Publications by authors named "Amy M Shui"

Background: Alcohol use and hepatitis C virus (HCV) often coexist and are associated with cardiovascular disease. One of the underlying drivers is dyslipidemia. We assessed lipid and lipoprotein levels and the relationship between alcohol use and atherogenic lipid profiles, specifically small dense low-density lipoprotein cholesterol (sdLDL-C), in Latinos with and without HCV.

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Background: Cannabis use is increasing in the United States, including among liver transplant candidates. Although the anesthesia literature suggests an association between cannabis use and increased post-operative pain, the impact of cannabis use on post-liver transplant (LT) opioid use remains unknown. This study investigates changes in cannabis use at a transplant center over time, as well as the impact of cannabis use on post-LT opioid use, healthcare utilization, and mortality.

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Pediatric liver transplant outcomes exhibit disparities, necessitating the identification of modifiable risk factors to develop targeted interventions. We characterized associations between household material economic hardship (eg, financial barriers to housing or food) and pediatric liver transplant outcomes. We recruited pediatric recipients of liver transplants <18 years at the time of transplant across 8 US centers.

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Importance: Conclusions vary substantially among studies examining associations between area-based social determinants of health (SDOH) and pediatric health disparities based on the selected patient population and SDOH index. Most national studies use zip codes, which encompass a wide distribution of communities, limiting the generalizability of findings.

Objectives: To characterize the distributions of composite SDOH indices for pediatric surgical patients within a national sample of academic children's hospitals and to assess SDOH index precision in classifying patients at similar levels of disadvantage.

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Article Synopsis
  • Treatment for alcohol use disorder (AUD) is important for improving health outcomes in patients with alcohol-associated cirrhosis, yet it remains underutilized, especially among socioeconomically disadvantaged groups.
  • A study of 196 diverse patients revealed that 67% had ever utilized AUD treatment, while only 32% accessed treatment in the last year; younger patients and those with worse mental health symptoms were more likely to seek treatment.
  • Factors such as older age and better liver disease quality of life were associated with lower treatment utilization, while those with significant anxiety or depression tended to seek treatment more frequently.
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Background: Anorectal malformations (ARMs) have an incidence of up to 1 in 4000 live births and can require immediate neonatal surgery due to associated intestinal blockage. Due to limited surgical access, Ugandan children present late and undergo three separate staged operations: (1) initial colostomy formation; (2) repair of the ARM (called anoplasty); and (3) colostomy closure. Three operations result in long treatment duration, potential complications with each procedure, delays in care, and stigmata associated with colostomies.

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  • Alcohol use is common among patients with chronic liver disease (CLD), and this study examined factors that affect their motivation to reduce drinking.
  • The study involved 121 participants from safety-net hospitals and Veterans Affairs systems, assessing their mental health, alcohol use, and motivation to decrease drinking through various questionnaires.
  • Results showed that depression and severity of alcohol problems were linked to higher motivation, while the treatment site impacted their importance score, indicating these factors should guide future interventions in hepatology care.
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Introduction: Limited health literacy - the ability to access, process, and use health information and services - contributes to persistent health inequities. Yet little is known about associations of limited health literacy with impacts from the COVID-19 pandemic, particularly for US adults in rural areas. This study sought to determine associations of limited health literacy with impacts from the COVID-19 pandemic among a diverse sample of adults in rural Northern Arizona.

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  • Autistic children often experience additional psychological, behavioral, or medical conditions, and the study explored how these factors interrelate through network analysis.
  • The analysis involved two age groups (2-5 years and 6-17 years) and revealed that sleep difficulties and aggressive behaviors were significant issues across both cohorts.
  • The findings suggest that sleep disturbances are a common concern that could guide treatment strategies, while aggressive behavior should be monitored closely as a potential warning sign.
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Importance: Many health systems use electronic consent (eConsent) for surgery, but few have used surgical consent functionality in the patient portal (PP). Incorporating the PP into the consent process could potentially improve efficiency by letting patients independently review and sign their eConsent before the day of surgery.

Objective: To evaluate the association of eConsent delivery via the PP with operational efficiency and patient engagement.

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  • Minimally invasive techniques are becoming common in colorectal surgery, with the Intuitive da Vinci Single-Port robotic platform offering a new, less invasive option, although it faces challenges like robotic arm collisions in tight spaces.
  • The study assesses the safety and feasibility of using this single-port robotic system for right segmental colectomies and could pave the way for broader adoption in surgical practices.
  • Results showed that out of 30 patients, complications occurred in both single-port (40%) and multiport (32%) groups, suggesting that while the single-port method is innovative, it still presents some risks compared to traditional techniques.
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Background And Aims: Fatty liver disease (FLD), alcohol-associated and metabolically associated, often coexists. Increase in physical activity is associated with metabolic health and decreased FLD. We aimed to identify factors associated with physical activity and its improvement following FLD education in a racially diverse, vulnerable population.

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Background: Protein-energy malnutrition is associated with poor surgical outcomes in liver transplant patients, but its impact on healthcare use has not been precisely characterized. We sought to quantify the burden of protein-energy malnutrition in hospitalized patients undergoing liver transplantation.

Methods: Current Procedural Terminology codes were used to identify United States hospitalizations between 2011 and 2018 for liver transplantation using the Nationwide Inpatient Sample.

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Physical frailty is a critical determinant of mortality in patients with cirrhosis and can be objectively measured using the Liver Frailty Index (LFI), which is potentially modifiable. We aimed to identify LFI cut-points associated with waitlist mortality. Ambulatory adults with cirrhosis without HCC awaiting liver transplantation from 9 centers from 2012 to 2021 for ≥3 months with ≥2 pre-liver transplantation LFI assessments were included.

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Objective: To examine the association between intersectionality of race, ethnicity, and sex on retention of U.S. general surgery residents.

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Mean arterial blood pressure (MAP), which decreases as portal hypertension progresses, may be a modifiable risk factor among patients with cirrhosis. We included adults enrolled in the Functional Assessment in Liver Transplantation study. We completed latent class trajectory analyses to define MAP trajectories.

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Objective: Health literacy is a critical health determinant, for which few computerized, self-administered assessments exist. This study adapted and tested the reliability of the Newest Vital Sign© (NVS) as a computerized, self-administered health literacy screener.

Methods: Phase one involved 33 participants to create response options for a computerized, self-administered NVS (C-NVS).

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Introduction: Efforts have been made to increase the number of women and physicians who are underrepresented in medicine (UIM). However, surgery has been slow to diversify, and there are limited data surrounding the impact of intersectionality.

Objective: To assess the combined association of race and ethnicity and sex with rates of promotion and attrition among US academic medical department of surgery faculty.

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Background: Management of cirrhosis is challenging and has been complicated by the COVID-19 pandemic due to decreased access to care, increased psychological distress, and alcohol misuse. Recently, The National Institute on Alcohol Abuse and Alcoholism has broadened the definition of recovery from alcohol use disorder to include quality of life (QoL) as an indicator of recovery. This study examined the associations of alcohol-associated cirrhosis etiology and problematic drinking with liver disease QoL (LDQoL).

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Background: Trauma recidivism is associated with future trauma-associated morbidity and mortality. Previous evidence suggests that socioeconomic factors predict trauma recidivism in older children (10-18 years); however, risk factors in US children 10 years and younger have not been studied. We sought to determine the factors associated with trauma recidivism in young children 10 years and younger.

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Article Synopsis
  • Liver transplant (LT) recipients face significant risks for cognitive impairment (CI), with this study finding that 36% had CI before surgery and 27% still experienced CI three months after LT.
  • The Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive performance, revealing that lower scores pre-LT were linked to higher odds of CI post-LT, emphasizing the influence of initial cognitive health on recovery.
  • The findings highlight a critical need for thorough neurological assessments in LT recipients to identify and tackle factors contributing to ongoing cognitive issues after transplantation.
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Background: Older adults have higher healthcare utilization after liver transplantation (LT), yet objective risk stratification tools in this population are lacking. We evaluated the Liver Frailty Index (LFI) as one potential tool.

Methods: Ambulatory LT candidates ≥65 years without hepatocellular carcinoma (HCC) who underwent LT from 1/2012 to 6/2022 at 8 U.

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Background: Patients with obesity have inferior outcomes after general surgery procedures, but studies evaluating post-liver transplant (LT) outcomes have been limited by small sample sizes or lack of granularity of outcomes. We evaluated the relationship between obesity and post-LT outcomes, including those observed in other populations to be obesity-related.

Methods: Included were 1357 LT recipients prospectively enrolled in the ambulatory pre-LT setting at 8 U.

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