Development and Pilot of a Checklist for Management of Acute Liver Failure in the Intensive Care Unit

Introduction Acute liver failure (ALF) is an ideal condition for use of a checklist. Our aims were to develop a checklist for the management of ALF in the intensive care unit (ICU) and assess the usability of the checklist among multiple providers. Methods The initial checklist was developed from published guidelines and expert opinion. The checklist underwent pilot testing at 11 academic liver transplant centers in the US and Canada. An anonymous, written survey was used to assess the usability and quality of the checklist. Written comments were used to improve the checklist following the pilot testing period. Results We received 81 surveys involving the management of 116 patients during the pilot testing period. The overall quality of the checklist was judged to be above average to excellent by 94% of users. On a 5-point Likert scale, the majority of survey respondents agreed or agreed strongly with the following checklist characteristics: the checklist was easy to read (99% agreed/agreed strongly), easy to use (97%), items are categorized logically (98%), time to complete the checklist did not interfere with delivery of appropriate and safe patient care (94%) and was not excessively burdensome (92%), the checklist allowed the user the freedom to use his or her clinical judgment (80%), it is a useful tool in the management of acute liver failure (98%). Web-based and mobile apps were developed for use of the checklist at the point of care. Conclusion The checklist for the management of ALF in the ICU was shown in this pilot study to be easy to use, helpful and accepted by a wide variety of practitioners at multiple sites in the US and Canada

Middle ground approach to paradox: Within- and between-culture examination of the creative benefits of paradoxical frames

The authors contributed equally to this work.</p

Institutional pedagogical waypoints : reflections on doctoral journeys between Taiwan and Australia

Spatial, social and academic journeys undertaken between Taiwan and Australia for doctoral education are the focus of reflection here. The discussion centres on the authors&rsquo; experiences of, on the one hand, the development of a Faculty of Education&rsquo;s doctoral pedagogies in the early 2000s to reflect its international PhD candidature profile &ndash; especially from Taiwan &ndash; and, on the other, of Taiwanese doctoral candidates&rsquo; journeys through their PhDs in the Faculty. The authors write from their particular perspectives: Evans as an Australian academic and a manager of doctoral studies, and Liou as a Taiwanese academic pursuing her doctorate in an Australian university. The article considers the Australian and Taiwanese doctoral contexts between which the students transited. The institutional pedagogical strategies, from pre-enrolment to completion, are examined as waypoints on the doctoral journey for both staff and candidates

Coagulopathy, Bleeding Events, and Outcome According to Rotational Thromboelastometry in Patients With Acute Liver Injury/Failure

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/169284/1/hep31767_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169284/2/hep31767-sup-0001-Supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169284/3/hep31767.pd

English as an international language and teachers\u27 professional identity

This thesis found that the notion of English as a lingua franca and its implications in teaching English are difficult for English teachers to accept in a social-cultural context where English is a foreign language. Teachers\u27 professional identity is the key to determine the success or failure of educational innovations

Healthcare resource utilization and costs by disease severity in an insured national sample of US patients with chronic hepatitis B

BACKGROUND & AIMS: Chronic hepatitis B (CHB) affects over 2 million people in the US, with little reported on healthcare utilization and cost. We aimed to quantify annual CHB utilization and costs by disease severity and payer type. METHODS: Using Commercial, Medicare, and Medicaid databases from 2004 to 2015 and ICD9 codes, we retrospectively identified adults with CHB, analyzing all-cause inpatient, outpatient, and pharmaceutical utilization and costs by disease severity. We compared healthcare utilization and costs between patients with CHB, without advanced liver disease, and matched non-CHB controls. All-cause inpatient, outpatient, and pharmaceutical utilization and costs were reported for each year and adjusted to 2015 dollars. RESULTS: Our sample consisted of 33,904 CHB cases and 86,072 non-CHB controls. All-cause inpatient admissions (average stay 6-10 days) were more frequent in advanced liver disease states. Across all payers, patients with decompensated cirrhosis had the highest emergency department utilization (1.6-2.8 annual visits) and highest mean annual costs. The largest all-cause cost components for Commercial and Medicaid were inpatient costs for all advanced liver disease groups (Commercial: 62%, 47%, 68%; Medicaid: 81%, 72%, 74%, respectively), and decompensated cirrhosis and hepatocellular carcinoma groups for Medicare (Medicare 49% and 48%). In addition, patients with compensated liver disease incurred costs 3 times higher than non-CHB controls. CONCLUSION: Patients with CHB, regardless of payer, who experienced decompensated cirrhosis, hepatocellular carcinoma, or a liver transplant incurred the highest annual costs and utilization of healthcare resources, but even patients with CHB and compensated liver disease incurred higher costs than those without CHB. All stakeholders in disease management need to combine efforts to prevent infection and advanced liver disease through improved vaccination rates, earlier diagnosis, and treatment. LAY SUMMARY: Hepatitis B virus can be a progressive disease leading to cirrhosis, hepatocellular carcinoma, liver transplant, and death. These progressive disease states are associated with a higher rate of hospitalizations, emergency room visits, outpatient visits, and costs compared to similar patients without hepatitis B. The most ill patients have the highest costs, but even patients who are less sick experience higher costs than patients without hepatitis B

Alcohol consumption is associated with the severity and outcome of acute liver injury/failure

Background & AimsNonâ medical factors which contribute to the severity of acute liver failure (ALF) remain poorly defined. The association of alcohol consumption on the severity of presentation and outcome were determined in patients with ALF and acute liver injury (ALI) in a large, multicentre registry.MethodsAlcohol consumption during the 6 months prior to study entry was analysed in 1170 patients enrolled in the ALF Study Group Registry. Consumption was categorized as none/minimal (<3 alcoholic beverages/week) or at least moderate (â ¥3/week). Clinical characteristics, the severity of liver injury at presentation (ALI or ALF) and outcome were compared.ResultsIn patients with acetaminophen (APAP) overdose, at least moderate alcohol consumption was associated with higher peak aminotransferases, bilirubin, creatinine and INR on admission, compared to no/minimal consumption. In patients with nonâ APAP ALI/ALF, at least moderate alcohol consumption was associated with higher peak aminotransferases and creatinine. In APAP, nonâ APAP or all aetiologies, at least moderate alcohol consumption was associated with a 75%, 89% and 82% higher odds, respectively, of presenting as ALF rather than ALI (all P < .005). At least moderate alcohol consumption increased the odds of death by 45% (P = .01) across all aetiologies. In multivariate analysis, older age, nonâ Caucasian race, peak INR, peak bilirubin and at least moderate alcohol consumption were significantly associated with death. Finally, in Kaplanâ Meier analysis of patients with all aetiologies, at least moderate alcohol consumption was associated with decreased timeâ dependent survival (P = .002).ConclusionAlcohol consumption adversely affects the presentation and outcome of both APAPâ and nonâ APAPâ induced ALI/ALF.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153538/1/liv14327.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153538/2/liv14327_am.pd

Prognostic Value of the 13C‐Methacetin Breath Test in Adults with Acute Liver Failure and Non‐acetaminophen Acute Liver Injury

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/169328/1/hep31783.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169328/2/hep31783-sup-0001-SupInfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169328/3/hep31783_am.pd