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
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
Externí odkaz: