BRIDGE to liver health: implementation of a group telehealth psychoeducational program through shared medical appointments for MASLD management.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significantly costly and increasingly prevalent disease, with treatment focused on lifestyle intervention. Integrating education and behavioral health into clinical care offers opportunities to engage and empower patients to prevent progression of liver disease. We describe the design and implementation of Behavioral Resources and Intervention through Digital Group Education (BRIDGE), a 6-session group telehealth program led by advanced practice providers (APPs) in 90-min shared medical appointments (SMAs) with small groups of MASLD patients in an academic outpatient hepatology clinic. The program contains multi-component group interventions, with didactic education and behavioral coaching, while leveraging peer-based learning and support. METHODS: A mixed-methods exploratory pilot study was conducted. Feasibility and acceptability of the clinical intervention were assessed by tracking recruitment, attendance, and retention of BRIDGE participants, patient interviews, and debriefing of clinician and staff views of the clinical program. Implementation metrics included program development time, workflow and scheduling logistics, and billing compliance for sustainability. Finally, patient parameters including changes in liver enzymes, FIB-4, weight, and BMI from pre- to post-BRIDGE were retrospectively analyzed. RESULTS: We included 57 participants (median age 57, interquartile range (IQR) 50 - 65 years), 38 (67%) female, 38 (67%) white, and 40% had public insurance. Thirty-three (58%) participants completed all six sessions, while 43 (75%) attended at least five sessions. Patients who completed all sessions were older (median age 61 vs 53.5; p = 0.01). Gender, race/ethnicity, and insurance type were not significantly associated with missed sessions, and patients had similar rates of completion regardless of weight, BMI, or stage of liver disease. Barriers to completion included personal illness, family reasons, work commitments, or insurance issues. Prior to BRIDGE, median BMI was 31.9 (SD 29 - 36), with a median weight loss of 2 pounds (IQR -2 - 6) after BRIDGE. CONCLUSION: The BRIDGE telehealth SMA program was feasible, well-attended, and positively reviewed. This pilot study informs future iterations of program development and evaluation of outcome measures.

Diagnosis and management of epiploic appendagitis: a single-institution 10-year experience.

<b>Introduction</b>: Epiploic appendagitis is known to be a benign and self-limiting process, yet optimal management is not well understood. Research focused on the efficacy of treatment in this rare condition may allow future patients diagnosed with epiploic appendagitis to be treated accordingly with the best evidence-based medical practice.<br/><b>Aim</b>: The aim of this study was to investigate the diagnosis, compare management options and follow up epiploic appendagitis. <br><b>Materials and methods</b>: This retrospective study included all patients over 18 years of age who were treated in a large tertiary hospital in the years 2009-2019 with a confirmed diagnosis of epiploic appendagitis and no coexisting acute intra-abdominal pathologies. Patients' health information was recorded and analysed.<br/><b>Results</b>: As many as 78 patients were diagnosed with epiploic appendagitis over a 10-year observation period. A minor male predominance (55%) and a broad range of ages at the moment of diagnosis (18-75) were found, with diabetes (n = 10) being the most common comorbidity in this condition . In the majority of cases, the disease was located in the sigmoid (41%) and descending colon (35%). Diagnosis was primarily based on imaging (computerised tomography 91%, ultrasonography 2.6%). Six percent of patients were diagnosed during surgery and these patients recovered with smaller rates of readmissions and recurrences (P < 0.05). Patients given opioids on discharge were less likely to be readmitted to hospital (P < 0.05), while those given antibiotics had a longer inpatient stay (P < 0.05) with no change in readmission rates (P = 0.78) or recurrence rates (P = 0.48). <br/><b>Discussion</b>: Managing epiploic appendagitis with antibiotics is shown to have no effect on patient outcomes, while opioid use for pain control did not affect the length of hospital stay but it reduced the number of readmissions when compared to simple analgesics alone.