Canadian liver journal最新文献

{"title":"The feasibility and acceptability of an online mind-body wellness program for patients with primary biliary cholangitis","authors":"Makayla Watt, Ashley Hyde, John C Spence, Gail M Wright, Shauna Vander Well, Emily Johnson, Andrew Mason, Magnus McLeod, Puneeta Tandon","doi":"10.3138/canlivj-2022-0045","DOIUrl":"https://doi.org/10.3138/canlivj-2022-0045","url":null,"abstract":"Background: Persons with primary biliary cholangitis (PBC) experience significantly higher rates of mental distress and impaired health related quality of life (HrQoL) than the general population. Given limited evidence, but a high need, our primary aim was to assess feasibility and acceptability of a 12-week, online, mind–body wellness program in people with PBC. Methods: This was a single-group, sequential mixed-methods, pre-post feasibility, and acceptability study. Core program components included follow-along movement, meditation and breathwork videos, and cognitive behavioural therapy informed activities. This was supplemented by weekly phone check-ins. Feasibility was assessed by recruitment, adherence, and retention. The pre-post exploratory efficacy assessment included surveys for fatigue, perceived stress, anxiety, depression, HrQoL, and resilience. A qualitative descriptive approach with semi-structured interviews evaluated study experiences. Results: Thirty-two participants were recruited within 30 days and 29 (91%) were retained to end-of-study. Of these, 25 (86%) adhered to carrying out the mind–body practice at least 2–3 days per week. Feedback supported acceptability (satisfaction score 90%). Significant improvements were observed in fatigue (13%, p = 0.004), anxiety (30%, p = 0.005), depression (28%, p = 0.004), and five PBC-40 domains (itch, fatigue, cognitive, emotional, general symptoms). Qualitative interviews revealed improved stress management, better coping, and a more positive mindset. Fatigue and self-sabotaging thoughts were cited as barriers to participation. Conclusions: These findings suggest that a 12-week online mind–body intervention is feasible and acceptable in patients with PBC. After iterative refinement, a randomized controlled trial will be designed using this feedback.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"233 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The benefits of a team approach to cirrhosis care","authors":"Puja Chauhan, Natasha Chandok","doi":"10.3138/canlivj-2023-0017","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0017","url":null,"abstract":"","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"33 35","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135819136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographical disparities in gastroenterologists and transient elastography across Canada","authors":"Jessica Burnside, Tyler Thomas, Giada Sebastiani, Sahar Saeed","doi":"10.3138/canlivj-2023-0010","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0010","url":null,"abstract":"Background: In the next decade, the incidence and prevalence of advanced liver disease are expected to increase across Canada. However, little is known about the country's resources for monitoring patients requiring specialized care. A resource assessment was conducted to evaluate regional disparities of specialists and transient elastography machines across Canada. Methods: Demographic data on licenced gastroenterologists were obtained from Scott's Medical Directory as of October 2022. The primary location of each specialist was linked to 2016 Statistics Canada to obtain the population size and density of province/territories and census division (CD). Results were summarized per 100,000 persons. CD were classified as resource scare or approaching resource scarcity. A list of transient elastography (TE) was provided by KNS Canada Inc. and summarized per 1,000,000 persons by province. Results: Eight hundred fifty-three specialists were identified. Rates of gastroenterologists per 100,000 people ranged from 0 in the territories to 2.9 in Quebec. Half the provinces had less than 2.0 gastroenterologists per 100,000 persons. Gastroenterologists were concentrated in 24% (71/293) of the CDs across Canada. We identified resource-scarce CDs as areas with no gastroenterologists and in the highest tercile of population density, which accounted for 33% (1 of 3) in Prince Edward Island, 32% in Quebec, 25% in Ontario, 7% in British Columbia, and 4% in Manitoba. Only 94 TEs were identified nationwide. Conclusion: We found significant variation in liver-specific resources across Canada. Given the increasing number of people living with liver disease, policies must be implemented to address access to specialized care.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135728807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a case definition to estimate the prevalence and incidence of cirrhosis in pan-Canadian primary care databases","authors":"Nabiha Faisal, Leanne Kosowan, Hasan Zafari, Farhana Zulkernine, Lisa Lix, Alyson Mahar, Harminder Singh, Eberhard Renner, Alexander Singer","doi":"10.3138/canlivj-2023-0002","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0002","url":null,"abstract":"Aims: To develop and validate case definitions to identify patients with cirrhosis and alcohol-related cirrhosis using primary care electronic medical records (EMRs) and to estimate cirrhosis prevalence and incidence in pan-Canadian primary care database, between 2011 and 2019. Methods: A total of 689,301 adult patients were included with ≥1 visit to a primary care provider within the Canadian Primary Care Sentinel Study Network between January 1, 2017 and December 31, 2018. Subsample of 17,440 patients was used to validate the case definitions. Sensitivity, specificity, predictive values were calculated with their 95% confidence intervals (CI) and then determined the population-level prevalence and incidence trends with the most accurate case definition. Results: The most accurate case definition included: ≥1 health condition, billing, or encounter diagnosis for International Classification of Diseases, Ninth Revision codes 571.2, 571.5, 789.59, or 571. Sensitivity (84.6; 95% CI: 83.1–86.%), specificity (99.3; 95% CI: 99.1–99.4%), positive predictive values (94.8; 95% CI: 93.9–95.7%), and negative predictive values (97.5; 95% CI: 97.3–97.7%). Application of this definition to the overall population resulted in a crude prevalence estimate of (0.46%, 95% CI: 0.45%–0.48%). Annual incidence of patients with a clinical diagnosis of cirrhosis nearly doubled between 2011 (0.05%, 95% CI: 0.04%–0.06%) and 2019 to (0.09%, 95% CI: 0.08%–0.09%). Conclusions: The EMR-based case definition accurately captured patients diagnosed with cirrhosis in primary care. Future work to characterize patients with cirrhosis and their primary care experiences can support improvements in identification and management in primary care settings.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"162 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135728956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of different definitions of metabolic syndrome and their associations with non-alcoholic fatty liver disease: a retrospective study","authors":"Carmen Tse, Nicholas Lisanti, Micah Grubert Van Iderstine, Julia Uhanova, Gerald Minuk, Nabiha Faisal","doi":"10.3138/canlivj-2023-0006","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0006","url":null,"abstract":"Background: Metabolic syndrome (MetS) is considered an important risk factor for non-alcoholic fatty liver disease (NAFLD). The aim of this study was to measure the prevalence of MetS based on six different MetS definitions and compare the performance of various definitions for identifying diabetes, hypertension, and dyslipidemia among NAFLD patients. Methods: The definitions compared were those developed by the World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), International Diabetes Federation (IDF), American Association of Clinical Endocrinologists (AACE), American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI), and Interim Joint Statement “Harmonized” criteria. Receiver operator characteristic (ROC) curves were plotted for the six MetS definitions with NAFLD diagnosis. The diagnosis for NAFLD was established based on liver imaging or biopsy compatible with fatty liver disease. Results: A total of 500 NAFLD patients were analyzed. The mean age was 61.2 ± 13.2 years, and BMI was 32.7 ± 8.0 kg/m 2 . The most prevalent MetS component was dyslipidemia 83%, followed by hypertension 60%, obesity 61%, and diabetes 57%. The prevalence of MetS according to the WHO, NCEP/ATP-III, IDF, AACE, AHA/NHLBI, and harmonized criteria was 69%, 59%, 54%, 64%, 78%, and 79%, respectively. The highest area under the receiver operating characteristic curve for diabetes and hypertension was with the WHO definition (0.7405) and (0.8120), respectively. Conclusions: The prevalence of MetS in NAFLD patients varies according to the definitions of MetS employed. The modified WHO definition appeared to be most useful for the screening of MetS in NAFLD patients.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135728939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying opportunities for hepatic encephalopathy self-management: A mixed methods systematic review and synthesis.","authors":"Kathleen P Ismond,&nbsp;Jude A Spiers,&nbsp;Puneeta Tandon","doi":"10.3138/canlivj-2022-0025","DOIUrl":"10.3138/canlivj-2022-0025","url":null,"abstract":"<p><strong>Background: </strong>Hepatic encephalopathy (HE) in cirrhosis is an extremely challenging complication for patients and care partners. To identify potentially modifiable factors to enhance HE self-management strategies, we conducted a synthesis of quantitative and qualitative research about real-world HE behaviours, knowledge, and experiences.</p><p><strong>Methods: </strong>Using the EPPI-Centre's mixed methods synthesis procedure, a systematic literature search in five databases was completed; methods of selected articles underwent critical appraisal followed by descriptive analysis and coded line-by-line of content. Through refutational translation, the findings from the quantitative and qualitative syntheses were juxtaposed to highlight congruencies, incongruencies, or gaps. These findings informed generation of cross-analytical themes that were transformed into action statements.</p><p><strong>Results: </strong>The quantitative narrative review of synthesis (<i>n</i> = 17) generated four themes (patients had low awareness of HE and low treatment adherence rates, physicians had a non-uniform approach to non-pharmaceutical therapies). Meta-aggregation of qualitative data from six articles yielded three themes (patients and care partners had low levels of HE awareness, were unfamiliar with HE self-management, and were adherent to treatments). Comparison of findings revealed three congruencies, two gaps, and one incongruency. The combined synthesis yielded two self-management themes: universal patient-oriented cirrhosis HE education and ensuring each health care encounter systematically addresses HE to guarantee health care is continuously modified to meet their needs.</p><p><strong>Conclusions: </strong>By drawing on elements of Bloom's Taxonomy and distributed knowledge networks, deliberate patient-oriented HE messaging at all health care encounters is greatly needed to improve health outcomes and reduce care burdens related to HE.</p>","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"6 2","pages":"215-233"},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370725/pdf/canlivj-2022-0025.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10301006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Canadian hepatitis C treatment landscape: Time to turn chaos into order.","authors":"Kienan P Williams, Kate Pr Dunn, Samuel S Lee","doi":"10.3138/canlivj-2023-0008","DOIUrl":"10.3138/canlivj-2023-0008","url":null,"abstract":"","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"6 2","pages":"187-189"},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370726/pdf/canlivj-2023-0008.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10264279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Priority actions for elevating liver health in Canada: A call to action.","authors":"Mayur Brahmania,&nbsp;Mia J Biondi,&nbsp;Supriya Joshi,&nbsp;Elizabeth Lee,&nbsp;Hsiao-Ming Jung,&nbsp;Mohit Kehar","doi":"10.3138/canlivj-2022-0041","DOIUrl":"10.3138/canlivj-2022-0041","url":null,"abstract":"<p><p>Chronic liver disease (CLD) has become a silent epidemic in our country and has resulted in significant physical, psychosocial, and financial burden. Although other international liver associations have published frameworks for the principal actions required to improve liver health across health systems, Canada does not have a strategy to address the growing concerns of CLD. Thus, a multidisciplinary group of care providers involved in CLD management in Canada gathered to review the current burden of disease, gaps in management, and key opportunities for improving the identification and management of people at risk of developing progressive CLD.</p>","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"6 2","pages":"283-290"},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370728/pdf/canlivj-2022-0041.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10264277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Province-to-province variability in hepatitis C testing, care, and treatment across Canada.","authors":"Erin Mandel,&nbsp;Kate Underwood,&nbsp;Chelsea Masterman,&nbsp;Robert A Kozak,&nbsp;Cheryl H Dale,&nbsp;Melinda Hassall,&nbsp;Camelia Capraru,&nbsp;Hemant Shah,&nbsp;Harry LA Janssen,&nbsp;Jordan J Feld,&nbsp;Mia J Biondi","doi":"10.3138/canlivj-2022-0029","DOIUrl":"https://doi.org/10.3138/canlivj-2022-0029","url":null,"abstract":"<p><strong>Background: </strong>Few countries have implemented the necessary policy changes to reduce the number of steps in the cascade of care to achieve hepatitis C virus (HCV) elimination, including Canada. The aim of this study was to describe and compare legislation, scope of practice, and policy as it relates to the provision of HCV care in each province.</p><p><strong>Methods: </strong>We reviewed grey literature and regulatory and legislative documents which affect various aspects of the HCV cascade of care. Findings were verified by content experts.</p><p><strong>Results: </strong>HCV RNA reflex testing ensures those that are antibody positive get an HCV RNA test; however only 80% of provinces have reflex test. Point-of-care antibody testing can be offered in most community non-health care settings, yet many types of health care providers are unable to do this independently. Following a positive test, it may not be feasible to complete venipuncture; however only a single province processes HCV RNA dried blood spot cards. In many provinces, training and verification are required for novice prescribers, and in some provinces prescribing continues to be restricted to specialists. Only a single province has task-shifted treatment to a non-physician non-nurse practitioner model, where pharmacists can prescribe treatment. Finally, 80% of provinces require authorization forms, and 30% require proof of investigations for treatment.</p><p><strong>Conclusions: </strong>No single province is optimizing the use of diagnostic tools and task shifting and decreasing paperwork to expedite treatment initiation. Collaboration between provinces is needed to streamline practice, update policy, and promote equity in HCV diagnosis, care, and treatment.</p>","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"6 2","pages":"234-248"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370727/pdf/canlivj-2022-0029.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9887661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of liver transplantation candidacy and outcomes among patients who use cannabis: Is it time for a change in policy?","authors":"Man Ting Kristina Yau,&nbsp;Trana Hussaini,&nbsp;Eric M Yoshida","doi":"10.3138/canlivj-2022-0038","DOIUrl":"https://doi.org/10.3138/canlivj-2022-0038","url":null,"abstract":"<p><strong>Background: </strong>Recreational cannabis was legalized in Canada in 2018. A controversial contraindication for liver transplantation is cannabis. There is currently no consensus regarding cannabis use in liver transplant candidates. We aim to investigate liver transplantation candidacy and outcomes among cannabis users.</p><p><strong>Methods: </strong>English peer-reviewed studies on PubMed and Google Scholar were searched on September 9, 2022, using keywords including \"cannabis,\" \"liver transplantation,\" and their synonyms. Titles and abstracts were screened, followed by full texts. Reference lists were reviewed. Studies that investigated liver transplantation candidacy and outcomes among cannabis users were included.</p><p><strong>Results: </strong>The proportion of patients listed for liver transplantation was significantly less among cannabis users than among non-users. Time to listing was longer for cannabis users than non-users. The incidence of delisting was similar. There is an inconsistency between transplant centres regarding transplantation candidacy for cannabis users. While only 14% of Canadian centres had a policy in place and preferred candidates to abstain or decrease cannabis use before transplantation, a third of Canadian centres rejected cannabis users. Observational studies failed to demonstrate significant differences in patient survival between pre-transplantation cannabis users and non-users. However, self-reported mental health ratings were worse in post-transplantation cannabis users than in non-users and former users.</p><p><strong>Conclusions: </strong>Current observational data do not support a link between cannabis use and poor patient survival post-transplantation. However, high-quality prospective studies are needed to better elucidate the impact of cannabis use on liver transplantation outcomes. Liver transplant candidacy should be evaluated through a multidisciplinary and comprehensive approach considering all relevant psychosocial factors.</p>","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"6 2","pages":"269-277"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370722/pdf/canlivj-2022-0038.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9887662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}