@nnekauferemd
Transplant Hepatologist at Massachusetts General Hospital. My mission statement: Increase healthcare system empathy for patients with cirrhosis #LiverPal #palliativehepatology #geripal #hpm #hapc #medsky #LiverSky
Our question: Can a longitudinal model of specialty aligned inpatient palliative care get more patients happier and healthier to and through transplant 🤔? We will know more at the end of our trial!
Today we enrolled our 100th patient into our LiverPal RCT assessing whether longitudinal inpatient palliative care can improve outcomes for hospitalized patients with liver disease and their families. What a Good Friday! #palliativehepatology #livertwitter #liversky
Harvard redid its whole homepage to push back against the administration’s demands. I mean, this is just a website but I think it’s kind of a great PR move: www.harvard.edu
How many hospitalized patients need care in the ICU? How many of them survive? What interventions do they receive there?
These are some of the questions I had two years ago while trying to write the "background" section for my masters thesis. But I couldn't find the answers... they did not exist.
As hepatologists, there are few things more devastating and very preventable that we see than HBV reactivation. If you are about to start your patient on an immunosuppressant, please keep this figure in mind. #LiverSky #MedSky
https://buff.ly/4gaKqf7
#liversky
Guys. Rifaximin
Albumin is the closest thing to a "universal remedy" in cirrhosis
We use it to treat different complications, with good evidence but also with debatable or negative evidence
Excellent analysis by Jonel Trebicka & @ggarciatsao.bsky.social
doi.org/10.1097/hep.0000000000000521
#LiverSky
Just created a document titled "R01 SA page".
So it begins. Both nervous but also really excited to think big.
Advice, thoughts, prayers, etc. welcome!
#LiverSky
God bless you and this program. Seriously. Thank you for the work you do.
Amongst the palliative care domains, it feels like the domain of moral/existential/spiritual needs often gets short shrift unless patients are truly end of life. I wonder if inverting this pyramid to make existential needs the base, and not the peak, opens up a wider world of therapeutic support?
In a space in which serious illness, psychological distress, and often addiction can so closely overlap, we have found that using a moral/existential/spiritual frame in serious illness convos and exploring coping is an almost necessary consideration: “How to live a better life with liver disease”
I enjoyed reading this - thank you. I’ve been thinking about coping a lot in context of serious illness conversations in hepatology/transplant. In our inpatient LiverPal work, our team talks about how our therapeutic alliance often starts with exploring our patients’ existential/spiritual distress.
“A donor wanted to give $2 million to my lab, but only wanted to allow a maximum 10 percent to go to indirect cost recovery. And the school declined to receive the $2 million because they wanted at minimum, I believe it was 20 percent.”
www.harvardmagazine.com/2025/01/harv...
Lets invest in true collaborative care with our palliative care colleagues-this is more than just a triggered referral. Working with my #LiverPal team has been the biggest professional joy of my life. Doing so has required YEARS of longitudinal teamwork and culture change. But its been so worth it.
We also need to invest in bidirectional collaboration to grow specialty-aligned palliative care and support our PC clinicians in learning disease-specific symptoms, common treatments, and complications that impact prognosis and outcomes of our patients @releiter.bsky.social
https://buff.ly/3Bw36Yu
Authors: "A multipronged effort is needed to meaningfully move the needle...detailed measurement of individual physical, psychological, sociocultural, and other palliative care needs instead of using screening tools that merely identify these unmet domains of needs at a superficial level."
PREACH
We need population-specific approaches to symptom management, serious illness conversations, end-of-life care. This requires foundational research. We need to ensure that outcomes that are so often used in PallOnc interventions are appropriate, responsive, and valid in non-cancer populations.
And not just ICU but also inpatient/outpatient PC interventions as well. I might go further and say that the copy-and-paste approach from PallOnc trials may not only show no benefit but may have the capacity to cause harm (extra burden of visits, care not aligned with population-specific needs)
Thus I could not agree more with the authors: "A heterogeneous array of interventions and outcomes founded on cancer-based models of palliative care (regardless of how they are tailored or targeted) may offer limited benefit above what contemporary ICU care can deliver to patients and families."
As a hepatologist who is a proud member of a palliative oncology research lab I'm both inspired by my mentors but have also had a deep realization for years that a "copy-and-paste" approach using PC models developed in cancer cannot, will not, and should not be the way to build #palliativehepatology
It is rare that an editorial will make me give a standing ovation to the authors - this one recently published in JAMA Internal Medicine by Kieran Quinn and colleagues did: https://buff.ly/4ggq9FS
@kencovinsky.bsky.social
#palliativehepatology #liversky #hapc
How do we apply the new SLD definitions in research? To study outcomes and implement trials for different SLD subtypes, we first need to be able to accurately identify each clinical entity using medical records/registry data.
www.cghjournal.org/article/S154...
@amergastroassn.bsky.social
@j-palliativemed.bsky.social Daniel Shalev et al respond to Susan Block's Special Report: Realizing the Imperative: The Future of Mental Health and Palliative Care Integration www.liebertpub.com/doi/10.1089/...
Everything you want to know about the management of depression and anxiety in #cirrhosis
From Zimbrean (@YalePsych) and Jakab (@YaleDigestive)
journals.lww.com/hepcomm/full...
#liversky
"What do you want?" This is probably one of the most insidiously deceptive questions in medical decision-making. 1/8 #HAPC #MedSky #MedEd
Wonderful 1st day of @amcollegegastro.bsky.social #DEI Scholar Adjoa Anyane-Yeboa MD MPH in Department of Medicine at Tufts Medical Center
Grand Rounds tomorrow:
Leveling the Playing Field: Colorectal Cancer Screening in Historically Marginalize Populations
The always-thoughtful Derek Angus, master of the large randomized trial, calls for “a qualitative assessment of [the clinical team’s] experience [to] provide insight on how the intervention worked and on features considered unhelpful”
The future of RCTs includes qual
jamanetwork.com/journals/jam...
+1. Incredibly proud of the hard work that went into this comprehensive review on sudden cardiac arrest in athletes. Understanding these events in athletes has implications that echo far beyond the field and touches the health of all young adults.
Full Text Link: bit.ly/3B1TxjT
