Johnson, P.J. (Philip J.)

Filtering

2020 - 20222

Settings

Author search.filters.isAuthorOfPublication.2dbfc160-215e-442b-8553-9cee7c667066

Search Results

Now showing 1 - 2 of 2
  • Thumbnail Image
    The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality
    (Elsevier BV, 2022) Yki-Järvinen, H. (Hannele); Christos, L. (Lionis); Verkade, H.J. (Henkjan J.); Karlsen, T.H. (Tom H.); Pryke, R. (Rachel); Flisiak, R. (Robert); Kelly, D. (Deirdre); Simonova, M. (Marieta); Serra-Burriel, M. (Miquel); Ginès, P. (Pere); Lerouge, A. (Alienor); Hutchinson, S.J. (Sharon J.); Barrett, D. (Damon); Manns, M.P. (Michael P.); Burra, P. (Patrizia); Mendive, J.M. (Juan M.); Ma, A.T. (Ann T.); Devaux, M. (Marion); Cecchini, M. (Michele); Belloni, A. (Annalisa); Sheena, B. (Brittney); Sangro, B. (Bruno); Marchesini, G. (Giulio); Ashworth-Dirac, M. (Mae); Reic, T. (Tatjana); Cortez-Pinto, H. (Helena); Zelber-Sagi, S. (Shira); Treloar, C. (Carla); Targher, G. (Giovanni); Cucchetti, A. (Alessandro); Carrieri, P. (Patrizia); Petersen, C. (Claus); Scott, N. (Nick); Byrne, C.D. (Chris D.); Buti, M. (Maria); Fabrellas, N. (Nuria); Rutter, H. (Harry); Hellard, M. (Margaret); Bugianesi, E. (Elisabetta); Schramm, C. (Christoph); Martin, N.K. (Natasha K.); Taylor, A. (Alison); Parés, A. (Albert); Lazarus, J.V. (Jeffrey V.); Sturm, E. (Ekkehard); Ponsioen, C.Y. (Cyriel Y.); Tur-Sinai, A. (Aviad); Pose, E. (Elisa); Johnson, P.J. (Philip J.); Burton, R. (Robyn); Mazzaferro, V. (Vicenzo); Newsome, P. (Philip N.); Ninburg, M. (Michael); Rhodes, T. (Tim); Sheron, N. (Nick); Dusheiko, G. (Geoffrey); Graupera, I. (Isabel)
    Liver diseases have become a major health threat across Europe, and the face of European hepatology is changing due to the cure of viral hepatitis C and the control of chronic viral hepatitis B, the increasingly widespread unhealthy use of alcohol, the epidemic of obesity, and undiagnosed or untreated liver disease in migrant populations. Consequently, Europe is facing a looming syndemic, in which socioeconomic and health inequities combine to adversely affect liver disease prevalence, outcomes, and opportunities to receive care. In addition, the COVID-19 pandemic has magnified pre-existing challenges to uniform implementation of policies and equity of access to care in Europe, arising from national borders and the cultural and historical heterogeneity of European societies. In following up on work from the Lancet Commission on liver disease in the UK and epidemiological studies led by the European Association for the Study of the Liver (EASL), our multidisciplinary Commission, comprising a wide range of public health, medical, and nursing specialty groups, along with patient representatives, set out to provide a snapshot of the European landscape on liver diseases and to propose a framework for the principal actions required to improve liver health in Europe. We believe that a joint European process of thinking, and construction of uniform policies and action, implementation, and evaluation can serve as a powerful mechanism to improve liver care in Europe and set the way for similar changes globally. On the basis of these data, we present ten actionable recommendations, half of which are oriented towards health-care providers and half of which focus primarily on health policy. A fundamental shift must occur, in which health promotion, prevention, proactive casefinding, early identification of progressive liver fibrosis, and early treatment of liver diseases replace the current emphasis on the management of end-stage liver disease complications. A considerable focus should be put on underserved and marginalised communities, including early diagnosis and management in children, and we provide proposals on how to better target disadvantaged communities through health promotion, prevention, and care using multilevel interventions acting on current barriers. Underlying this transformative shift is the need to enhance awareness of the preventable and treatable nature of many liver diseases. Therapeutic nihilism, which is prevalent in current clinical practice across a range of medical specialities as well as in many patients themselves, has to end. We wish to challenge medical specialty protectionism and invite a broad range of stakeholders, including primary care physicians, nurses, patients, peers, and members of relevant communities, along with medical specialists trained in obesity, diabetes, liver disease, oncology, cardiovascular disease, public health, addictions, infectious diseases, and more, to engage in integrated person-centred liver patient care across classical medical specialty boundaries. This shift includes a revision in how we converse about liver disease and speak with our patients, and a reappraisal of disease-related medical nomenclature conducted to increase awareness and reduce the social stigmatisation associated with liver disease. Reimbursement mechanisms and insurance systems must be harmonised to account for patient-centric, multimorbidity models of care across a range of medical specialties, and the World Health Assembly resolution to improve the transparency and fairness of market prices for medicines throughout Europe should be reinforced. Finally, we outline how Europe can move forward with implementation of effective policy action on taxation, food reformulation, and product labelling, advertising, and availability, similar to that implemented for tobacco, to reduce consumption of alcohol, ultraprocessed foods, and foods with added sugar, especially among young people. We should utilise the window of opportunity created by the COVID-19 pandemic to overcome fragmentation and the variability of health prevention policies and research across Europe. We argue that the liver is a window to the 21st-century health of the European population. Through our proposed syndemic approach to liver disease and social and health inequities in Europe, the liver will serve as a sentinel for improving the overall health of European populations.
  • Thumbnail Image
    Prediction of survival among patients receiving transarterial chemoembolization for hepatocellular carcinoma: A response-based approach
    (American Association for the Study of Liver Diseases, 2020) Ottaviani, D. (Diego); Jang, J.W. (Jeong W.); Elshaarawy, O. (Omar); Waked, I. (Imam); Berhane, S. (Sarah); García-Fiñana, M. (Marta); Peck-Radosavljevic, M. (Markus); Aithal, G.P. (Guru P.); Han, G. (Guohong); Hucke, F. (Florian); Pinato, D.J. (David J.); Sharma, R. (Rohini); Pirisi, M. (Mario); Kirstein, M. (Martha); Rewisha, E. (Eman); Chan, S.L. (Stephen L.); Meyer, T. (Tim); Sangro, B. (Bruno); Kudo, M. (Masatoshi); Vogel, A. (Arndt); Stern, N. (Nick); Palmer, D. (Daniel); Bettinger, D. (Dominik); Cucchetti, A. (Alessandro); Travis, S. (Simon); Gomaa, A. (Asmaa); Labeur, T.A. (Tim A.); Delden, O.M. (Otto M.) van; Mosconi, C. (Cristina); Takkenberg, R.B. (R. B.); Chan, A.W.H. (Anthony W. H.); Johnson, P.J. (Philip J.); Toyoda, H. (Hidenori); Fateen, W. (Waleed)
    Background and aims: The heterogeneity of intermediate-stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable. Approach and results: Clinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological responses (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) were also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A pre-TACE model ("Pre-TACE-Predict") and a post-TACE model ("Post-TACE-Predict") that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. The median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha-fetoprotein, albumin, bilirubin, vascular invasion, cause, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared with existing models (the hepatoma arterial embolization prognostic score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years. Conclusions: A TACE-specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient-level prognostication