海外実習：Day 2（Outpatient)

Visiting Scholars' Lecture

• My Learning

  • Current trend for liver transplant: decrease in HCV, increase in alcohol and MASLD

  • MELD (Model for End-stage Liver Disease) score -> equity and social justice of liver allocation 

    • MELD was originally developed to predict three-month mortality following transjugular intrahepatic portosystemic shunt (TIPS) placement.

    • short = limited size of abdominal cavity -> limits on size of the liver  

    • HCC more likely to get the transplantation 

    • Cre -> men have more muscle 

      • With the order score, men had more advantage in getting the liver than women. 

      • Now it is capped to Cre 3 -> in the future possibly get rid of it?

    • Future -> acute on chronic liver failure (greater than 2 organ failure), 

  • Policy making. How fast new things get incorporated into the system. 

  • AI vs Human -> importance of interpreting the model by human 

    • From the data collected, hyponatremia and hypernatremia seems to be associated with worse prognosis. However, when you look into the detail with hypernatremia -> hepatic encephalopathy -> drinking center in the brain is down -> doesn't feel the thirst -> dehydrate -> hypernatremia. (The presenter was kind making it as a joke, so I'm not really sure my understanding is correct. The point is, be critical with the data you get.) 

• My Takeaways

  • Occasionally, I do see revised version of the predictive models. However, I never understood the reason behind the revision. I thought it was because the previous models became outdated, so they were forced to create a better one. With the case of MELD, the doctor had the vision of revising the score for the best of the patient (for organs to be placed in hands of those who need it). 

  • The importance of using your head to think. Not just relying on the AI. 

• My Thoughts（個人的な感想）

  • The scholar was img and has risen to the top. Being ambitious is really important.

  •  めちゃくちゃ凄い人だと思った。経歴もそうだし。プレゼンする時も堂々としていて、人前で話慣れしていた。アメリカ人みたいに所々jokeを入れてた。もちろん、発音も完璧だった。ぱっとした見た目は落ち着いた方だったけど、内側には沢山のambitionを秘めていることを感じた。MELDスコアでも十分な業績なのに、それとは別に新しいことをやろうとしていた。あの穏やかな雰囲気な中にどこか、怖さも感じとれた。

Clinic 

• My Learning (Notes)

  • Cancer Screening for cirrhosis and HBV 

  • Transplant and HCC with relation to MELD

  • Hemochromatosis

  • Imaging

    • iron overload -> can be detected by MRI 

    • fibrosis scanning by ultrasound -> better to be done on empty stomach 

• My Thoughts 

  • I was amazed by the doctor patient interaction. Two of the patient was basically telling me how amazing the she was. You could tell that the doctor really cared for the patient.

    • The main difference was, the doctor was making sure that the patient really understood their situation. If the patient skipped their schedule for the US, she would ask "Do you know what we are looking with the US?" Doctor first confirmed the patient's knowledge to get a look at their understanding level -> tell them the importance of screening for cancer. I could tell, she was trying to understand at which point the patient was "stuck" on.

      • One of the patient was like, even if a liver cancer were founded, I have so many other medical issues to worry about that liver is the least of my problems. She explained how if they find a liver cancer very small, they will be able to treat in a less invasive way.  

      • Another patient said that he knows that he was fatty liver, but there are now treatment option pharmaceutically, just diet and exercise, so why bother do them anyway. The doctor was explaining how there are new treatment options becoming available for MASLD. 

    • You could literally see how trust is formed between the doctor and the patient by the way patient starts listening to you. 

  • There are doctors who seem kind and nice. However, there are sometimes you need to be kind of "strict" with them. I understood the importance of educating the patient. This is one way to build trust.