scholarly journals Non-alcoholic Steatohepatitis: From Pathophysiology to Clinical Practice

2021 ◽  
Vol 17 (2) ◽  
pp. 112
Author(s):  
Sherwyn Schwartz ◽  
Jean Lucas ◽  
Mark H DeLegge ◽  
◽  
◽  
...  
Keyword(s):  
Clinical Practice ◽  
Alcoholic Steatohepatitis

Gut Microbiota and Host Cyp450s Co-contribute to Pharmacokinetic Variability in Mice With Non-Alcoholic Steatohepatitis: Vary From Drug to Drug

2021 ◽  
Author(s):  
Jing Guo ◽  
Ying Xu ◽  
Li-Jie Chen ◽  
Song-xia Zhang ◽  
Tai Rao ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Gut Microbiota ◽  
Intravenous Administration ◽  
Underlying Mechanism ◽  
Control Group ◽  
Intragastric Administration ◽  
Minimal Effect ◽  
Pharmacokinetic Variability ◽  
Alcoholic Steatohepatitis ◽  
Nash Group

Abstract Background: Pharmacokinetic variability in disease state is common in clinical practice, but the underlying mechanism remains unclear. We aim to investigate the effects of gut microbiota and host Cyp450s on pharmacokinetic variability in mice with non-alcoholic steatohepatitis (NASH).Methods: The pharmacokinetic variability of mice with NASH was explored under intragastric and intravenous administration of a cocktail mixture of omeprazole, phenacetin, midazolam, tolbutamide, chlorzoxazone, and metoprolol compared with the control group. The pharmacokinetic variability of the drugs and its relation with changes of gut microbiota and host Cyp450s were compared and analyzed.Results: The exposure of all drugs, except metoprolol, significantly increased in the NASH group under intragastric administration. However, no significant increase in the exposure of all drugs, except tolbutamide, was observed in the NASH group under intravenous administration. The pharmacokinetic variabilities of phenacetin, midazolam, omeprazole, and chlorzoxazone were mainly associated with decreased elimination activity of the gut microbiota. By contrast, the pharmacokinetic variability of tolbutamide was mainly related to the change in host Cyp2c65. However, gut microbiota and host Cyp450s exerted minimal effect on the pharmacokinetic variability of metoprolol.Conclusions: Gut microbiota and host Cyp450s co-contribute the pharmacokinetic variability in mice with NASH, and the degree of contribution varies from drug to drug.

scholarly journals Evidence-based clinical practice guidelines for Liver Cirrhosis 2020

2021 ◽  
Author(s):  
Hitoshi Yoshiji ◽  
Sumiko Nagoshi ◽  
Takemi Akahane ◽  
Yoshinari Asaoka ◽  
Yoshiyuki Ueno ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Hepatopulmonary Syndrome ◽  
International Standards ◽  
Muscle Cramp ◽  
Future Research ◽  
Alcoholic Steatohepatitis ◽  
New Findings

AbstractThe first edition of the clinical practice guidelines for liver cirrhosis was published in 2010, and the second edition was published in 2015 by the Japanese Society of Gastroenterology (JSGE). The revised third edition was recently published in 2020. This version has become a joint guideline by the JSGE and the Japan Society of Hepatology (JSH). In addition to the clinical questions (CQs), background questions (BQs) are new items for basic clinical knowledge, and future research questions (FRQs) are newly added clinically important items. Concerning the clinical treatment of liver cirrhosis, new findings have been reported over the past 5 years since the second edition. In this revision, we decided to match the international standards as much as possible by referring to the latest international guidelines. Newly developed agents for various complications have also made great progress. In comparison with the latest global guidelines, such as the European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD), we are introducing data based on the evidence for clinical practice in Japan. The flowchart for nutrition therapy was reviewed to be useful for daily medical care by referring to overseas guidelines. We also explain several clinically important items that have recently received focus and were not mentioned in the last editions. This digest version describes the issues related to the management of liver cirrhosis and several complications in clinical practice. The content begins with a diagnostic algorithm, the revised flowchart for nutritional therapy, and refracted ascites, which are of great importance to patients with cirrhosis. In addition to the updated antiviral therapy for hepatitis B and C liver cirrhosis, the latest treatments for non-viral cirrhosis, such as alcoholic steatohepatitis/non-alcoholic steatohepatitis (ASH/NASH) and autoimmune-related cirrhosis, are also described. It also covers the latest evidence regarding the diagnosis and treatment of liver cirrhosis complications, namely gastrointestinal bleeding, ascites, hepatorenal syndrome and acute kidney injury, hepatic encephalopathy, portal thrombus, sarcopenia, muscle cramp, thrombocytopenia, pruritus, hepatopulmonary syndrome, portopulmonary hypertension, and vitamin D deficiency, including BQ, CQ and FRQ. Finally, this guideline covers prognosis prediction and liver transplantation, especially focusing on several new findings since the last version. Since this revision is a joint guideline by both societies, the same content is published simultaneously in the official English journal of JSGE and JSH.

scholarly journals Real-world management of non-alcoholic steatohepatitis differs from clinical practice guideline recommendations and across regions

JHEP Reports ◽  
2021 ◽  
pp. 100411
Author(s):  
Quentin M. Anstee ◽  
Kate Hallsworth ◽  
Niall Lynch ◽  
Adrien Hauvespre ◽  
Eid Mansour ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Real World ◽  
Practice Guideline ◽  
Alcoholic Steatohepatitis

Non-alcoholic steatohepatitis: From cell biology to clinical practice

2006 ◽  
Vol 44 (1) ◽  
pp. 197-208 ◽  
Author(s):  
Helena Cortez-Pinto ◽  
Miguel Carneiro de Moura ◽  
Christopher Paul Day
Keyword(s):  
Clinical Practice ◽  
Cell Biology ◽  
Alcoholic Steatohepatitis

The miR-21 potential of serving as a biomarker for liver diseases in clinical practice

2020 ◽  
Vol 48 (5) ◽  
pp. 2295-2305
Author(s):  
Jiawei Zhang ◽  
Dandan Li ◽  
Rui Zhang ◽  
Peng Gao ◽  
Rongxue Peng ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Liver Diseases ◽  
Hepatic Disease ◽  
Noninvasive Detection ◽  
Diagnosis And Prognosis ◽  
Expected Performance ◽  
Potential Biomarker ◽  
Disease Condition ◽  
Complex Regulatory Network

The role of miR-21 in the pathogenesis of various liver diseases, together with the possibility of detecting microRNA in the circulation, makes miR-21 a potential biomarker for noninvasive detection. In this review, we summarize the potential utility of extracellular miR-21 in the clinical management of hepatic disease patients and compared it with the current clinical practice. MiR-21 shows screening and prognostic value for liver cancer. In liver cirrhosis, miR-21 may serve as a biomarker for the differentiating diagnosis and prognosis. MiR-21 is also a potential biomarker for the severity of hepatitis. We elucidate the disease condition under which miR-21 testing can reach the expected performance. Though miR-21 is a key regulator of liver diseases, microRNAs coordinate with each other in the complex regulatory network. As a result, the performance of miR-21 is better when combined with other microRNAs or classical biomarkers under certain clinical circumstances.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Hybrid Telecoaching for Corporate Speech Training and Potential Applications to Clinical Practice

2019 ◽  
Vol 4 (2) ◽  
pp. 322-324
Author(s):  
Thomas F. Burke
Keyword(s):  
Clinical Practice ◽  
Engineering Teams ◽  
Corporate Strategies ◽  
Corporate Speech ◽  
Phone Calls ◽  
Future Clinical Practice ◽  
Fortune 100 ◽  
Potential Applications ◽  
Language Pathology ◽  
Development Engineering

Purpose The purpose of this article was to describe a model for “hybrid speech telecoaching” developed for a Fortune 100 organization and offer a “thought starter” on how clinicians might think of applying these corporate strategies within future clinical practice. Conclusion The author contends in this article that corporate telecommunications and best practices gleaned from software development engineering teams can lend credibility to e-mail, messaging apps, phone calls, or other emerging technology as viable means of hybrid telepractice delivery models and offer ideas about the future of more scalable speech-language pathology services.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

Issues in Language Sample Collection and Analysis With Children Using AAC

2014 ◽  
Vol 23 (2) ◽  
pp. 65-74 ◽  
Author(s):  
Gail Van Tatenhove
Keyword(s):  
Clinical Practice ◽  
Augmentative And Alternative Communication ◽  
Language Production ◽  
Expressive Language ◽  
Sample Analysis ◽  
Alternative Communication ◽  
Sample Collection ◽  
Speech Language Pathologists ◽  
Language Sample Analysis ◽  
Language Sample

Language sample analysis is considered one of the best methods of evaluating expressive language production in speaking children. However, the practice of language sample collection and analysis is complicated for speech-language pathologists working with children who use augmentative and alternative communication (AAC) devices. This article identifies six issues regarding use of language sample collection and analysis in clinical practice with children who use AAC devices. The purpose of this article is to encourage speech-language pathologists practicing in the area of AAC to utilize language sample collection and analysis as part of ongoing AAC assessment.

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