Knowledge and Perceptions of Hepatitis B and Hepatocellular Carcinoma Screening Guidelines Among Trainees: A Tale of Three Centers

Mahfouz, Mahmoud; Nguyen, Harry; Tu, Jonathan; Díaz, Carlos Romero; Anjan, Shweta; Brown, Steven M.; Bosire, Kassandra; Carrasquillo, Olveen; Martin, Paul; Jones, Patricia D.

doi:10.1007/s10620-019-05980-1

Cited by 8 publications

(4 citation statements)

References 45 publications

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“…While we tried to retain the intent of the clinical cases, the wording of these cases may not be the same as those evaluated by trainees and ChatGPT in prior studies. 23,24 This may have affected the comparisons in Table 3.…”

Section: Discussionmentioning

confidence: 99%

“…We pre-set three sample questions into “Sample Questions” section of the LiVersa interface: What are the indications for liver transplantation? Who should be screened for chronic hepatitis B? What is the recommended therapy for a patient with BCLC 0-A HCC without portal hypertension? To compare LiVersa’s performance on free-form clinical hepatology questions, we compared its responses to medical trainees’ responses in a previously published case-vignette based knowledge assessment questions on HBV treatment and hepatocellular carcinoma (HCC) surveillance. 23 We chose this set of questions because they have also been evaluated by the publicly available ChatGPT. 24 Prior to input into LiVersa, case-vignettes were edited for clarity and appropriateness with the goal of retaining the essence of the clinical scenario.…”

Section: Methodsmentioning

confidence: 99%

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Development of a Liver Disease-Specific Large Language Model Chat Interface using Retrieval Augmented Generation

Ge,

Sun,

Owens

et al. 2023

Preprint

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BackgroundLarge language models (LLMs) have significant capabilities in clinical information processing tasks. Commercially available LLMs, however, are not optimized for clinical uses and are prone to generating incorrect or hallucinatory information. Retrieval-augmented generation (RAG) is an enterprise architecture that allows embedding of customized data into LLMs. This approach “specializes” the LLMs and is thought to reduce hallucinations.MethodsWe developed “LiVersa,” a liver disease-specific LLM, by using our institution’s protected health information (PHI)-complaint text embedding and LLM platform, “Versa.” We conducted RAG on 30 publicly available American Association for the Study of Liver Diseases (AASLD) guidelines and guidance documents to be incorporated into LiVersa. We evaluated LiVersa’s performance by comparing its responses versus those of trainees from a previously published knowledge assessment study regarding hepatitis B (HBV) treatment and hepatocellular carcinoma (HCC) surveillance.ResultsLiVersa answered all 10 questions correctly when forced to provide a “yes” or “no” answer. Full detailed responses with justifications and rationales, however, were not completely correct for three of the questions.DiscussionsIn this study, we demonstrated the ability to build disease-specific and PHI-compliant LLMs using RAG. While our LLM, LiVersa, demonstrated more specificity in answering questions related to clinical hepatology – there were some knowledge deficiencies due to limitations set by the number and types of documents used for RAG. The LiVersa prototype, however, is a proof of concept for utilizing RAG to customize LLMs for clinical uses and a potential strategy to realize personalized medicine in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Development of a Liver Disease-Specific Large Language Model Chat Interface using Retrieval Augmented Generation

Ge,

Sun,

Owens

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Moreover, insufficient health education programs and obtaining unreliable Hepatitis B information from friends, relatives, and co-workers may increase the likelihood of acquiring incorrect information ( 42 ). To increase HBV knowledge among HCWs, improvement in clinical practice, 53 training, and practical skills are required ( 56 , 57 ).…”

Section: Discussionmentioning

confidence: 99%

Seroprevalence of Hepatitis B Among Healthcare Workers in Asia and Africa and Its Association With Their Knowledge and Awareness: A Systematic Review and Meta-Analysis

Maamor

Muhamad

Dali

et al. 2022

Front. Public Health

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IntroductionThe hepatitis B virus (HBV) is a blood-borne virus that can be transmitted by percutaneous and mucocutaneous contact with infected bodily fluid. Healthcare workers (HCWs) are more exposed to HBV infection. They must have a thorough understanding of HBV infection since they can contract and spread the virus. In this study, we systematically reviewed all published evidence on the seroprevalence of Hepatitis B virus (HBV) infection among HCWs. and synthesize evidence on the association between knowledge and awareness with HBV infection.MethodsWe searched PubMed, EMBASE, Cochrane Library and Scopus for studies reporting on HBV seroprevalence from January 1997 to September 2021 among healthcare workers. We used random-effects meta-analyses to estimate the pool prevalence of HBV infection.ResultsWe identified 25 studies that met our inclusion criteria, with data on 10,043 adults from 11 countries and two regions: Africa and Asia. The overall seroprevalence of HBV was 5.0% (95% confidence interval [CI] 3.6%), with Africa reporting higher estimates (5.0%, 95% CI 3.7%) than Asia population (4.0%, 95% CI 1.9%). The highest pooled prevalence estimate in African countries came from studies published in the Cameroon region (8.0%, 95% CI 5–10%) while the lowest came from Ethiopia (4.0%, 95% CI 2.6%). The overall seroprevalence estimates in the African population were significantly higher than those in the Asian group. Studies in Africa found that the average knowledge and seroprevalence were 1.4% and 11.0%, respectively where, eight studies (53.3%) reported good knowledge and seven studies (46.7%) reported average knowledge. In Asia, two studies (40.0%) reported good knowledge, one study (20.0%) reporting average knowledge, and two studies (40.0%) reporting poor knowledge. African studies demonstrated good knowledge despite the fact that their HBV infection rate was higher than 6.7%.ConclusionAfrica and Asia have the highest seroprevalence of HBV infection. Improving the comparability of epidemiological and clinical studies constitutes an important step forward. More high-quality data is needed to improve the precision of burden estimates.Systematic Review RegistrationPROSPERO CRD42021279905.

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“…The World Health Organization estimates that ~257 million people worldwide have chronic hepatitis B (HBV) infection. 1 In the US, there are an estimated 880,000–1.89 million people living with chronic HBV, 2 – 4 with a prevalence of 8 times higher in foreign-born than US-born individuals. 4 Of those in the US with chronic HBV, it is estimated that only 35% of individuals have been diagnosed.…”

Section: Introductionmentioning

confidence: 99%

Disparities in presentation and management of chronic hepatitis B among Hispanics in a diverse safety net system

Wang

Terrault

Fong

et al. 2023

Hepatology Communications

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Background: Chronic hepatitis B (HBV) prevalence is highest in foreign-born Asian and African individuals in the US, though Hispanics make up the largest proportion of the immigrant population. Differences in the diagnosis and management of chronic HBV in Hispanics might exist due to the lower awareness of risk. We aim to examine racial/ethnic disparities in the diagnosis, presentation, and immediate management of chronic HBV in a diverse safety net system enriched for Hispanics. Methods: In a large urban safety-net hospital system, we retrospectively identified patients with chronic HBV by serological data and categorized them into mutually exclusive self-identified racial/ethnic groups: Hispanics, Asians, Blacks, and Whites. We then examined differences in screening, disease phenotype and severity, follow-up testing, and referral by race/ethnicity. Results: Among 1063 patients, 302 (28%) were Hispanics, 569 (54%) Asians, 161 (15%) Blacks, and 31 (3%) Whites. More Hispanics (30%) were screened in the acute setting (defined as inpatient or emergency department encounters) than Asians (13%), Blacks (17%), or Whites (23%) ( p <0.01). Hispanics also had lower rates of follow-up testing after HBV diagnosis than Asians including HBeAg status (43% vs. 60%, p <0.01) and HBV DNA levels (42% vs. 58%, p <0.01) and lower rates of linkage to specialty care (32% vs. 55%, p <0.01). Among those with available testing, however, the presence of immune-active chronic HBV was infrequent and similar across racial/ethnic groups. 25% of Hispanics had cirrhosis at initial presentation, proportionally higher than other groups ( p <0.01). Conclusion: Our results underscore the importance of raising chronic HBV awareness and increasing both screening and linkage to care among Hispanic immigrants in addition to the existing risk groups, with the goal of mitigating downstream liver-related complications.

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Knowledge and Perceptions of Hepatitis B and Hepatocellular Carcinoma Screening Guidelines Among Trainees: A Tale of Three Centers

Cited by 8 publications

References 45 publications

Development of a Liver Disease-Specific Large Language Model Chat Interface using Retrieval Augmented Generation

Development of a Liver Disease-Specific Large Language Model Chat Interface using Retrieval Augmented Generation

Seroprevalence of Hepatitis B Among Healthcare Workers in Asia and Africa and Its Association With Their Knowledge and Awareness: A Systematic Review and Meta-Analysis

Disparities in presentation and management of chronic hepatitis B among Hispanics in a diverse safety net system

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