Distinguishing Autoimmune Hepatitis From Steatohepatitis in Adolescents With Obesity and Positive Screening Alanine Aminotransferase.

Screening children with obesity for nonalcoholic fatty liver disease leads to identification of elevated alanine aminotransferase (ALT) and is a common cause for referral to pediatric gastroenterology. Guidelines recommend that children with positive screening ALT be evaluated for causes of ALT elevation beyond nonalcoholic fatty liver disease. One clinical challenge is that autoantibodies can be present in patients with obesity and thus may or may not represent autoimmune hepatitis. This case series highlights the importance of a comprehensive evaluation to reach an accurate diagnosis.

Development and Usability Testing of a Computer-Tailored Decision Support Tool for Lung Cancer Screening: Study Protocol.

BACKGROUND: Awareness of lung cancer screening remains low in the screening-eligible population, and when patients visit their clinician never having heard of lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Therefore, methods to effectively support both patients and clinicians to engage in these important discussions are essential. To facilitate shared decision making about lung cancer screening, effective methods to prepare patients to have these important discussions with their clinician are needed. OBJECTIVE: Our objective is to develop a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards instrument version 4.0 that will support shared decision making in lung cancer screening decisions. METHODS: Using a 3-phase process, we will develop and test a prototype of a computer-tailored decision support tool in a sample of lung cancer screening-eligible individuals. In phase I, we assembled a community advisory board comprising 10 screening-eligible individuals to develop the prototype. In phase II, we recruited a sample of 13 screening-eligible individuals to test the prototype for usability, acceptability, and satisfaction. In phase III, we are conducting a pilot randomized controlled trial (RCT) with 60 screening-eligible participants who have never been screened for lung cancer. Outcomes tested include lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), perception of being prepared to engage in a patient-clinician discussion about lung cancer screening, occurrence of a patient-clinician discussion about lung cancer screening, and stage of adoption for lung cancer screening. RESULTS: Phases I and II are complete. Phase III is underway. As of July 15, 2017, 60 participants have been enrolled into the study, and have completed the baseline survey, intervention, and first follow-up survey. We expect to have results by December 31, 2017 and to have data analysis completed by March 1, 2018. CONCLUSIONS: Results from usability testing indicate that the computer-tailored decision support tool is easy to use, is helpful, and provides a satisfactory experience for the user. At the conclusion of phase III (pilot RCT), we will have preliminary effect sizes to inform a future fully powered RCT on changes in (1) knowledge about lung cancer and screening, (2) perceived risk of lung cancer, (3) perceived benefits of lung cancer screening, (4) perceived barriers to lung cancer screening, (5) self-efficacy for lung cancer screening, and (6) perceptions of being adequately prepared to engage in a discussion with their clinician about lung cancer screening.

Endpoints for hemodialysis access procedures: correlation between fistulography and intraaccess blood flow measurements.

PURPOSE: The success of percutaneous interventions on stenotic hemodialysis prosthetic grafts and autogenous fistulas is assessed by comparing vessel diameter before and after treatment. These changes do not correlate with gold standard access blood flow (ABF) measurements obtained during hemodialysis. The AngioFlow (AngioDynamics, Inc, Queensbury, New York) calculates real-time blood flow through access circuits and may provide more physiologically relevant data in the interventional suite. This study compares angiographic vessel diameter and access circuit flow rates obtained with the AngioFlow Meter before and after percutaneous interventions on stenotic hemodialysis prosthetic grafts and autogenous fistulas ABF measurements obtained during hemodialysis. MATERIALS AND METHODS: Angiographic images and AngioFlow measurements for 76 procedures in 35 patients undergoing hemodialysis with arteriovenous grafts or fistulas were analyzed retrospectively. Correlations between ABF, fistulography, and AngioFlow measurements before and after treatment were computed. Regression analyses of AngioFlow measurements and measurements after ABF were performed to account for confounding factors. Time to failure of treatment was modeled in first-time patients stratified by AngioFlow values obtained after treatment. Only patients with ABF measurements obtained within 5 weeks of intervention were included. RESULTS: Correlations between initial ABF and fistulography measurement (ρ = 0.781), initial ABF and AngioFlow (ρ = 0.675), and final AngioFlow and ABF measurement (ρ = 0.798) were statistically significant. The correlation between final ABF and AngioFlow was significantly stronger than final ABF and fistulography (difference = 0.418, 95% bootstrap confidence interval [CI] [0.054, 0.914]). AngioFlow values and access survival after treatment did not show significant correlation. CONCLUSIONS: AngioFlow measurements performed after treatment correlate more strongly with hemodialysis ABF values than fistulography measures. Further studies are needed to determine the target AngioFlow value obtained after treatment that is associated with the greatest survival benefit for access circuits.