Browsing by Author "Parikh, Neehar D."

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    Attacking Alcohol-Related Liver Disease by Taxing Alcohol Sales
    (Wiley, 2021) Tapper, Elliot B.; Parikh, Neehar D.; Liangpunsakul, Suthat; Medicine, School of Medicine
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    Oral simethicone tablets with PEG-ELS split-prep reduces frequency of inadequate bowel cleansing and decreases bubbles
    (Wiley, 2021) Maratt, Jennifer K.; Freeman, Alison E.; Schoenfeld, Philip; Saini, Sameer D.; Su, Grace L.; Tai, Andrew W.; Prabhu, Anoop; Rubenstein, Joel H.; Waljee, Akbar K.; Glass, Lisa; Dang, Duyen; Parikh, Neehar D.; Govani, Shail M.; Patel, Swati G.; Menees, Stacy B.; Medicine, School of Medicine
    Background: Intraluminal bubbles may prevent the visualisation of mucosa during a colonoscopy. Simethicone minimises bubbles, but its impact on incomplete bowel preparation and optimal protocols for use are unclear. Aim: To assess the impact of oral simethicone tablets when added to 2-litre, split-prep, polyethylene glycol electrolyte lavage solution + ascorbic acid on bubble score and frequency of incomplete bowel preparation. Methods: This QA/QI project assessed outpatients who underwent colonoscopy at the Veterans Affairs Ann Arbor Healthcare System. After endoscopists were trained in intraluminal bubble scoring systems, data about bubble score, frequency of inadequate bowel preparation requiring early repeat colonoscopy, quality of bowel preparation using Boston Bowel Preparation Scale (BBPS), and patient tolerance were collected before and after addition of oral simethicone 160mg to each dose of 2-litre split-prep. Results: There were no differences in patient characteristics between the baseline group (n = 348) and the simethicone group (n = 354). Simethicone improved the total mean intraluminal bubble score from 8.18 to 8.78 (P < 0.001). Early repeat colonoscopy due to inadequate bowel preparation was higher in the baseline group vs simethicone group: 8.7% vs 4.6%, P = 0.03 with an RRR = 0.5 (95% CI 0.26-0.95). Using BBPS, the frequency of having inadequate cleansing in any colon segment was higher in the baseline group vs simethicone group: 6.6% vs 3.1%; RRR = 0.55 (95% CI 0.21-0.94). Conclusions: The addition of oral simethicone to each dose of 2-litre, split-prep of polyethylene glycol + ascorbic acid decreased intraluminal bubbles and reduced the frequency of inadequate bowel preparation.
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    Patient-reported outcomes in HCC: A scoping review by the Practice Metrics Committee of the American Association for the Study of Liver Diseases
    (Wolters Kluwer, 2022) Serper, Marina; Parikh, Neehar D.; Thiele, Grace; Ovchinsky, Nadia; Mehta, Shivang; Kuo, Alexander; Ho, Chanda; Kanwal, Fasiha; Volk, Michael; Asrani, Sumeet K.; Ghabril, Marwan S.; Lake, John R.; Merriman, Raphael B.; Morgan, Timothy R.; Tapper, Elliot B.; Medicine, School of Medicine
    Background and aims: HCC is a leading cause of mortality in patients with advanced liver disease and is associated with significant morbidity. Despite multiple available curative and palliative treatments, there is a lack of systematic evaluation of patient-reported outcomes (PROs) in HCC. Approach and results: The American Association for the Study of Liver Diseases Practice Metrics Committee conducted a scoping review of PROs in HCC from 1990 to 2021 to (1) synthesize the evidence on PROs in HCC and (2) provide recommendations on incorporating PROs into clinical practice and quality improvement efforts. A total of 63 studies met inclusion criteria investigating factors associated with PROs, the relationship between PROs and survival, and associations between HCC therapy and PROs. Studies recruited heterogeneous populations, and most were cross-sectional. Poor PROs were associated with worse prognosis after adjusting for clinical factors and with more advanced disease stage, although some studies showed better PROs in patients with HCC compared to those with cirrhosis. Locoregional and systemic therapies were generally associated with a high symptom burden; however, some studies showed lower symptom burden for transarterial radiotherapy and radiation therapy. Qualitative studies identified additional symptoms not routinely assessed with structured questionnaires. Gaps in the literature include lack of integration of PROs into clinical care to guide HCC treatment decisions, unknown impact of HCC on caregivers, and the effect of palliative or supportive care quality of life and health outcomes. Conclusion: Evidence supports assessment of PROs in HCC; however, clinical implementation and the impact of PRO measurement on quality of care and longitudinal outcomes need future investigation.