XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

Since the publication of the American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of hepatocellular carcinoma (HCC) in 2005, new information has emerged that requires that the guidelines be updated. The full version of the new guidelines is available on the AASLD Web site at http://www.aasld.org/practiceguidelines/ Documents/Bookmarked%20Practice%20Guidelines/ HCCUpdate2010.pdf. Here, we briefly describe only new or changed recommendations.

/pdf/aasld-practice-guideline-management-of-hepatocellular-51bocalv0r.pdf

AASLD PRACTICE GUIDELINE Management of Hepatocellular Carcinoma: An Update

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.20933

Management of hepatocellular carcinoma.

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946 Association between CCR5 promoter polymorphism and hepatitis B virus infection

3 ISSN 2045-0923 10.2217/HEP.13.1 © 2014 Future Medicine Ltd Hepatic Oncol. (2014) 1(1), 3–5 The surveillance of hepatocellular carcinoma (HCC), which has been a standard of care in the management of patients with chronic liver diseases, greatly contributed to the early detection of liver cancers amenable to curative treatment. Nonetheless, the current strategy for HCC surveillance does not seem to be ideal and the problems may mostly arise from the incompleteness of surveillance tools. As revealed by a study using the cohort of the HALT-C trial, the most common reason for identifying HCC at a late stage was an absence of detection despite adherence to surveillance, which clearly implies that better surveillance tools are required [1]. Ultrasonography (US) is a noninvasive, safe and easy-to-apply method in HCC surveillance, showing a sensitivity of 65–80% [2]. However, the performance characteristics of US becomes poor in obese patients or nodular cirrhotic livers. The role of adding serum a-fetoprotein (AFP) measurement complementary to US is still in debate between eastern and western countries. Unfortunately, a marked progress has not yet been made in terms of development or discovery of novel noninvasive imaging (or a serum biomarker) that could outperform US or AFP. Looking at the recommendation by American Association for the Study of Liver Diseases, the proposed interval of 6–12 months for HCC surveillance is based on the tumor doubling time [3,4]. Although initial studies of small sample size reported that there was no difference in the rate of early HCC detection or survival between 6 and 12 months [5,6], in an Italian study, the median survival of patients with a 6-month interval was significantly longer than those with a 12-month interval, after correction of lead-time bias [7]. Furthermore, in a 15-year prospective Korean study, the corrected 5-year survival of patients, whose surveillance interval was less than 6 months, was significantly higher compared with those with an interval of more than 6 months [8]. Accordingly, the superiority of a 6-month interval compared with a 12-month interval was confirmed both in hepatitis C and B virus-related chronic liver diseases. Based on such recent data, a 6-month interval should be preferred over 12 months in clinical practice. A basic concept regarding HCC surveillance is that determination of interval should be made according to the tumor growth rate, not by the degree of tumor

/pdf/impact-of-a-shortened-surveillance-interval-on-1alrhyklk8.pdf

Impact of a shortened surveillance interval on hepatocellular carcinoma survival.

With recent progress in treatment modalities, mortality from upper gastrointestinal (UGI) bleeding has decreased appreciably. The aim of this study was to establish how UGI bleeds are managed in Korean patients with cirrhosis and to evaluate treatment outcomes. A total of 479 episodes of acute UGI bleeding in 464 patients with cirrhosis were included during a six-month period at nine tertiary medical centers. Treatment outcomes were assessed by failure to control bleeding, rebleeding and mortality. The source of bleeding was esophagogastric varices in 77.7% of patients, nonvariceal lesions in 15.9%, and undefined in 6.5%. For control of bleeding, endoscopic and pharmacologic treatments were used in 74.7% and 81.9% of patients, respectively. Variceal ligation was a major technique for endoscopic treatment (90%), and terlipressin and somatostatin were the main pharmacologic agents used (96.4%). Initial hemostasis was achieved in 86.8% of cases, but rebleeding occurred in 3.8% and 16.8% of cases within five days and six weeks of hemorrhage, respectively. Five-day and six-week mortality were 11.3% and 25.9%, respectively. Survival of patients with variceal bleeding seems to be remarkably improved than previous reports, which may suggest the advances in hemostatic methods for control of variceal hemorrhage.

Clinical Features and Treatment Outcomes of Upper Gastrointestinal Bleeding in Patients with Cirrhosis

https://ir.ymlib.yonsei.ac.kr/bitstream/22282913/97653/1/T200700471.pdf

이차성 비기능항진증에서 부분적 비장동맥색전술의 장기 치료 효과

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. With the advancement of diagnostic tools and therapeutic options, the management of HCC has improved remarkably. However, the majority of patients with HCC are diagnosed at an advanced stage and overall prognosis is still grave. Major milestones have occurred in the management of advanced HCC after the introduction of the molecular targeted therapy (MTX). Owing to emerging new targeted therapeutic agents in first-line and second-line settings, HCC seemed to be manageable. In addition, immune checkpoint inhibitors (ICI) are also an attractive choice for the treatment of HCC. Although emerging systemic therapeutic agents may have shifted the treatment paradigm for HCC, there is still an unmet need for effective systemic therapy as monotherapy. Recently, ICI-based combination therapy is expected to improve therapeutic efficacy for HCC. Given the complex nature of the treatment strategy of advanced HCC, optimal treatment of HCC remains complex despite the treatment guidelines for HCCs. Although there are guidelines for the management of HCC, optimal care of HCC remains complex because of the complexity of managing HCC. Multidisciplinary team approaches using multimodality treatment are therefore used in the management of HCC.

Kwang Hyub Han

Papers

946 Association between CCR5 promoter polymorphism and hepatitis B virus infection

Impact of a shortened surveillance interval on hepatocellular carcinoma survival.

Clinical Features and Treatment Outcomes of Upper Gastrointestinal Bleeding in Patients with Cirrhosis

이차성 비기능항진증에서 부분적 비장동맥색전술의 장기 치료 효과

Multidisciplinary Team Approaches for the Management of Hepatocellular Carcinoma