Crawling C. elegans
Gary Sachs, MD
Associate Clinical Professor of Psychiatry
Harvard Medical School
MedicalResearch.com: What is the background for this data milestone?
Response: Bipolar disorder affects about 5.7 million adults in the United States. It is a common, often disabling condition in which abnormal mood states impair a person’s ability to carry out everyday tasks. Bipolar disorder touches nearly every family and community in America, because periods of illness, a patient’s symptoms often impact their family, their friends, and their community.
There are a limited number of products approved to treat bipolar depression and even fewer products that have been studied and approved to treat the full spectrum of bipolar disorder, from mania through depression. Having another product proven to treat the full range of bipolar disorder would be a welcome addition to the treatment options currently available to the psychiatry community and patients.
Benjamin M. Seitz
Doctoral Student
Department of Psychology, Learning & Behavior
University of California, Los Angeles
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The adaptive memory literature is based on two crucial theories.
The first is that we process information on different ‘levels’ and these different levels of processing information strongly influence our ability to later remember that information.
The second is that our evolutionary history has shaped our cognitive abilities and that these abilities therefore perform optimally when performing tasks related to evolutionary fitness. It has been established that processing words based on their relevancy to an imagined ancestral survival scenario yields incredible memory performance far superior than processing those same words based on their relevancy to similar imagined scenarios that do not involve the survival element or ancestral environment.
Our study demonstrates that thinking about raising offspring in an ancestral environment while processing words leads to a similar benefit to recall of those words as when thinking about survival, suggesting the human memory system while also useful in helping our species survive may have also been particularly useful in helping us raise our offspring.
Richard Allen Miech, PhD
Research Professor, Survey Research Center
Institute for Social Research
University of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Monitoring the Future conducts annual, nationally-representative surveys of ~45,000 adolescents every year to assess trends in substance use. We track which drugs are gaining traction among adolescents and which are falling out of favor. The survey draws separate, nationally-representative samples of 8th, 10th, and 12th grade students from about 400 total schools every year. Once a recruited school agrees to participate, a field interviewer travels to the school to administer the paper-and-pencil survey, typically in classrooms. The project is funded by the National Institute of Drug Abuse and is carried out by the University of Michigan. More details on the project's survey design and survey procedures can be found in chapter 3 here: http://monitoringthefutu re.org/pubs/monographs/mtf- vol1_2016.pdf
Dr. Kim[/caption]
Annette S. Kim, MD, PhD
Associate Professor, Harvard Medical School
Brigham & Women's Hospital
Boston MA 02115
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The recent debate on laboratory developed tests (LDTs) and FDA-approved companion diagnostics (FDA-CDs) has centered upon both the regulatory and performance aspects of LDTs and we, at the College of American Pathologists (CAP), had the data through our proficiency testing (PT) programs to address the latter point, performance that we wanted to share with the community. We analyzed almost 7000 PT responses on three molecular oncology tests, those for BRAF, EGFR, and KRAS mutations, and found that both LDTs and FDA-CDs demonstrated excellent performance, with both test types exceeding 97% accuracy overall.
The second key finding of the study was that more than 60% of all laboratories in our study that were using an FDA-CD kit report using it with modifications from the FDA-approved protocol. These modifications in fact render these test LDTs. These modifications appear to be driven by the exigencies of real day-to-day clinical practice that requires adapting the assays to meet the needs of a variety of clinical situations that may not be accommodated by the FDA-approved protocol. These modifications include, for example, the testing of other tumor types that may carry targetable variants, different types of input specimen preparations available in pathology such as cytology smears or other fresh specimens rather than paraffin blocks, and availability of different methods of DNA quantification that those mandated by the FDA approval based upon pre-existing technologies in the laboratories. In the clinical laboratory, we are always acutely aware that there is a patient awaiting this result.
Therefore, we validate our assays to ensure that we can provide reliable and accurate results from our laboratory under as many varied clinical situations as possible. These data support that practice.
Dr. Krista Huybrechts[/caption]
Krista F. Huybrechts, MS PhD
Assistant Professor of Medicine
Division of Pharmacoepidemiology and Pharmacoeconomics
Brigham and Women's Hospital
Harvard Medical School
Boston, MA 02120
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In recent years, use of stimulant medications in adults, including women of reproductive age, has increased substantially.
However, data regarding the safety of stimulant medications in early pregnancy are sparse and conflicting. For example, two recent cohort studies failed to detect an association between use of methylphenidate in early pregnancy and overall or cardiac malformations, while another found an 81% increased risk of cardiac malformations, although the estimate was imprecise.
Given the rapidly increasing use of stimulant medications during pregnancy and among women of reproductive age who may become pregnant inadvertently, there is an urgent need to better understand their safety.
Dr. Marty[/caption]
Francisco M. Marty, M.D
Associate Professor, Harvard Medical School
Dana–Farber Cancer Institute and
Brigham and Women’s Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Cytomegalovirus (CMV) is the most common infection in patients who undergo allogeneic hematopoietic-cell transplantation (bone marrow transplantation with cells from donors different than the patient). Up until now, we had no antiviral agent that could be used for prophylaxis (prevention) of CMV post-transplant because of the side effects of drugs available to date (ganciclovir, valganciclovir, foscarnet, cidofovir).
This trial confirmed that letermovir was highly effective in preventing CMV infection when used in the first 100 days after allogeneic HCT, was associated with minimal side effects of concern and was also associated with lower all-cause mortality by Week 24 post-HCT.
Dr. Ladapo[/caption]
Joseph A. Ladapo, MD, PhD
Principal Substudy Investigator, PRESET Registry
Subgroup Analysis, Elderly Patients
Associate Professor, Division of General Internal Medicine and Health Services Research
David Geffen School of Medicine
University of California, Los Angeles
MedicalResearch.com: What is the background for this study?
Response: The mapping of the Human Genome 14 years ago ushered in a new era of precision medicine. Many people are familiar with advances in oncology using precision medicine, but recently, new developments in precision medicine in cardiology have allowed us to develop a tool to differentiate patients likely to have obstructive coronary artery (CAD) from those who have non-cardiac causes of their symptoms.
Diagnosing CAD in the elderly is challenging. Aging individuals often present with atypical symptoms of CAD which can complicate the evaluation process. The typical diagnostic pathway for possible CAD often starts with less invasive testing and progresses to invasive testing, especially in older patients. Invasive procedures pose greater risk in the elderly population than they do in younger patients because of the higher risk of side effects, including bleeding, vascular complications and kidney injury.
Elderly adults evaluated for CAD have a higher pretest probability of CAD and are also at higher risk of experiencing procedure-related complications during their evaluation.[i],[ii] It is also important to note that elderly patients are often underrepresented in clinical trials and other types of comparative effectiveness research.[iii],[iv] For example, the 2013 American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease Risk Algorithm is only formally approved to be used in individuals up to the age of 75, despite the fact that individuals exceeding this threshold in age experience higher rates of adverse cardiovascular events.[v]
All of this means that the elderly population may have the most to gain from timely and accurate determination of their currently likelihood of obstructive CAD.
This precision medicine tool, the age, sex and gene expression score (ASGES), and its clinical utility in the elderly population is the focus of this study. It was based on patient data from the PRESET Registry, a prospective, multicenter, observational study enrolling stable, symptomatic outpatients from 21 U.S. primary care practices from August 2012 to August 2014.
Marissa J. Seamans, Ph.D
Postdoctoral Fellow
Department of Mental Health
Johns Hopkins School of Public Health
Baltimore, MD 21205
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Many patients report sharing their prescriptions for opioids with family members. What we didn’t know is whether family members of opioid users are more likely to fill opioid prescriptions themselves than family members of non-opioid users. Our study found that the 1-year risk of prescription opioid initiation among family members of prescription opioid users was an absolute 0.71% higher than among family members of non-opioid users. The risks were particularly higher for initial prescriptions with refills or longer days supply.
MedicalResearch.com Interview with:
[caption id="attachment_38832" align="alignleft" width="161"]
Dr. Larsson[/caption]
Susanna C. Larsson, PhD Associate Professor, Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
MedicalResearch.com: What is the background for this study? Response: The causes of Alzheimer’s disease are largely unknown and there are currently no medical treatments that can halt or reverse its effects. This has led to growing interest in identifying risk factors for Alzheimer’s that are amenable to modification. Several observational studies have found that education and various lifestyle and vascular risk factors are associated with the risk of Alzheimer’s disease, but whether these factors actually cause Alzheimer’s is unclear.
We used a genetic epidemiologic method known as ‘Mendelian randomization’. This method involves the use of genes with an impact on the modifiable risk factor – for example, genes linked to education or intelligence – and assessing whether these genes are also associated with the disease. If a gene with an impact on the modifiable risk factor is also associated with the disease, then this provides strong evidence that the risk factor is a cause of the disease.
MedicalResearch.com: What are the main findings?
Response: Our results, based on aggregated genetic data from 17 000 Alzheimer’s disease patients and 37 000 healthy controls, revealed that genetic variants that predict higher education were clearly associated with a reduced risk of Alzheimer’s disease. A possible explanation for this link is ‘cognitive reserve’, which refers to the ability to recruit and use alternative brain networks or structures not normally used to compensate for brain ageing. Previous research has shown that high education increases this reserve.
We found suggestive evidence for possible associations of intelligence, circulating vitamin D, coffee consumption, and smoking with risk of Alzheimer’s disease. There was no evidence for a causal link with other modifiable factors, such as vascular risk factors.
Dr. Thiel[/caption]
Cassandra Thiel, PhD
Assistant Professor in the Departments of Population Health and Opthamology at NYU Langone Health, and Assistant Professor at NYU Wagner and
NYU Tandon School of Engineering
MedicalResearch.com: What is the background for this study?
Response: Everyone is concerned about the health impacts of climate change, from the United Nations to the Lancet. While other industries are trying to monitor and minimize their environmental footprint, healthcare services have been largely overlooked. Yet, the US healthcare sector emits 10% of the US’s total greenhouse gases.
Cataract surgery is one of the most commonly performed procedures in the world. In the US, these surgeries generate large quantities of waste due to the use of single-use, disposable materials and supplies. However, at Aravind Eye Care System in southern India, the outcomes for this procedure are the same as in the US, but the materials they use are mostly reusable. This study assessed the environmental footprint of Aravind’s surgical process, to determine how their process design and material selection affected their emissions.
Dr. Dave Thomas PhD
Health Scientist Administrator
National Institute on Drug Abuse
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: At the National Institute on Drug Abuse, we support research on all forms of drug use, and are aware that cocaine misuse is on the rise. We are aware that various forms of drug use can have greater prevalence by race, sex, age and other population characteristics.
The main finding of this paper is that cocaine overdose rates are on the rise and that that the group hit hardest is the non-Hispanic black population.
Dr. Sparks[/caption]
Jeffrey A. Sparks, M.D., M.M.Sc.
Assistant Professor of Medicine
Division of Rheumatology, Immunology and Allergy
Department of Medicine
Brigham and Women’s Hospital
Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We compared women diagnosed with rheumatoid arthritis (RA) during follow-up in the Nurses’ Health Study and matched women without RA during the same index time period. Women with RA had higher mortality than women without RA. In both groups, those that had severe weight loss (>30 pounds), had the highest mortality after the early RA/index period. Weight gain in the early RA period was not associated with mortality for either group.
MedicalResearch.com Interview with: [caption id="attachment_38692" align="alignleft" width="100"] Dr. Salo[/caption] Dr. Pӓivi Salo, PhD Epidemiologist National Institute of Environmental Health Sciences NIH MedicalResearch.com: What is the background for this study? Response: Indoor allergens are important risk factors for asthma and respiratory allergies. Only a few studies have investigated residential allergen exposures on a national scale; the...
Paolo Piaggi PhD and
Marie Thearle MD
Phoenix Epidemiology and Clinical Research Branch
National Institute of Diabetes and Digestive and Kidney Diseases
National Institutes of Health, Phoenix, Arizona
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Changes in food preparation have occurred over the recent decades including wide-spread availability of convenience foods and use of fructose as a sweetener. In addition, there is a growing trend to label certain foods as “healthy”. As the ingestion of added sugars and the prevalence of obesity have steadily increased over time, it has been suggested that the increased consumption of simple sugars may have contributed to the recent obesity epidemic.
We were interested in understanding whether the body responded to overeating foods with a high carbohydrate content differently if the source of the carbohydrate differed. For example, does it matter if we overeat foods containing whole wheat instead of high-fructose corn syrup? To answer this question, we conducted a study investigating changes in metabolism, circulating hormones, and appetite ratings in humans who were overfed a diet containing 75% carbohydrates for 24 hours. The subjects in the study were overfed with a high carbohydrate diet twice – once with a diet where the source of carbohydrates was whole wheat and once with a diet that contained simple sugars, primarily high-fructose corn syrup (HFCS). Note that the diets were given in random order with at least three days of recovery in between the overfeeding periods.
There was no difference in people’s metabolic rate over 24 hours between the whole-wheat versus high-fructose corn syrup diets; however, the diet containing HFCS resulted in increased hunger scores the next morning even though people had overeaten the day prior. These increased hunger scores were comparable to the hunger scores reported after a day of fasting. Also, 24-hour urinary free cortisol concentrations were higher the day after the diet containing high-fructose corn syrup. Cortisol is a hormone released by the adrenal glands in response to physiologic stress.
Mr. Zachary Ward
Center for Health Decision Science
Harvard T.H. Chan School of Public Health
Boston, MA 02115
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although the current obesity epidemic in the US has been well documented in children and adults, less is known about the long-term risks of adult obesity for children given their current age and weight. As part of the CHOICES project (Childhood Obesity Intervention Cost Effectiveness Study), we developed new methods to simulate height and weight trajectories across the life course based on individual-level data. We also used a novel statistical approach to account for long-term population-level trends in weight gain, allowing us to make more realistic projections of obesity into the future.
Dr Chris Gale
Clinical Senior Lecturer in Neonatal Medicine
Imperial College London and
Consultant Neonatologist at Chelsea and Westminster Hospital
NHS Foundation Trust
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As part of a drive to make England a safer place to give birth, the Department of Health in England has set a target of reducing the number of babies that incur brain injury during or soon after birth by 20% by 2020 and to halve them by 2030.
Before now United Kingdom health services did not have a standard definition of brain injury in babies and there has been no systematic collection of data for this purpose. With colleagues and in collaboration with the Department of Health, we have devised a practical way to measure the incidence rate of brain injury in babies using routinely recorded data held in the National Neonatal Research Database.
The research estimated that 3,418 babies suffered conditions linked to brain injury at or soon after birth in 2015, which equates to an incidence rate of 5.14 per 1,000 live births. For preterm births (babies born at or less than 37 weeks) the rate was 25.88 per 1,000 live births in 2015, almost six times greater than the rate for full-term births, which was 3.47 per 1,000 live births.
Overall, the research found that the most common type of condition that contributed brain injuries was damage caused by lack of oxygen to the brain, called hypoxic ischaemic encephalopathy; this is seen mainly in term babies. For preterm babies, the largest contributor to brain injuries is from bleeding into and around the ventricles of the brain, a condition called periventricular haemorrhage.
It is also the first time that brain injuries in babies have been measured using data gathered routinely during day to day clinical care on NHS neonatal units. The use of routine data required no additional work for clinical staff and provides a valuable way to measure the effectiveness of interventions to reduce brain injury.
Dr. Andrews[/caption]
Jinsy Andrews, MD, MS
Director of Neuromuscular Clinical Trials
Columbia University
The Neurological Institute
New York, NY 10032
MedicalResearch.com: What is the background for this study?
Response: The importance of respiratory function in Amyotrophic Lateral Sclerosis (ALS) has long been recognized. Despite ALS being a clinical diagnosis with variable presentation and variable rates of disease progression, all patients experience respiratory symptoms and inevitably die typically from respiratory failure. At present there is no validated biomarker of disease progression or clinical staging system. Direct measure of respiratory function in ALS is important and can be measured using vital capacity. Although the forced maneuver (FVC) has been widely used in patients with ALS, it can underestimate the actual lung capacity by causing fatigue or inducing bronchospasm in patients with ALS. More recently, the slow maneuver (SVC) has been used since it can be obtained from patients with advancing disease which can potentially minimize missing data and may reduce any underestimation of actual lung capacity due to a forceful effort. However, the prognostic value of the decline in SVC is unclear in patients with ALS.
Dr. Maier[/caption]
Alex Maier, PhD
Assistant Professor of Psychology
Assistant Professor of Ophthalmology and Visual Science
Vanderbilt University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We were interested in finding out about how the brain shifts attention from one location to another. We knew that when we attend a certain location, brain activity increases in a specific way. This increase in activity is how we perform better when we use attention. What we knew less about is what happens when attention moves between locations.
To our surprise, we found that there is a brief moment in between these attentional enhancements, while attention moves from one location to another, where the brain does the complete opposite and decreases its activity. Shifting attention thus has a brief negative effect on our brain’s ability to process information about the world around us.
Shari Liu -image by Kris Brewer.[/caption]
Shari Liu
Dept Psychology
Harvard University
Cambridge, MA 02138
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Every day, we look out into the social world and see more than pixels changing across our retinas, or bodies moving in space. We see people brimming with desires, governed by their beliefs about the world and concerned about the costs of their actions and the potential rewards those actions may bring. Reasoning about these mental variables, while observing only people’s overt behaviors, is at the heart of commonsense psychology.
The brain of one patient who died from sporadic Creutzfeldt-Jacob disease (sCJD) appears nearly identical to the brain of a mouse inoculated with infectious prions taken from the skin of patients who died from sCJD.
Elizabeth George, MD
PGY-4 Radiology Resident
Brigham and Women’s Hospital
Dr. Bharti Khurana MD
Clinical Fellow, Harvard Medical School and
Assistant Director, Emergency Radiology
Director, Emergency Musculoskeletal Radiology
Program Director, Emergency Radiology Fellowship
Assistant Professor, Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: According to the CDC, 1 in 3 women in the United States are victims of abuse by their intimate partner. Despite the US Preventive Services Task Force recommendations, intimate partner violence (IPV) screening is still not widely implemented and IPV remains very prevalent and often under-recognized.
The goals of this study are to increase the awareness among physicians about this public health problem and to elucidate the potential role of imaging in the identification of these patients. In fact, there is a striking disparity in the literature on the role of imaging in identifying non-accidental trauma in children compared to intimate partner violence.
The common patterns of injury we identified in this population were soft tissue injuries (swelling, hematoma or contusion) followed by extremity fractures, which often involve the distal upper extremities, suggesting injury from defensive attempts. Other common injuries were facial fractures, which represent an easily accessible site for inflicting trauma, and pregnancy failure. Since radiologists have access to both current and prior radiological studies of these patients, they could play a critical role by putting the pieces together in identifying victims of IPV.
Dr. Bredella[/caption]
Miriam Bredella, MD
Associate Professor of Radiology
Harvard Medical School
Department of Radiology
Massachusetts General Hospital
Boston, MA 02114
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It is well known that body composition differs between men and women, with women having proportionally more fat and men more muscle mass.
But not the amount of fat but its distribution is an important determinant of cardiometabolic risk, with certain ectopic fat depots, such as visceral adipose tissue, fat within muscle cells - intramyocellular (IMCL), and liver fat, being more detrimental than others, such as femorogluteal subcutaneous adipose tissue.
We therefore wanted to study sex differences in body composition and cardiometabolic risk in men and women with obesity.
We found that at the same BMI, men had relatively higher visceral adipose tissue, IMCL, liver fat, muscle and lean mass, while women higher percent fat mass and higher subcutaneous adipose tissue. This female anthropometric phenotype was associated with a better cardiometabolic risk profile at similar BMI compared to men. However, ectopic fat depots were more strongly associated with adverse cardiometabolic risk factors in women compared to men
Normal rhythm tracing (top) Atrial fibrillation (bottom) Wikipedia[/caption]
Interview with:
Dr Xiaoxi Yao PhD
Assistant Professor
Researcher
Mayo Clinic
What is the background for this study? What are the main findings?
Response: Lifelong oral anticoagulation, either with warfarin or a non-vitamin K antagonist oral anticoagulant (NOAC), is indicated for stroke prevention in most patients with atrial fibrillation (AF). Emerging evidence suggests that NOACs may be associated with better renal outcomes than warfarin.
The study found renal function decline is common among patients with atrial fibrillation treated with oral anticoagulants. NOACs, particularly dabigatran and rivaroxaban, may be associated with lower risks of adverse renal outcomes than warfarin.
Marta Guasch-Ferre, PhD
Research Fellow
Department of Nutrition. Harvard TH Chan School of Public Health
655 Huntington Ave, Building 2
Boston, Ma, 02115
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although previous evidence has shown that frequent nut consumption is associated with reduced cardiovascular risk factors including dyslipidaemia, type 2 diabetes and metabolic syndrome; as well as with lower risk of coronary heart disease (CHD); most of the previous prospective studies have focused on total nut consumption in relation to the risk of CVD. However, the associations between peanut butter and specific types of nuts, such as peanuts and walnuts, with major cardiovascular events, and specifically the relation with stroke were unclear. Of note, because the nutritional composition of peanuts and walnuts differs from other nuts, it was of particular interest to evaluate the health effects of specific types of nuts. Therefore, our main aim was to look at several types of nuts including total nut consumption, peanuts, walnuts, and tree nuts.
Briefly, in three large prospective cohorts with up to 32 years of follow-up, people who regularly eat nuts, including peanuts, walnuts and tree nuts, have a lower risk of developing cardiovascular disease or coronary heart disease compared to people who never or almost never eat nuts. We found a consistent inverse association between total nut consumption and total cardiovascular disease (14% lower risk for those consuming nuts five or more times per week) and coronary heart disease (20% lower risk).
Also, after looking at individual nut consumption, eating walnuts one or more times per week was associated with a 19 percent lower risk of cardiovascular disease and 21 percent lower risk of coronary heart disease. Participants who ate peanuts or tree nuts two or more times per week had a 15 percent and 23 percent, respectively, lower risk of coronary heart disease compared to those who never consumed nuts.
MedicalResearch.com Interview with: [caption id="attachment_38419" align="alignleft" width="200"] Dr. Fralick[/caption] Michael Fralick, MD FRCPC Research Fellow at the Division of Pharmacoepidemiology and Pharmacoeconomics Harvard University and General Internist at the University of Toronto MedicalResearch.com: What is the background for this study? Response: Manufacturers of Food and Drug Administration (FDA)-approved prescription drugs often apply for additional indications based on randomized...
Dr. Bischoff[/caption]
Kara Bischoff, MD
Assistant Clinical Professor, Hospital Medicine & Palliative Care
Director of Quality Improvement for the Palliative Care Service
UCSF Department of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Care planning, which we define as including both advance care planning and goals of care discussions, are a common need in seriously ill patients and a key function of palliative care teams.
However, few studies have looked at how often and how care planning is being done by inpatient palliative care teams throughout the United States, and similarly few studies have examined the precise impact of these care planning activities. Therefore, using data from a large quality improvement registry in palliative care called the Palliative Care Quality Network, we examined:
1) the characteristics of hospitalized patients who are referred to inpatient palliative care consult services,
2) the activities that occurred during those inpatient palliative care consults, and
3) the outcomes that resulted.
In looking at data from 73,145 patients who referred for an inpatient palliative care consult, we found that care planning was the most common reason for inpatient palliative care consultation, requested for 71.9% of patients who were referred to palliative care. Further, care planning needs were found in more than half (58%) of palliative care patients even when the consult was requested for reasons other than care planning. Patients referred to palliative care for care planning were somewhat older than patients referred for other reasons, they were less likely to have cancer, and were more often full code at the time of referral. Through care planning conversations, palliative care clinicians frequently identified surrogates and clarified patients’ preferences for life-sustaining treatments (including code status). For instance, 31% more patients chose a code status of DNR/DNI after a conversation with the palliative care team.
However, we also found that legal forms such as advance directives and Physician Orders for Life-Sustaining Treatments (POLST) forms were completed for just 3.2% and 12.3% of the patients see by palliative care teams, respectively. This highlights an important quality gap in need of improvement.