Health literacy is independently associated with self-care behavior in patients with heart failure.

OBJECTIVE: Health literacy (HL) has been recognized as an important concept in patient education and disease management for heart failure (HF). However, previous studies on HL have focused predominantly on the relationships between functional HL (the ability to read and write), comprehensive HL including the ability to access information (communicative HL), and the ability to critically evaluate information (critical HL). Self-care behavior has not been evaluated. This study determined the relationship between functional, communicative, and critical HL and self-care behavior in HF patients. METHODS: Cross-sectional analysis of the data was completed for HL, HF-related knowledge, and HF-related self-care behaviors. Sociodemographic and clinical characteristics were also assessed. Multivariate linear regression analysis was used to estimate the associations between literacy and self-care behavior. RESULTS: 249 patients with HF were assessed (mean age, 67.7±13.9years). Patients with low HL had poorer knowledge and self-care behavior than those with high HL. Critical HL was an independent determinant of self-care behavior (sß=-0.154, P=0.027). CONCLUSIONS: Critical HL was independently associated with self-care behavior in HF patients. PRACTICE IMPLICATIONS: Effective intervention should be developed to improve patient skills for critically analyzing information and making decisions.

Development and Validation of a Heart Failure-Specific Health Literacy Scale.

BACKGROUND: Health literacy (HL) is an important concept for patient education and disease management with heart failure (HF). However, research on HL has predominantly focused on functional HL (ability to read and write). The World Health Organization advocates evaluating comprehensive HL, including the ability to access information (communicative HL) and critically evaluate that information (critical HL). OBJECTIVE: We developed an instrument for measuring functional, communicative, and critical levels of HL in patients with HF. METHODS: We evaluated the reliability and validity of those 3 HL scales in a sample of 191 outpatients with HF (mean [SD] age, 66.9 [13.9] years; 64.9% males). Sociodemographic and clinical characteristics, knowledge of HF, a well as motivation to obtain health information were assessed for each patient through a self-administered questionnaire and review of electronic medical records. RESULTS: We constructed scale items to reflect directly the comprehensive World Health Organization definition of HL. We identified 3 interpretable factors by exploratory factor analysis. Internal consistency was marginally acceptable for total HL (Cronbach α = 0.71), functional HL (α = 0.73), communicative HL (α = 0.68), and critical HL (α = 0.69); the interclass correlation coefficients of the functional, communicative, and critical HL subscales were 0.882, 0.898, and 0.882, respectively. Low functional, communicative, and critical HL was characteristic of older patients, those with lower socioeconomic status, patients living alone, those without a high school education, and patients lacking HF knowledge. CONCLUSIONS: Our new HL scale was demonstrated to be a reliable, valid instrument for measuring functional, communicative, and critical HL in patients with HF. Exploring a patient's HL level, including the ability to access, understand, and use health information as well as the ability to read and write, may provide better understanding of patients' potential barriers to self-care.

Severe outflow block syndrome caused by compression by the swollen caudate lobe after living donor liver transplantation: report of a case.

A 50-year-old man with primary biliary cirrhosis underwent living-donor liver transplantation (LDLT) using a graft of a left hemiliver with a left caudate lobe and duct-to-duct hepaticocholedochostomy. Postoperative bile leakage necessitated percutaneous drainage 22 days after LDLT. The patient presented to our hospital 205 days after the LDLT with abdominal distension and fever. Computed tomography showed ascites and a diffusely mottled pattern in the graft. The caudate lobe was swollen, and its bile ducts were dilated. The inferior vena cava was forced to the right by the swollen caudate lobe, and the root of the hepatic vein was stretched. The hepatic vein was not contrasted. Endoscopic retrograde cholangiography showed a biliary anastomotic stricture. Based on these findings, we diagnosed a severe outflow block of the hepatic vein and biliary anastomotic stricture. We performed balloon dilation of the biliary anastomosis and implanted a metallic stent in the hepatic vein. Thereafter, his clinical symptoms improved dramatically.

Amphiregulin is a promising prognostic marker for liver metastases of colorectal cancer.

PURPOSE: Aberrant activation of epidermal growth factor receptors (EGFR/HER1) by ligand stimulation or heterodimerization with human epidermal growth factor 2 (HER2) is considered to play an important role in the development of colorectal carcinoma. Amphiregulin (AR) is a ligand of EGFR that might be related to the development and progression of gastrointestinal tumors. The aim of this study was to determine the AR, EGFR, and HER2 protein expression levels and to evaluate their prognostic relevance to the clinical course of colorectal cancer. EXPERIMENTAL DESIGN: The AR, EGFR, and HER2 protein levels in primary tumors of colorectal cancer (n = 106) were examined using immunohistochemistry. Metastatic sites in liver specimens (n = 16) were also analyzed in the same manner. RESULTS: Thirteen (81.6%) metastatic lesions of the liver stained positive for AR. Among the primary lesions of colorectal cancer, 58 (54.7%) stained positive for AR, 13 (12.3%) stained positive for EGFR, and 5 (4.7%) stained positive for HER2. When the relationships between each protein expression level and the clinicopathologic factors were examined, only the AR expression level was significantly related to liver metastasis (P = 0.0296). A multivariate analysis of liver metastasis proved that AR expression was an independent prognostic factor of liver metastasis from colorectal cancer (P = 0.0217). CONCLUSIONS: AR expression in primary lesions of colorectal cancer is an important predictive marker of liver metastasis.

Clinical features and surgical outcome of hepatic caudate lobe metastases from colorectal cancer.

BACKGROUND: The difficulty encountered in hepatectomy for the removal of a malignant tumor in the hepatic caudate lobe has recently been reported. However, few reports have described the clinical features of hepatic caudate lobe metastases from colorectal carcinoma. PATIENTS AND METHODS: Retrospective clinicopathological data for 13 consecutive patients with colorectal metastases to the hepatic caudate lobe were analyzed for their various clinical aspects and long-term outcomes. RESULTS: The tumor-free margin of the resected specimen was significantly smaller in the hepatic caudate lobe metastases group than in the other 178 patients with colorectal metastases in other sites of the liver (p<0.01), while the invasiveness of hepatectomy, as judged by the volume of liver resected and the duration of the procedure, was higher in the hepatic caudate lobe metastases group. Hepatic disease-free survival rates in the caudate lobe metastases group were lower than in the other group (p<0.01). By multivariate analysis, metastases to the hepatic caudate lobe negatively impacted hepatic disease-free survival (adjusted relative risk, 2.085; p=0.048). CONCLUSION: In patients with hepatic caudate lobe metastases, hepatectomy with clear surgical margins is difficult, even when major hepatectomy is attempted. Hepatic metastasis in the caudate lobe is a risk factor for early liver recurrence after hepatectomy.

Histopathologically-diagnosed splenic metastasis in a hepatocellular carcinoma case with adrenal metastasis.

We encountered a patient with hepatocellular carcinoma (HCC), with adrenal gland metastasis, in whom splenic metastasis was diagnosed histopathologically. A 59-year-old man visited our hospital in May 2001 with chief complaints of abdominal distension and pretibial pitting edema. Multiple HCCs associated with HCV-positive liver cirrhosis were detected. Transarterial embolization (TAE) was performed a total of 4 times for HCCs. A left adrenal gland metastatic lesion was detected and it was found to increase in diameter from 3 cm to 6 cm over a four-month period; left adrenalectomy was performed in June 2002. Because of marked splenomegaly and findings of hypersplenism, the spleen was also resected. Although no metastatic lesions were evident on macroscopic examination of the spleen, a small metastatic lesion from moderately differentiated HCC, approximately 0.5 mm in diameter, was detected histopathologically. Splenic metastasis from HCC is rare, usually occurring with metastases involving other organs. Our patient also had adrenal gland metastasis. Therefore, hematogenous metastasis to the congested spleen via the systemic circulation was suspected.