healthcare assistants (HCA). In accordance with the Medical Research Council guidance on developing and evaluating complex interventions, we prepared for the main study by testing the feasibility of the intervention and study design in a cluster randomised pilot study.

Setting: 20 general practices in Hesse, Germany.

Medical Assistant-Based Care Management for High-Risk Patients in Small Primary Care Practices: A Cluster Randomized Clinical Trial.

Background: Patients with multiple chronic conditions are at high risk for potentially avoidable hospitalizations, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices.

Objective: To determine whether protocol-based care management delivered by medical assistants improves care in patients at high risk for future hospitalization in primary care.

A complex nursing intervention of complementary and alternative medicine (CAM) to increase quality of life in patients with breast and gynecologic cancer undergoing chemotherapy: study protocol for a partially randomized patient preference trial.

Background: Health-related quality of life (HRQoL) is most adversely affected in cancer patients between diagnosis and the end of chemotherapy. The aim of the Complementary Nursing in Gynecologic Oncology (CONGO) study is to assess the effectiveness of a complex nursing care intervention of CAM to increase HRQoL in cancer patients undergoing chemotherapy.

Methods/design: CONGO is a prospective partially randomized patient preference (PRPP) trial including adult women diagnosed with breast and gynecologic cancer starting a new chemotherapy regimen.

The Ariadne principles: how to handle multimorbidity in primary care consultations.

Multimorbidity is a health issue mostly dealt with in primary care practice. As a result of their generalist and patient-centered approach, long-lasting relationships with patients, and responsibility for continuity and coordination of care, family physicians are particularly well placed to manage patients with multimorbidity. However, conflicts arising from the application of multiple disease oriented guidelines and the burden of diseases and treatments often make consultations challenging.

Internal consistency of the readiness for interprofessional learning scale in German health care students and professionals.

Background: The implementation of a bachelor degree in "Interprofessional Health Care" at the University of Heidelberg, Germany has fostered the need to evaluate the impact of this innovative programme. The Readiness for Interprofessional Learning Scale (RIPLS) was developed by Parsell and Bligh (1999) to assess student's attitudes towards interprofessional education. The RIPLS consists of 19 items and four subscales were identified by McFadyen (J Interprof Care19:595-603, 2005): "teamwork and collaboration", "negative professional identity", "positive professional identity" and "roles and responsibilities".