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Thomsen HS, Jørgensen BE, Kynde Schøtz J, Bech LM, Grønkjær LL. Evaluation of a new concept to improve and organize clinical practice in nursing education: a pilot-study. BMC Nurs 2024; 23:203. [PMID: 38532438 DOI: 10.1186/s12912-024-01888-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/21/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Nursing students may experience clinical practice as unsafe due to the interactions with patients, fear of making mistakes, lack of clinical experience and supervision, which results in anxiety and stress. Thus, interventions to improve and organize the learning environment in clinical practice for nursing students are warranted, and the aim of this pilot-study was to evaluate a new concept of clinical practice in order to get insight on the different initiatives and gain knowledge for further developing. METHODS The new concept consisted of nursing students being affiliated to the same department during their clinical practices, reflective supervision, and participation in a self-compassion course. Data was collected using questionnaires and focus group interviews of 17 nursing students, 17 clinical supervisors, and 14 head nurses. A mixed-methods strategy was employed to give the study a pragmatic approach. Finding from the questionnaires and focus group interviews were analyzed separately and then weaved together into themes. RESULTS The results generated four themes: Information and involvement before and during the new concept, Learning outcomes, safety, and well-being, Impact of reflective supervision and self-compassion course, and Transition from study life to working life. In general, the participating nursing students, clinical supervisors, and head nurses had positives experiences regarding the new concept. They felt well-informed, and they experienced that it contributed to a safe learning environment, increased well-being, strengthened the relationship between nursing students and clinical supervisors and healthcare staff at the department, and prepared the nursing students to working life. CONCLUSION Our results complement the suggestion that improved quality of clinical practice for nursing students is an effective strategy to establish a safe and supportive learning environment that contribute with satisfaction, successful experiences, and attraction of future nurses. However, further intervention studies are needed to compare the effect of the new concept with traditional clinical practice.
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Affiliation(s)
- Helle Skou Thomsen
- Department of Education, Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Britt Egeris Jørgensen
- Department of Education, Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Jette Kynde Schøtz
- Department of Education, Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
- Nursing Education, University College South Denmark, Esbjerg, Denmark
| | - Line Muff Bech
- Department of Education, Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Lea Ladegaard Grønkjær
- Department of Gastroenterology, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
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Wernberg CW, Grønkjær LL, Jacobsen BG, Vilstrup H, Lauridsen MM. Reply to Letter to the Editor: Neurocognitive impairment in obesity and liver disease-An unsolved mystery. Hepatol Commun 2023; 7:e0308. [PMID: 37902471 PMCID: PMC10586859 DOI: 10.1097/hc9.0000000000000308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Charlotte Wilhelmina Wernberg
- Department of Gastroenterology and Hepatology, Liver Research Group, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Lea Ladegaard Grønkjær
- Department of Gastroenterology and Hepatology, Liver Research Group, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Birgitte Gade Jacobsen
- Department of Gastroenterology and Hepatology, Liver Research Group, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Hendrik Vilstrup
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus. Denmark
| | - Mette Munk Lauridsen
- Department of Gastroenterology and Hepatology, Liver Research Group, University Hospital of Southern Denmark, Esbjerg, Denmark
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Østberg N, Jacobsen BG, Lauridsen MM, Ladegaard Grønkjær L. Mental Health, Quality of Life, and Stigmatization in Danish Patients with Liver Disease. Int J Environ Res Public Health 2023; 20:ijerph20085497. [PMID: 37107779 PMCID: PMC10139198 DOI: 10.3390/ijerph20085497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 05/11/2023]
Abstract
The mental health of patients with liver diseases is often overlooked when assessing their overall health and planning care and treatment. The aim of this study was to assess anxiety, depression, hopelessness, quality of life, and the perception of stigmatization in a large cohort of patients with chronic liver disease of different aetiology and severity, as well as to identify predictors associated with mental health disorders. A total of 340 patients completed a survey assessing mental health using the Beck Anxiety Inventory, the Beck Hopelessness Scale, and the Major Depression Inventory. Quality of life was measured with the Chronic Liver Disease Questionnaire and the European Quality-of-Life visual analogue scale. To assess stigmatization, validated questions from the Danish Nationwide Survey of Patient Experiences were used. Predictors associated with anxiety, hopelessness, and depression were analysed using univariable and multivariable logistic regression analyses. Overall, 15% of the patients had moderate or severe anxiety, 3% had moderate or pronounced hopelessness, and 8% had moderate or severe depression. The prevalence of all three was highest in patients with cirrhosis and was associated with a low quality of life. More patients with cirrhosis had perceived stigmatization compared to patients with liver disease without cirrhosis, which affected their self-perception, and more than one-third of the patients refrained from telling others about their liver disease. The results emphasize the need for increased focus on mental health problems and awareness on preventing the discrimination of patients with liver disease.
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Hansen SG, Wernberg CW, Grønkjær LL, Jacobsen BG, Caterino TD, Krag A, Juhl CB, Lauridsen MM, Shanbhogue VV. Are Nonalcoholic Fatty Liver Disease and Bone Mineral Density Associated? - A Cross-Sectional Study Using Liver Biopsy and Dual-Energy X-Ray Absorptiometry. JBMR Plus 2023; 7:e10714. [PMID: 36936359 PMCID: PMC10020916 DOI: 10.1002/jbm4.10714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/03/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
There is controversy regarding the association between nonalcoholic fatty liver disease (NAFLD) and osteoporosis. Our study aim was to assess bone mineral density (BMD) in patients with biopsy-proven NAFLD and examine if the severity of NAFLD affects BMD. A total of 147 adult women (n = 108) and men (n = 39) aged 18-76 years (mean ± standard deviation [SD] age 45.3 ± 12.5) were recruited in this cross-sectional study and underwent a liver biopsy and dual-energy X-ray absorptiometry (DXA). NAFLD activity score (NAS) based on the degree of steatosis, lobular inflammation and hepatocellular ballooning was used to assess NAFLD severity. The majority of subjects, 53%, had steatosis, 25% had nonalcoholic steatohepatitis (NASH) whereas 23% served as control subjects with no evidence of NAFLD. There were no significant differences in the lumbar spine (1.09 ± 0.12, 1.11 ± 0.18, and 1.12 ± 0.15 g/cm2, p = 0.69, in controls, steatosis, and NASH, respectively) or hip BMD (1.10 ± 0.15, 1.12 ± 0.13, and 1.09 ± 0.13 g/cm2, p = 0.48, in controls, steatosis, and NASH, respectively) between the groups. Adjusting for age, gender, body mass index, and diabetes in multiple regression models did not alter the results. There was no correlation between NAS and neither lumbar spine BMD (r = 0.06, p = 0.471), nor hip BMD (r = -0.03, p = 0.716). In conclusion, BMD was similar across the spectrum of NAFLD in both genders and not related to the severity of the underlying histological lesions, suggesting that neither steatosis nor NASH exerts a detrimental effect on BMD in these relatively young patients. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
| | - Charlotte Wilhelmina Wernberg
- Department of Gastroenterology and Hepatology, Sydvestjysk SygehusSyddansk UniversitetshospitalEsbjergDenmark
- Open Patient data Explorative Network (OPEN)Odense University HospitalOdenseDenmark
| | - Lea Ladegaard Grønkjær
- Department of Gastroenterology and Hepatology, Sydvestjysk SygehusSyddansk UniversitetshospitalEsbjergDenmark
| | - Birgitte Gade Jacobsen
- Department of Gastroenterology and Hepatology, Sydvestjysk SygehusSyddansk UniversitetshospitalEsbjergDenmark
| | | | - Aleksander Krag
- Center for Liver Research FLASH (Fibrosis Fatty Liver and Steatohepatitis Research Centre)Odense University HospitalOdenseDenmark
| | - Claus Bogh Juhl
- Department of Endocrinology, Sydvestjysk SygehusSyddansk UniversitetshospitalEsbjergDenmark
- Steno Diabetes CenterOdense University HospitalOdenseDenmark
| | - Mette Munk Lauridsen
- Department of Gastroenterology and Hepatology, Sydvestjysk SygehusSyddansk UniversitetshospitalEsbjergDenmark
- Open Patient data Explorative Network (OPEN)Odense University HospitalOdenseDenmark
| | - Vikram V. Shanbhogue
- Department of Endocrinology, Sydvestjysk SygehusSyddansk UniversitetshospitalEsbjergDenmark
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Indira Chandran V, Wernberg CW, Lauridsen MM, Skytthe MK, Bendixen SM, Larsen FT, Hansen CD, Grønkjær LL, Siersbæk MS, Caterino TD, Detlefsen S, Møller HJ, Grøntved L, Ravnskjaer K, Moestrup SK, Thiele MS, Krag A, Graversen JH. Circulating TREM2 as a noninvasive diagnostic biomarker for NASH in patients with elevated liver stiffness. Hepatology 2023; 77:558-572. [PMID: 35712786 PMCID: PMC9869959 DOI: 10.1002/hep.32620] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/24/2022] [Accepted: 06/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS Reliable noninvasive biomarkers are an unmet clinical need for the diagnosis of NASH. This study investigates the diagnostic accuracy of the circulating triggering receptor expressed on myeloid cells 2 (plasma TREM2) as a biomarker for NASH in patients with NAFLD and elevated liver stiffness. APPROACH AND RESULTS We collected cross-sectional, clinical data including liver biopsies from a derivation ( n = 48) and a validation cohort ( n = 170) of patients with elevated liver stiffness measurement (LSM ≥ 8.0 kPa). Patients with NAFLD activity scores (NAS) ≥4 were defined as having NASH. Plasma TREM2 levels were significantly elevated in patients with NASH of the derivation cohort, with an area under the receiver operating characteristics curve (AUROC) of 0.92 (95% confidence interval [CI], 0.84-0.99). In the validation cohort, plasma TREM2 level increased approximately two-fold in patients with NASH, and a strong diagnostic accuracy was confirmed (AUROC, 0.83; 95% CI, 0.77-0.89; p < 0.0001). Plasma TREM2 levels were associated with the individual histologic features of NAS: steatosis, lobular inflammation, and ballooning ( p < 0.0001), but only weakly with fibrosis stages. Dual cutoffs for rule-in and rule-out were explored: a plasma TREM2 level of ≤38 ng/ml was found to be an optimal NASH rule-out cutoff (sensitivity 90%; specificity 52%), whereas a plasma TREM2 level of ≥65 ng/ml was an optimal NASH rule-in cutoff (specificity 89%; sensitivity 54%). CONCLUSIONS Plasma TREM2 is a plausible individual biomarker that can rule-in or rule-out the presence of NASH with high accuracy and thus has the potential to reduce the need for liver biopsies and to identify patients who are eligible for clinical trials in NASH.
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Affiliation(s)
| | - Charlotte Wilhelmina Wernberg
- Liver Research Group, Department of Gastroenterology and Hepatology, University Hospital of South Denmark, Esbjerg, Denmark,Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Mette Munk Lauridsen
- Liver Research Group, Department of Gastroenterology and Hepatology, University Hospital of South Denmark, Esbjerg, Denmark
| | | | | | - Frederik Tibert Larsen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Camilla Dalby Hansen
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Lea Ladegaard Grønkjær
- Liver Research Group, Department of Gastroenterology and Hepatology, University Hospital of South Denmark, Esbjerg, Denmark
| | - Majken Storm Siersbæk
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Tina Di Caterino
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Holger Jon Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Grøntved
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Kim Ravnskjaer
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Søren Kragh Moestrup
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Maja Sofie Thiele
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Aleksander Krag
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
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Hansen MKG, Kjærgaard K, Eriksen LL, Grønkjær LL, Mikkelsen ACD, Sandahl TD, Vilstrup H, Thomsen KL, Lauridsen MME. Psychometric methods for diagnosing and monitoring minimal hepatic encephalopathy -current validation level and practical use. Metab Brain Dis 2022; 37:589-605. [PMID: 35102491 DOI: 10.1007/s11011-022-00913-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/14/2022] [Indexed: 02/07/2023]
Abstract
Hepatic encephalopathy (HE) is cerebral dysfunction caused by liver failure and inflicts 30-40% of patients with liver cirrhosis during their disease course. Clinically manifest HE is often preceded by minimal HE (MHE) - a clinically undetectable cognitive disturbance closely associated with loss of quality of life. Accordingly, detecting and treating MHE improve the patients' daily functioning and prevent HE-related hospital admissions. The scope of this review article is to create an overview of the validation level and usage of psychometric tests used to detect MHE: Portosystemic hepatic encephalopathy test, continuous reaction time test, Stroop EncephalApp, animal naming test, critical flicker frequency test, and inhibitory control test. Our work is aimed at the clinician or scientist who is about to decide on which psychometric test would fit best in their clinic, cohort, or study. First, we outline psychometric test validation obstacles and requirements. Then, we systematically approach the literature on each test and select well-conducted studies to answer the following questions:• Which percentage of patients with cirrhosis does the test deem as having MHE?• Is the test able to predict clinically manifest HE?• Is there a well-known test-retest variation and inter-observer variation?• Is the test able to detect a treatment response?• Is the test result affected by age, educational level, gender, or comorbidities?
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Affiliation(s)
- Mads Kingo Guldberg Hansen
- Department of Gastroenterology and Hepatology, University Hospital South Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Kristoffer Kjærgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Lotte Lindgreen Eriksen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Lea Ladegaard Grønkjær
- Department of Gastroenterology and Hepatology, University Hospital South Denmark, Finsensgade 35, 6700, Esbjerg, Denmark
| | - Anne Catrine Daugaard Mikkelsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Thomas Damgaard Sandahl
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Karen Louise Thomsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Mette Munk Enok Lauridsen
- Department of Gastroenterology and Hepatology, University Hospital South Denmark, Finsensgade 35, 6700, Esbjerg, Denmark
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Grønkjær LL, Lauridsen MM. Reply to: "Comment on "Quality of life and unmet needs in patients with chronic liver disease: A mixed-method systematic review"". JHEP Rep 2022; 4:100414. [PMID: 34984332 PMCID: PMC8693004 DOI: 10.1016/j.jhepr.2021.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Mette Munk Lauridsen
- Department of Gastroenterology, University Hospital of South Denmark Esbjerg, Denmark
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Grønkjær LL, Lauridsen MM. Quality of life and unmet needs in patients with chronic liver disease: A mixed-method systematic review. JHEP Rep 2021; 3:100370. [PMID: 34805816 PMCID: PMC8585663 DOI: 10.1016/j.jhepr.2021.100370] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/23/2021] [Accepted: 09/21/2021] [Indexed: 02/06/2023]
Abstract
Background & Aims In an attempt to uncover unmet patient needs, this review aims to synthesise quantitative and qualitative studies on patients’ quality of life and their experience of having liver disease. Methods Three databases (CINAHL, Embase, and PubMed) were searched from January 2000 to October 2020. The methodological quality and data extraction of both quantitative and qualitative studies were screened and appraised using Joanna Briggs Institute instruments for mixed-method systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A convergent, integrated approach to synthesis and integration was used. Studies including patients with autoimmune and cholestatic liver disease, chronic hepatitis B and C, non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, cirrhosis, and hepatocellular carcinoma were considered. Results The searches produced 5,601 articles, of which 95 (79 quantitative and 16 qualitative) were included in the review. These represented studies from 26 countries and a sample of 37,283 patients. The studies showed that patients´ quality of life was reduced. Unmet needs for information and support and perceived stigmatisation severely affected patients’ quality of life. Conclusions Our study suggests changes to improve quality of life. According to patients, this could be achieved by providing better education and information, being aware of patients’ need for support, and raising awareness of liver disease among the general population to reduce misconceptions and stigmatisation. Registration number PROSPERO CRD42020173501. Lay summary Regardless of aetiology, patients with liver diseases have impaired quality of life. This is associated with disease progression, the presence of symptoms, treatment response, and mental, physical, and social factors such as anxiety, confusion, comorbidities, and fatigue, as well as limitations in daily living, including loneliness, low income, stigmatisation, and treatment costs. Patients highlighted the need for information to understand and manage liver disease, and awareness and support from healthcare professionals to better cope with the disease. In addition, there is a need to raise awareness of liver diseases in the general population to reduce negative preconceptions and stigmatisation. Patients with liver disease regardless of aetiology and severity have impaired quality of life. Patients call for better education and information to understand and manage their liver disease, and for increased awareness and support from healthcare professionals. Owing to the limited knowledge of liver diseases among the general population, patients experience stigmatisation, resulting in loneliness and social isolation. Addressing unmet needs of patients with liver disease could improve their quality of life.
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Key Words
- CLDQ, Chronic Liver Disease Questionnaire
- EQ-5D, European Quality of Life
- FACT-Hep, Functional Assessment of Cancer Therapy Hepatobiliary Carcinoma
- HBQOL, Hepatitis B Quality of Life
- HCC, hepatocellular carcinoma
- JBI, Joanna Briggs Institute
- LC-PROM, Liver Cirrhosis Patient Reported Outcome Measure
- LDQOL, Liver Disease Quality of Life
- Liver disease
- MELD, model for end-stage liver disease
- Mixed method
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- PBC, Primary Biliary Cholangitis Questionnaire
- Patient experience
- Patient reported outcomes
- PedsQL, Pediatric Quality of Life Inventory
- Quality of life
- SF, Short Form
- SIP, Sickness Impact Profile
- Systematic review
- Unmet needs
- VAS, visual analogue scale
- WHOQOL-BREF, WHO Quality of Life
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
- Corresponding author. Address: Department of Gastroenterology, University Hospital of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark. Tel.: +45-26668184; Fax: +45-79182316.
| | - Mette Munk Lauridsen
- Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
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Abstract
OBJECTIVE The objective of this systematic review is to explore the impact of liver disease on patients' quality of life in an attempt to develop effective evidence-based recommendations and strategies useful for clinical practice and health care professionals. INTRODUCTION Liver diseases are common worldwide and a major cause of illness and death due to health problems and serious complications, which not only cause hospitalization and death, but also emotional distress, depression, and impaired quality of life. INCLUSION CRITERIA This review will consider qualitative and quantitative studies on patients with liver disease of different severity and type. The qualitative component of this review will consider all studies that describe patients' lived experience and perception of having liver disease. The quantitative component will include studies that explore the quality of life in patients with liver disease. METHODS CINAHL (EBSCO), Embase (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), Scopus (Elsevier), and Web of Science (Ovid) will be searched for articles published in Danish and English without any restriction in terms of year of publication. Articles describing both qualitative and quantitative studies will be screened for inclusion, critically appraised for methodological quality, and have data extracted using JBI instruments for mixed methods systematic reviews. A convergent integrated approach to synthesis and integration will be used. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020173501.
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Ladegaard Grønkjær L, Holmstrup P, Jepsen P, Vilstrup H. The impact of oral diseases in cirrhosis on complications and mortality. JGH Open 2021; 5:294-300. [PMID: 33553670 PMCID: PMC7857277 DOI: 10.1002/jgh3.12489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/31/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The aims of this study were to describe the prevalence of various oral diseases and to examine the association of the oral diseases with complications and mortality of cirrhosis. METHODS A total of 184 cirrhosis patients were enrolled and were followed up for 2 years. They underwent oral clinical and radiographic examination. At study entry, the associations between oral diseases with nutrition, inflammation, and cirrhosis complication status were examined. Then, the associations of oral diseases with all-cause and cirrhosis-related mortality were examined using Cox regression to adjust for confounding by age, gender, smoking, alcohol use, alcoholic cirrhosis, cirrhosis complications, comorbidity, Child-Pugh, and Model of End-Stage Liver Disease (MELD) score. RESULTS At entry, 26% of the patients had gross caries, 46% periapical lesions, 27% oral mucosal lesions, and 68% periodontitis. Having one or more oral diseases was associated with a higher prevalence of cirrhosis complications (46.7 vs 20.5%), higher C-reactive protein (28.5 mg/L vs 10.4 mg/L), and higher nutritional risk score (4 vs 3). Two-thirds of the patients died during follow-up. The patients with more than one oral disease had an increasingly higher all-cause mortality (two diseases: hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.02-1.98; three and four diseases: HR 1.75, 95% CI 1.05-3.24) and even higher cirrhosis-related mortality (two diseases: HR 1.60, 95% CI 1.01-2.40; three and four diseases: HR 2.04, 95% CI 1.05-8.83) compared to those with no oral disease. CONCLUSION In cirrhosis, having more than one oral disease was associated with more complications and with higher mortality.
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Department of Hepatology and GastroenterologyAarhus University HospitalAarhusDenmark
- Department of GastroenterologyHospital of South West JutlandAarhusDenmark
| | - Palle Holmstrup
- Section of Periodontology, Department of OdontologyFaculty of Health and Medical Sciences, University of CopenhagenCopenhagenDenmark
| | - Peter Jepsen
- Department of Hepatology and GastroenterologyAarhus University HospitalAarhusDenmark
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - Hendrik Vilstrup
- Department of Hepatology and GastroenterologyAarhus University HospitalAarhusDenmark
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Ladegaard Grønkjær L, Berg K, Søndergaard R, Møller M. Assessment of Written Patient Information Pertaining to Cirrhosis and Its Complications: A Pilot Study. J Patient Exp 2020; 7:499-506. [PMID: 33062870 PMCID: PMC7534118 DOI: 10.1177/2374373519858025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Written patient information may play an important role in the compliance of the cirrhosis disease, but little is known on the quality and patients' understanding of them. OBJECTIVES To assess the written patient information leaflet pertaining to cirrhosis and its complications. METHODS The Baker Able Leaflet Design (BALD) criteria and the Ensuring Quality Information for Patients (EQIP) questionnaire were applied to assess design, layout characteristics, and information quality. Readability was calculated using the Læsbarhedsindex (LIX) and the Simple Measure of Gobbledygook (SMOG). A cross-sectional study with a mixed methods design was carried out, using a questionnaire consisting of closed- and open-ended questions. RESULTS The BALD score was 24 and the EQIP score 70%. The LIX score was 46 and the SMOG score 15.8. Sixteen phrases from the leaflet were selected to explore patients' understanding. Four phrases were understood by 100% of the patients, 6 phrases by more than 50% of the patients, and 6 phrases were understood by less than 50% of the patients. The meaning condensation showed that knowledge and understanding of cirrhosis and its complications were not enhanced by the availability of the leaflet. CONCLUSION The leaflet had a good design, layout, and information quality but was difficult to read. Patients appeared to relate poorly to the leaflet and demonstrated limited health literacy. These results suggest that an assessment of written patient information ought to be made in an effort to improve readability. Further studies on intervention to improve patients' health literacy are recommended.
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Kirsten Berg
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Søndergaard
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
| | - Majbritt Møller
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
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Ladegaard Grønkjær L, Hoppe Sehstedt T, Norlyk A, Vilstrup H. Overt Hepatic Encephalopathy Experienced by Individuals With Cirrhosis: A Qualitative Interview Study. Gastroenterol Nurs 2019; 41:468-476. [PMID: 28759517 PMCID: PMC6259814 DOI: 10.1097/sga.0000000000000286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 12/08/2016] [Indexed: 12/24/2022] Open
Abstract
Hepatic encephalopathy (HE) markedly reduces an individual's quality of life as measured by established scoring systems. However, the experiences of having HE that can be assumed to cause the loss of quality of life have not yet been examined. This study aimed to explore how individuals with cirrhosis experienced overt HE by means of an in-depth interview with a tailored semistructured interview guide and qualitative analysis. Eight patients with cirrhosis who had clinically recovered from disorientation, somnolence, and stupor due to episodic HE Grade II or III were interviewed. The collected data were analyzed using systematic text condensation, as described by K. . The analysis process identified 4 themes, "multiple losses," "anxiety," "dependence on others," and "social isolation," which described the experiences of HE both during an episode and in recovery. We believe that these findings provide an important contribution to gain a deeper understanding of the widespread loss of quality of life caused by HE. Management of these individuals should involve procedures and attitudes targeted against the described experiences. However, more research is needed about the individuals' experiences of HE to further detail such efforts.
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Correspondence to: Lea Ladegaard Grønkjær, PhD, MNSc, Department of Hepatology and Gastroenterology, Aarhus University Hospital, 44 Nørrebrogade, 8000 Aarhus C, Denmark ()
| | - Thomas Hoppe Sehstedt
- Lea Ladegaard Grønkjær, PhD, MNSc, is a PhD at Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Thomas Hoppe Sehstedt, RN, is a nurse at Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Annelise Norlyk, PhD, MNSc, RN, is a teacher at Section for Nursing, Department of Public Health, VIA University College, Aarhus University, Health, Aarhus, Denmark
- Hendrik Vilstrup, DMSc, is Professor, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Annelise Norlyk
- Lea Ladegaard Grønkjær, PhD, MNSc, is a PhD at Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Thomas Hoppe Sehstedt, RN, is a nurse at Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Annelise Norlyk, PhD, MNSc, RN, is a teacher at Section for Nursing, Department of Public Health, VIA University College, Aarhus University, Health, Aarhus, Denmark
- Hendrik Vilstrup, DMSc, is Professor, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Vilstrup
- Lea Ladegaard Grønkjær, PhD, MNSc, is a PhD at Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Thomas Hoppe Sehstedt, RN, is a nurse at Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Annelise Norlyk, PhD, MNSc, RN, is a teacher at Section for Nursing, Department of Public Health, VIA University College, Aarhus University, Health, Aarhus, Denmark
- Hendrik Vilstrup, DMSc, is Professor, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Grønkjær LL, Holmstrup P, Schou S, Kongstad J, Jepsen P, Vilstrup H. Periodontitis in patients with cirrhosis: a cross-sectional study. BMC Oral Health 2018; 18:22. [PMID: 29439734 PMCID: PMC5811961 DOI: 10.1186/s12903-018-0487-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/09/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many patients with cirrhosis have poor oral health but little is known on periodontitis, and its clinical significance is largely unknown. This study aimed to examine the prevalence and predictors of periodontitis, and evaluate the association of periodontitis with nutritional and systemic inflammation status. METHODS 145 patients with cirrhosis were consecutively enrolled. Clinical, oral examination of plaque, pocket depth, clinical attachment level, and bleeding on probing was performed. Patients were categorized as having no-or-mild, moderate, or severe periodontitis. Predictors of severe periodontitis and the association with nutritional and systemic inflammation status were analyzed using univariable and multivariable logistic regression analyses. RESULTS The large majority of patients had periodontitis, 46% of them severely and 39% moderately. Predictors of severe periodontitis included smoking (odds ratio (OR) 2.93, 95% confidence interval (CI) 1.29-6.63), brushing teeth twice daily (OR 0.30, 95% CI 0.11-0.79), and visiting the dentist annually (OR 3.51, 95% CI 1.22-10.81). Cirrhosis etiology or severity was not predictors of severe periodontitis. The patients with severe periodontitis had a higher nutritional risk score than patients with moderate, mild, or no periodontitis (3, interquartile range (IQR) 3-5 vs. 3, IQR 2-4, P = 0.02). CONCLUSIONS Most cirrhosis patients had significant periodontitis, the severity of which was related to life style factors and was associated with higher nutrition risk score. Our results emphasize the need for further research to establish the effect of periodontitis on cirrhosis.
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Palle Holmstrup
- Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schou
- Section for Oral Surgery, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johanne Kongstad
- Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
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Ladegaard Grønkjær L, Holmstrup P, Schou S, Jepsen P, Vilstrup H. Severe periodontitis and higher cirrhosis mortality. United European Gastroenterol J 2017; 6:73-80. [PMID: 29435316 DOI: 10.1177/2050640617715846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/15/2017] [Indexed: 12/28/2022] Open
Abstract
Background Periodontitis and edentulism are prevalent in patients with cirrhosis, but their clinical significance is largely unknown. Objective The objective of this article is to determine the association of severe periodontitis and edentulism with mortality in patients with cirrhosis. Methods A total of 184 cirrhosis patients underwent an oral examination. All-cause and cirrhosis-related mortality was recorded. The associations of periodontitis and edentulism with mortality were explored by Kaplan-Meier survival plots and Cox proportional hazards regression adjusted for age, gender, cirrhosis etiology, Child-Pugh score, Model for End-Stage Liver Disease score, smoker status, present alcohol use, comorbidity, and nutritional risk score. Results The total follow-up time was 74,197 days (203.14 years). At entry, 44% of the patients had severe periodontitis and 18% were edentulous. Forty-four percent of the patients died during follow-up. Severe periodontitis was associated with higher all-cause mortality in the crude analysis (HR 1.56, 95% CI 1.06-2.54), but not in the adjusted analysis (HR 1.45, 95% CI 0.79-2.45). Severe periodontitis was even more strongly associated with higher cirrhosis-related mortality (crude HR 2.19, 95% CI 1.07-4.50 and adjusted HR 2.29, 95% CI 1.04-4.99). No association was found between edentulism and mortality. Conclusion The presence of severe periodontitis predicted a more than double one-year cirrhosis mortality. These findings may motivate intervention trials on the effect of periodontitis treatment in patients with cirrhosis.
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Palle Holmstrup
- Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schou
- Section for Oral and Maxillofacial Surgery, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Grønkjær LL, Andersen NG, Hansen LB, Sehstedt TH, Svensson NT, Sømod IE, Norlyk A, Bager P. Different views on hepatic encephalopathy: patients, relatives and nurses. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/gasn.2016.14.sup10.s24] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Lea Ladegaard Grønkjær
- Nurses, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Nanna Gasberg Andersen
- Nurses, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Lene Bolvig Hansen
- Nurses, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Thomas Hoppe Sehstedt
- Nurses, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | | | - Ida Elbek Sømod
- Nurses, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Annelise Norlyk
- Associate Professor, Aarhus University and VIA University College, Denmark
| | - Palle Bager
- Clinical Nurse Specialist, Aarhus University Hospital, Denmark
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Abstract
Background Periapical radiolucency is the radiographic sign of inflammatory bone lesions around the apex of the tooth. We determined the prevalence and predictors of periapical radiolucency in patients with cirrhosis and the association with systemic inflammation status and cirrhosis-related complications. Methods A total of 110 cirrhosis patients were consecutively enrolled. Periapical radiolucency was defined as the presence of radiolucency or widening of the periapical periodontal ligament space to more than twice the normal width. Predictors of periapical radiolucency and the association with systemic inflammation markers and cirrhosis-related complications were explored by univariable and multivariable logistic regression analyses. Results Periapical radiolucency was present in one or more teeth in 46% of the patients. Strong predictors were gross caries (odds ratio [OR] 3.12, 95% confidence interval [CI] 1.43–6.79) and severe periodontitis (OR 3.98, 95% CI 1.04–15.20). Also old age (OR 1.10, 95% CI 1.01–1.19) and smoking (OR 3.24, 95% CI 1.02–17.62) were predictors. However, cirrhosis etiology (alcoholic vs nonalcoholic) or severity (Model of End-Stage Liver Disease score) were not predictors. The patients with periapical radiolucency had higher C-reactive protein (15.8 mg/L vs 8.1 mg/L, P=0.02) and lower albumin contents (25 g/L vs 28 g/L, P=0.04) than those without. Furthermore, the patients with periapical radiolucency had a higher prevalence of cirrhosis-related complications such as ascites, hepatic encephalopathy, and/or variceal bleeding (46% vs 27%, P=0.05). Conclusion Periapical radiolucency is often present as an element of poor oral health status and likely has an adverse clinical significance, which should motivate diagnostic and clinical attention to the findings.
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Affiliation(s)
| | - Palle Holmstrup
- Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences
| | - Søren Schou
- Section for Oral and Maxillofacial Surgery, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | | | - Johanne Kongstad
- Section of Periodontology, Microbiology, and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus
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Abstract
OBJECTIVES Studies suggest that periodontal disease, a source of subclinical and persistent infection, may be associated with various systemic conditions, including liver cirrhosis. The aim of this study was to examine the literature and determine the relationship between periodontal disease and liver cirrhosis and to identify opportunities and directions for future research in this area. METHODS A systematic review of English articles in the PubMed, EMBASE, and Scopus databases was conducted using search terms including 'liver cirrhosis', 'end-stage liver disease', 'liver diseases', 'oral health', 'periodontal disease', 'mouth disease', 'gingivitis', and 'periodontitis'. RESULTS Thirteen studies published between 1981 and 2014 were found to include data on oral health and periodontal disease in cirrhotic patients. Studies indicated an increased incidence of periodontal disease in patients with liver cirrhosis, measured with several different periodontal indices. The reported prevalence of periodontal disease in cirrhosis patients ranged from 25.0% to 68.75% in four studies and apical periodontitis was found in 49%-79% of the patients. One study found that mortality was lower among patients who underwent dental treatment versus non-treated patients. Another study suggested an association between periodontal disease and the progression of liver cirrhosis, but data are sparse and conflicting as to whether periodontal disease is correlated to cirrhosis aetiology and severity. CONCLUSION Despite the clinical reality of periodontal disease in liver cirrhosis patients, there are few published studies. Before clinical implications can be addressed, more data on the prevalence of and correlation between periodontal disease and liver cirrhosis aetiology, duration, and progression are needed.
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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