Faculty Bibliography

Importance/UNASSIGNED:Interest is growing in targeting physician attire to improve the patient experience. Few studies in ophthalmology have examined patient preferences for physician attire. Objective/UNASSIGNED:To understand patient preferences for physician attire in ophthalmology practices in the United States. Design/UNASSIGNED:Survey-based, cohort study. Setting/UNASSIGNED:Two private and two academic ophthalmology practices. Participants/UNASSIGNED:A convenience sample of patients receiving ophthalmic care between June 1, 2015 and October 31, 2016. Methods/UNASSIGNED:A questionnaire containing 22 questions and photographs of a male and female physician in seven forms of attire were presented to patients; 14 unique questionnaires were randomly distributed. Patient preference for physician attire was the primary outcome determined by summing ratings of how knowledgeable, trustworthy, caring, approachable, and comfortable the pictured physician made the respondent feel. One-way ANOVA assessed differences in mean composite scores. Comparisons between respondent demographics, practice type, and attire preferences were assessed by chi-square tests. Patient satisfaction was assessed by agreement with questions about importance of physician attire and whether this influences happiness with care. Results/UNASSIGNED:< 0.05). Preferences for attire varied by clinical setting: patients preferred surgeons (45.2%) and physicians in emergency rooms (41.7%) in scrubs rather than formal attire with white coat. Conclusions/UNASSIGNED:Physician attire is important to patients receiving ophthalmic care. Policies aimed at physician attire in ophthalmology practices should be considered.

INTRODUCTION/BACKGROUND:HLA-B*5701 screening identifies patients at increased risk for abacavir (ABC) hypersensitivity reaction (HSR). Screening was adopted in GlaxoSmithKline and ViiV Healthcare clinical trials in 2007 and HIV treatment guidelines in 2008. Company meta-analyses of trials pre-HLA-B*5701 screening reported HSR rates of 4% to 8%. We analyzed the effectiveness of HLA-B*5701 screening on reducing HSR rates using clinical trial, observational (OPERA) cohort, and spontaneous reporting data. METHODS:A meta-analysis examined 12 trials in 3063 HLA-B*5701-negative patients receiving an ABC-containing regimen from April 9, 2007 to September 22, 2015. Potential cases were identified using pre-specified MedDRA preferred terms (drug hypersensitivity, hypersensitivity, anaphylactic reaction, anaphylaxis) and adjudicated against a Company ABC HSR case definition. Investigator-diagnosed cases were identified and rates were calculated. In the OPERA cohort, 9619 patients initiating their first ABC-containing regimen from January 1, 1999 to January 1, 2016 were identified. Patients were observed from regimen start until the earliest-following censoring event: ABC discontinuation, loss to follow-up, death, or study end (July 31, 2016). OPERA physicians evaluated events against OPERA definitions for definite/probable cases of ABC HSR; rates were calculated pre- and post-2008. The Company case definition was used to identify spontaneously reported cases for four marketed ABC-containing products; reporting rates were calculated using estimated exposure from sales data, through December 31, 2016. RESULTS:Suspected ABC HSR rates were 1.3% or less in the meta-analysis. In the OPERA cohort, the rate was 0.4% among patients initiating ABC post-2008 versus 1.3% pre-2008 (p<0.0001). Spontaneous reporting rates were low post-2008 (54 to 22 cases per 100,000 patient-years exposure [PYE]) versus pre-2008 (618 to 55 cases per 100,000 PYE). CONCLUSIONS:Clinically suspected ABC HSR rates were 1.3% or less in HLA-B*5701-negative patients. Recognizing their limitations, data from the OPERA cohort and spontaneous reporting indicate that HLA-B*5701 screening has reduced reporting rates of suspected HSR in clinical practice. Where screening for HLA-B*5701 is standard care, patients should be confirmed negative for this allele before starting ABC treatment.

OBJECTIVE:The objective of the study is to examine the validity of body mass index z score (zBMI) as a measure of percent body fat in prepubertal children. METHODS:One hundred eleven multiethnic, healthy, Tanner 1 children aged 6-12 years had fat percent and fat mass measured by the four-compartment method as part of the Paediatric Rosetta Body Composition Cohort. Multiple regression models were developed with fat percent as the dependent variable and zBMI, age, sex and ethnicity as independent variables. RESULTS:0.81). The average percent error was 7.2% in girls and 8.7% in boys. Age was associated with percentage body fat (P < 0.01), while ethnicity was not (P > 0.05). CONCLUSIONS:scores are associated with significantly lower absolute percent errors in girls and boys.

OBJECTIVE:To investigate the effects of epigallocatechin-3-gallate (EGCG) on proliferation and apoptosis of human gastric cancer SGC7901 cells under a hypoxic state. MATERIALS AND METHODS/METHODS:Human gastric cancer SGC7901 cells were sub-cultured, and the cobalt chloride (CoCl2) hypoxia model was established. The blank control group (normoxia group), hypoxia control group (hypoxia group) and hypoxia + different concentrations of EGCG subgroups (20, 40, 60, 80, 100 μg/mL EGCG) were set up. Cell viability was detected via methyl thiazolyl tetrazolium (MTT) assay, apoptosis was detected via flow cytometry, and expressions of hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) were detected via reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting. RESULTS:Relatively low concentrations of EGCG (20-80 μg/mL) presented no significant inhibiting effect on SGC7901 cell growth within a short time (24 h) (p>0.05). The increasing concentration of EGCG inhibited cell proliferation under a hypoxia state (p<0.05). EGCG induced apoptosis in a dose-dependent manner under hypoxia (p<0.05). EGCG could significantly impede expressions of HIF-1α and VEGF proteins (p<0.05), and down-regulate the level of VEGF mRNA (p<0.05), but it showed no significant effect on the HIF-1α mRNA expression (p>0.05). CONCLUSIONS:EGCG inhibited cell proliferation under hypoxia via the downregulation of HIF-1α and its downstream target gene VEGF levels, providing a theoretical basis for the early diagnosis and treatment of gastric cancer in clinic.

Learning Objectives: Radiologist interpretations contribute to anchoring bias. Differentiating problems with similar presentations requires thorough exams and detailed patient histories. Correct management often requires a patient-centered approach. Case Information: A 48 year old woman developed a limp from pain in the ball of the right foot while training for her fifth half marathon. A radiologist diagnosed Freiberg's Disease Stage 2, a rare avascular necrosis of the metatarsal head, based on an x-ray ordered by her podiatrist. X-ray findings include flattening of the metatarsal head, which is a normal variant in 10% of people. The podiatrist prescribed a fracture boot. The patient consulted an orthopedist who changed management to a metatarsal pad for her insole after reviewing the x-ray without an alternative diagnosis. Doubting her diagnosis, the patient consulted a physiatrist who confirmed Freiberg's Disease. After 6 weeks of pain, her orthopedist ordered an MRI that ruled out Freiberg's and showed a partial plantar plate tear with significant localized bursitis. She was taught to tape her toe, but pain persisted with the metatarsal pad. A new podiatrist noticed that the metatarsal pad was creating gait problems and he altered her running shoe insole instead. After two weeks, she was running again.
Discussion(s): Metatarsalgia has many causes, yet three doctors anchored their diagnosis on an incorrect radiology report. Listening to the nuances of the patient's story and performing an extensive exam may have expedited the correct diagnosis. Many doctors use metatarsal pads, but this management may cause harm in some patients. (Figure Presented)

Background: Identifying genetic risk factors for AKI could provide insights into pathophysiology and help identify novel pathways for therapeutic development.
Method(s): We conducted a genome-wide association study in a multi-ethnic population of 1,370 prospectively enrolled subjects in the ASSESS-AKI Study. Genotyping was completed using the Illumina MEGA chip and the Haplotype Reference Consortium was used for genome-wide multiple imputation. Genetic association testing for AKI was conditioned on: age, sex, diabetes, center and first three principal components of ancestry. Threshold for significance included single-nucleotide polymorphisms (SNPs) with a p < 5 X 10^-6.
Result(s): Among 637 AKI and 733 non-AKI participants, 5,645,675 SNPs were tested for the association with AKI. Among AKI participants, 72% had Stage 1 AKI and 7% required new dialysis during hospitalization. We found that 56 SNPs in six novel loci were associated with the development of AKI (Figure 1). The SNP with the strongest association with AKI was rs17538288>A. The minor allele of rs17538288 was associated with an increased risk for AKI (adjusted odds ratio 1.53, 95% confidence interval 1.30-1.79, p=2.08 x 10^-7). Utilizing integrated functional epigenomic analyses, we found that top-performing SNPs localized to regulatory DNA elements in primary human glomerular and cortex cell culture. We also investigated 22 SNPs identified in two prior AKI GWAS studies and found that none of the SNPs replicated in ASSESS-AKI (p<0.05).
Conclusion(s): We identified six novel genetic loci that were associated with prevalent AKI. Functional annotation in kidney cells/tissue provides insights into the mechanism of kidney injury. Future work will require replication in well-phenotyped AKI cohorts and mechanistic studies to understand the relationship of genetic variation and AKI development. (Figure Presented)

BACKGROUND:Hidradenitis suppurativa (HS) is a debilitating dermatologic condition presenting with recurrent abscesses. While there are multiple scales to determine HS severity, none are designed for self-administration. A validated severity self-assessment tool may facilitate survey research and improve communication by allowing patients to objectively report their HS severity between clinic visits. OBJECTIVES/OBJECTIVE:The purpose of this study was to assess a self-administered HS measure. METHODS:An HS self-assessment tool (HSSA) with 10 photographs of different Hurley stages was developed. The tool was administered to patients diagnosed with HS who visited the Wake Forest Baptist Health dermatology clinic over a span of 2 months. Physician-administered Hurley stage was recorded to determine criterion validity. To assess test-retest reliability of the measure, patients completed the HSSA again at least 30 minutes after the first completion. RESULTS:Twenty-four patients completed the measure, and 20 of these patients completed it twice. Agreement between physician-determined Hurley stage and self-determined Hurley stage was 66.7% with a weighted kappa of 0.57 (95% confidence interval [CI]: 0.30-0.84). The weighted kappa for agreement between patients' initial and second completion of the HSSA was 0.81 (95% CI: 0.64-0.99). CONCLUSIONS:The self-administered measure provides moderate agreement with physician-determined Hurley stage and good test-retest reliability.