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Background and study aims The Bethesda ERCP Skill Assessment Tool (BESAT) is a video-based assessment tool of technical endoscopic retrograde cholangiopancreatography (ERCP) skill with previously established validity evidence. We aimed to assess the discriminative validity of the BESAT in differentiating ERCP skill levels. Methods Twelve experienced ERCP practitioners from tertiary academic centers were asked to blindly rate 43 ERCP videos using the BESAT. ERCP videos consisted of native biliary cannulation and sphincterotomy and were recorded from 10 unique endoscopists of various ERCP experience (from advanced endoscopy fellow to > 10 years of ERCP experience). Inter-rater reliability, discriminative validity, and internal structure validity were subsequently assessed. Results The BESAT was found to reliably differentiate between endoscopists of varying levels of ERCP experience with experienced ERCPists scoring higher than novice ERCPists in 11 of 13 (85%) instrument items. Inter-rater reliability for BESAT items ranged from good to excellent (intraclass correlation range: 0.86 to 0.93). Internal structure validity was assessed with item-total correlations ranging from 0.53 to 0.83. Conclusions Study findings demonstrate that the BESAT, a video-based ERCP skill assessment tool, has high inter-rater reliability and has discriminative validity in differentiating novice from expert ERCP skill. Further investigations are needed to determine the role of video-based assessment in improving trainee learning curves and patient outcomes.

With the introduction of direct-acting antiviral drugs, treatment of hepatitis C is both highly effective and tolerable. Access to treatment for patients, however, remains limited in low- and middle-income countries due to the lack of supportive health infrastructure and the high cost of treatment. Poorer countries are being encouraged by international bodies to organize public health responses that would facilitate the roll-out of care and treatment on a national scale. Yet few countries have documented formal plans and policies. Here, we outline the approach taken In Rwanda to a public health framework for hepatitis C control and care within the World Health Organization hepatitis health sector strategy. This Includes the development and implementation of policies and programmes, prevention efforts, screening capacity, treatment services and strategic information systems. We highlight key successes by the national programme for the control and management of hepatitis C: establishment of national governance and planning; development of diagnostic capacity; approval and introduction of direct-acting antiviral treatments; training of key personnel; generation of political will and leadership; and fostering of key strategic partnerships. Existing challenges and next steps for the programme include developing a detailed monitoring and evaluation framework and tools for monitoring of viral hepatitis. The government needs to further decentralize care and integrate hepatitis C management into routine clinical services to provide better access to diagnosis and treatment for patients. Introducing rapid diagnostic tests to public health-care facilities would help to increase case- finding. Increased public and private financing is essential to support care and treatment services. Grace a l'introduction d'antiviraux a action directe, le traitement de l'hepatite C est a la fois tres efficace et bien tolere. Neanmoins, l'acces des patients au traitement demeure limite dans les pays a revenu faible et intermediaire en raison du manque d'infrastructures sanitaires de soutien et du cout eleve du traitement. Les pays pauvres sont encourages par des organismes internationaux a elaborer des mesures, de sante publique qui faciliteraient la mise en place de soins et de traltements a l'echelle nationale. Peu de pays ont cependant etabli des politiques et des plans officiels. Dans cet article, nous presentons l'approche adoptee au Rwanda a l'egard d'un cadre de sante publique pour le controle de l'hepatite C et les soins qui lui sont associes dans le contexte de la strategie du secteur de la sante contre l'hepatite de l'Organisation mondiale de la Sante. Cela inclut le developpement et la mise en oeuvre de politiques et de programmes, d'efforts de prevention, de capacites de depistage, de services de traitement et de systemes d'information strategiques. Nous mettons en avant les principaux success du programme national pour le controle et la gestion de l'hepatite C: l'etablissement d'une gouvernance et d'une plantation nationales; le renforcement des capacites de diagnostic; l'approbation et l'introduction de traitements antiviraux a action directe; la formation de personnel d'encadrement; le developpement d'une volonte et d'un leadership politiques; et la promotion de partenariats strategiques cles. Les enjeux actueis et les prochaines etapes du programme incluent l'elaboration d'un cadre detaille de suivi et devaluation, ainsi que des outils pour le suivi de l'hepatite virale. Le gouvernement doit favoriser la decentralisation des soins et integrer la gestion de l'hepatite C aux services cliniques courants afin de fournir aux patients un meilleur acces au diagnostic et au traitement. L'utilisation de tests de diagnostic rapide dans les etablissements publics de sante permettrait d'ameliorer le depistage. II est essentiel d'augmenter les financements publics et prives poursoutenir les services de soins et de traitement. Con la introduccion de los farmacos antiviricos de accion directa, el tratamiento de la hepatitis C es altamente eficaz y tolerable. Sin embargo, el acceso al tratamiento por parte de los pacientes sigue siendo limitado en los paises de Ingresos medios y bajos, debido a la falta de infraestructuras sanitarias de apoyo y a los altos costos del tratamiento. Los organismos internacionales alientan a los paises mas pobres a organizar respuestas de salud publica que podrian facilitar la puesta en marcha de atencion y tratamiento a escala nacional. Sin embargo, son pocos los paises que han documentado planes y politicas formales. En el presente estudio, esbozamos el enfoque adoptado en Rwanda para un marco de salud publica para el control y la atencion de la hepatitis C dentro de la estrategia del sector de la salud contra la hepatitis de la Organizacion Mundial de la Salud. Este Incluye la elaboracion y aplicacion de politicas y programas, medidas preventivas, capacidad de cribado, servicios de tratamiento y sistemas de informacion estrategica. Destacamos los exitos clave del programa nacional para el control y tratamiento de la hepatitis C: establecimiento de la gobernanza y planificacion nacional; desarrollo de capacidad diagnostica; aprobacion e introduccion de tratamientos antiviricos de accion directa;formacion de personal clave; generacion de voluntad politica y liderazgo; y promocion de asociaciones estrategicas clave. Los desafios actuales y los proximos pasos del programa incluyen el desarrollo de un marco de seguimiento y evaluacion detallado, asi como herramientas para el seguimiento de la hepatitis viral. El gobierno necesita descentralizartodavia mas la atencion e integrar la gestion de la hepatitis C en los servicios clinicos corrientes para proporcionar un mejor acceso al diagnostico y tratamiento de los pacientes. La introduccion de pruebas diagnosticas rapidas en los centros de atencion de salud publica ayudaria a aumentar la busqueda de casos. El aumento de la financiacion publica y privada es esencial para apoyar los servicios de atencion y tratamiento., Introduction Worldwide, an estimated 71 million people, 1% of the global population, are chronically infected with hepatitis C virus (HCV). (1) The prevalence in sub-Saharan countries is significantly higher. In [...]

Epidemiologic and animal studies implicate overconsumption of fructose in the development of nonalcoholic fatty liver disease, but the molecular mechanisms underlying fructose-induced chronic liver diseases remain largely unknown. Here, we have presented evidence supporting the essential function of the lipogenic transcription factor carbohydrate response element-binding protein (ChREBP) in mediating adaptive responses to fructose and protecting against fructose-induced hepatotoxicity. In WTmice, a high-fructose diet (HFrD) activated hepatic lipogenesis in a ChREBP-dependent manner; however, in Chrebp-KO mice, a HFrD induced steatohepatitis. In Chrebp-KO mouse livers, a HFrD reduced levels of molecular chaperones and activated the C/EBP homologous protein-dependent (CHOP-dependent) unfolded protein response, whereas administration of a chemical chaperone or Chop shRNA rescued liver injury. Elevated expression levels of cholesterol biosynthesis genes in HFrD-fed Chrebp-KO livers were paralleled by an increased nuclear abundance of sterol regulatory element-binding protein 2 (SREBP2). Atorvastatin-mediated inhibition of hepatic cholesterol biosynthesis or depletion of hepatic Srebp2 reversed fructose-induced liver injury in Chrebp-KO mice. Mechanistically, we determined that ChREBP binds to nuclear SREBP2 to promote its ubiquitination and destabilization in cultured cells. Therefore, our findings demonstrate that ChREBP provides hepatoprotection against a HFrD by preventing overactivation of cholesterol biosynthesis and the subsequent CHOP-mediated, proapoptotic unfolded protein response. Our findings also identified a role for ChREBP in regulating SREBP2-dependent cholesterol metabolism., Introduction Nonalcoholic fatty liver disease (NAFLD), which affects almost one-quarter of the population in the United States (1), is a slowly progressive metabolic liver disorder, ranging from simple steatosis and [...]

The current burden of Hepatitis C virus infection and the availability of HCV-related services in Ghana are not well described. Previous estimates on HCV seroprevalence in the country are outdated. This study investigated the HCV seroprevalence and testing and treatment capacity in Ghana. A multi-centre cross-sectional study was conducted in which laboratory and blood bank registers from 17 public healthcare institutions in Ghana were reviewed. A survey on cost and availability of HCV-related testing and treatment was also performed. Crude and pooled estimates of HCV seroprevalence, frequency and median cost of available diagnostic tests and medicines were described. The crude HCV seroprevalence was 2.62% (95% CI 2.53–2.72) and the pooled estimate was 4.58% (95% CI 4.06–5.11) among 103,609 persons tested in laboratories. Age (OR 1.02 95% CI 1.01–1.02) and male sex (OR 1.26 95% CI 1.08–1.48) were predictors of a positive anti-HCV RDT test. Northern administrative regions in Ghana had the highest HCV seroprevalence ranging from 8.3–14.4%. Among 55, 458 potential blood donors, crude HCV seroprevalence was 3.57% (95% CI 3.42–3.72). Testing was through Rapid Diagnostic Test (RDT) kits in most facilities, and only 2 of 17 centres were performing HCV RNA testing. The median cost of an anti-HCV RDT test was $0.97 (0–1.61) and $3.23 (1.61–7.58) for persons with and without government health insurance respectively. The median cost of a 12-week course of the pan-genotypic direct-acting antiviral therapy sofosbuvir-daclatasvir was $887.70. In conclusion, there are significant regional differences in HCV burden across Ghana. Limited access to and cost of HCV RNA and DAA therapy hinders testing and treatment capability, and consequently HCV elimination efforts. A national HCV program supported with a sustainable financing plan is required to accelerate HCV elimination in Ghana. [ABSTRACT FROM AUTHOR]