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Bloom PP, Che Z, Hyde A, Johnson E, Miguel-Cruz A, Carbonneau M, Hazra D, Tandon P. Development and Evaluation of a Patient Cirrhosis Knowledge Assessment. Dig Dis Sci 2024; 69:399-409. [PMID: 38170334 DOI: 10.1007/s10620-023-08238-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND AIMS Self-management skills improve outcomes for patients with cirrhosis. While education programs exist to teach these skills, there are limited patient assessments to evaluate their efficacy. We aimed to develop and evaluate cirrhosis knowledge assessments for patients with compensated and decompensated cirrhosis. METHODS Across two institutions, a 4-stage process was undertaken: first, we developed a comprehensive set of questions regarding cirrhosis self-management. Second, the questions underwent critical review by patients and hepatology providers. Third, patients with cirrhosis answered these questions before and after a written educational tool. Questions were updated based on results. Fourth, patients answered the updated questions before and after a video educational tool. Binomial test or paired sample t-test was used to compare pre- and post-tests depending on question type. RESULTS In phase 3, 134 patients completed pre- and post-tests. 44% were decompensated, 81% were diagnosed with cirrhosis at least 3 years, and 52% were 60-75 years. 95% of single-answer questions were answered correctly by at least 70% of patients in the pre-test. None of the answers improved significantly with education. After phase 3, 6 questions were removed and 6 questions were edited to increase challenge. In phase 4, 96 patients (42 compensated, 54 decompensated) completed pre- and post-tests. In the compensated assessment, 3 questions improved after education and the summative score increased (7.9 to 9.0, P < 0.001). In the decompensated assessment, 4 questions improved after education and the summative score increased (7.0 to 7.7, P = 0.004). CONCLUSION Through a rigorous process, we created and evaluated cirrhosis knowledge assessments for patients with compensated and decompensated cirrhosis. Further validation is required and then these assessments can be used to improve patient education.
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Affiliation(s)
- Patricia P Bloom
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Zheng Che
- Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ashley Hyde
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Emily Johnson
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Antonio Miguel-Cruz
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
- Glenrose Rehabilitation Research, Innovation & Technology (GRRIT), Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
- University of Waterloo, Waterloo, ON, Canada
| | - Michelle Carbonneau
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Deepan Hazra
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Alwesabi SAM, Abdalla YHA, Abdulrahman EE, Osman AMA, Alkhadher MA, Alshameri FA, Hakami MSA, Ahmed WAM. The Level of Knowledge Among Nurses Regarding Care of Patients with Hepatic Encephalopathy at Najran Hospitals, Saudi Arabia. Int J Gen Med 2023; 16:4719-4727. [PMID: 37872964 PMCID: PMC10590595 DOI: 10.2147/ijgm.s437818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
Background/Aim Hepatic encephalopathy (HE) is a significant complication of acute and chronic liver disease. It is crucial for nurses to have knowledge of encephalopathy symptoms to enable prompt and effective responses when caring for such patients. Therefore, this study aimed to evaluate nurses' HE knowledge in Najran hospitals in Saudi Arabia. Methods This cross-sectional analytical study was conducted with nurses at the Najran Hospital in Najran City, Saudi Arabia. The sample size was determined using Epi-Calc 2000, resulting in a final sample of 125 nurses from intensive care units (ICU), cardiac surgical ICU and pediatric ICU, and they were selected by convenience sampling technique. Data were collected using a self-administered questionnaire, and 125 nurses participated in knowledge assessment. The data were coded and entered into SPSS version 21.0 for descriptive and inferential statistics. Information letters and consent forms were obtained from all the participants. Results The majority of nurses (88.8%) were female, and 59.2% were married. The age range of participants was 20-30 years (50.4%). Approximately 36.8% had 4-6 years of work experience. The majority of the nurses (87.2%) held a bachelor's degree. More than half (56%) of the nurses demonstrated moderate HE knowledge, whereas over a quarter (28%) exhibited good knowledge. There was a highly statistically significant association between marital status, level of education, nationality, and level of nurses' knowledge regarding HE (P-value = 0.01, 0.02, and 0.02, respectively). Conclusion The study concludes that nurses in Najran hospitals have an adequate knowledge levels, ranging from moderate to good. This highlights the importance of tailored educational programs to enhance nurses' understanding of HE symptoms and management. Furthermore, the marital status, education level, and nationality have significant association with nurses' knowledge.
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Affiliation(s)
| | | | | | | | - Mugahed Ali Alkhadher
- Medical and Surgical Nursing Department, Nursing College, Najran University, Najran, Saudi Arabia
| | | | - Manal S A Hakami
- Nursing Department, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Waled A M Ahmed
- Nursing Department, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
- Community Medicine Department, Faculty of Medicine, Postgraduate Studies, Al-Saeeda University, Sana’a, Yemen
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Development and validation of the Adult cirrhosiS Knowledge Questionnaire. Eur J Gastroenterol Hepatol 2023; 35:333-341. [PMID: 36708305 DOI: 10.1097/meg.0000000000002493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Assessing a patient's knowledge regarding liver cirrhosis is important to improve patient outcomes. This study aimed to develop and validate the Adult cirrhosiS Knowledge Questionnaire (ASK-Q) to assess patients' knowledge regarding liver cirrhosis from multiple aspects. METHODS A 24-item ASK-Q with four domains: self-understanding (5 items), aetiology (5 items), complications (5 items) and management (9 items) of liver cirrhosis was developed based on literature review and expert panel input. It was then piloted in five English-speaking patients with liver cirrhosis. These patients commented that the font size was too small. Hence, the font was enlarged and the final version of the ASK-Q was administered to English-speaking patients with liver cirrhosis, aged ≥18 years, with or without decompensation, at a tertiary hospital, from September 2020 to November 2021, at baseline and fortnight later. Patients with encephalopathy were excluded. RESULTS 120/135 patients agreed to participate (response rate = 88.9%). The overall median score was 59.1 (45.6-68.2). A total of 7/22 (31.8%) items were "easy", 14/22 (63.6%) items were "moderately easy" and 1/22 (4.5%) items were "difficult". Exploratory factor analysis extracted nine factors, and two items were omitted. The ASK-Q was able to discriminate the knowledge level of patients with and without tertiary education [59.1 (50.0-72.7) vs. 54.5 (36.4-63.6); P < 0.05]. The overall Kuder-Richardson coefficient was 0.760, indicating adequate internal consistency. At retest, 77/120 patients participated (response rate = 64.2%) and 15/22 items were not statistically significant, indicating adequate reliability. CONCLUSIONS The ASK-Q was found to be a valid and reliable questionnaire for evaluating the knowledge of liver cirrhosis among English-speaking adult patients.
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Measuring Medication Use, Obstacles, and Knowledge in Individuals With Cirrhosis. Clin Gastroenterol Hepatol 2022:S1542-3565(22)00821-7. [PMID: 36055568 PMCID: PMC9971355 DOI: 10.1016/j.cgh.2022.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/25/2022] [Accepted: 08/16/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although patient knowledge is modifiable, there are no widely accepted tools to measure patient understanding during cirrhosis care. We aimed to develop and validate "My Cirrhosis Coach" (MCC), a personalized, self-administered questionnaire to evaluate cirrhosis-related medication use, obstacles, and understanding. METHODS Adults with cirrhosis were prospectively enrolled at 3 tertiary centers from July 2016 through July 2020. Psychometrics including confirmatory factor analysis was used to develop and validate a final questionnaire. Content validity was measured via the content validity index and expert performance. Discriminant validity was assessed by comparing scores between groups hypothesized to have varying performance. RESULTS The MCC was tested in a diverse cohort (n = 713) with cirrhosis and its complications including ascites (45%) and hepatic encephalopathy (33%) with median Model for End-Stage Liver Disease-Sodium 10 (interquartile range, 9-15). A 6-factor model of the MCC fit the data well (root mean square error of approximation, 0.22; comparative fit index, 0.96; standardized root mean squared residual, 0.104; final domains: Medication Use & Accessibility, Medication Obstacles, Lactulose Use, Diuretic Use, Beta Blocker Use, and Dietary Sodium Use). The MCC had excellent content validity (content validity index, 81%-94%) and accuracy (91%-100%) ratings by experts. Mean domain scores ranged from 1.1 to 2.6 (range, 0-3; 3 indicating better performance). Those with a cirrhosis complication scored higher in the relevant medication domain (ie, diuretic use score in ascites). Compared with outpatients, inpatients scored higher in all knowledge domains except salt use and reported more medication obstacles. Scores differed by income, education level, and having an adult at home. CONCLUSIONS In a large, diverse cohort, we validated the MCC, which can serve to standardize medication use and knowledge measurement in clinical practice and education-based studies in cirrhosis.
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Wu S, Yang Z, Wu T, Tao X, Hong Y, Cheng B, Xia J. Application of online learning combined with case-based discussion in oral medicine education. J Dent Educ 2022; 86:1399-1404. [PMID: 35442534 DOI: 10.1002/jdd.12939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND During the past decades, the rapid development of modern teaching tools and methods has been observed, and the new teaching module constructed through digitization or networking has been widely used in the field of medical education. This study aimed to investigate the effectiveness and acceptability of the online learning combined with case-based discussion (CBD) approach in oral medicine education. METHODS Sixty senior students majoring in stomatology were randomly divided into two groups. One group (new module-based teaching group [NG], n = 30) watched an online teaching video and discussed clinical cases in groups. The control group (traditional lecture-based group [TG], n = 30) was assigned to the traditional lecture-based teaching. Subsequently, a theory assessment was conducted on the topics taught, and the scores of both groups were compared. Feedback about this teaching model was obtained from the NG. RESULTS The results showed that students in the NG had significantly better performance in terms of mastering professional knowledge than did students in the TG. Moreover, most students in the NG had a high degree of satisfaction with this new teaching method, as they agreed that it can mobilize their learning enthusiasm and promote their engagement, interaction, and cooperation in the learning of oral medicine. CONCLUSIONS Our findings indicate the effectiveness and high satisfaction of CBD combined with online learning in the teaching of oral medicine. This study is expected to provide new ideas for improving the dental teaching quality.
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Affiliation(s)
- Shujie Wu
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Zaiwu Yang
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Tong Wu
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Xiaoan Tao
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Yun Hong
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Bin Cheng
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR China
| | - Juan Xia
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, PR China
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Ufere NN, Donlan J, Indriolo T, Richter J, Thompson R, Jackson V, Volandes A, Chung RT, Traeger L, El-Jawahri A. Burdensome Transitions of Care for Patients with End-Stage Liver Disease and Their Caregivers. Dig Dis Sci 2021; 66:2942-2955. [PMID: 32964286 DOI: 10.1007/s10620-020-06617-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with end-stage liver disease (ESLD) experience frequent readmissions; however, studies focused on patients' and caregivers' perceptions of their transitional care experiences to identify root causes of burdensome transitions of care are lacking. AIM To explore the transitional care experiences of patients with ESLD and their caregivers in order to identify their supportive care needs. METHODS We conducted interviews with 15 patients with ESLD and 14 informal caregivers. We used semi-structured interview guides to explore their experiences since the diagnosis of ESLD including their care transitions. Two raters coded interviews independently (κ = 0.95) using template analysis. RESULTS Participants reported feeling unprepared to manage their informational, psychosocial, and practical care needs as they transitioned from hospital to home after the diagnosis of ESLD. Delay in the timely receipt of supportive care services addressing these care needs resulted in hospital readmissions, emotional distress, caregiver burnout, reduced work capacity, and financial hardship. Participants shared the following resources that they perceived would improve their quality of care: (1) discharge checklist, (2) online resources, (3) mental health support, (4) caregiver support and training, and (5) financial navigation. CONCLUSION Transitional care models that attend to the informational, psychosocial, and practical domains of care are needed to better support patients with ESLD and their caregivers at the time of diagnosis and beyond. Without attending to the multidimensional care needs of newly diagnosed patients with ESLD and their caregivers, they are at risk of burdensome transitions of care, high healthcare utilization, and poor health-related quality of life.
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Affiliation(s)
- Nneka N Ufere
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - John Donlan
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Teresa Indriolo
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - James Richter
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ryan Thompson
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vicki Jackson
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angelo Volandes
- Section of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raymond T Chung
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Louissaint J, Foster C, Harding-Theobald E, Lok AS, Tapper EB. Social Support Does Not Modify the Risk of Readmission for Patients with Decompensated Cirrhosis. Dig Dis Sci 2021; 66:1855-1861. [PMID: 32578043 PMCID: PMC7755706 DOI: 10.1007/s10620-020-06421-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with decompensated cirrhosis are at high risk of frequent hospitalizations. Whether the level of perceived social support impacts this risk is unknown. We sought to determine the relationship between social support and burden of hospitalization in patients with decompensated cirrhosis. METHODS A total of 73 patients, all with decompensated cirrhosis and an index cirrhosis-related admission between 7/1/2017 and 7/1/2019, completed the modified medical outcomes study social support (mMOS-SS) survey. We retrospectively assessed the relationship between mMOS-SS scores and probability of readmission 90-days after the index admission. Additionally, we prospectively analyzed the association between mMOS-SS scores at enrollment and risk of 90-day hospitalization. RESULTS At enrollment, 50.7% were female, median age 61 years, and median mMOS-SS score was 87.5. Median model for end-stage liver disease sodium (MELD-Na) at the time of the index admission was 15 and was 13 at the time of enrollment. The mMOS-SS score did not modify the rate of readmission 90 days after the index admission date (adjusted HR 1.01, 95%CI 0.98-1.03) nor was it associated with the rate of admission 90 days after enrollment prospectively (adjusted HR 0.99, 95%CI 0.96-1.02). The MELD-Na score at enrollment was the only significant predictor of hospitalization during prospective follow-up (adjusted HR 1.18, 95%CI 1.09-1.27). CONCLUSIONS Social support, as measured by the mMOS-SS survey, in patients with decompensated cirrhosis was high. However, this did not modify the risk of cirrhosis-related hospitalizations. Future investigation to define the specific components of social support that could modify readmission risk is needed.
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Affiliation(s)
- Jeremy Louissaint
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman, SPC 5362 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Chelsey Foster
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman, SPC 5362 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Emily Harding-Theobald
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman, SPC 5362 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Anna S Lok
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman, SPC 5362 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Elliot B Tapper
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman, SPC 5362 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
- Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Saleh ZM, Bloom PP, Grzyb K, Tapper EB. How Do Patients With Cirrhosis and Their Caregivers Learn About and Manage Their Health? A Review and Qualitative Study. Hepatol Commun 2021; 5:168-176. [PMID: 33553967 PMCID: PMC7850304 DOI: 10.1002/hep4.1621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 02/04/2023] Open
Abstract
The complexity of cirrhosis requires patients and their caregivers to be well educated to improve outcomes. Data are lacking regarding how to best educate patients and their caregivers in the setting of cirrhosis. Our aim is to understand (both through existing literature and by asking patients and their caregivers) how patients learn about their disease, barriers in their education and disease management, and self-management strategies. We performed a structured search of published articles in PubMed (1973 to 2020) using keywords "cirrhosis" plus "barriers", "education", "self-management", or "self-care". Additionally, we conducted a focus group of a representative sample of patients and their caregivers to understand how knowledge about cirrhosis is found and incorporated into self-management. Of 504 returned manuscripts, 11 pertained to barriers in cirrhosis, interventions, or educational management. Barriers are well documented and include disease complexity, medication challenges, comorbid conditions, and lack of effective education. However, data regarding addressing these barriers, especially effective educational interventions, are scarce. Current strategies include booklets and videos, patient empowerment, and in-person lectures. Without widespread use of these interventions, patients are left with suboptimal knowledge about their disease, a sentiment unanimously echoed by our focus group. Despite linkage to subspecialty care and consistent follow-up, patients remain uncertain about their disease origin, prognosis, and therapies to manage symptoms. It is clear that more data are needed to assess effective strategies to address unmet educational needs. Existing strategies need to be blended and improved, their effectiveness evaluated, and the results distributed widely.
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Affiliation(s)
- Zachary M Saleh
- Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Patricia P Bloom
- Division of GastroenterologyMassachusetts General HospitalBostonMAUSA
| | - Katie Grzyb
- Quality and Continuous Improvement TeamDepartment of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Elliot B Tapper
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMIUSA
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