Assessment of the spectrum of hepatic encephalopathy: A multicenter study
| Autor: | Scott W. Biggins, Patrick S. Kamath, Jennifer C. Lai, Jasmohan S. Bajaj, James B. Wade, Bradley Reuter, Puneeta Tandon, Christopher F. Rose, Julien Bissonnette, Kara Walter, Michael D. Leise |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_treatment
Video Recording Practice Patterns Neuropsychological Tests Liver transplantation Severity of Illness Index chemistry.chemical_compound Cognition 0302 clinical medicine Liver Function Tests Risk Factors 030212 general & internal medicine Practice Patterns Physicians' Hepatic encephalopathy Practice Patterns Nurses' Liver Disease Gastroenterology Rifamycins Physician Assistants 030211 gastroenterology & hepatology Clinical Competence Canada medicine.medical_specialty Concordance Clinical Sciences Protein-Restricted Rifaximin Simulated patient Education 03 medical and health sciences Ammonia Predictive Value of Tests Medical Internal medicine Severity of illness Diet Protein-Restricted medicine Humans Nurse Practitioners Graduate Transplantation Physicians' Hepatology business.industry Gastroenterologists medicine.disease United States Diet Patient Simulation Clinical trial Nurses' chemistry Education Medical Graduate Health Care Surveys Hepatic Encephalopathy Emergency medicine Surgery Digestive Diseases business Biomarkers |
| Zdroj: | Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol 24, iss 5 |
| ISSN: | 1527-6473 1527-6465 |
| DOI: | 10.1002/lt.25032 |
| Popis: | Hepatic encephalopathy (HE) is a major cause of morbidity in cirrhosis. However, its severity assessment is often subjective, which needs to be studied systematically. The aim was to determine how accurately trainee and nontrainee practitioners grade and manage HE patients throughout its severity. We performed a survey study using standardized simulated patient videos at 4 US and 3 Canadian centers. Participants were trainees (gastroenterology/hepatology fellows) and nontrainees (faculty, nurse practitioners, physician assistants). We determined the accuracy of HE severity identification and management options between grades 2. Serum ammonia levels were ordered in almost a third of grade ≥2 patients. For trainees and nontrainees, HE grades were identified similarly between groups. Trainees were less likely to order serum ammonia and low-protein diets, more likely to order rifaximin, and more likely to perform a more thorough workup for precipitating factors compared with nontrainee respondents. There was excellent concordance in the classification of grade ≥2 HE between nontrainees versus trainees, but lower grades showed discordance. Important differences were seen regarding blood ammonia, specialized testing, and nutritional management between trainees and nontrainees. These results have important implications at the patient level, interpreting multicenter clinical trials, and in the education of practitioners. Liver Transplantation 24 587-594 2018 AASLD. |
| Databáze: | OpenAIRE |
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