Background Healthcare delivery now mandates shorter visits with higher documentation requirements, undermining the patient-provider interaction. To improve clinic visit efficiency, we developed a patient-provider portal that systematically collects patient symptoms using a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS). AEGIS also automatically “translates” the patient report into a full narrative history of present illness (HPI). We aimed to compare the quality of computer-generated vs. physician-documented HPIs. Methods We performed a cross-sectional study with a paired sample design among individuals visiting outpatient adult gastrointestinal (GI) clinics for evaluation of active GI symptoms. Participants first underwent usual care and then subsequently completed AEGIS. Each individual thereby had both a physician-documented and computer-generated HPI. Forty-eight blinded physicians assessed HPI quality across six domains using 5-point scales: (1) overall impression; (2) thoroughness; (3) usefulness; (4) organization; (5) succinctness; and (6) comprehensibility. We compared HPI scores within patient using a repeated measures model. Results Seventy-five patients had both computer-generated and physician-documented HPIs. The mean overall impression score for computer-generated HPIs was higher versus physician HPIs (3.68 vs. 2.80; p<.001), even after adjusting for physician and visit type, location, mode of transcription, and demographics. Computer-generated HPIs were also judged more complete (3.70 vs. 2.73; p<.001), more useful (3.82 vs. 3.04; p<.001), better organized (3.66 vs. 2.80; p<.001), more succinct (3.55 vs. 3.17; p<.001), and more comprehensible (3.66 vs. 2.97; p<.001). Conclusion Computer-generated HPIs were of higher overall quality, better organized, and more succinct, comprehensible, complete and useful compared to HPIs written by physicians during usual care in GI clinics.

Summary Background Infection is the most common cause of mortality in end‐stage liver disease (ESLD). The impact of obesity on infection risk in ESLD is not established. Aim To characterise the impact of obesity on infection risk in ESLD. Methods We evaluated the association between infection and obesity in patients with ESLD. Patients grouped as non‐obese, obesity class I–II and obesity class III were studied using the Nationwide Inpatient Sample. Validated diagnostic code based algorithms were utilised to determine weight category and infections, including bacteraemia, skin/soft tissue infection, urinary tract infection (UTI), pneumonia/respiratory infection, Clostridium difficile infection (CDI) and spontaneous bacterial peritonitis (SBP). Risk factors for infection and mortality were assessed using multivariable logistic regression analysis. Results Of 115 465 patients identified, 100 957 (87.5%) were non‐obese and 14 508 (12.5%) were obese, with 9489 (8.2%) as obesity class I–II and 5019 (4.3%) as obesity class III. 37 117 patients (32.1%) had an infection diagnosis. Infection was most prevalent among obesity class III (44.0%), followed by obesity class I–II (38.9%) and then non‐obese (31.9%). In multivariable modelling, class III obesity (OR = 1.41; 95% CI 1.32–1.51; P < 0.001), and class I–II obesity (OR = 1.08; 95% CI 1.01–1.15; P = 0.026) were associated with infection. Compared to non‐obese patients, obese individuals had greater prevalence of bacteraemia, UTI, and skin/soft tissue infection as compared to non‐obese patients. Conclusions Obesity is newly identified to be independently associated with infection in end‐stage liver disease. The distribution of infection sites varies based on weight category.

The effect of highly active antiretroviral therapy (HAART) on hepatitis C virus (HCV) infection remains unclear. Spontaneous HCV clearance with initiation of HAART in non-cirrhotic HCV patients co-infected with human immunodeficiency virus (HIV) has been reported. We describe an HIV/HCV patient with decompensated cirrhosis, who had spontaneous HCV clearance after an episode of elevated liver enzymes and a change in HAART regimen. His HCV RNA level remained undetectable for six months by quantitative and qualitative polymerase chain reaction (PCR) tests. The disappearance of HCV RNA may be due to a combination of host immune recovery, genetic polymorphism and direct effect of HAART against HCV.

Mild idiopathic adulthood ductopenia (IAD) is a rare cholestatic disease of unknown cause and characterized by interlobular bile duct loss in less than 50% of the portal tracts. We describe the case of a middLe-aged male who presented with persistent elevation of transaminases and alkaline phosphatase. He had a normal biliary tree on endoscopic retrograde cholangiopathy and negative anti-mitochondrial antibody. His liver biopsy specimen showed chronic biliary disease, duct loss in 4 out of 15 portal tracts and prominent cholestasis. Based on the work-up, he likely had mild IAD. Liver transplantation would be necessary if his disease becomes progressive.