Predicting Overt Hepatic Encephalopathy for the Population With Cirrhosis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149748/1/hep30533.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149748/2/hep30533_am.pd

Nonalcoholic fatty liver disease, metabolic syndrome, and the fight that will define clinical practice for a generation of hepatologists

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143796/1/hep29722.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143796/2/hep29722_am.pd

Cost Saving or Cost Effective? Unanswered Questions in the Screening of Patients With Nonalcoholic Fatty Liver Disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151870/1/hep41386_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151870/2/hep41386.pd

Optimizing medication management for patients with cirrhosis: Evidence‐based strategies and their outcomes

Cirrhosis is a morbid condition associated with frequent hospitalizations and high mortality. Management of cirrhosis requires complex medication regimens to treat underlying liver disease, complications of cirrhosis and comorbid conditions. This review examines the complexities of medication management in cirrhosis, barriers to optimal medication use, and potential interventions to streamline medication regimens and avoid medication errors. A literature review was performed by searching PUBMED through December 2017 and article reference lists to identify articles relevant to medication management, complications, adherence, and interventions to improve medication use in cirrhosis. The structural barriers in cirrhosis include sheer medication complexity related to the number of medications and potential for cognitive impairment in this population, faulty medication reconciliation and limited adherence. Tested interventions have included patient self‐education, provider driven patient education, intensive case management including medication blister packs and smartphone applications. Initiatives are needed to improve patient, caregiver and provider education on appropriate use of medications in patients with cirrhosis. A multidisciplinary team should be established to coordinate care with close monitoring, address patient and caregiver concerns, and to provide timely access to outpatient evaluation of urgent/complex issues. Future studies evaluating the clinical outcomes and cost effectiveness of interventions are needed.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146454/1/liv13892_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146454/2/liv13892.pd

Hepatic encephalopathy impacts the predictive value of the Fried Frailty Index

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146338/1/ajt15020.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146338/2/ajt15020_am.pd

Frailty, Psychoactive Medications, and Cognitive Dysfunction Are Associated With Poor Patient‐Reported Outcomes in Cirrhosis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148384/1/hep30336-sup-0001-Supinfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148384/2/hep30336_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148384/3/hep30336.pd

Acceptance and use of a smartphone application in cirrhosis

Background and AimsThe development of cirrhosis‐related smartphone applications for remote monitoring is increasing. Whether patients with cirrhosis will welcome such new technology, however, is uncertain.MethodsWe prospectively enrolled patients with cirrhosis (N = 102) to determine predictors of acceptance and utilization of a smartphone application for cirrhosis management using a 12‐item Technology Acceptance Model (TAM) survey. Patients were then shown the EncephalApp© and evaluated for their willingness to download and use the application.ResultsPatients had a median age of 61.3 years and 63.7% had a history of hepatic decompensation. Intention to use the hypothetical application was associated with perceived usefulness (β: 0.4, 95% CI: 0.3‐0.5) and the presence of a caregiver (β: 1.1, 95% CI: 0.2‐2.0). Of the eligible participants, 71% agreed to download the EncephalApp© and the decision was influenced by computer anxiety, behavioural intent, caregiver presence and disease state factors. Actual usage was 32% and not associated with baseline characteristics or the technology acceptance model.ConclusionsPatient acceptance of smartphone applications for the management of cirrhosis is high and related to their attitudes towards technology and the presence of a caregiver. However, usage was low. Future research must employ behavioural interventions to optimize uptake and utilization of remote monitoring technology.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155977/1/liv14494_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155977/2/liv14494.pd

Hepatocellular carcinoma surveillance, early detection and survival in a privately insured US cohort

Background/AimsSemiannual hepatocellular carcinoma (HCC) surveillance is recommended in patients with cirrhosis; however, recent studies have raised questions over its utility. We investigated the impact of surveillance on early detection and survival in a nationally representative database.MethodsWe included patients with cirrhosis and HCC from the Optum database (2001‐2015) with >6 months of follow‐up between cirrhosis and HCC diagnoses. Surveillance adherence was defined as proportion of time covered (PTC), with each 6‐month period after abdominal imaging defined as ‘covered’. To determine the association between surveillance and mortality, we compared PTC between fatal and non‐fatal HCC.ResultsOf 1001 patients with cirrhosis and HCC, 256 died with median follow‐up 30 months. Median PTC by any imaging was greater in early‐stage vs late‐stage HCC (43.6% vs 37.4%, P = .003) and non‐fatal vs fatal HCC (40.8% vs 34.3%, P = .001). In multivariable analyses, each 10% increase in PTC was associated with increased early HCC detection (OR 1.07, 95% CI 1.01‐1.12) and decreased mortality (HR 0.95; 95% CI 0.90‐1.00). On subgroup analysis, PTC by CT/MRI was associated with early tumour detection and decreased mortality; however, PTC by ultrasound was only associated with early detection but not decreased mortality. These findings were robust across sensitivity analyses.ConclusionsIn a US cohort of privately insured HCC patients, PTC by any imaging modality was associated with increased early detection and decreased mortality. Continued evaluation of HCC surveillance strategies and effectiveness is warranted.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154974/1/liv14379_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154974/2/liv14379.pd

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Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142921/1/hep29806_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142921/2/hep29806.pd

Hospital volume and mortality after transjugular intrahepatic portosystemic shunt creation in the United States

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141487/1/hep29354-sup-0001-suppinfo1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141487/2/hep29354_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141487/3/hep29354.pd