Browsing by Author "Congly, Stephen E"
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Item Open Access The cirrhosis care Alberta (CCAB) protocol: implementing an evidence-based best practice order set for the management of liver cirrhosis - a hybrid type I effectiveness-implementation trial(2020-06-18) Carbonneau, Michelle; Eboreime, Ejemai A; Hyde, Ashley; Campbell-Scherer, Denise; Faris, Peter; Gramlich, Leah; Tsuyuki, Ross T; Congly, Stephen E; Shaheen, Abdel A; Sadler, Matthew; Zeman, Marilyn; Spiers, Jude; Abraldes, Juan G; Sugars, Benjamin; Sia, Winnie; Green, Lee; Abdellatif, Dalia; Schaefer, Jeffrey P; Selvarajah, Vijeyakumar; Marr, Kaleb; Ryan, David; Westra, Yolande; Bakshi, Neeja; Varghese, Jayant C; Tandon, PuneetaAbstract Background Liver cirrhosis is a leading cause of morbidity, premature mortality and acute care utilization in patients with digestive disease. In the province of Alberta, hospital readmission rates for patients with cirrhosis are estimated at 44% at 90 days. For hospitalized patients, multiple care gaps exist, the most notable stemming from i) the lack of a structured approach to best practice care for cirrhosis complications, ii) the lack of a structured approach to broader health needs and iii) suboptimal preparation for transition of care into the community. Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial which aims to address these gaps. The proposed intervention is initiated at the time of hospitalization through implementation of a clinical information system embedded electronic order set for delivering evidence-based best practices under real-world conditions. The overarching objective of the CCAB trial is to demonstrate effectiveness and implementation feasibility for use of the order set in routine patient care within eight hospital sites in Alberta. Methods A mixed methods hybrid type I effectiveness-implementation design will be used to evaluate the effectiveness of the order set intervention. The primary outcome is a reduction in 90-day cumulative length of stay. Implementation outcomes such as reach, adoption, fidelity and maintenance will also be evaluated alongside other patient and service outcomes such as readmission rates, quality of care and cost-effectiveness. This theory-based trial will be guided by Normalization Process Theory, Consolidated Framework on Implementation Research (CFIR) and the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) Framework. Discussion The CCAB project is unique in its breadth, both in the comprehensiveness of the multi-component order set and also for the breadth of its roll-out. Lessons learned will ultimately inform the feasibility and effectiveness of this approach in “real-world” conditions as well as adoption and adaptation of these best practices within the rest of Alberta, other provinces in Canada, and beyond. Trial registration ClinicalTrials.gov: NCT04149223, November 4, 2019.Item Open Access Worldwide Prevalence and Incidence of Non-Alcoholic Fatty Liver Disease (NAFLD) in the 21st Century: A Systematic Review and Meta-Analysis(2021-09-10) Riazi, Kiarash; Kaplan, Gilaad G; Shaheen, Abdel Aziz; Swain, Mark G; Congly, Stephen ENon-alcoholic fatty liver disease (NAFLD) is defined as the presence of lipid deposition in more than 5% of hepatocytes, also known as fatty liver, in the absence of any history of excessive alcohol use or secondary causes of fatty liver. NAFLD is the most common liver disorder worldwide and the leading cause of liver-related morbidity and mortality, mainly because of cirrhosis, end-stage liver disease, liver transplant, and an increased incidence of hepatocellular carcinoma.The prevalence of NAFLD is constantly rising. Due to a silent presentation, high prevalence, and the detrimental outcomes associated with it, NAFLD is a major global health problem. Since there are currently no approved treatments for NAFLD, disease prevention is the only available option for reducing the disease burden. Since primary epidemiological data are the crucial cornerstones for every public health and preventive medicine attempt, updated and accurate epidemiological data are of utmost importance. There are currently a few existing research publications on the prevalence and incidence of NAFLD worldwide, which are either outdated, methodologically imperfect, or geographically restricted. Therefore, there is a need to update current data and accurately estimate NAFLD's worldwide prevalence and incidence.We performed a systematic review to identify all the studies reporting on the prevalence or incidence of NAFLD among the general adult population of different world regions over the past two decades. We used a random-effects meta-analysis method to calculate overall or sex-specific pooled prevalence or incidence rates. We also created static and interactive choropleth maps of pooled data to highlight the geographic differences in NAFLD prevalence/incidence.We estimated that the overall prevalence of NAFLD is appreciably higher than what had previously been assessed and is growing at an alarming rate. Furthermore, our findings show that the epidemiological reports regarding NAFLD from many parts of the world are missing. A dramatic rise in prevalence should drive enhanced awareness of NAFLD among primary care physicians, public health specialists, and health policymakers to encourage the development of more effective preventive policies.