The American journal of medicine
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Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States and is soon to be the leading cause of liver transplantation. Patients at the greatest risk are those with obesity and type 2 diabetes mellitus. In 2019 the American Diabetes Association guidelines called, for the first time, for clinicians to screen for steatohepatitis and fibrosis all patients with type 2 diabetes and liver steatosis or abnormal plasma aminotransferases. ⋯ Early diagnosis in the primary care setting is critical to prevent progression to end-stage liver disease. Patients with NAFLD are also at a higher risk of developing type 2 diabetes mellitus and cardiovascular disease. Despite general perception to the contrary, weight loss by lifestyle intervention or bariatric surgery and several pharmacological treatments (eg, vitamin E in nondiabetics, pioglitazone or glucagon-like peptide 1 receptor agonists in patients with or without diabetes) can often be successful to reverse steatohepatitis and prevent disease progression.
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It is acknowledged that empathy plays a critical role in the physician-patient relationship and has a positive impact on health outcomes. However, as the field of empathy expands, the lack of conceptual coherence challenges advances in medicine. In fact, in some medical settings, there is little added theoretical or clinical value in applying the all-encompassing term of empathy, which is by nature multidimensional, interpersonal, and modulated by context. ⋯ These components are relatively independent but often interact and are deeply interwoven in the fabric of the brain. Nevertheless, it seems clear from this review that cultivating empathic concern or compassion in today's medicine is more important than other aspects of empathy, like vicariously experiencing and introspecting about patients' emotions. Specific neurobiological mechanisms explain the benefit to patients of their physicians' perceived empathy.