Citations

AbstractBackgroundStudies reveal that ileal pouch‐anal anastomosis (IPAA) has long‐term success. These reports, however, use well‐selected cohorts and exclude patients presenting with fulminant colitis (FC). Herein, we aimed to characterize long‐term functional outcomes in patients with fulminant ulcerative colitis (UC) undergoing IPAA.MethodsA prospective database identified patients who underwent IPAA between 1998 and 2008. Patients with FC and chronic UC were matched by age, gender, date of surgery, and follow‐up duration. Clinical and laboratory parameters, immunomodulator use at the time of surgery, and functional outcomes were compared.ResultsForty patients with FC and 73 patients with chronic UC were identified. Preoperative albumin, hemoglobin, leukocyte count, and steroid dose were significantly different for those with FC. Average survey follow‐up was 5.2 years for FC and 6.7 years for chronic UC patients. Functional outcomes were not significantly different. The 3‐year fistula‐free rate was 91.4 versus 98.6 % and the 3‐year stricture‐free rate was 79.3 versus 87.2 % for FC versus chronic UC patients, respectively.ConclusionPatients undergoing colectomy for FC secondary to UC have similar long‐term functional outcomes after IPAA despite significantly worse presentation. This study confirms that IPAA is an appropriate and durable treatment for patients with FC.

Abstract Background. The increase in breast cancer risk during pregnancy and postpartum is well known; however, the molecular phenotype of breast cancers occurring shortly after pregnancy has not been well studied. Given this, we investigated whether nulliparity and the time interval since pregnancy among parous women affects the breast cancer phenotype in young women. Materials and Methods. We examined molecular phenotype in relation to time since pregnancy in a prospective cohort of 707 young women (aged ≤40 years) with breast cancer. Parity was ascertained from study questionnaires. Using tumor histologic grade on central review and biomarker expression, cancers were categorized as luminal A- or B-like, HER2 enriched, and triple negative. Results. Overall, 32% were luminal A-like, 41% were luminal B-like, 9% were HER2 enriched, and 18% were triple negative. Although, numerically, patients diagnosed >5 years after pregnancy had more luminal A-like subtypes than women with shorter intervals since pregnancy, there was no evidence of a relationship between these intervals and molecular subtypes once family history of breast cancer and age at diagnosis were considered. Conclusion. Distribution of breast cancer molecular phenotype did not differ significantly among young women by parity or time interval since parturition when important predictors of tumor phenotype such as age and family history were considered. Implications for Practice: Distribution of breast cancer molecular phenotype did not differ among parous young women by time interval since pregnancy. The implication of these findings for clinical practice suggests that pregnancy-associated breast cancers may be seen up to 5 years beyond parturition.

BACKGROUNDThere is little research regarding characteristics of effective continuing medical education (CME) presentations in hospital medicine (HM). Therefore, we sought to identify associations between validated CME teaching effectiveness scores and characteristics of CME presentations in the field of HM.DESIGN/SETTINGThis was a cross‐sectional study of participants and didactic presentations from a national HM CME course in 2014.MEASUREMENTSParticipants provided CME teaching effectiveness (CMETE) ratings using an instrument with known validity evidence. Overall CMETE scores (5‐point scale: 1 = strongly disagree; 5 = strongly agree) were averaged for each presentation, and associations between scores and presentation characteristics were determined using the Kruskal‐Wallis test. The threshold for statistical significance was set at P < 0.05.RESULTSA total of 277 out of 368 participants (75.3%) completed evaluations for the 32 presentations. CMETE scores (mean [standard deviation]) were significantly associated with the use of audience response (4.64 [0.16]) versus no audience response (4.49 [0.16]; P = 0.01), longer presentations (≥30 minutes: 4.67 [0.13] vs <30 minutes: 4.51 [0.18]; P = 0.02), and larger number of slides (≥50: 4.66 [0.17] vs <50: 4.55 [0.17]; P = 0.04). There were no significant associations between CMETE scores and use of clinical cases, defined goals, or summary slides.CONCLUSIONSTo our knowledge, this is the first study regarding associations between validated teaching effectiveness scores and characteristics of effective CME presentations in HM. Our findings, which support previous research in other fields, indicate that CME presentations may be improved by increasing interactivity through the use of audience response systems and allowing longer presentations. Journal of Hospital Medicine 2015;10:569–573. © 2015 Society of Hospital Medicine

The objective of this analysis of 4500 inpatients was to identify the experience and expectations of 18–35 year olds regarding chaplain visitation and to compare results with data from older adults. 71% of young adults reported wanting to be visited by a chaplain; 45.5% were visited; 68% indicated that this was important. Young adults value chaplains' role as a sign of God's care and presence (77.4%), in providing support for family (73.6%), being present during times of anxiety (66.0%), and praying/reading scripture with them (62.3%). Results were similar to older respondents, but young adults were more likely to value ethical counsel from chaplains (58.5% vs. 38.2%). This study provides clinically relevant information and suggestions for further research.

ABSTRACTBioinformatics approaches to examine gene‐gene models provide a means to discover interactions between multiple genes that underlie complex disease. Extensive computational demands and adjusting for multiple testing make uncovering genetic interactions a challenge. Here, we address these issues using our knowledge‐driven filtering method, Biofilter, to identify putative single nucleotide polymorphism (SNP) interaction models for cataract susceptibility, thereby reducing the number of models for analysis. Models were evaluated in 3,377 European Americans (1,185 controls, 2,192 cases) from the Marshfield Clinic, a study site of the Electronic Medical Records and Genomics (eMERGE) Network, using logistic regression. All statistically significant models from the Marshfield Clinic were then evaluated in an independent dataset of 4,311 individuals (742 controls, 3,569 cases), using independent samples from additional study sites in the eMERGE Network: Mayo Clinic, Group Health/University of Washington, Vanderbilt University Medical Center, and Geisinger Health System. Eighty‐three SNP‐SNP models replicated in the independent dataset at likelihood ratio test P < 0.05. Among the most significant replicating models was rs12597188 (intron of CDH1)–rs11564445 (intron of CTNNB1). These genes are known to be involved in processes that include: cell‐to‐cell adhesion signaling, cell‐cell junction organization, and cell‐cell communication. Further Biofilter analysis of all replicating models revealed a number of common functions among the genes harboring the 83 replicating SNP‐SNP models, which included signal transduction and PI3K‐Akt signaling pathway. These findings demonstrate the utility of Biofilter as a biology‐driven method, applicable for any genome‐wide association study dataset.

Abstract Background: Racial disparities in breast cancer (BC) outcomes are well-documented. As guidelines for BC screening change, it is particularly important that women have accurate knowledge of risk factors in order to meaningfully participate in screening decisions. We examined knowledge of risk factors for BC among a nationally representative sample of women for whom mammography screening is routinely recommended. Method: Non-Hispanic black (B), non-Hispanic white (W), Hispanic (H), and women of other/multiple races (O) were surveyed using a probability-based web panel weighted to match the known U.S. population of females aged 40-74 years. A total of 17 items were presented in English or Spanish; response options included: “does not put you at increased risk,” “puts you at a small increased risk,” and “puts you at a large increased risk.” For scoring, the latter two categories were combined to reflect “increased risk.” Items included 9 established risk factors: having mammographically dense breasts, first-degree relative diagnosed with BC, second-degree relative diagnosed with BC, drinking alcohol in excess, history of a breast biopsy, having a first child after age 30, use of hormone therapy for postmenopausal symptoms, BRCA gene mutation, late onset of menopause; 5 protective factors: menarche after age 15, having children, breastfeeding, having a diet rich in fruits and vegetables, exercising or being active; one factor with no clear association: being a smoker (correct response was no increased risk); and 2 distractors (beliefs for which there is no evidence, correct response was no increased risk): using antiperspirant/talc under your arms, experiencing injury/trauma to the breast. The survey cooperation rate was 65% (1,506 responders out of 2,311). Items were scored correct if the respondent's answer matched the actual risk profile (either does/does not put you at increased risk). Percent correct was calculated for each item overall and by race/ethnicity. All reported percentages and analyses are weighted to be nationally representative and compared for differences based on race/ethnicity using logistic regression models. P-values represent differences in percent correct between the racial/ethnic groups. Results: Knowledge of risk factors varied across items (range &gt;90% to 20% correct). Percent correct was high overall for classifying a first-degree relative with BC as a risk factor and differed by race/ethnicity, with 86% B, 98% W, 92% H and 92% O recognizing this risk factor (p&lt;0.001); similar percentages were observed for second-degree relatives (p=0.003). Lower knowledge overall was observed for risk factors including BRCA mutation (25% B, 44% W, 24% H, 38% O, p=0.002), later onset of menopause (41% B, 38% W, 42% H, 37% O, p=0.92), and having the first child after age 30 (39% B, 41% W, 38% H, 33% O, p=0.53). Having mammographically dense breasts is one of the strongest risk factors for BC, however knowledge of this was only moderate and did not differ by race/ethnicity (61% B, 54% W, 56% H, 52% O, p=0.64). Relative to risk factors, knowledge of protective factors was generally higher; only correct classification of fruits/vegetables as a protective factor differed by race/ethnicity (84% B, 93% W, 88% H, 89% O, p=0.03). Most women correctly responded that use of antiperspirant/talc does not increase risk of BC, however 60% of H women incorrectly classified injury/trauma to the breast as a risk factor, relative to 50% B, 41% W, and 40% O (p=0.02). Conclusions: Among U.S. women, there is wide variation in knowledge across several established BC risk factors and only moderate knowledge of breast density as an important risk factor. Differences in knowledge by race/ethnicity for several risk factors highlight the need for targeted education. Citation Format: Carmen Radecki Breitkopf, Deborah J. Rhodes, Sarah M. Jenkins, Jeanette Y. Ziegenfuss, Celine M. Vachon. Racial and ethnic differences in knowledge of risk factors for breast cancer: Findings from a recent national survey. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B42. doi:10.1158/1538-7755.DISP13-B42