Research Spotlight

Howard, C. E. and P. A. McCullough (2017). “Decoding acute myocardial infarction among patients on dialysis.” J Am Soc Nephrol 28(5): 1337-1339.

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In this issue of the Journal of the American Society of Nephrology, Shroff et al. utilized hospital billing records from patients on HD in the United States.3 In brief, professional coding specialists determine the principal diagnosis as that condition, established after study, which resulted in the patient’s admission to the hospital. Secondary diagnoses include comorbidities, complications, and other diagnoses that are documented by the attending physician on the inpatient face sheet, discharge summary, history and physical, consultation reports, operative reports, and other ancillary reports. Age, sex, discharge destination, principal diagnosis, up to 24 secondary diagnoses, and up to 25 procedure codes are entered into a computerized algorithm to generate the Medicare diagnosis-related group that determines payment to the hospital.4 The authors demonstrated that although the overall AMI claims in patients on dialysis have increased, the proportion of those in the principal position decreased, whereas those in the secondary position increased.3 In particular, the overall and proportional increase of NSTEMI claims increased dramatically in both the principal and secondary coding positions. These data are consistent with the general population, where several studies have shown a sharp decline in ST-segment elevation myocardial infarction (STEMI) and a lesser decline or increase in NSTEMI.5,6 Interestingly, other data sources suggest that unstable angina is ever less frequent because more sensitive troponin assays clinch a diagnosis of NSTEMI over unstable angina in about 98% of cases.7

Hollander, P., H. E. Bays, J. Rosenstock, M. E. Frustaci, A. Fung, F. Vercruysse and N. Erondu (2017). “Coadministration of canagliflozin and phentermine for weight management in overweight and obese individuals without diabetes: A randomized clinical trial.” Diabetes Care 40(5): 632-639.

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OBJECTIVE: To assess the efficacy and safety of coadministration of canagliflozin (CANA) and phentermine (PHEN) compared with placebo (PBO) and CANA or PHEN monotherapies in individuals who were overweight and obese without type 2 diabetes. RESEARCH DESIGN AND METHODS: This 26-week, phase 2a, randomized, double-blind, PBO-controlled, multicenter, parallel-group study enrolled individuals who were obese or overweight without type 2 diabetes (N = 335, aged 18-65 years, BMI >/=30 to <50 kg/m2 or BMI >/=27 to <50 kg/m2 with hypertension and/or dyslipidemia). Participants were randomized (1:1:1:1) to receive PBO, CANA 300 mg, PHEN 15 mg, or coadministration of CANA 300 mg and PHEN 15 mg (CANA/PHEN) orally once daily. The primary end point was percent change in body weight from baseline to week 26; key secondary end points were the proportion of participants achieving weight loss >/=5% and change from baseline in systolic blood pressure. RESULTS: CANA/PHEN provided statistically superior weight loss from baseline versus PBO at week 26 (least squares mean difference -6.9% [95% CI -8.6 to -5.2]; P < 0.001). CANA/PHEN also provided statistically superior achievement of weight loss >/=5% and reduction in systolic blood pressure compared with PBO. CANA/PHEN was generally well tolerated, with a safety and tolerability profile consistent with that of the individual components. CONCLUSIONS: CANA/PHEN produced meaningful reductions in body weight and was generally well tolerated in individuals who were overweight or obese without type 2 diabetes. Further studies are warranted to evaluate potential use of this combination for long-term weight management.

Havrdova, E., G. Giovannoni, R. Gold, R. J. Fox, L. Kappos, J. T. Phillips, M. Okwuokenye and J. L. Marantz (2017). “Effect of delayed-release dimethyl fumarate on no evidence of disease activity in relapsing-remitting multiple sclerosis: Integrated analysis of the phase iii define and confirm studies.” Eur J Neurol 24(5): 726-733.

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BACKGROUND AND PURPOSE: Significant effects on clinical/neuroradiological disease activity have been reported in patients with relapsing-remitting multiple sclerosis treated with delayed-release dimethyl fumarate (DMF) in phase III DEFINE/CONFIRM trials. We conducted a post hoc analysis of integrated data from DEFINE/CONFIRM to evaluate the effect of DMF on achieving no evidence of disease activity (NEDA) in patients with relapsing-remitting multiple sclerosis. METHODS: The analysis included patients randomized to DMF 240 mg twice daily, placebo or glatiramer acetate (CONFIRM only) for

Mack, M. (2017). “The transatlantic relationship: Hands across the ocean from borst to mohr.” Thorac Cardiovasc Surg 65(S 03): S164-s166.

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The metaphor of “hands across the ocean” was first embraced by Hans Borst in 1985 to define the close, collaborative relationship between German and American thoracic surgeons ([Fig. 1]).[1] In the postwar era, numerous American surgeons helped put German thoracic surgery back on its feet. This led to a bidirectional transatlantic alliance in which patients in both countries benefited from the cross-fertilization and coeducation among surgeons. Prof. Friedrich Mohr crossed the ocean in the late 1980s to build a lifelong collaboration with, among others, Jack Matloff and Frank Litvak at the Cedars-Sinai Medical Center in Los Angeles, United States.

Roden-Foreman, J. W., M. M. Bennett, E. E. Rainey, J. S. Garrett, M. B. Powers and A. M. Warren (2017). “Secondary traumatic stress in emergency medicine clinicians.” Cogn Behav Ther: 1-11.

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Previously called Secondary Traumatic Stress (STS), secondary exposure to trauma is now considered a valid DSM-5 Criterion A stressor for posttraumatic stress disorder (PTSD). Previous studies have found high rates of STS in clinicians who treat traumatically injured patients. However, little research has examined STS among Emergency Medicine (EM) physicians and advanced practice providers (APPs). The current study enrolled EM providers (N = 118) working in one of 10 hospitals to examine risk factors, protective factors, and the prevalence of STS in this understudied population. Most of the participants were physicians (72.9%), Caucasian (85.6%), and male (70.3%) with mean age of 39.7 (SD = 8.9). Overall, 12.7% of the sample screened positive for STS with clinical levels of intrusion, arousal, and avoidance symptom clusters, and 33.9% had at least one symptom cluster at clinical levels. Low resilience and a history of personal trauma were positively associated with positive STS screens and STS severity scores. Borderline significance suggested that female gender and spending >/=10% of one’s time with trauma patients could be additional risk factors. Findings suggest that resilience-building interventions may be beneficial.