Electronic Consultations: Delivering Specialty Care Anywhere

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151261/1/hep41409.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151261/2/hep41409_am.pd

Introducing the AASLD president: Anna S.F. Lok

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136432/1/hep29073_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136432/2/hep29073.pd

Pathogenesis of Alcoholic Liver Disease–Recent Advances

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65715/1/j.1530-0277.2002.tb02598.x.pd

Reply

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

Comparison of Body Size, Morphomics, and Kidney Function as Covariates of High‐Dose Methotrexate Clearance in Obese Adults with Primary Central Nervous System Lymphoma

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154919/1/phar2379.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154919/2/phar2379_am.pd

The Educational Impact of the Specialty Care Access Network–Extension of Community Healthcare Outcomes Program

Background: With the aging hepatitis C cohort and increasing prevalence of fatty liver disease, the burden on primary care providers (PCPs) to care for patients with liver disease is growing. In response, the Veterans Administration implemented initiatives for primary care-specialty referral to increase PCP competency in complex disease management. The Specialty Care Access Network?Extension of Community Healthcare Outcomes (SCAN-ECHO) program initiative was designed to transfer subspecialty knowledge to PCPs through case-based distance learning combined with real-time consultation. There is limited information regarding the initiative's ability to engage PCPs to learn and influence their practice. Materials and Methods: We surveyed PCPs to determine the factors that led to their participation in this program and the educational impact of participation. Results: Of 51 potential participants, 24 responded to an anonymous survey. More than 75% of respondents participated more than one time in a SCAN-ECHO clinic. Providers were motivated to participate by a desire to learn more about liver disease, to apply the knowledge gained to future patients, and to save their patients time traveling to another center for specialty consultation. Seventy-one percent responded that the didactic component and case-based discussion were equally important. It is important that participation changed clinical practice: 75% of providers indicated they had personally discussed the information they learned from the case presentations with their colleague(s), and 42% indicated they helped a colleague care for their patient with the knowledge learned during discussions of other participants' cases. Conclusions: This study shows that the SCAN-ECHO videoconferencing program between PCPs and specialists can educate providers in the delivery of specialty care from a distance and potentially improve healthcare delivery.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140279/1/tmj.2013.0302.pd

A risk score to predict the development of hepatic encephalopathy in a populationâ based cohort of patients with cirrhosis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146442/1/hep29628_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146442/2/hep29628-sup-0001-suppinfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146442/3/hep29628.pd

Comorbid illness is an important determinant of health-related quality of life in patients with chronic hepatitis C

Chronic hepatitis C (CHC) patients selected for entry into treatment trials have been reported to have impaired health-related quality of life (HRQOL). However, these trials have an inherent selection bias, and HRQOL in CHC patients may have been underestimated because of the exclusion of patients with comorbid illness. The aim of this study was to assess HRQOL in an unselected group of CHC patients and to identify factors associated with impairment in HRQOL. METHODS : A total of 220 consecutive eligible CHC patients were enrolled from a hepatology clinic. HRQOL was assessed by the short form 36 (SF-36) and comorbid illnesses were assessed by an interview. RESULTS : CHC patients had significantly lower SF-36 scores in all subscales and in the summary scales when compared to those of the healthy general population in the United States ( p < 0.001 ). Compared to CHC patients entering treatment trials, our patients had lower SF-36 scores on five subscales ( p < 0.001 ). The presence of comorbid illness was the most important predictor of HRQOL in CHC patients. However, CHC alone resulted in significantly lower SF-36 scores in all subscales and summary scales ( p ≤ 0.003 ) compared to those of the healthy U.S. population. There was no correlation between SF-36 scores and history of i.v. drug use or dependence, alcohol dependence, and serum aminotransferase levels. CONCLUSIONS : We conclude that unselected CHC patients presenting for medical evaluation have a reduced HRQOL, which is lower than that reported for CHC patients entering treatment trials. CHC alone is associated with significant impairment in HRQOL, but the presence of comorbid illness leads to further diminution in HRQOL.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75569/1/j.1572-0241.2001.04133.x.pd

Sibling comparisons elucidate the associations between educational attainment polygenic scores and alcohol, nicotine and cannabis.

Background and aimsThe associations between low educational attainment and substance use disorders (SUDs) may be related to a common genetic vulnerability. We aimed to elucidate the associations between polygenic scores for educational attainment and clinical criterion counts for three SUDs (alcohol, nicotine and cannabis).DesignPolygenic association and sibling comparison methods. The latter strengthens inferences in observational research by controlling for confounding factors that differ between families.SettingSix sites in the United States.ParticipantsEuropean ancestry participants aged 25 years and older from the Collaborative Study on the Genetics of Alcoholism (COGA). Polygenic association analyses included 5582 (54% female) participants. Sibling comparisons included 3098 (52% female) participants from 1226 sibling groups nested within the overall sample.MeasurementsOutcomes included criterion counts for DSM-5 alcohol use disorder (AUDSX), Fagerström nicotine dependence (NDSX) and DSM-5 cannabis use disorder (CUDSX). We derived polygenic scores for educational attainment (EduYears-GPS) using summary statistics from a large (&gt; 1 million) genome-wide association study of educational attainment.FindingsIn polygenic association analyses, higher EduYears-GPS predicted lower AUDSX, NDSX and CUDSX [P &lt; 0.01, effect sizes (R2 ) ranging from 0.30 to 1.84%]. These effects were robust in sibling comparisons, where sibling differences in EduYears-GPS predicted all three SUDs (P &lt; 0.05, R2 0.13-0.20%).ConclusionsIndividuals who carry more alleles associated with educational attainment tend to meet fewer clinical criteria for alcohol, nicotine and cannabis use disorders, and these effects are robust to rigorous controls for potentially confounding factors that differ between families (e.g. socio-economic status, urban-rural residency and parental education)

Impaired Hepatocyte Regeneration in Toll-Like Receptor 4 Mutant Mice

Multiple lines of evidence suggest a role for endogenous lipopolysaccharides in toxin-induced liver injury. Toll-like receptor 4 has recently been implicated as a cell surface receptor important for lipopolysaccharide responsiveness. In these experiments, we sought to determine the role of toll-like receptor 4 in acute liver injury by carbon tetrachloride by utilizing the naturally occurring toll-like receptor 4 mutant and wild-type mice strains. Mice were injected with either carbon tetrachloride or the carrier. Serum transaminase levels peaked at 24 hr after carbon tetrachloride administration for both wild-type and mutant mice, with no significant histological difference in initial liver injury between the two groups. However, an overall decrease in hepatocyte proliferation was found in the mutant mice. Examination of the liver tissue revealed significant decreases in intrahepatic expressions of proinflammatory mediators. In conclusion, our results suggest that toll-like receptor 4 is important in the hepatic regenerative response to CCl 4 liver injury via its role in modulating the inflammatory response to hepatic injury.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44432/1/10620_2004_Article_490703.pd