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Fagan A, Gallagher ML, Mousel T, Davis BC, Fuchs M, Puri P, Anstey J, Tiede D, Simonetto DA, Kraus A, Bajaj JS. Artificial Intelligence Evaluation of Stool Quality Guides Management of Hepatic Encephalopathy Using a Smartphone App. Am J Gastroenterol 2024; 119:977-981. [PMID: 38153339 DOI: 10.14309/ajg.0000000000002646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Lactulose-based hepatic encephalopathy treatment requires bowel movements/day titration, which is improved with Bristol stool scale (BSS) incorporation. Dieta app evaluates artificial intelligence (AI)-based BSS (AI-BSS) with stool images. Initially, controls (N = 13) and cirrhosis patients on lactulose/not on lactulose (n = 33) were trained on the app. They entered self-reported BSS (self-BSS) with AI-BSS communicated. Lactulose dose changes were tracked. A subset (n = 12) was retested with AI communication blocked. Most subjects were comfortable with the app. Self/AI-BSS and lactulose dose/AI-BSS correlation increased with app use. AI-BSS communications improved insight into self-BSS over time. Dieta app to gauge stool AI characteristics was acceptable and increased insight into lactulose dose and BSS in cirrhosis.
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Affiliation(s)
- Andrew Fagan
- Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
| | - Mary Leslie Gallagher
- Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
| | - Travis Mousel
- Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
| | - Brian C Davis
- Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
| | - Michael Fuchs
- Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
| | - Puneet Puri
- Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
| | | | - David Tiede
- Dieta Incorporated, Oak Park, California, USA
| | | | - Asaf Kraus
- Dieta Incorporated, Oak Park, California, USA
| | - Jasmohan S Bajaj
- Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
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Shaw J, Acharya C, Albhaisi S, Fagan A, McGeorge S, White MB, Lachar J, Olson J, Olofson A, Bergstrom L, Kamath PS, Bajaj JS. Subjective and objective burden on providers from a multicenter app-based study of patients with cirrhosis and caregivers. Hepatol Commun 2023; 7:e0030. [PMID: 36706194 PMCID: PMC9988316 DOI: 10.1097/hc9.0000000000000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/30/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND App-based technologies could enhance patient and caregiver communication and provide alerts that potentially reducing readmissions. However, the burden of App alerts needs to be optimized to reduce provider burnout. AIM The purpose of this study was to determine subjective and objective burden of using the Patient Buddy App, a health information technology (HIT) on providers in a randomized multicenter trial, who completed a semi-quantitative Likert scale survey regarding training procedures, data and privacy concerns, follow-up details, and technical support. This randomized multicenter trial recruits cirrhosis inpatients and their caregivers, and randomizes them into standard-of-care, HIT (communication only via App) and HIT+visits (App+phone calls/visits) for 30 days after discharge. The alerts are monitored by providers through a central iPad. The reason(s) and number of alerts were recorded as the objective burden. A total of 1442 messages were sent as alerts from the 103 dyads (patient + caregiver) (n=206) randomized to HIT arms. The most common messages related to Hepatic Encephalopathy (HE) (high or low bowel movement=50% or orientation tests=37%). Twelve providers completed the surveys reflecting the following themes-92% and 100%, felt adequately trained and confident about educating the patients and caregivers before roll out of App and had no concerns related to data and privacy; 70%, felt that appropriate time was spent on pursuing reason for data not being logged; 60% each, had issues with availability of adequate technical support and connectivity. CONCLUSION The Patient Buddy App randomized multicenter trial till date shows an overall favorable rating regarding training procedures/education, privacy concerns, and ease of message follow-up, from providers. However, it is important to gauge and address subjective and objective burdens of monitoring human resources in current and future HIT studies to avoid burnout and to ensure successful study completion.
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Affiliation(s)
- Jawaid Shaw
- Division of Hospital Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Chathur Acharya
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Somaya Albhaisi
- Division of Hospital Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Andrew Fagan
- GI Section, Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | - Sara McGeorge
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Melanie B. White
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Jatinder Lachar
- Division of Hospital Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Jessica Olson
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Amy Olofson
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Lori Bergstrom
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Patrick S. Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jasmohan S. Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
- GI Section, Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
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Wu Q, Pei H, Ran X, Chen X, Jiang L, Wei A, Xiang X, Wang Y, Gan X. Qualitative Study on the Information Needs of Patients Undergoing Da Vinci Robotic Surgery. Clin Nurs Res 2023; 32:433-440. [PMID: 35699515 DOI: 10.1177/10547738221103337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
To explore the information needs and experiences of patients who underwent Da Vinci robotic surgery and to establish a reference for providing information support to these patients. Semi-structured interviews were conducted with 11 patients who underwent robotic surgery. Thematic analysis was subsequently executed on the data obtained from the interviews to identify the themes. Thematic analysis generated two main themes with six supporting sub-themes. The main themes were (1) surgical information acquisition experience and (2) the need for personalization to obtain satisfactory information. Patients who received Da Vinci robotic surgery had insufficient understanding of the surgical methods and possessed high demand for surgical-related information. Although patients' understanding of robotic surgery might be improved through multi-channel information support, due to the differences in patient access to information, personalized experiences would occur during this process. Professional information support could effectively enhance their positive psychological experiences with surgery.
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Affiliation(s)
- Qiuping Wu
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Haoyu Pei
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiaoli Ran
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xian Chen
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Limei Jiang
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Aihua Wei
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xing Xiang
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yaling Wang
- Department of Nursing, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiaoqin Gan
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
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Shaw J, Beyers L, Bajaj JS. Inadequate practices for hepatic encephalopathy management in the inpatient setting. J Hosp Med 2022; 17 Suppl 1:S8-S16. [PMID: 35972037 PMCID: PMC9542542 DOI: 10.1002/jhm.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022]
Abstract
Hepatic encephalopathy (HE) is an important complication of decompensated liver disease. Hospital admission for episodes of HE are very common, with these patients being managed by the hospitalists. These admissions are costly and burdensome to the health-care system. Diagnosis of HE at times is not straightforward, particularly in patients who are altered and unable to provide any history. Precipitants leading to episodes of HE, should be actively sought and effectively tackled along with the overall management. This mandates timely diagnostics, appropriate initiation of pharmacological treatment, and supportive care. Infections are the most important precipitants leading to HE and should be aggressively managed. Lactulose is the front-line medication for primary treatment of HE episodes and for prevention of subsequent recurrence. However, careful titration in the hospital setting along with the appropriate route of administration should be established and supervised by the hospitalist. Rifaximin has established its role as an add-on medication, in those cases where lactulose alone is not working. Overall effective management of HE calls for attention to guideline-directed nutritional requirements, functional assessment, medication reconciliation, patient education/counseling, and proper discharge planning. This will potentially help to reduce readmissions, which are all too common for HE patients. Early specialty consultation may be warranted in certain conditions. Numerous challenges exist to optimal care of hospitalized OHE patients. However, hospitalists if equipped with knowledge about a systematic approach to taking care of these frail patients are in an ideal position to ensure good inpatient and transition of care outcomes.
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Affiliation(s)
- Jawaid Shaw
- Department of Internal Medicine, Division of Hospital MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Lisa Beyers
- Department of Internal Medicine, Strong Memorial HospitalUniversity of RochesterRochesterNew YorkUSA
| | - Jasmohan S. Bajaj
- Division of Gastroenterology, Hepatology and NutritionVirginia Commonwealth University and Central Virginia Veterans Healthcare SystemRichmondVirginiaUSA
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Wu T, Simonetto DA, Halamka JD, Shah VH. The digital transformation of hepatology: The patient is logged in. Hepatology 2022; 75:724-739. [PMID: 35028960 PMCID: PMC9531185 DOI: 10.1002/hep.32329] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022]
Abstract
The rise in innovative digital health technologies has led a paradigm shift in health care toward personalized, patient-centric medicine that is reaching beyond traditional brick-and-mortar facilities into patients' homes and everyday lives. Digital solutions can monitor and detect early changes in physiological data, predict disease progression and health-related outcomes based on individual risk factors, and manage disease intervention with a range of accessible telemedicine and mobile health options. In this review, we discuss the unique transformation underway in the care of patients with liver disease, specifically examining the digital transformation of diagnostics, prediction and clinical decision-making, and management. Additionally, we discuss the general considerations needed to confirm validity and oversight of new technologies, usability and acceptability of digital solutions, and equity and inclusivity of vulnerable populations.
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Affiliation(s)
- Tiffany Wu
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas A. Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - John D. Halamka
- Mayo Clinic Platform, Mayo Clinic, Rochester, Minnesota, USA
| | - Vijay H. Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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