Publications by authors named "Matthew Clark"

420 Publications

Burkitt Lymphoma Masquerading as Osteomyelitis: An Interesting Road to Diagnosis.

J Craniofac Surg 2021 Jul 30. Epub 2021 Jul 30.

Class of 2023, Columbia University College of Dental Medicine Division of Oral and Maxillofacial Surgery Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY.

Abstract: Sporadic Burkitt lymphoma (BL) is a clinical form of BL that typically presents with abdominal and cervical lymph node involvement in male children. We present a rare case of disseminated sporadic BL of a 37-year-old female diagnosed via the workup in response to nonhealing tooth extraction sockets.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000008015DOI Listing
July 2021

Coreceptor therapy has distinct short- and long-term tolerogenic effects intrinsic to autoreactive effector T cells.

JCI Insight 2021 Sep 8;6(17). Epub 2021 Sep 8.

Department of Microbiology and Immunology, and.

Immunotherapies are needed in the clinic that effectively suppress β cell autoimmunity and reestablish long-term self-tolerance in type 1 diabetes. We previously demonstrated that nondepleting anti-CD4 (αCD4) and αCD8α antibodies establish rapid and indefinite remission in recent-onset diabetic NOD mice. Diabetes reversal by coreceptor therapy (CoRT) is induced by suppression of pathogenic effector T cells (Teffs) and the selective egress of T cells from the pancreatic lymph nodes and islets that remain free of infiltration in the long term. Here, we defined CoRT-induced events regulating early Teff function and pancreatic residency, and long-term tolerance. TCR-driven gene expression controlling autoreactive Teff expansion and proinflammatory activity was suppressed by CoRT, and islet T cell egress was dependent on sphingosine-1 phosphate. In both murine and human T cells, CoRT upregulated the Foxo1 transcriptional axis, which in turn was required for suppression and efficient pancreatic egress of Teffs. Interestingly, long-term tolerance induced in late-preclinical NOD mice was marked by reseeding of the pancreas by a reduced CD8+ Teff pool exhibiting an exhausted phenotype. Notably, PD-1 blockade, which rescues exhausted Teffs, resulted in diabetes onset in protected animals. These findings demonstrate that CoRT has distinct intrinsic effects on Teffs that impact events early in induction and later in maintenance of self-tolerance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1172/jci.insight.149130DOI Listing
September 2021

Evaluation of Antibiotic Initiation Tools in End-of-Life Care.

Am J Hosp Palliat Care 2021 Jun 25:10499091211027806. Epub 2021 Jun 25.

173678Hospice of Southern Illinois, Inc, Belleville, IL, USA.

Background: Hospice patients are frequently confronted with potentially infectious complications necessitating antibiotic consideration. Information regarding the appropriate use of antibiotics and their impact on symptom management in hospice patients are unknown.

Objectives: This study aimed to evaluate and describe the use of an antibiotic initiation tool in patients admitted to outpatient hospice services. The primary outcome assessed the percentage of antibiotics that were appropriately initiated based on Loeb's Minimum Criteria (LMC) for Antibiotic Initiation Tool. Secondary outcomes included the number of patients with documented symptom resolution following antibiotic completion, the number of antibiotic courses that were successfully completed, and treatment-related adverse events.

Methods: This was a retrospective, multisite, descriptive analysis of hospice patients treated with antibiotics between April 2019 and September 2020.

Results: Two hundred and thirty patients were assessed for inclusion, with 172 meeting eligibility criteria and receiving a total of 201 antibiotic courses. Based on LMC, 84 of the 201 (42%) antibiotics ordered were appropriate, with 60% of these LMC-approved courses resulting in symptom resolution. Out of 201 total courses, 99 (49%) resulted in symptom resolution. Overall, 160 (80%) antibiotic courses were successfully completed.

Conclusion: In this study, antibiotic initiation in hospice patients frequently did not meet LMC. Less than half of the antibiotics prescribed led to symptom resolution despite antibiotic course completion in most patients. There is no consensus or guidelines directing appropriate antibiotic decision-making in hospice patients. The appropriate use of antibiotics in terminally ill patients warrants additional research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/10499091211027806DOI Listing
June 2021

Pathophysiologic Signature of Impending ICU Hypoglycemia in Bedside Monitoring and Electronic Health Record Data: Model Development and External Validation.

Crit Care Med 2021 Jun 24. Epub 2021 Jun 24.

Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA. Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA. Advanced Medical Predictive Devices, Diagnostics, and Displays, Charlottesville, VA. Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.

Objectives: We tested the hypothesis that routine monitoring data could describe a detailed and distinct pathophysiologic phenotype of impending hypoglycemia in adult ICU patients.

Design: Retrospective analysis leading to model development and validation.

Setting: All ICU admissions wherein patients received insulin therapy during a 4-year period at the University of Virginia Medical Center. Each ICU was equipped with continuous physiologic monitoring systems whose signals were archived in an electronic data warehouse along with the entire medical record.

Patients: Eleven thousand eight hundred forty-seven ICU patient admissions.

Interventions: The primary outcome was hypoglycemia, defined as any episode of blood glucose less than 70 mg/dL where 50% dextrose injection was administered within 1 hour. We used 61 physiologic markers (including vital signs, laboratory values, demographics, and continuous cardiorespiratory monitoring variables) to inform the model.

Measurements And Main Results: Our dataset consisted of 11,847 ICU patient admissions, 721 (6.1%) of which had one or more hypoglycemic episodes. Multivariable logistic regression analysis revealed a pathophysiologic signature of 41 independent variables that best characterized ICU hypoglycemia. The final model had a cross-validated area under the receiver operating characteristic curve of 0.83 (95% CI, 0.78-0.87) for prediction of impending ICU hypoglycemia. We externally validated the model in the Medical Information Mart for Intensive Care III critical care dataset, where it also demonstrated good performance with an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.77-0.81).

Conclusions: We used data from a large number of critically ill inpatients to develop and externally validate a predictive model of impending ICU hypoglycemia. Future steps include incorporating this model into a clinical decision support system and testing its effects in a multicenter randomized controlled clinical trial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CCM.0000000000005171DOI Listing
June 2021

Novel irreversible covalent BTK inhibitors discovered using DNA-encoded chemistry.

Bioorg Med Chem 2021 Jul 19;42:116223. Epub 2021 May 19.

X-Chem Inc., 100 Beaver Street, Waltham, MA 02453, USA. Electronic address:

Libraries of DNA-Encoded small molecules created using combinatorial chemistry and synthetic oligonucleotides are being applied to drug discovery projects across the pharmaceutical industry. The majority of reported projects describe the discovery of reversible, i.e. non-covalent, target modulators. We synthesized multiple DNA-encoded chemical libraries terminated in electrophiles and then used them to discover covalent irreversible inhibitors and report the successful discovery of acrylamide- and epoxide-terminated Bruton's Tyrosine Kinase (BTK) inhibitors. We also demonstrate their selectivity, potency and covalent cysteine engagement using a range of techniques including X-ray crystallography, thermal transition shift assay, reporter displacement assay and intact protein complex mass spectrometry. The epoxide BTK inhibitors described here are the first ever reported to utilize this electrophile for this target.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bmc.2021.116223DOI Listing
July 2021

Twelve-month Durability of a Fully-implanted, Nickel-sized and Shaped Tibial Nerve Stimulator for the Treatment of Overactive Bladder Syndrome with Urgency Urinary Incontinence: A Single-Arm, Prospective Study.

Urology 2021 May 26. Epub 2021 May 26.

University of Chicago, Pritzker School of Medicine, Chicago, IL.

Objectives: To evaluate the safety and efficacy of the eCoin - a nickel-sized, primary battery-powered, neuromodulation device for the treatment of urgency urinary incontinence which is implanted in the lower leg in a 20-minute procedure under local anesthesia. A feasibility clinical trial was conducted and the results after 1 year of treatment with the eCoin are presented.

Methods: A total of 46 participants with refractory urgency urinary incontinence were included in this prospective, single-arm, open-label study. This study was conducted at 7 sites in the United States and New Zealand. Participants in this study were implanted with the eCoin in the lower leg over the tibial nerve and activated after 4 weeks. Bladder diary data and validated quality-of-life instruments, collected at 3, 6, and 12 months' post-activation, were compared to baseline values.

Results: Responders were defined as those who had a ≥50% reduction in reported episodes of urgency urinary incontinence. At 12 months', 65% of participants were considered responders with 26% of participants achieving complete continence. The median number of urgency urinary incontinence episodes per day decreased from 4.2 at baseline to 1.7 at 12 months'. Seventy percent of participants reported feeling "better", "much better", or "very much better" on the Likert 7-point maximum scale. One participant experienced a related serious adverse event.

Conclusion: The eCoin is a safe and effective treatment for urgency urinary incontinence associated with overactive bladder syndrome, with significant reduction or complete resolution of symptoms and no significant safety concerns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2021.04.039DOI Listing
May 2021

Predictive Monitoring-Impact in Acute Care Cardiology Trial (PM-IMPACCT): Protocol for a Randomized Controlled Trial.

JMIR Res Protoc 2021 Jul 2;10(7):e29631. Epub 2021 Jul 2.

University of Virginia, Charlottesville, VA, United States.

Background: Patients in acute care wards who deteriorate and are emergently transferred to intensive care units (ICUs) have poor outcomes. Early identification of patients who are decompensating might allow for earlier clinical intervention and reduced morbidity and mortality. Advances in bedside continuous predictive analytics monitoring (ie, artificial intelligence [AI]-based risk prediction) have made complex data easily available to health care providers and have provided early warning of potentially catastrophic clinical events. We present a dynamic, visual, predictive analytics monitoring tool that integrates real-time bedside telemetric physiologic data into robust clinical models to estimate and communicate risk of imminent events. This tool, Continuous Monitoring of Event Trajectories (CoMET), has been shown in retrospective observational studies to predict clinical decompensation on the acute care ward. There is a need to more definitively study this advanced predictive analytics or AI monitoring system in a prospective, randomized controlled, clinical trial.

Objective: The goal of this trial is to determine the impact of an AI-based visual risk analytic, CoMET, on improving patient outcomes related to clinical deterioration, response time to proactive clinical action, and costs to the health care system.

Methods: We propose a cluster randomized controlled trial to test the impact of using the CoMET display in an acute care cardiology and cardiothoracic surgery hospital floor. The number of admissions to a room undergoing cluster randomization was estimated to be 10,424 over the 20-month study period. Cluster randomization based on bed number will occur every 2 months. The intervention cluster will have the CoMET score displayed (along with standard of care), while the usual care group will receive standard of care only.

Results: The primary outcome will be hours free from events of clinical deterioration. Hours of acute clinical events are defined as time when one or more of the following occur: emergent ICU transfer, emergent surgery prior to ICU transfer, cardiac arrest prior to ICU transfer, emergent intubation, or death. The clinical trial began randomization in January 2021.

Conclusions: Very few AI-based health analytics have been translated from algorithm to real-world use. This study will use robust, prospective, randomized controlled, clinical trial methodology to assess the effectiveness of an advanced AI predictive analytics monitoring system in incorporating real-time telemetric data for identifying clinical deterioration on acute care wards. This analysis will strengthen the ability of health care organizations to evolve as learning health systems, in which bioinformatics data are applied to improve patient outcomes by incorporating AI into knowledge tools that are successfully integrated into clinical practice by health care providers.

Trial Registration: ClinicalTrials.gov NCT04359641; https://clinicaltrials.gov/ct2/show/NCT04359641.

International Registered Report Identifier (irrid): DERR1-10.2196/29631.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/29631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285742PMC
July 2021

Discovery of soluble epoxide hydrolase inhibitors through DNA-encoded library technology (ELT).

Bioorg Med Chem 2021 07 13;41:116216. Epub 2021 May 13.

Encoded Library Technologies/NCE Molecular Discovery, GSK, 200 Cambridge Park Drive, Cambridge, MA 02140, USA.

Inhibition of soluble epoxide hydrolase (sEH) has recently emerged as a new approach to treat cardiovascular disease and respiratory disease. Inhibitors based on 1,3,5-triazine chemotype were discovered through affinity selection against two triazine-based DNA-encoded libraries. The structure and activity relationship study led to the expansion of the original 1,4-cycloalkyl series to related aniline, piperidine, quinoline, aryl-ether and benzylic series. The 1,3-cycloalkyl chemotype led to the discovery of a clinical candidate (GSK2256294) for COPD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bmc.2021.116216DOI Listing
July 2021

Liver Transplantation After Bariatric Surgery: a Clinical Cohort Study.

Obes Surg 2021 08 22;31(8):3700-3706. Epub 2021 May 22.

Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.

Purpose: Individuals that undergo bariatric surgery are at higher risk for problematic alcohol use via pharmacokinetic changes in alcohol metabolism and cross addictions. Little data exists regarding post-bariatric surgery patients with alcohol-related liver disease (ALD) who ultimately require liver transplantation. The aim of this project was to better understand demographic, medical, and psychological characteristics of post-bariatric surgery patients who undergo liver transplantation due to ALD.

Methods: This retrospective clinical cohort identified 1416 patients who underwent ALD liver transplantation over a 10-year timespan at three academic medical centers. Electronic medical records were reviewed for patient characteristics, including sex, age, body mass index, surgery dates, Model for End Stage Liver Disease (MELD) scores, medical history, psychiatric history, and mortality rates.

Results: Within the sample of liver transplantation patients, 1.3% had undergone bariatric surgery prior to transplantation. Fifty percent of the post-bariatric surgery sample was female. The MELD score was higher and the median age at transplantation was younger in the post-bariatric surgery subgroup in comparison to that in the non-bariatric surgery patients. Mood and anxiety disorders were more common among those with a history of having bariatric surgery, with major depressive disorder having the largest difference between subgroups.

Conclusions: Among patients who require a liver transplantation due to ALD, those with a history of bariatric surgery are more likely to be female, younger, and diagnosed with mood disorders. Further studies with larger and more diverse samples are necessary to better understand how to prevent development of alcohol use disorder in the bariatric surgery population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11695-021-05483-xDOI Listing
August 2021

Discovery of Novel, Potent Inhibitors of Hydroxy Acid Oxidase 1 (HAO1) Using DNA-Encoded Chemical Library Screening.

J Med Chem 2021 05 6;64(10):6730-6744. Epub 2021 May 6.

X-Chem Inc., 100 Beaver Street, Waltham, Massachusetts 02453, United States.

Inhibition of hydroxy acid oxidase 1 (HAO1) is a strategy to mitigate the accumulation of toxic oxalate that results from reduced activity of alanine-glyoxylate aminotransferase (AGXT) in primary hyperoxaluria 1 (PH1) patients. DNA-Encoded Chemical Library (DECL) screening provided two novel chemical series of potent HAO1 inhibitors, represented by compounds -. Compound was further optimized via various structure-activity relationship (SAR) exploration methods to , a compound with improved potency and absorption, distribution, metabolism, and excretion (ADME)/pharmacokinetic (PK) properties. Since carboxylic acid-containing compounds are often poorly permeable and have potential active glucuronide metabolites, we undertook a brief, initial exploration of acid replacements with the aim of identifying non-acid-containing HAO1 inhibitors. Structure-based drug design initiated with Compound led to the identification of a nonacid inhibitor of HAO1, , which has weaker potency and increased permeability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/acs.jmedchem.0c02271DOI Listing
May 2021

Linking chondrocyte and synovial transcriptional profile to clinical phenotype in osteoarthritis.

Ann Rheum Dis 2021 Apr 26. Epub 2021 Apr 26.

Institute for Translational Genomics, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany

Objectives: To determine how gene expression profiles in osteoarthritis joint tissues relate to patient phenotypes and whether molecular subtypes can be reproducibly captured by a molecular classification algorithm.

Methods: We analysed RNA sequencing data from cartilage and synovium in 113 osteoarthritis patients, applying unsupervised clustering and Multi-Omics Factor Analysis to characterise transcriptional profiles. We tested the association of the molecularly defined patient subgroups with clinical characteristics from electronic health records.

Results: We detected two patient subgroups in low-grade cartilage (showing no/minimal degeneration, cartilage normal/softening only), with differences associated with inflammation, extracellular matrix-related and cell adhesion pathways. The high-inflammation subgroup was associated with female sex (OR 4.12, p=0.0024) and prescription of proton pump inhibitors (OR 4.21, p=0.0040). We identified two independent patient subgroupings in osteoarthritis synovium: one related to inflammation and the other to extracellular matrix and cell adhesion processes. A seven-gene classifier including , and recapitulated the main axis of molecular heterogeneity in low-grade knee osteoarthritis cartilage (correlation =-0.88, p<10) and was reproducible in an independent patient cohort (=-0.85, p<10).

Conclusions: These data support the reproducible stratification of osteoarthritis patients by molecular subtype and the exploration of new avenues for tailored treatments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/annrheumdis-2020-219760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292595PMC
April 2021

Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study.

J Eat Disord 2021 Apr 23;9(1):55. Epub 2021 Apr 23.

Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.

Background: Family-Based Treatment (FBT) is considered the first-line intervention for adolescent anorexia nervosa. However, access to this treatment is limited. Treatment programs for other pediatric mental health conditions have successfully overcome barriers to accessing evidence-based intervention by integrating mental health services into primary care. This study evaluated the proof-of-concept of a novel modification of FBT, Family-Based Treatment for Primary Care (FBT-PC) for adolescent restrictive eating disorders designed for delivery by primary care providers in their practices.

Methods: This retrospective clinical cohort study evaluated 15 adolescents with restrictive eating disorders receiving FBT-PC and 15 adolescents receiving standard FBT. We examined improvement in BMI percentile, reduction in weight suppression, and clinical benchmarks of eating disorder recovery including weight restoration to > 95% of expected body weight (EBW) and resolution of DSM-5 criteria for eating disorders.

Results: In both groups, effect sizes for increased BMI percentile exceeded Cohen's convention for a large effect (FBT-PC: d = .94; standard FBT: d = 1.15) as did effect sizes for reduction in weight suppression (FBT-PC: d = 1.83; standard FBT: d = 1.21). At the end of treatment, 80% of the FBT-PC cohort and 87% in the standard FBT group achieved > 95%EBW and 67% in the FBT-PC group and 60% in the standard FBT group no longer met DSM-5 criteria for an eating disorder. There were no cohort differences in the number of treatment drop-outs or referrals to a more intensive level of eating disorder treatment.

Conclusions: Findings suggest that primary care providers have potential to improve weight and clinical status in adolescents with restrictive eating disorders. Based on these results, more rigorous testing of the FBT-PC model is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40337-021-00413-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067301PMC
April 2021

The Prevalence of Incidental Mastoid Opacification and the Need for Intervention: A Meta-Analysis.

Laryngoscope 2021 Apr 21. Epub 2021 Apr 21.

Department of ENT, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.

Objectives/hypothesis: The increasing use of cross-sectional imaging has led to the predicament of incidental mastoid opacification (IMO). We investigated the prevalence of IMO and the clinical need for ENT assessment or intervention when identified.

Study Design: Systematic review and meta-analysis.

Methods: The PRISMA statement standards were used to search electronic databases including Medline, Embase, PubMed, and Web of Science. The selection criteria were mastoid opacification found on computed tomography (CT) or magnetic resonance imaging (MRI) as incidental findings.

Results: A total of 16 studies were identified for qualitative analysis and 15 for quantitative analysis, mainly retrospective. The pooled prevalence of IMO in 246,288 patients was 8.4% (95% CI 5.5-12.0). The prevalence of IMO was significantly higher in studies with children (17.2%, 95% CI 10.9-24.6) than those with adults (6.1%, 95% CI 3.3-9.6); smaller sample size studies (12.4%, 95% CI 8.1-17.3) compared to larger sample size studies (4.1%, 95% CI 1.5-7.8); and when IMO was detected by viewing images (14.5%, 95% CI 9.9-19.8) compared to reading reports (3.5%, 95% CI 1.3-6.6). Imaging modality was not a significant moderator due to similar IMO rate on CT (8.6%, 95% CI 1.8-19.7) and MRI (10.4%, 95% CI 4.9-17.6). Nine studies reported on clinical outcomes of patients with IMO, and none reliably reported any cases of clinical mastoiditis.

Conclusions: The term "mastoiditis" on radiology reports based on IMO does not indicate a clinical diagnosis of mastoiditis, although the current body of evidence is limited. Otolaryngology review is suggested if clinical correlation detects otological signs or symptoms.

Level Of Evidence: NA. Laryngoscope, 2021.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.29581DOI Listing
April 2021

Efficacy and Safety of Endoscopic Balloon Placement for Weight Loss in Patients With Cirrhosis Awaiting Liver Transplantation.

Liver Transpl 2021 09 26;27(9):1239-1247. Epub 2021 Jul 26.

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

The efficacy and safety of a fluid-filled intragastric balloon (IGB) for weight loss in patients with cirrhosis on the liver transplantation (LT) waiting list is unknown. We enrolled stable compensated patients with body mass index >35 kg/m and on the waiting list for IGB placement endoscopically for a maximum of 6 months. A total of 8 patients (7 men) aged mean ± SD, 56 ± 4.6 years with Model for End-Stage Liver Disease-sodium (MELD-Na) scores 14.1 ± 3.4 experienced weight reduction (146 ± 22.2 kg versus 127 ± 21.6 kg [P = 0.005] with IGB in place and 130 ± 24.6 kg [P = 0.014] at 6 months), with a total body weight loss of 12.2% ± 8.8% with IGBs in place and 10.9% ± 8.9% at 6 months. Body fat decreased from 48.6% ± 5.8% to 40.6% ± 6.4% (P = 0.001) and lean mass increased from 51.3% ± 6% to 59.4% ± 6.4% (P = 0.001). No change in MELD-Na scores occurred (P = 0.770). Early balloon retrieval was attributed to accommodative symptoms (n = 2) and liver decompensation (n = 1). Mallory Weiss tears (n = 3), but no portal hypertensive bleeding, occurred. Liver decompensation and/or hepatocellular carcinoma (HCC) developed in 3 patients. A total of 4 patients with LT ± sleeve gastrectomy maintained overall weight loss. Of 4 patients who did not receive transplants, 2 experienced weight regain. IGB results in short-term weight loss in patients with cirrhosis awaiting LT, with body fat loss without lean mass loss. Adverse effects were common. Decompensation and HCC did occur, with uncertainty of the relation to weight loss, and thus careful patient selection and close follow-up are required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lt.26074DOI Listing
September 2021

Bispecific Estrogen Receptor α Degraders Incorporating Novel Binders Identified Using DNA-Encoded Chemical Library Screening.

J Med Chem 2021 04 12;64(8):5049-5066. Epub 2021 Apr 12.

X-Chem Inc., 100 Beaver Street, Waltham, Massachusetts 02453, United States.

Bispecific degraders (PROTACs) of ERα are expected to be advantageous over current inhibitors of ERα signaling (aromatase inhibitors/SERMs/SERDs) used to treat ER+ breast cancer. Information from DNA-encoded chemical library (DECL) screening provides a method to identify novel PROTAC binding features as the linker positioning, and binding elements are determined directly from the screen. After screening ∼120 billion DNA-encoded molecules with ERα WT and 3 gain-of-function (GOF) mutants, with and without estradiol to identify features that enrich ERα competitively, the off-DNA synthesized small molecule exemplar exhibited nanomolar ERα binding, antagonism, and degradation. Click chemistry synthesis on an alkyne E3 ligase engagers panel and an azide variant of rapidly generated bispecific nanomolar degraders of ERα, with PROTACs and inhibiting ER+ MCF7 tumor growth in a mouse xenograft model of breast cancer. This study validates this approach toward identifying novel bispecific degrader leads from DECL screening with minimal optimization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/acs.jmedchem.1c00127DOI Listing
April 2021

Identifying Opportunities to Promote Physical Activity in a Diverse Low-Income Population: A Mixed-Method Study at a Boys & Girls Club Site.

Child Youth Care Forum 2020 Apr 12;49(2):171-200. Epub 2019 Sep 12.

Mayo Clinic.

Background: Prevalence and consequences of obesity and sedentary lifestyle are well-documented public health concerns for youth in the United State of America (U.S.A) that disproportionally affect children from low income and minority families.

Objective: This mixed-method study focused on estimating levels of physical activity and sedentary behavior and prevalence of overweight and obesity among the child members served in one Boys and Girls Club in the Midwest U.S.A. We aimed to better understand opportunities for improving children's engagement in physical activity through focus groups with members, staff, and parents/caregivers of members.

Methods: Social cognitive learning theory, the ecological model of health behavior, and community based participatory research principles provided the study framework. Members completed assessments of physical activity, sedentary activity, height, and weight. Focus groups with members, staff, and parents/caregivers identified barriers, facilitators, and opportunities for promoting physical activity. RESULTS: Nearly 50% of members were overweight or obese. Most (87%) participants reported at least 60 minutes physical activity every day across the 3-day recall. Fewer than half (41%) reported 2 hours or less of sedentary screen time every day across the 3 day recall. Focus group themes identified opportunities for addressing needs associated with health disparities in physical activity and pediatric obesity.

Conclusions: Findings suggest stakeholder interest in physical activity promotion through afterschool programs. We discuss study implications regarding needs specific to individuals from diverse, low-income households that may not be adequately addressed with existing empirically-supported treatments and opportunities to address health disparities in physical activity and pediatric obesity through afterschool programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10566-019-09521-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025775PMC
April 2020

Pharmacogenomics in Pain Management: A Review of Relevant Gene-Drug Associations and Clinical Considerations.

Ann Pharmacother 2021 Mar 26:10600280211003875. Epub 2021 Mar 26.

Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, IL, USA.

Objective: To provide an overview of clinical recommendations regarding genomic medicine relating to pain management and opioid use disorder.

Data Sources: A literature review was conducted using the search terms , , , , , and on PubMed (inception to February 1, 2021), CINAHL (2016 through February 1, 2021), and EMBASE (inception through February 1, 2021).

Study Selection And Data Extraction: All relevant clinical trials, review articles, package inserts, and guidelines evaluating applicable pharmacogenotypes were considered for inclusion.

Data Synthesis: More than 300 Food and Drug Administration-approved medications contain pharmacogenomic information in their labeling. Genetic variability may alter the therapeutic effects of commonly prescribed pain medications. Pharmacogenomic-guided therapy continues to gain traction in clinical practice, but a multitude of barriers to widespread pharmacogenomic implementation exist.

Relevance To Patient Care And Clinical Practice: Pain is notoriously difficult to treat given the need to balance safety and efficacy when selecting pharmacotherapy. Pharmacogenomic data can help optimize outcomes for patients with pain. With improved technological advances, more affordable testing, and a better understanding of genomic variants resulting in treatment disparities, pharmacogenomics continues to gain popularity. Unfortunately, despite these and other advancements, pharmacogenomic testing and implementation remain underutilized and misunderstood in clinical care, in part because of a lack of health care professionals trained in assessing and implementing test results.

Conclusions: A one-size-fits-all approach to pain management is inadequate and outdated. With increasing genomic data and pharmacogenomic understanding, patient-specific genomic testing offers a comprehensive and personalized treatment alternative worthy of additional research and consideration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/10600280211003875DOI Listing
March 2021

Selection of Antiobesity Medications Based on Phenotypes Enhances Weight Loss: A Pragmatic Trial in an Obesity Clinic.

Obesity (Silver Spring) 2021 04;29(4):662-671

Department of Psychology and Psychiatry, Mayo Clinic, Rochester, Minnesota, USA.

Objective: Little is known about the predictors of response to obesity interventions.

Methods: In 450 participants with obesity, body composition, resting energy expenditure, satiety, satiation, eating behavior, affect, and physical activity were measured by validated studies and questionnaires. These variables were used to classify obesity phenotypes. Subsequently, in a 12-month, pragmatic, real-world trial performed in a weight management center, 312 patients were randomly assigned to phenotype-guided treatment or non-phenotype-guided treatment with antiobesity medications: phentermine, phentermine/topiramate, bupropion/naltrexone, lorcaserin, and liraglutide. The primary outcome was weight loss at 12 months.

Results: Four phenotypes of obesity were identified in 383 of 450 participants (85%): hungry brain (abnormal satiation), emotional hunger (hedonic eating), hungry gut (abnormal satiety), and slow burn (decreased metabolic rate). In 15% of participants, no phenotype was identified. Two or more phenotypes were identified in 27% of patients. In the pragmatic clinical trial, the phenotype-guided approach was associated with 1.75-fold greater weight loss after 12 months with mean weight loss of 15.9% compared with 9.0% in the non-phenotype-guided group (difference -6.9% [95% CI -9.4% to -4.5%], P < 0.001), and the proportion of patients who lost >10% at 12 months was 79% in the phenotype-guided group compared with 34% with non-phenotype-guided treatment group.

Conclusions: Biological and behavioral phenotypes elucidate human obesity heterogeneity and can be targeted pharmacologically to enhance weight loss.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/oby.23120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8168710PMC
April 2021

Fine Mapping of Leaf Trichome Density Revealed a 747-kb Region on Chromosome 1 in Cold-Hardy Hybrid Wine Grape Populations.

Front Plant Sci 2021 3;12:587640. Epub 2021 Mar 3.

Department of Horticultural Science, University of Minnesota, Twin Cities, MN, United States.

Segregation for leaf trichome density was observed in a cold-hardy hybrid grape population GE1025 ( = ∼125, MN1264 × MN1246) that was previously used to detect a quantitative trait locus (QTL) underlying foliar phylloxera resistance on chromosome 14. Our hypothesis was that high trichome density was associated with resistance to phylloxera. Existing literature found trichome density QTL on chromosomes 1 and 15 using a hybrid grape population of "Horizon" × Illinois 547-1 and suggested a few candidate genes. To validate the reported QTL and our hypothesis, interval mapping was conducted in GE1025 with previous genotyping-by-sequencing (GBS) single nucleotide polymorphism (SNP) genotype data and phenotypic scores collected using a 0-6 trichome density scale at several leaf positions. Evaluations were done on replicated forced dormant cuttings in 2 years and on field-grown leaves in 1 year. There was no strong relationship between trichome density and phylloxera resistance except for a Pearson's correlation (r) of about -0.2 between a few trichome density traits and phylloxera severity traits at 2 and 3 weeks after infestation. Two genetic regions were repeatedly detected for multiple trichome density traits: from 10 to 20.7 Mbp (∼10 Mbp) on chromosome 1 for ribbon and simple density traits and from 2.4 to 8.9 Mbp on chromosome 10 for ribbon density traits, explaining 12.1-48.2 and 12.6-27.5% of phenotypic variation, respectively. To fine map, we genotyped a larger population, GE1783 ( = ∼1,023, MN1264 × MN1246), with conserved rhAmpSeq haplotype markers across multiple species and phenotyped 233 selected potential recombinants. Evaluations were conducted on field-grown leaves in a single year. The QTL for ribbon trichome density on adaxial vein and adaxial leaf and simple density on abaxial vein was fine mapped to 12.63-13.38 Mbp (747 kb) on chromosome 1. We found variations of MN1264 and MN1246 at candidate genes NAC transcription factor 29, EF-hand protein, and MYB140 in this region and three other surrounding candidate genes proposed previously. Even though no strong relationship between foliar phylloxera resistance and trichome density was found, this study validated and fine mapped a major QTL for trichome density using a cold-hardy hybrid grape population and shed light on a few candidate genes that have implications for different breeding programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpls.2021.587640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7965957PMC
March 2021

Synergistic effect of sleep depth and seizures correlates with postictal heart rate.

Epilepsia 2021 May 13;62(5):e65-e69. Epub 2021 Mar 13.

Department of Neurology, University of Virginia, Charlottesville, VA, USA.

Our objective was to determine the effect of sleep on heart rate following a recorded seizure. We prospectively acquired heart rate data in hospitalized epilepsy monitoring unit patients. We analyzed heart rate trends for multiple seizures (n = 101) in patients (n = 42) with electroencephalographically confirmed events. The patient's sleep state was scored for the 5 min preceding each seizure and correlated with the postictal nadir heart rate (PINHR). The depth of sleep during the 5 min before a seizure correlated (correlation coefficient [CC] = -.229, p < .05) with PINHR. This result was more significant and strengthened (CC = -.272, 95% confidence interval = -.392 to -.152, p < .001) when adjusted for covariates of age, generalized tonic-clonic seizures, and baseline heart rate. Sleep depth is an independent predictor of the change in heart rate following a seizure. Diminished heart rate following a seizure in the setting of sleep is likely secondary to non-rapid eye movement sleep's synergistic effect on parasympathetic tone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/epi.16869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114574PMC
May 2021

Generating Selective Leads for Mer Kinase Inhibitors-Example of a Comprehensive Lead-Generation Strategy.

J Med Chem 2021 03 8;64(6):3165-3184. Epub 2021 Mar 8.

X-Chem, Inc., Waltham, Massachusetts 02453, United States.

Mer is a member of the TAM (Tyro3, Axl, Mer) kinase family that has been associated with cancer progression, metastasis, and drug resistance. Their essential function in immune homeostasis has prompted an interest in their role as modulators of antitumor immune response in the tumor microenvironment. Here we illustrate the outcomes of an extensive lead-generation campaign for identification of Mer inhibitors, focusing on the results from concurrent, orthogonal high-throughput screening approaches. Data mining, HT (high-throughput), and DECL (DNA-encoded chemical library) screens offered means to evaluate large numbers of compounds. We discuss campaign strategy and screening outcomes, and exemplify series resulting from prioritization of hits that were identified. Concurrent execution of HT and DECL screening successfully yielded a large number of potent, selective, and novel starting points, covering a range of selectivity profiles across the TAM family members and modes of kinase binding, and offered excellent start points for lead development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/acs.jmedchem.0c01904DOI Listing
March 2021

Diagnostic Reference Levels for Common Orthopedic Hand and Wrist Procedures Using Intraoperative mini C-arm Fluoroscopy.

Hand (N Y) 2021 Mar 6:1558944721994257. Epub 2021 Mar 6.

Rotherham General Hospital, UK.

Background: Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to contribute to national diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Small joint and digital fracture procedure diagnostic reference levels have not been reported in significant numbers previously with procedure-level stratification.

Methods: Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on fluoroscopy machines. A total of 603 procedures were included.

Results: The median radiation dose for wrist fracture open fixation was 2.73 cGycm, Kirschner wiring (K-wiring) procedures was 2.36 cGycm, small joint arthrodesis was 1.20 cGycm, small joint injections was 0.58 cGycm, and phalangeal fracture fixation was 1.05 cGycm.

Conclusions: Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses, and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. National and international recommendations are that institutional audit data should be collected regularly and should be stratified by procedure type. This study helps to define standards for this activity by adding to the data available for wrist fracture diagnostic reference levels and defining standards for digital and injection procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1558944721994257DOI Listing
March 2021

Evolving Antibody Therapies for the Treatment of Type 1 Diabetes.

Front Immunol 2020 18;11:624568. Epub 2021 Feb 18.

Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Type 1 diabetes (T1D) is widely considered to be a T cell driven autoimmune disease resulting in reduced insulin production due to dysfunction/destruction of pancreatic β cells. Currently, there continues to be a need for immunotherapies that selectively reestablish persistent β cell-specific self-tolerance for the prevention and remission of T1D in the clinic. The utilization of monoclonal antibodies (mAb) is one strategy to target specific immune cell populations inducing autoimmune-driven pathology. Several mAb have proven to be clinically safe and exhibit varying degrees of efficacy in modulating autoimmunity, including T1D. Traditionally, mAb therapies have been used to deplete a targeted cell population regardless of antigenic specificity. However, this treatment strategy can prove detrimental resulting in the loss of acquired protective immunity. Nondepleting mAb have also been applied to modulate the function of immune effector cells. Recent studies have begun to define novel mechanisms associated with mAb-based immunotherapy that alter the function of targeted effector cell pools. These results suggest short course mAb therapies may have persistent effects for regaining and maintaining self-tolerance. Furthermore, the flexibility to manipulate mAb properties permits the development of novel strategies to target multiple antigens and/or deliver therapeutic drugs by a single mAb molecule. Here, we discuss current and potential future therapeutic mAb treatment strategies for T1D, and T cell-mediated autoimmunity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fimmu.2020.624568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930374PMC
June 2021

Mental Health and Chemical Dependency Services at US Cancer Centers.

J Natl Compr Canc Netw 2021 03 4;19(7):829-838. Epub 2021 Mar 4.

Department of Psychiatry & Psychology.

Background: It is standard of care and an accreditation requirement to screen for and address distress and psychosocial needs in patients with cancer. This study assessed the availability of mental health (MH) and chemical dependency (CD) services at US cancer centers.

Methods: The 2017-2018 American Hospital Association (AHA) survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases were used to assess availability of services and associations with hospital-level and health services area (HSA)-level characteristics.

Results: Of 1,144 cancer centers surveyed, 85.4% offered MH services and 45.5% offered CD services; only 44.1% provided both. Factors associated with increased adjusted odds of offering MH services were teaching status (odds ratio [OR], 1.76; 95% CI, 1.18-2.62), being a member of a hospital system (OR, 2.00; 95% CI, 1.31-3.07), and having more beds (OR, 1.04 per 10-bed increase; 95% CI, 1.02-1.05). Higher population estimate (OR, 0.98; 95% CI, 0.97-0.99), higher percentage uninsured (OR, 0.90; 95% CI, 0.86-0.95), and higher Mental Health Professional Shortage Area level in the HSA (OR, 0.99; 95% CI, 0.98-1.00) were associated with decreased odds of offering MH services. Government-run (OR, 2.85; 95% CI, 1.30-6.22) and nonprofit centers (OR, 3.48; 95% CI, 1.78-6.79) showed increased odds of offering CD services compared with for-profit centers. Those that were members of hospital systems (OR, 1.61; 95% CI, 1.14-2.29) and had more beds (OR, 1.02; 95% CI, 1.01-1.03) also showed increased odds of offering these services. A higher percentage of uninsured patients in the HSA (OR, 0.92; 95% CI, 0.88-0.97) was associated with decreased odds of offering CD services.

Conclusions: Patients' ability to pay, membership in a hospital system, and organization size may be drivers of decisions to co-locate services within cancer centers. Larger organizations may be better able to financially support offering these services despite poor reimbursement rates. Innovations in specialty payment models highlight opportunities to drive transformation in delivering MH and CD services for high-need patients with cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.6004/jnccn.2020.7657DOI Listing
March 2021

A molecular quantitative trait locus map for osteoarthritis.

Nat Commun 2021 02 26;12(1):1309. Epub 2021 Feb 26.

Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.

Osteoarthritis causes pain and functional disability for over 500 million people worldwide. To develop disease-stratifying tools and modifying therapies, we need a better understanding of the molecular basis of the disease in relevant tissue and cell types. Here, we study primary cartilage and synovium from 115 patients with osteoarthritis to construct a deep molecular signature map of the disease. By integrating genetics with transcriptomics and proteomics, we discover molecular trait loci in each tissue type and omics level, identify likely effector genes for osteoarthritis-associated genetic signals and highlight high-value targets for drug development and repurposing. These findings provide insights into disease aetiopathology, and offer translational opportunities in response to the global clinical challenge of osteoarthritis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41467-021-21593-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910531PMC
February 2021

Lay health worker as interventionist training: reflective writing in US family health promotion practice.

Health Promot Int 2021 Feb 23. Epub 2021 Feb 23.

Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA.

Lay health worker-led health promotion interventions are well received within racial and ethnic minority communities. Increasing numbers of trained lay health workers will be needed to meet global health goals. The purpose of this process evaluation was to gain insights about how lay health worker as interventionists used theory-based approaches within a nutrition and physical activity health behavior change intervention in a clinical trial enrolling immigrant and refugee families. Data were comprised of ongoing reflective writing statements from four health workers about their implementation of the intervention. Using content analysis three themes emerged: (i) encouraging setting of small, family focused and relevant goals, (ii) being flexible in content delivery and (iii) being personally transformed (i.e. gained a sense of meaning from their experience). Lay health worker interventionist reflections on practice revealed they delivered the intervention within the primacy of the family partnering relationship by attending to unique family needs, and adjusting educational content and goal setting accordingly. Our results provide guidance for training and process evaluation of lay health worker intervention delivery in ethnically and racially diverse populations. Incorporating real-time reflection upon what was learned about skills of facilitating family motivation and family confidence enhanced affective learning and may be useful in future research studies and health promotion practice. The processes identified including setting small goals, flexibility and personal transformation could be considered in future lay health worker-delivered health promotion interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/heapro/daaa143DOI Listing
February 2021

Clinician Satisfaction with Rapid Adoption and Implementation of Telehealth Services During the COVID-19 Pandemic.

Telemed J E Health 2021 Feb 19. Epub 2021 Feb 19.

VA Northern California Health Care System, Mather, California, USA.

To examine clinician perspectives on the acceptability, appropriateness/suitability, and feasibility of video telehealth as a way to deliver mental health services during the COVID-19 pandemic. Mental health clinicians were surveyed with 27 Likert questions, using previously validated measures, on satisfaction and implementation experience with video telehealth visits between March and June 2020. A total of 112 of 193 clinicians completed the survey (58.0%), including psychiatrists, psychologists, trainees (i.e., residents and fellows), advanced practice providers, and licensed mental health counselors. Clinicians reported high levels of acceptability, feasibility, and appropriateness of video telehealth; they also reported high levels of satisfaction with video telehealth visits. Seventy-nine and a half (79.5%) reported that their patients seemed highly satisfied with video telehealth visits, and 107 (95.5%) of clinicians responded that they would like video telehealth visits to represent at least 25% of their practice in the future. Mental health clinicians showed positive attitudes toward the implementation of video telehealth visits, high levels of satisfaction with this care, and indicated strong interest in continuing this modality as a significant portion of clinical practice. This study demonstrates the ability of mental health clinicians to embrace new technology to expand access to care during the COVID-19 pandemic. Results indicate that telemental health is likely to be an integral part of clinic practice in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/tmj.2020.0575DOI Listing
February 2021

The Role of T Cell Receptor Signaling in the Development of Type 1 Diabetes.

Front Immunol 2020 2;11:615371. Epub 2021 Feb 2.

Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

T cell receptor (TCR) signaling influences multiple aspects of CD4 and CD8 T cell immunobiology including thymic development, peripheral homeostasis, effector subset differentiation/function, and memory formation. Additional T cell signaling cues triggered by co-stimulatory molecules and cytokines also affect TCR signaling duration, as well as accessory pathways that further shape a T cell response. Type 1 diabetes (T1D) is a T cell-driven autoimmune disease targeting the insulin producing β cells in the pancreas. Evidence indicates that dysregulated TCR signaling events in T1D impact the efficacy of central and peripheral tolerance-inducing mechanisms. In this review, we will discuss how the strength and nature of TCR signaling events influence the development of self-reactive T cells and drive the progression of T1D through effects on T cell gene expression, lineage commitment, and maintenance of pathogenic anti-self T cell effector function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fimmu.2020.615371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884625PMC
June 2021

Cannabis use and bariatric surgery psychology practice: survey and insights.

Surg Obes Relat Dis 2021 Apr 16;17(4):701-710. Epub 2020 Dec 16.

Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota; Department of Internal Medicine, Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.

Background: Cannabis is second only to alcohol as a substance of abuse and dependence in the United States. While there is extensive research examining alcohol use and bariatric surgery, there is currently little research and there are no published guidelines specific to cannabis use and bariatric surgery.

Objectives: To identify major themes and general guidelines applied by bariatric surgery psychology clinicians.

Setting: This practice survey was disseminated to bariatric surgery psychologists at various U.S. academic medical centers, hospitals, and private practices.

Methods: An electronic, 35-question survey was sent to 47 bariatric surgery psychologists to collect information on current clinical practice guidelines regarding cannabis use before and after bariatric surgery.

Results: The survey questionnaire was completed by 34 (72.34%) bariatric surgery psychologists. The major identified themes included: (1) the lack of a standardized assessment of cannabis use; (2) a requirement for 3 months of abstinence from cannabis before bariatric surgery; (3) recommended lifetime abstinence from cannabis after bariatric surgery; and (4) discussion of cannabis use risks following bariatric surgery, including appetite stimulation, addiction potential, and possible negative impacts on judgment.

Conclusion: Cannabis use will likely further increase in the United States. This survey highlighted common bariatric surgery psychology practices in the absence of extensive research and published guidelines. These findings suggest a preliminary framework with which to address cannabis use in patients seeking bariatric surgery. It is recommended that professional organizations and societies build on these initial survey findings to develop guidelines for more consistent, evidence-based practice regarding cannabis use and bariatric surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.soard.2020.12.004DOI Listing
April 2021
-->