Ahn and Neeman Win 2018 Rubenstein Award
Improving healthcare for patients with liver disease and cancer were the goals of the two studies that won this year's Rubenstein Award for Excellence in Resident Research. Joseph Ahn, MD, and Elad Neeman, MD, received their awards and $3,000 prizes on May 30 in Harvey Morse Auditorium. The annual event featured oral presentations by the four finalists.
Ahn's study found that obesity places patients with extensive liver scarring, known as decompensated cirrhosis, at higher risk for developing severe liver dysfunction, which rapidly can lead to multi-organ failure. About 30 percent of patients hospitalized with decompensated cirrhosis develop this severe dysfunction, known as acute-on-chronic liver failure (ACLF).
The findings were based on analyzing data from a nationwide database of 387,884 individuals with decompensated cirrhosis who were waiting for liver transplants. ACLF was found to be significantly more prevalent among the severely obese patients—those with a body mass index of 40 or higher. Another condition, known as ACLF-related renal failure, was more prevalent among obese patients at all levels of severity.
"We concluded that class III obesity is a newly identified risk factor for ACLF development in patients with decompensated cirrhosis, which highlights the importance of weight management to reduce the risk of ACLF," Ahn said. "Patients with class III obesity also should be closely monitored for renal failure."
The multicenter study was published online in April in the Journal of Hepatology. Ahn was a co-author. The principal investigator and first author was his mentor, Vinay Sundaram, MD, director of Hepatology Outcomes Research and assistant medical director of Liver Transplantation.
Neeman's research examined how well physicians' and nurses' scorings of the daily living activities of patients with various malignant solid tumors predicted disease progression and treatment outcomes. The scores were based on the Eastern Cooperative Oncology Group Performance Status standardized criteria, which quantify cancer's impact on a patient’s functioning, such as walking and working, and help inform treatment and prognosis.
Thirty-two oncologists and 41 chemotherapy nurses at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute independently scored the performance status of 311 cancer patients receiving outpatient chemotherapy.
Neeman and his team found that the nurses' scores of the patients' abilities were stronger predictors of important outcomes, such as hospitalizations, mortality and severe side effects from chemotherapy, than were the doctors' scores. They also found that significant differences in a physician's and a nurse's scores for the same patient were predictive of a poor prognosis. The findings could help improve patient care, Neeman said.
"Having nurses evaluate patients' performance status may offer a simple, inexpensive, and easy-to-implement intervention to improve quality of care and better direct medical decision-making in the care of cancer patients," he said.
Neeman was the study's first author. His mentor was Arvind Shinde, MD.
The two other award finalists were: Amir Hadi Maghzi, MD, presenting "Impact of Multiple Sclerosis-Associated TNF-α Receptor Polymorphism on Clinical Characteristics and Serological Biomarkers of IBD Patients"; and Devin Patel, MD, presenting "Early Urinary Catheter Removal Following Pelvic Colorectal Surgery: A Prospective Randomized, Non-Inferiority Trial."
Named for Paul Rubenstein, MD, Cedars-Sinai's first director of medical education, the annual award recognizes outstanding research by residents. It is sponsored by the Burns and Allen Research Institute and the Clinical and Translational Science Institute at Cedars-Sinai.