Research Spotlight

Brill, J. V., J. A. Ashmore, M. L. Brengman, D. E. Buffington, S. D. Feldshon, K. E. Friedman, P. S. Margolis, D. Markus, L. Narramore, A. Rastogi, A. A. Starpoli, K. Strople, J. V. White and S. E. Streett (2017). “White paper aga: An episode-of-care framework for the management of obesity-moving toward high value, high quality care: A report from the american gastroenterological association institute obesity episode of care and bundle initiative work group.” Clin Gastroenterol Hepatol 15(5): 650-664.

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The American Gastroenterological Association acknowledges the need for gastroenterologists to participate in and provide value-based care for both cognitive and procedural conditions. Episodes of care are designed to engage specialists in the movement toward fee for value, while facilitating improved outcomes and patient experience and a reduction in unnecessary services and overall costs. The episode of care model puts the patient at the center of all activity related to their particular diagnosis, procedure, or health care event, rather than on a physician’s specific services. It encourages and incents communication, collaboration, and coordination across the full continuum of care and creates accountability for the patient’s entire experience and outcome. This paper outlines a collaborative approach involving multiple stakeholders for gastrointestinal practices to assess their ability to participate in and implement an episode of care for obesity and understand the essentials of coding and billing for these services.

Farber, A. J., K. Suarez, K. Slicker, C. D. Patel, B. Pope, R. Kowal and J. B. Michel (2017). “Frequency of troponin testing in inpatient versus outpatient settings.” Am J Cardiol 119(8): 1153-1155.

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Troponin elevation is required to diagnose acute myocardial infarction (AMI), yet elevated values are often encountered in noncardiac disease states. We evaluated inpatient (IP) and outpatient (OP) encounters at 14 hospitals in calendar year 2014 and found that troponin assays were performed during 12% of all OP visits and 29% of all IP visits: 82,853 encounters in all. We employed an expert panel to estimate the likelihood of AMI based on primary International Statistical Classification of Diseases and Related Health Problems, 9th edition diagnoses. We compared IP and OP testing, finding that AMI would not be expected in most IP encounters. Sepsis was the most common diagnosis associated with IP troponin testing. We found an association between troponin testing in patients with sepsis and utilization of electrocardiography, echocardiography, and cardiac catheterization. Our data indicate that troponin testing has expanded beyond patient populations in whom AMI might be expected.

Garofalo, R., E. Ceccarelli, A. Castagna, V. Calvisi, B. Flanagin, M. Conti and S. G. Krishnan (2017). “Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for type v acromioclavicular joint dislocation.” Knee Surg Sports Traumatol Arthrosc: Apr [Epub ahead of print].

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PURPOSE: Appropriate surgical management for type V complete acromioclavicular (AC) joint dislocation remains controversial. The purpose of this paper is to retrospectively report the clinical and radiographic outcomes of an open surgical technique consisting for AC joint ligamentous and capsular reconstruction using autologous hamstring tendon grafts and semi-permanent sutures. METHODS: Between January 2005 and December 2011, 32 consecutive patients with symptomatic type V complete AC joint dislocation underwent surgical treatment using the same technique. The median time from injury to surgery was 45 days (range 24-90). The average median postoperative clinical and radiographic follow-up time was 30 months (range 24-33). Clinical outcomes measures included the ASES score, the visual analog score (VAS), and subjective patient satisfaction score. Minimum follow-up was 2 years. RESULTS: ASES score increased from a median of 38.2 +/- 6.2 preoperative to 92.1 +/- 4.7 postoperatively (p

Kim, T. W., E. Choi, J. Park, D. H. Shin, S. K. Jung, S. Seok, K. H. Cho, J. Y. Kim, D. Y. Kim, T. H. Kim, Y. K. Suh, Y. J. Kim and S. H. Moon (2017). “Clinical outcomes of proton beam therapy for choroidal melanoma at a single institute in korea.” Cancer Res Treat: Apr [Epub ahead of print].

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Purpose: This study retrospectively evaluated the clinical outcomes and complications of proton beam therapy (PBT) in a single institution in Korea and quantitatively analyzed the change in tumor volume after PBT using magnetic resonance imaging (MRI). Materials and Methods: Twenty-four treatment-naive patients who underwent PBT for choroidal melanoma between 2009 and 2015 were reviewed. Dose fractionation was 60-70 CGE over 5 fractions. Orbital MRIs were taken at baseline and 3, 6, and 12 months after PBT and annually thereafter. The tumor volume was reconstructed and evaluated by stacking the tumor boundary in each thin-sliced axial T1-weighted image using MIM software (MIM software Inc., Cleveland, OH, USA). Results: The median follow-up duration was 36.5 (range, 9-82) months. One patient had suspicious local progression and two patients had distant metastasis. The 3-year local progression-free survival, distant metastasis-free survival, and overall survival rates were 95.8%, 95.8%, and 100%, respectively. Five CTCAE (v 4.03) grade 3-4 toxicities were observed in four patients (16.7%), including one with neovascular glaucoma. The mean tumor volume at the baseline MRI was 0.565 +/- 0.084 (range, 0.074-1.61) ml, and the ratios of the mean volume at 3, 6, and 12 months to that at baseline were 81.8%, 67.3%, and 60.4%, respectively. Conclusions: The local control rate and complication profile after PBT in patients with choroidal melanoma in Korea were comparable with those reported in a previous PBT series. The change in tumor volume after PBT exhibited a gradual regression pattern on MRI.

Jacquart, J., S. Papini, M. L. Davis, D. Rosenfield, M. B. Powers, G. M. Frierson, L. B. Hopkins, S. O. Baird, B. H. Marcus, T. S. Church, M. W. Otto, M. J. Zvolensky and J. A. J. Smits (2017). “Identifying attendance patterns in a smoking cessation treatment and their relationships with quit success.” Drug Alcohol Depend 174: 65-69.

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BACKGROUND: While important for substance use outcomes, knowledge about treatment attendance patterns, and their relation with clinical outcomes is limited. We examined the association between attendance patterns and smoking outcomes in a randomized, controlled smoking cessation intervention trial. METHODS: In addition to standard smoking cessation treatment, participants were randomized to 15 weeks of an exercise intervention (n=72) or an education control condition (n=64). Latent class growth analysis (LCGA) tested whether intervention attendance would be better modeled as qualitatively distinct attendance patterns rather than as a single mean pattern. Multivariate generalized linear mixed modeling (GLMM) was used to evaluate associations between the attendance patterns and abstinence at the end of treatment and at 6-month follow-up. RESULTS: The LCGA solution with three patterns characterized by high probability of attendance throughout (Completers, 46.3%), gradual decreasing probability of attendance (Titrators, 23.5%), and high probability of dropout within the first few weeks (Droppers, 30.1%) provided the best fit. The GLMM analysis indicated an interaction of attendance pattern by treatment condition, such that titration was associated with lower probability of quit success for those in the control condition. Probability of quit success was not significantly different between Titrators and Completers in the exercise condition. CONCLUSIONS: These findings underscore the importance of examining how treatment efficacy may vary as a function of attendance patterns. Importantly, treatment discontinuation is not necessarily indicative of poorer abstinence outcome.