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      Saturday, December 2, 2023
      News & Perspective Drugs & Diseases CME & Education Academy Video Decision Point
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      CME / ABIM MOC / CE

      Frequently Overlooked Complications of Liver Disease: Guide for Community Providers

      • Authors: Steven L. Flamm, MD; Amanda Chaney, DNP, APRN, FAANP; Arun Jesudian, MD
      • CME / ABIM MOC / CE Released: 5/25/2023
      • Valid for credit through: 5/25/2024, 11:59 PM EST
      Start Activity

      • Credits Available

        Physicians - maximum of 0.75 AMA PRA Category 1 Credit(s)™

        ABIM Diplomates - maximum of 0.75 ABIM MOC points

        Nurses - 0.75 ANCC Contact Hour(s) (0.25 contact hours are in the area of pharmacology)

        IPCE - 0.75 Interprofessional Continuing Education (IPCE) credit

        You Are Eligible For

        • Letter of Completion
        • ABIM MOC points

      Target Audience and Goal Statement

      This activity is intended for gastroenterologists, primary care physicians, nurse practitioners, nurses/advanced practice nurses, and other clinicians who manage patients with hepatic encephalopathy (HE).

      The goal of this activity is for learners to be better able to identify at-risk individuals and manage HE with a multidisciplinary care team in rural settings.

      Upon completion of this activity, participants will:

      • Have increased knowledge regarding the
        • Complications of cirrhosis
        • Clinical manifestations of HE
      • Have greater competence related to
        • Assessment and diagnosis of HE within an interprofessional care team
        • Tailoring treatments for HE based on clinical evidence

      Disclosures

      Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

      All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.

      Faculty

      • Steven L. Flamm, MD

        Professor of Medicine
        Rush University Medical Center
        Chicago, Illinois

        Disclosures

        Steven L. Flamm, MD, has no relevant financial relationships.

      • Amanda Chaney, DNP, APRN, FAANP

        Senior Director of Advanced Practice Provider Services
        Cleveland Clinic
        Weston, Florida

        Disclosures

        Amanda Chaney, DNP, APRN, FAANP, has no relevant financial relationships.

      • Arun Jesudian, MD

        Associate Professor of Clinical Medicine
        Weill Cornell Medicine
        New York, New York

        Disclosures

        Arun Jesudian, MD, has the following relevant financial relationships:
        Consultant or advisor for: Dynavax Technologies Corporation; Salix Pharmaceuticals, Inc.
        Speaker or member of speakers bureau for: Salix Pharmaceuticals, Inc.
        Research funding from: Camurus; Salix Pharmaceuticals, Inc.

      Editors

      • Karen Badal, MD, MPH

        Senior Medical Education Director, Medscape, LLC

        Disclosures

        Karen Badal, MD, MPH, has no relevant financial relationships.

      • Jason Luis Quiñones, PhD

        Associate Medical Writer, Medscape, LLC

        Disclosures

        Jason Luis Quiñones, PhD, has no relevant financial relationships.

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        Associate Director, Accreditation and Compliance, Medscape, LLC

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        Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

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      Medscape

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      In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

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      This activity was planned by and for the healthcare team, and learners will receive 0.75 Interprofessional Continuing Education (IPCE) credit for learning and change.

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        Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.75 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

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        Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

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      • Awarded 0.75 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.25 contact hours are in the area of pharmacology.

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      This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

      Follow these steps to earn CME/CE credit*:

      1. Read about the target audience, learning objectives, and author disclosures.
      2. Study the educational content online or print it out.
      3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

      You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

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      From Medscape Education Gastroenterology
      CME / ABIM MOC / CE

      Frequently Overlooked Complications of Liver Disease: Guide for Community Providers

      Authors: Steven L. Flamm, MD; Amanda Chaney, DNP, APRN, FAANP; Arun Jesudian, MDFaculty and Disclosures

      CME / ABIM MOC / CE Released: 5/25/2023

      Valid for credit through: 5/25/2024, 11:59 PM EST

      processing....

      References

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      3. Scaglione S, et al. The epidemiology of cirrhosis in the United States. J Clin Gastroenterol. 2015;49:690-696.
      4. Loomba R, et al. AGA clinical practice update on screening for hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: expert review. Gastroenterology. 2020;158:1822-1830.
      5. Hofmeister MG, et al. Estimating prevalence of hepatitis C virus infection in the United States, 2013-2016. Hepatology. 2019;69:1020-1031.
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      8. Chen PH, et al. Inter-hospital escalation-of-care referrals for severe alcohol-related liver disease with recent drinking during the COVID-19 pandemic. Alcohol Alcohol. 2022;57:185-189.
      9. Larson PS, et al. Impact of the COVID-19 pandemic on temporal patterns of mental health and substance abuse related mortality in Michigan: an interrupted time series analysis. Lancet Reg Health Am. 2022;10:100218.
      10. Singal AK, et al. Diagnosis and treatment of alcohol-associated liver disease: a review. JAMA. 2021;326:165-176.
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      23. Thomas DL, et al. Detection of liver disease in injection drug users. J Addict Dis. 2008;27:19-24.
      24. Alberts C, et al. Worldwide prevalence of hepatitis B virus and hepatitis C virus among patients with cirrhosis at country, region, and global levels: a systematic review. Lancet Gastroenterol Hepatol. 2022;7:724-735.
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      33. Vilstrup H, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Disease and the European Association for the Study of the Liver. Hepatology. 2014;60:715-735.
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      35. Child CG, et al. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1-85.
      36. Pugh RN, et al. Transection of the esophagus for bleeding esophageal varices. Br J Surg. 1973;60:646-649.
      37. Ufere N, et al. Rural-urban disparities in mortality from cirrhosis in the United States from 1999 to 2019. Am J Gastroenterol. 2022;1162-1165.
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      39. US Food and Drug Administration. Rural health. Updated June 22, 2021. Accessed April 26, 2023. https://www.fda.gov/consumers/minority-health-and-health-equity-resources/rural-health
      40. Rongey C, et al. Impact of rural residence and health system structure on quality of liver care. PLoS One. 2013;8:e84826.
      41. Chartampilas E, et al. Imaging of nonalcoholic fatty liver disease and its clinical utility. Hormones. 2018;17:69-81.
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      43. Mellinger JL, et al. Multidisciplinary management of patients with cirrhosis: a need for care coordination. Clin Gastroenterol Hepatol. 2013;11:217-223.
      44. Mukthinuthalapati VVPK, et al. Early predictors of outcomes of hospitalization for cirrhosis and assessment of the impact of race and ethnicity at safety-net hospitals. PLoS One. 2019;14:e0211811.
      45. Perez IC, et al. Step by step: managing the complications of cirrhosis. Hepat Med. 2021;13:45-57.
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      47. Iwakiri Y. Pathophysiology of portal hypertension. Clin Liver Dis. 2014;18:281-291.
      48. Bustamente J, et al. Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol. 1999;30:890-895.
      49. Kabaria S, et al. Hepatic encephalopathy: a review. EMJ Hepatol. 2021;9:89-97.
      50. Elsaid MI, et al. Epidemiology of hepatic encephalopathy. Clin Liver Dis. 2020;24:157-174.
      51. López-Franco Ó, et al. Cognitive impairment after resolution of hepatic encephalopathy: a systematic review and meta-analysis. Front Neurosci. 2021;15:579263.
      52. Moore KP, et al. Guidelines on the management of ascites in cirrhosis. Gut. 2006;55(Suppl 6):vi1-vi12.
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