Sunday Poster Sessions, October 29, 2006
Behavioral, Quality of Life, and Practice Issues
D. M. Zucker.
Purpose:
The purpose of this study was to test a relationship-centered
model of hepatitis C educational communication with incarcerated former
injection drug users, using a peer education approach, based on mutual support,
trust and equality.
Aims:
The aims of this study were to:
1. Convey education about prevention,
protection and safety related to HCV,
2. Provide this information through
relations-centered communication,
3. Test the reliability and validity of
the behavior, knowledge and relationship instruments,
and
4. Evaluate the effectiveness of this
intervention by measuring changes in behavior,
knowledge and relationship in the learner.
The long term goal of this work is to prevent the spread of
HCV in the community focusing on those most at risk of spreading and
contracting the disease.
Methods:
This study is a prospective pretest
post-test descriptive pilot. A convenience sample of 30 male incarcerates
participated. A hepatitis C prevention and harm reduction manual was co-created
by inmates and health care providers for the peer education curriculum.
Evaluation:
To measure aim 1, the PI and addictions specialist used
teaching scripts focused on prevention, protection and safety based on CDC
guidelines and teaching materials. To measure aim 2, the Each One Teach One
theory and method was used. The teacher measures three component parts;
teaching, observation and feedback. Mutual support, trust and equality are
measured as positive responses to relationship questions. To measure aim 3,
alpha reliabilities are calculated using the Statistical Package for the Social
Sciences (SPSS v 13) for each item and the entire instrument. To measure aim 4
all data will be analyzed using SPSS. Correlations between pre and post-test
scores are calculated. To measure behavior and
relationship learners’ scores will reflect at least a mean of 6 on those
questions reflecting positive behaviors and
relationships. To measure knowledge it is expected the learner will score 100%
on knowledge questions.
Results:
Knowledge questions:
Pretest cumulative correct 71.4%
Post test cumulative correct 88.9%
Discussion:
This pilot project has significance because:
1) It utilized an innovative,
relationship-based form of communication based on Each One Teach One theory.
2) This method is consistent with
successes seen in similar peer-led initiatives.
3) Teaching is tailored to the at-risk
group and the messages are taught by peers in the learner’s everyday language.
4) Behavior, knowledge and relationship
questions evaluate the 3 main problems associated with the target population:
spreading the disease, maintaining good health and preventing liver damage.
Conclusions:
This study has significance because
it utilized an innovative, relationship-centered form of communication based on
EOTO and relations common theories. Behavior, knowledge and relationship instruments evaluated
HCV prevention, protection and safety, and were found to be moderate to very
strong. Preliminary data is trending
towards an increase in healthy behaviour and relationship after engaging in a 6
week HCV prevention and harm reduction curriculum. The curriculum should be part of an overall
assessment of wellness in incarcerates ready for release.
V. Medici; J. Nakai; K. Fisher; L. Rossaro; F. J. Meyers.
Background
The primary goal of hospice care is the palliation of
physical and emotional suffering of terminally ill patients. Liver transplant
(LT) candidacy and enrollment in hospice care have
always been perceived as mutually exclusive. We have previously reported a case
of combined provision of pre-operative palliative care through hospice for
patients awaiting LT (Rossaro, et al. Transpl Int (17: 473-75; 2004).
We hypothesize that patients with end stage liver disease (ESLD) could make
improve use of hospice to deliver palliative care.
Aims/Methods:
This is a four-year retrospective analysis on patients with
ESLD admitted to hospice at UC Davis Health System. We recorded the MELD score
at hospice referral, at listing for LT, and at the time of LT, using a minimum
score of 17 for hospice referral. Our goal was to provide at least one month of
hospice (LOS) in order to optimize end of life care.
Patient Features:
·
Liver
related diagnosis at hospice admission:
o
HCV
– 33%
o
HBV
– 10%
o
HCC—52%
·
Liver
related complications while enrolled in the hospice program
o
Tense
ascites, dyspnea – 75%
o
GI
bleeding – 10%
o
Hepatic
encephalophy—66%
Results:
169 ESLD patients were admitted to the hospice service. 29% (49
cases) were also evaluated for LT. The mean age was 58.1 years (87-31). In 24%
cases, the chronic liver disease was complicated by hepatocellular carcinoma.
The mean hospice LOS was 37±51.9 days.
At the time of hospice admission the mean MELD score of the
whole group was 21±8.3.
Five patients were offered a liver graft while on the
combined program; they revoked hospice and received LT. MELD, waiting time, and
LOS in hospice are shown in Table 1. The mean time elapsed between the hospice
admission and LT was 96.7 days (60-153). Four patients survived with a follow
up of 7-45 months. One patient died after LT because of progressive heart and
kidney failure. A significant correlation was observed between hospice LOS and
MELD score at hospice admission (r= - 0.286, p= 0.004).
Conclusions:
1. Timely referral to hospice/palliative
care is improved using the MELD score as a guide to prognosis: referring
patients with a lower MELD score to the hospice can optimize quality of care
2. We suggest hospice care as an
effective strategy to improve the care of ESLD in patients waiting for LT.
|
Patient |
Listed MELD |
Hospice Admission
MELD |
LT MELD |
Waiting Time
(months) |
Hospice LOS (months) |
|
1 |
6 |
17 |
19 |
9.9 |
3.5 |
|
2 |
39 |
35 |
42 |
0.4 |
2.1 |
|
3 |
21 |
22 |
17 |
6.3 |
5.2 |
|
4 |
15 |
23 |
22 |
15.5 |
3.8 |
|
5 |
15 |
18 |
18 |
13.9 |
2.0 |
|
Mean |
19.2 |
23 |
23.6 |
9.2 |
3.1 |
|
SD |
12.3 |
7.2 |
10.4 |
6.1 |
1.6 |
L. Graf; J. S. Bajaj; M. Perez; M. Adams; C. Mueller; R. Anderson; J. Franco.
Background
Nurses are an integral part of the multi-disciplinary care of
liver transplant(LT) candidates and recipients. Therefore the study of their
attitudes regarding the appropriate selection for LT candidates is essential.
Aim:
To determine nursing attitudes regarding candidacy for LT.
Methods: In a medium-sized, midwestern transplant
center, a anonymous survey inquiring about nursing attitudes towards candidacy
for LT with respect to alcohol use, intravenous drug use, social support,
compliance, psychiatric disorders, incarceration, illiteracy, HIV status and
obesity was sent to 170 nurses (ICU and floor nurses caring for(CLT) or not
caring for(NCLT) LT recipients).
Results:
Overall 145 of 170 (83%) nurses replied; 102 ICU (65 CLT and
37 NCLT) and 43 floor(24 CLT and 19 NCLT) nurses. There were no significant
differences in the duration of nursing experience between groups. A striking
minority of nurses in all 4 groups agreed with the current recommendation of 6
month abstinence from alcohol and IV drugs and compliance for 6 months (Table).
The majority believed that longer periods of abstinence and compliance are
needed for LT candidacy. Among ICU nurses(both CLT and NCLT), the majority
believed that obese (95 vs 90%),HIV+(63 vs.54%),
patients with depression(77 vs 81%), schizophrenic(57
vs 54%), illiterate(75 vs
76%) and tylenol overdose(62 vs
60%) patients should be LT candidates. Similarly among floor nurses (both CLT
and NCLT),the majority believed that obese (92 vs
84%),HIV+(65 vs.64%), patients with depression(92 vs
84%), schizophrenic(57 vs 54%), illiterate (88 vs 84%) and tylenol overdose(62 vs 60%) patients should be LT candidates. The majority of
nurses indicated that incarcerated patients and those without social support
should not be LT candidates.
Conclusion:
·
Nursing
opinions with respect to LT candidacy conflict with the current practice of
most US transplant centers.
·
The
majority of nurses feel that 12 or more months of sobriety and compliance
should be required of liver transplant candidates.
·
The
majority of nurses in all 4 groups favored liver transplantation
for obese patients with fatty liver disease, depression, schizophrenia, HIV +
status, illiteracy and acetaminophen overdose, but not incarceration.
·
Additional
nursing research and education with regard to current transplant
recommendations may be required to bridge the large gap that currently exists.
Percentage
of nurses agreeing with LT candidacy recommendations
|
Percent |
Alcohol abuse |
IV Drug use |
Compliance |
||||||
|
|
Abstinent≥6mths
|
Never |
Others |
Abstinent ≥6mths
|
Never |
Others |
≥6mths |
1 mth |
Others |
|
ICU CLT |
9 |
1 |
90 |
6 |
6 |
88 |
24 |
0 |
76 |
|
ICU NCLT |
5 |
0.2 |
94.8 |
3 |
3 |
94 |
27 |
0 |
73 |
|
Floor CLT |
8 |
4 |
88 |
4 |
25 |
73 |
13 |
0 |
77 |
|
Floor NCLT |
5 |
1 |
94 |
0 |
5 |
95 |
21 |
0 |
79 |
NCLT:not taking care of LT, CLT:taking
care of LT
504. Can HIV/HCV Coinfection be Effectively Treated in a Community Based Clinic by Midlevel Providers?
L. Shahatto; R. Pozza; A. Hefner; K. Biando; M. El-Kabany; T. Hassanein.
04. Can HIV/HCV Coinfection be Effectively Treated in a Community Based Clinic by Midlevel Providers?
L. Shahatto; R. Pozza; A. Hefner; K. Biando; M. El-Kabany; T. Hassanein.
Introduction/Aim:
Hepatitis C (HCV) infection is reported in approximately 30%
of HIV infected patients. HCV disease progression is more rapid in the setting
of HIV. Since the use of antiretroviral therapy, the leading cause of morbidity
and mortality is chronic liver disease. The combination of Pegylated Interferon
and Ribavirin is currently the standard treatment for coinfected patients. In
pivotal clinical trials, the sustained virologic response (SVR) is in the range
of 27% to 40%. We report a single center experience in treating HCV/HIV
coinfected patients by midlevel providers (NP) with the support of attending
physicians, according to the standard community practices.
Methods:
119 consecutive patients with HCV/HIV coinfection were
referred to the clinic for treatment of Hepatitis C. The mean age was 47.9 ±
7.6 years. 100 patients were male; 65.5% were Caucasian, 16.8%
African-American, 13.5% Hispanic, and 4.2% others. 82% had HIV titer <50. 83% were HCV Genotype 1, 15% G2/3, and 4%
others.
Results:
50 patients successfully finished treatment and followup. SVR was achieved in 30% patients, nonresponse in 28 58% and relapse occurred in 6%. 19
patients are still in therapy. 50 patients were not treated due to: advanced
HIV disease (4%), decompensated cirrhosis (2%), nonadherence
to clinic visits (14%), normal liver biopsy (20%), and 23% patients deferred
therapy.
Summary:
a) the majority of patients referred by
their HIV caregivers were appropriate for HCV therapy;
b) treatment of HIV/HCV coinfected
patients in the community clinics achieve similar SVR rates as reported in
pivotal trials;
c) coinfected patients still
underestimate the importance of treating HCV infection; d) with the support of
physicians, midlevel providers can treat coinfection in the community.
Conclusion:
a) community clinics managed by midlevel
providers and supported by physicians can successfully treat patients with
HIV/HCV coinfection;
b) educational efforts about the hazards
of living with HCV are needed for the HIV/AIDS community.
|
102 |
||||||||
|
57 |
45 |
|||||||
|
47 |
10 |
2 Advanced HIV |
1 Advanced Cirrhosis
|
9 |
10 Normal Liver Bx |
23 Deferred
Treatment |
||
|
14 |
28 |
5 |
|
|
|
|
|
|
505. An excess of corrupted humours:
healing the liver in 16th -century Europe..
P. Rizzi.
Introduction
The treatment of the liver in Early Modern Europe (1500-1800)
has never been studied. Physicians practised Galenic
medicine where health was the balance of 4 humours: blood, phlegm, yellow and
black bile. Health was restored by favouring discharge or re-absorption of
excessive or corrupted humours. In Galen’s physiology1, the 3 vital organs were
brain, heart and liver: this was in charge of nutrition and produced 2 humours,
blood and yellow bile. In 1544 Matthioli published in
Venice an edition of Discorides’ Materia
Medica (c.65 AD), a compendium of plants, minerals and
animals with healing properties. Translated into Latin, English, French and
German, it became the most authoritative pharmacopoeia in Early Modern Europe.
My aim was to study the liver treatment in this text.
Methods
I analyzed the liver remedies listed in an anastatic copy of the 1557 edition of Materia
Medica2 , keeping the original nomenclature without attemptation
to modern medical terms. Results Six liver conditions were identified and 97
remedies available, with multiple action. 17 cured inflammation, 52 jaundice,
41 hydropsy, 8 coldness, 3 pain, 1 hardness; 14
healed inflammation and jaundice, 6 jaundice and hydropsia.
4/52 remedies for jaundice and 3/41 for hydropsia
treated itch. Remedies were obtained from plants (58), roots (26), fungi (2),
minerals (5) and animals (4), own urine and seawater. Pine cortex healed
inflammation. Salt, river sand, own urine, seawater, hedgehog and snails cured hydropsia. Aloe, sulphur, millipede and deer’s horn treated
jaundice. Rhubarb treated inflammation and jaundice, oregano jaundice and hydropsia. 40 remedies cleared the liver from bad humours
by virtue of diuretic properties, 20 were constrictive, 13 drying, 8
mollifying; 20 were purges and 9 provoked vomit. Most remedies had multiple
actions: 8 were diuretics and purges. None of the remedies were liver specific:
they were also used for kidneys (17), stomach (16) and spleen (25). 90 remedies
could be found in Europe; 4 plants only grew in India and 1 in Arabia, Armenia
and Libya respectively. Conclusions Although disease was humour, not organ
related, 16th-century European physicians recognized six liver conditions. A
wide range of plants, animals and minerals was available to clear the liver
from bad humours, mainly by provoking diuresis. No
remedy was liver specific. This is the first study looking at liver treatment
in Early Modern Europe.
1Galen On the usefulness of the parts of the body c.165 AD Cornell University Press Ithaca New York 1968
2I Discorsi di A Matthioli ne i sei libri de la materia medicinale di Discoride Venice 1557 Anastatic copy Forni Editore 1984
506. Prospective Audit of Liver Biopsy
Practice: Is Bigger Better?.
K.
Li; G. Mortimore; M. Jackson; D. Semeraro;
D. Clarke; J. Freeman; A. S. Austin.
Background:
Percutaneous liver biopsy remains an important tool in the diagnosis and staging of chronic liver disease. For reliable and reproducible interpretation, a specimen containing a minimum of six portal