Discoveries & Impact (July 2021)

Discoveries & Impact highlights select publications per section across the Department of Internal Medicine.

Cardiovascular Medicine

Compared with second-generation drug eluting stents, devices with ultrathin struts were associated with a 19% reduction in target lesion failure at three years, a long-term meta-analysis of 18 publications from 10 trials published in the journal Catheterization and Cardiovascular Interventions suggests.

Hussain Y, Gaston S, Kluger J, Shah T, Yang Y, Tirziu D, Lansky A. Long term outcomes of ultrathin versus standard thickness second-generation drug eluting stents: Meta-analysis of randomized trials. Catheter Cardiovasc Interv. 2021 Jul 8. doi: 10.1002/ccd.29866. Epub ahead of print. PMID: 34236755.

Digestive Diseases

In the United States, acute bleeding is the most common gastrointestinal (GI) diagnosis requiring hospitalization, but the existing risk stratification scores are not being used in real time. In “Early identification of patients with acute gastrointestinal bleeding using natural language processing and decision rules,” the authors created EHR phenotypes using decision rules to identify patients suffering from GI bleeding in real time and compared them to other phenotypes derived using natural language processing and neural networks. Learn more about the study here.

Shung D, Tsay C, Laine L, Chang D, Li F, Thomas P, Partridge C, Simonov M, Hsiao A, Tay JK, Taylor A. Early identification of patients with acute gastrointestinal bleeding using natural language processing and decision rules. J Gastroenterol Hepatol. 2021 Jun;36(6):1590-1597. doi: 10.1111/jgh.15313. PMID: 33105045.

Endocrinology & Metabolism

In their JAMA Internal Medicine research letter, authors performed a retrospective analysis of new levothyroxine prescriptions between 2008 and 2018. They found that levothyroxine was commonly prescribed for patients with mildly increased thyrotropin levels, at odds with clinical practice guidelines, as 60% had subclinical hypothyroidism and 30% normal thyroid function. Learn more.

Brito JP, Ross JS, El Kawkgi OM, Maraka S, Deng Y, Shah ND, Lipska KJ. Levothyroxine Use in the United States, 2008-2018. JAMA Intern Med. 2021 Jun 21:e212686. doi: 10.1001/jamainternmed.2021.2686. PMID: 34152370; PMCID: PMC8218227.

General Internal Medicine

Research suggests that female trainees are penalized on evaluations for gender non-conforming behavior during medical training. Studies of evaluations and performance scores reflect a gender bias, although the studies are of varying methodology and results have not been consistent. Using natural language processing (NLP), we examined the differences in word use, competency themes, and length within written evaluations of internal medicine residents, considering the impact of both faculty and resident gender. See our findings in Medical Education.

Andrews J, Chartash D, Hay S. Gender Bias in Resident Evaluations: Natural Language Processing and Competency Evaluation. Med Educ. 2021 Jul 5. doi: 10.1111/medu.14593. Epub ahead of print. PMID: 34224606.

Geriatrics

In “A Controlled Pilot Study of the Wish Outcome Obstacle Plan Strategy for Spouses of Persons with Early-Stage Dementia,” researchers studied the use of the Wish Outcome Obstacle Plan (WOOP) tool for spouses of persons with dementia. Through this randomized control trial, the team saw significant effects on perceived stress of caregivers, but suggest further trials.

Monin JK, Oettingen G, Laws H, David D, DeMatteo L, Marottoli R. A Controlled Pilot Study of the Wish Outcome Obstacle Plan Strategy for Spouses of Persons with Early-Stage Dementia. J Gerontol B Psychol Sci Soc Sci. 2021 Jun 25:gbab115. doi: 10.1093/geronb/gbab115. PMID: 34171086.

Hematology

In this new publication, Yale clinicians describe the transition from clinic infusions to home-based intravenous immune globulin (IVIG) therapy for patients with hypogammaglobulinemia. Learn more about the successful transition in the American Journal of Health-System Pharmacy.

Perreault S, Schiffer M, Clinchy-Jarmoszko V, Bocchetta N, Barbarotta L, Abdelghany O, Foss F, Huntington S, Seropian S, Isufi I. Mitigating the risk of COVID-19 exposure by transitioning from clinic-based to home-based immune globulin infusion. Am J Health Syst Pharm. 2021 Jun 7;78(12):1112-1117. doi: 10.1093/ajhp/zxab072. PMID: 33617630; PMCID: PMC7929449.

Infectious Diseases

In a recent PNAS research article, Yale researchers explain that SARS-CoV-2 is able to shut down host protein synthesis, including synthesis of antiviral proteins, and that SARS-CoV-2 nonstructural protein NSP14 exerts this activity. Understanding the strategies used by SARS-CoV-2 to subvert host immune responses is critical for the design of next-generation antivirals, and to prepare for future emerging viral pathogens.

Hsu JC, Laurent-Rolle M, Pawlak JB, Wilen CB, Cresswell P. Translational shutdown and evasion of the innate immune response by SARS-CoV-2 NSP14 protein. Proc Natl Acad Sci U S A. 2021 Jun 15;118(24):e2101161118. doi: 10.1073/pnas.2101161118. PMID: 34045361.

Medical Oncology

In “Analysis of Survival Among Adults With Early-Onset Colorectal Cancer in the National Cancer Database,” authors designed a cohort study evaluating 769,871 patients with colorectal cancer (CRC) to determine if there was a difference in survival for those diagnosed with early-onset CRC (<50 years old) compared to those diagnosed between 51 to 55 years. They found that younger patients were less likely to have localized (early stage) cancer and that more attention to screening should be given to younger individuals, urging further study.

Cheng E, Blackburn HN, Ng K, Spiegelman D, Irwin ML, Ma X, Gross CP, Tabung FK, Giovannucci EL, Kunz PL, Llor X, Billingsley K, Meyerhardt JA, Ahuja N, Fuchs CS. Analysis of Survival Among Adults With Early-Onset Colorectal Cancer in the National Cancer Database. JAMA Netw Open. 2021 Jun 1;4(6):e2112539. doi: 10.1001/jamanetworkopen.2021.12539. PMID: 34132794; PMCID: PMC8209612.

Nephrology

A recent study in the European Journal of Heart Failure adds significantly to the discussion of the relationship between incomplete decongestion and improved renal function (IRF), Jeffrey M. Turner, MD, and Jeffrey M. Testani, MD, write in an editorial comment in the journal.

Turner JM, Cox ZL, Testani JM. Improving renal function during diuresis: useful information or just noise? Eur J Heart Fail. 2021 Jun 11. doi: 10.1002/ejhf.2267. PMID: 34117684.

Pulmonary, Critical Care & Sleep Medicine

Untreated obstructive sleep apnea (OSA) is associated with adverse outcomes in patients with coronary artery disease (CAD). Continuous positive airway pressure (CPAP) is the most common treatment, but only 1 in 2 patient use CPAP long-term. They set out to determine if physiological traits that cause OSA can also predict which patients can adhere to CPAP long-term and help improve precision of OSA therapy approaches. Read the study in the American Journal of Respiratory and Critical Care Medicine.

Zinchuk AV, Chu JH, Liang J, Celik Y, Op de Beeck S, Redeker NS, Wellman A, Yaggi HK, Peker Y, Sands SA. Physiological Traits and Adherence to Therapy of Sleep Apnea in Individuals with Coronary Artery Disease. Am J Respir Crit Care Med. 2021 Jun 22. doi: 10.1164/rccm.202101-0055OC. Epub ahead of print. PMID: 34156917.

Rheumatology, Allergy & Immunology

Can research advances in translational approaches, data generation and sharing, and computational techniques be harnessed to advance our understanding of the aging process and its role in disease? An “elegant and informative” study in Nature Aging that uses big data to disentangle aging and COVID-19 proves that we can, argues Ruth R. Montgomery in a News & Views, co-authored by Hanno Steen.

Montgomery, R.R., Steen, H. Using ‘big data’ to disentangle aging and COVID-19. Nat Aging 1, 496–497 (2021). https://doi.org/10.1038/s43587-021-00078-8