Research Spotlight

Kane, E. P., A. W. Collinsworth, K. L. Schmidt, R. M. Brown, C. A. Snead, S. A. Barnes, N. S. Fleming and J. W. Walton (2016). “Improving diabetes care and outcomes with community health workers.” Fam Pract 33(5): 523-528.

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BACKGROUND: Type II diabetes continues to be a major health problem in USA, particularly in minority populations. The Diabetes Equity Project (DEP), a clinic-based diabetes self-management and education program led by community health workers (CHWs), was designed to reduce observed disparities in diabetes care and outcomes in medically underserved, predominantly Hispanic communities. OBJECTIVE: The purpose of this study was to evaluate the impact of the DEP on patients’ clinical outcomes, diabetes knowledge, self-management skills, and quality of life. METHODS: The DEP was implemented in five community clinics from 2009 to 2013 and 885 patients completed at least two visits with the CHW. Student’s paired t-tests were used to compare baseline clinical indicators with indicators obtained from patients’ last recorded visit with the CHW and to assess differences in diabetes knowledge, perceived competence in managing diabetes, and quality of life. A mixed-effects model for repeated measures was used to examine the effect of DEP visits on blood glucose (HbA1c), controlling for patient demographics, clinic and enrolment date. RESULTS: DEP patients experienced significant (P < 0.0001) improvements in HbA1c control, blood pressure, diabetes knowledge, perceived competence in managing diabetes, and quality of life. Mean HbA1c for all DEP patients decreased from 8.3% to 7.4%. CONCLUSION: Given the increasing prevalence of diabetes in USA and documented disparities in diabetes care and outcomes for minorities, particularly Hispanic patients, new models of care such as the DEP are needed to expand access to and improve the delivery of diabetes care and help patients achieve improved outcomes.

Jupiter, D. C., J. C. Thorud, C. J. Buckley and N. Shibuya (2016). “The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review.” Int Wound J 13(5): 892-903.

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A great deal of emphasis, clinical and financial, is placed on limb salvage efforts in diabetic patients suffering from lower extremity ulceration. This is because of the impression that amputation in such patients may be a proximal cause of death. While amputation is certainly a negative clinical outcome, it is not entirely clear that it causes death. In this systematic review, we examine the available literature to attempt to understand the role that the ulceration itself may play in mortality. In brief, we searched for human studies in OVID, CINAHL and the COCHRANE CENTRAL DATABASE from 1980 to 2013, looking for articles related to ulcer or wound of the foot, in patients with diabetes or peripheral vascular disease, and death. We looked for articles with 5 years of follow-up, or Kaplan-Meier estimates of 5-year mortality, and excluded reviews and letters. Articles were assessed for quality and potential bias using the Newcastle-Ottawa scale. We find that while the patient populations studied varied widely in terms of demographics and comorbidities, limiting generalisability, 5-year mortality rates after ulceration were around 40%. Risk factors for death commonly identified were increased age, male gender, peripheral vascular disease and renal disease.

Jackson, W. C., N. B. Desai, V. Tumati, J. Y. Lee, R. T. Dess, P. D. Soni, A. Abugharib, D. A. Hamstra, J. W. Hearn, H. M. Sandler, Z. S. Zumsteg, J. Montgomery, B. Hollenbeck, G. Palapattu, S. A. Tomlins, R. Mera, T. Morgan, F. Y. Feng and D. E. Spratt (2016). “Anatomic patterns of recurrence following biochemical relapse after postprostatectomy radiation therapy: A multi-institutional study.” Int J Radiat Oncol Biol Phys 96(2s): E234.

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The patterns of failure for patients receiving post-radical prostatectomy (RP) radiation therapy (RT) have not been well described. We sought to characterize the frequency of recurrence and development of distant metastases (DM) and describe the most common anatomic sites of DM in a cohort of men who received post-RP RT.E

Jackson, W. C., N. B. Desai, V. Tumati, J. Y. Lee, R. T. Dess, P. D. Soni, A. Abugharib, D. A. Hamstra, J. W. Hearn, H. M. Sandler, Z. S. Zumsteg, J. Montgomery, B. Hollenbeck, D. Miller, G. Palapattu, S. A. Tomlins, R. Mera, T. Morgan, F. Y. Feng and D. E. Spratt (2016). “Predictors of rapid treatment failure after postoperative radiation therapy: A multicenter study.” Int J Radiat Oncol Biol Phys 96(2s): S184-s185.

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Post-radical prostatectomy (RP) radiation therapy (RT) for prostate cancer is delivered with the assumption that residual disease remains localized within the post-operative bed. However, only 30-70% of patients remain disease-free long term, suggesting the presence of either micrometastatic or radioresistant disease. To identify these patients, we analyzed predictors of rapid early PSA progression within the first year following post-RP RT.

Iyengar, P., K. D. Westover, L. E. Court, M. K. Patel, A. T. Shivnani, M. W. Saunders, Y. Li, J. Y. Chang, A. Gao, C. Ahn, H. Choy and R. D. Timmerman (2016). “A phase iii randomized study of image guided conventional (60 gy/30 fx) versus accelerated, hypofractionated (60 gy/15 fx) radiation for poor performance status stage ii and iii nsclc patients-an interim analysis.” Int J Radiat Oncol Biol Phys 96(2s): E451.

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To evaluate overall survival (OS) in a comparison of image guided conventional versus accelerated, hypofractionated radiation delivered to poor performance status (PS) stage II and III non-small cell lung cancer (NSCLC) patients in a randomized phase III study.