Background: Recently, the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) put forth their latest expectations of residents using Entrustable Professional Activities (EPA). Furthermore, prompted by an interest in improving the health of the population, enhancing the experience and outcome of the patient, and reducing the per capita [...]

Background: Cholangiocarcinoma is an uncommon cancer with a very bad prognosis despite advances made in treatment. Location intrahepatic versus extrahepatic – determines surgical options. In our study, we examined variations in outcomes between patients admitted to the hospital with intrahepatic versus extrahepatic disease. Methods: Data from the National Inpatient Sample (NIS) which is part of [...]

Background: There are an estimated 3.5 million people in the United States living with Hepatitis C virus (HCV); 75-85% of those will develop a chronic infection that can result in liver complications. It is crucial to identify positive infections immediately to ensure linkage to a provider and prevent the advancement of HCV. Initial face-to-face contact [...]

Background: Approximately 1.6 million men and 800,000 women in the US are alcohol dependent and have an alcohol-use disorder. Half will experience withdrawal symptoms after decreased alcohol consumption. Complications including seizures and delirium tremens occur in 3-5% . Benzodiazepines are the gold standard for treatment of alcohol withdrawal but choice of drug regimens varies widely. [...]

Background: Hospitalized patients receiving direct oral anticoagulants (DOACs) sometimes require bridging with unfractionated heparin (UFH). Monitoring UFH with anti-Xa assays has been shown to correlate with better outcomes. However, DOACs interfere with anti-Xa assays resulting in inappropriate UFH dose adjustments that can negatively impact patient care. In 2015, we deployed an electronic health record (EHR) [...]

Background: Rifaximin 550 mg tablets is a nonsystemic antibiotic indicated for reducing the risk of overt hepatic encephalopathy (OHE) recurrence in adults and may be used alone or in combination with the cathartic lactulose. This analysis evaluated the safety profile of rifaximin alone vs rifaximin + lactulose (combination) in patients with cirrhosis. Methods: In a [...]

Background: Veterans in care at Veterans Affairs (VA) medical centers have a higher prevalence of Hepatitis C (HCV) antibody positivity than the general population1,2. Despite high tolerability and cure rates approaching 95% with new direct-acting antiviral (DAA) drugs, a significant proportion of veterans have not been initiated on treatment due to barriers including active substance [...]

Background: Hepatic encephalopathy (HE) is a common complication in patients with end stage liver disease. Variability in presentation can be a source of clinical uncertainty for medical providers. Ammonia levels have historically been used to aid in the diagnosis of HE despite low positive and negative predictive values. Our primary objective was to determine the [...]

Background: Sub-optimal discharge preparation during hospitalization may adversely impact safety and lead to a poor patient experience. As part of an AHRQ-funded study, we designed and developed interactive digital health tools (Figure 1) to engage patients and caregivers in self-assessing discharge preparedness: an educational video and 16-item discharge checklist addressing 4 domains (understanding the plan, [...]

Background: Rifaximin 550 mg tablets is a nonsystemic antibiotic indicated for reducing the risk of overt hepatic encephalopathy (HE) recurrence in adults and may be used in combination with lactulose. Practice guidelines state that rifaximin is effective as add-on therapy to lactulose for preventing overt HE recurrence. This pooled analysis evaluated the efficacy and safety [...]