Screening for hepatitis B virus and hepatitis C virus at a community fair: a single-center experience.

Despite recommendations for screening for hepatitis B virus (HBV) and hepatitis C virus (HCV), most individuals are still unaware of their infection status. The disparities in screening for HBV and HCV can be attributed to lack of awareness, language barriers, and difficulty in accessing healthcare. To address these issues, an exhibit booth was set up at an annual cultural festival to promote awareness about HBV and HCV and also provide free screening for a local Floridian community. Recruitment was conducted in various languages by physicians and nurses who specialize in hepatology. All materials associated with the screening process were sponsored by the Schiff Center for Liver Diseases, which is located at the University of Miami Miller School of Medicine in Florida. In the first year of the screening initiative, 173 of 11,000 fair attendees were screened for HBV. Twenty-nine (17%) of those screened tested positive for antibodies to hepatitis B core antigen (anti-HBc), and only 1 individual tested positive for chronic HBV, with positive hepatitis B surface antigen (HBsAg). Screening for HCV and an extended patient questionnaire were added to the screening program in the second year of the initiative. A total 231 of 9,000 fair attendees volunteered to be screened for both HBV and HCV. Twenty-nine (13%) of these people tested positive for anti-HBc, and 3 tested positive for HBsAg. Only 1 person tested positive for anti-HCV, but this individual had undetectable HCV RNA levels. Our single-center experience illustrates that, despite efforts to improve access to screening, only 2-3% of attendees at a cultural fair embraced the screening efforts. Other strategies will be required to enhance participation in screening programs for viral hepatitis.

Long-term management of alcoholic liver disease.

Alcoholic liver disease is a major cause of morbidity and mortality worldwide. Patients with cirrhosis caused by alcohol are at risk for developing complications associated with a failing liver. The long-term management of alcoholic liver disease stresses the following: (1) Abstinence of alcohol (Grade 1A), with referral to an alcoholic rehabilitation program; (2) Adequate nutritional support (Grade 1B), emphasizing multiple feedings and a referral to a nutritionist; (3) Routine screening in alcoholic cirrhosis to prevent complications; (4) Timely referral to a liver transplant program for those with decompensated cirrhosis; (5) Avoid pharmacologic therapies, as these medications have shown no benefit.

Effects of hospitalist attending physicians on trainee satisfaction with teaching and with internal medicine rotations.

BACKGROUND: Hospitalists are increasingly serving as inpatient attendings at teaching hospitals. The educational impact of this new model is unclear. We evaluated the relationship between type of attending (hospitalist vs traditional) and trainees' ratings of attending teaching and the overall ward rotation. METHODS: We analyzed data from a Web-based evaluation system containing all house staff and student evaluations of their attendings and internal medicine ward rotations at 2 university-affiliated teaching hospitals over a 2-year period (1999-2001). RESULTS: The overall evaluation completion rate was 91% (1587 of 1742 evaluations) by trainees working with 17 hospitalists and 52 traditional attendings. Trainees reported significantly more overall satisfaction with hospitalists than traditional attendings (8.3 vs 8.0 on a 9-point scale; P<.001) and rated hospitalists' overall teaching effectiveness as superior (4.8 vs 4.5 on a 5-point scale; P<.001). Perceived overall educational value of rotations was higher with hospitalist attendings (3.9 vs 3.7 on a 5-point scale; P =.04). Trainees evaluated hospitalists' knowledge, teaching, and feedback as superior to that of traditional attendings. There were no significant differences in reports of attendings' interest in teaching or patients, availability, or emphasis on cost-effectiveness. CONCLUSIONS: Trainees reported more effective teaching and more satisfying inpatient rotations when supervised by hospitalists. This analysis suggests that hospitalists may possess or accrue a specific inpatient knowledge base and teaching skill that distinguishes them from nonhospitalists.