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Preventing Hepatic Encephalopathy in Patients With Cirrhosis: Rural Medicine Perspectives

Gain expert perspectives on managing patients at risk for recurrent HE and selecting effective oral therapies for patients with a history of HE.

Physicians: Maximum of 0.75 AMA PRA Category 1 Credit

Released: March 17, 2020

Expiration: March 16, 2021

No longer available for credit.



Terry D. Box

Terry D. Box, MD

Associate Professor of Medicine
Department of Internal Medicine
Division for Gastroenterology, Hepatology, Nutrition
University of Utah School of Medicine
Salt Lake City, Utah

Provided by

Provided by Clinical Care Options, LLC
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Supported by educational grants from

Mallinckrodt Pharmaceuticals

Salix Pharmaceuticals



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Target Audience

This program is intended for physicians, nurses, physician assistants, nurse practitioners, and other healthcare providers who care for patients with or at risk of recurrent HE.

Learning Objectives

Upon completion of this activity, participants should be able to:
  • Identify individuals at risk for HE
  • Monitor and effectively manage patients at risk for recurrent HE
  • Consider the mechanisms of actions, administration, effectiveness, and adverse events of oral therapies that can be used in patients with a history of HE


Clinical Care Options, LLC (CCO) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any relevant conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to CCO policy. CCO is committed to providing its learners with high-quality CME/CE activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME/CE activity:

Faculty Disclosure

Primary Author

Terry D. Box, MD

Associate Professor of Medicine
Department of Internal Medicine
Division for Gastroenterology, Hepatology, Nutrition
University of Utah School of Medicine
Salt Lake City, Utah

Terry D. Box, MD, has disclosed that he has received consulting fees from Gilead Sciences, Intercept, and Targeted Oncology and fees for non-CME/CE services from Chronic Liver Disease Foundation, Gilead Sciences, and Intercept.

Staff Disclosure


David C. Howard,

Editorial Contributor

David C. Howard has no relevant conflicts of interest to report.

Kiran Mir-Hudgeons, PhD

Clinical Editor

Kiran Mir-Hudgeons, PhD, has no relevant conflicts of interest to report.

Anne Roc, PhD

Director, Scientific Services

Anne Roc, PhD, has no relevant conflicts of interest to report.

Zachary Schwartz, MSc, ELS

Scientific Director

Zachary Schwartz, MSc, has no relevant conflicts of interest to report.

Instructions for Credit


Joint Accreditation Statement

In support of improving patient care, Clinical Care Options, LLC (CCO) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Credit Designation

CCO designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Additional Information

Participation in this self-study activity should be completed in approximately 0.75 hours. To successfully complete this activity and receive credit, participants must follow these steps during the period from March 17, 2020, through March 16, 2021:

1. Register online at
2. Read the target audience, learning objectives, and faculty disclosures.
3. Study the educational activity online or printed out.
4. Submit answers to the posttest questions and evaluation questions online.

You must receive a test score of at least 65% and respond to all evaluation questions to receive a certificate. After submitting the evaluation, you may access your online certificate by selecting the certificate link on the posttest confirmation page. Records of all CME/CE activities completed can be found on the "CME/CE Manager" page. There are no costs/fees for this activity.

Program Medium

This program has been made available online.


The goal of this activity is to improve rural clinicians’ knowledge of HE and increase their competence in delivering care aimed at preventing recurrent HE in patients with cirrhosis.