The Kaiser Permanente Los Angeles Annual Research Week Abstracts



 

John J Sim, MD1; Kristen Ironside, MA2; Gary W Chien, MD3

Perm J 2019;23:18-233 [Full Citation]

https://doi.org/10.7812/TPP/18-233
E-pub: 05/31/2019

History Highlights: Los Angeles Medical Center Research Week

June 7, 2018, was another warm sunny day in Southern California and a period of transition at the Kaiser Permanente (KP) Los Angeles Medical Center. Spring at KP marks the end of the academic year for our residency and fellowship programs, and those in their last year of training were eagerly looking forward to the next step in their careers and lives. Faculty physicians greeted the end of another academic year with mixed emotions: A sadness and fondness for the departing trainees coupled with excitement and anticipation for the incoming eager but inexperienced new batch of trainees. This first Thursday in June also marked the end of the annual KP Los Angeles Research Week. The 19th event of its kind.

The exact dates are vague, but many people refer to J Fenimore Cooper, MD, (a urologist) as the very first Los Angeles Medical Center research lead, dating to the 1960s. We often refer to the 1960s as the days of giants because these individuals stood tall from the norm, and they represented people who went against the grain and did not follow the path of least resistance. For the KP physicians of this era, research was truly a labor of love. “People doing research at KP at the time were often chastised by others, and their work was deemed inappropriate conduct for a KP physician,” said Sheldon Wolfe, MD, a neurologist. Wolfe assumed the first official research chair position in the 1970s. Nevertheless, this small army of scholars and trendsetters persisted and continued to grow.

It was not until the fall of 2001 that there was enough interest and support to hold the first research week. According to Michael Glowalla, MD, Research Chair at the time, it took the form of an informal luncheon to acknowledge the few researchers and house staff doing research on campus. As miniscule as it may have seemed at the time, it represented another meaningful step in the growth and acceptance of research at KP Los Angeles. Since then, the event has grown tremendously in the number of researchers, the magnitude and number of projects presented, and the number of people interested, attending, and supporting research. People like Dennis Kim, MD; Bruce Goldberg, MD; Albert Shen, MD; and Nilesh Patel, DM; come to mind, helping to lead and oversee the surging culture of research. Overall, the transformation of the annual event has paralleled the growth of the research infrastructure including the clinician researchers, dedicated research scientists, research funding, and the findings that affect our organization. The following pages include the abstracts from the 19th annual KP Los Angeles Research Week. We feel that some of this year’s work, like others in the past, will affect future care within KP and elsewhere. This annual event is just a small sample of the number, quality, and vastness of the research conducted in Los Angeles, Southern California, and KP nationally. The year 2018 also marked the first year that KP Fontana (nearly 30 research posters presented this year) had such an event, and KP San Diego will follow suit in 2019. Although 2018’s panel of judges included Edward Ellison, MD (Executive Medical Director of KP Southern California); Steven Jacobsen, MD (Director of Research and Evaluation); and Adam Sharp, MD (Research Scientist and Emergency Physician); previous judges have included Michael Kanter, MD (Chief Quality Officer of the KP Federation); and Marc Klau, MD (Vice Dean KP School of Medicine). Chairman and CEO of Kaiser Foundation Health Plan and Hospitals, Bernard J Tyson, made this comment: “Kaiser Permanente has one of the nation’s most-respected research institutions, and the research we develop improves the quality of care and health outcomes we deliver for our members and the communities we serve. The Los Angeles Medical Center Research Week is an exciting example of how we are working together—through research—to find new ways to impact and transform the future of health.”

The Annual Kaiser Permanente (KP) Los Angeles Research Week is culminated by the highly anticipated oral abstract competition. This research competition is often described by the house staff as the highlight of the academic year with its competitive intensity, celebratory aura, and even drama. The work is often a product of effort spanning the entire duration of training. The judges for this prestigious competition are a diverse group representing research, operations, clinical medicine, and medical education.

Several days before the competition, the Medical Center hosted the annual research abstract poster session of original research, quality and patient outcomes, operational research, and case reports. The set of 40 papers in the linked-bibliography came from different medical subspecialties and from different health fields, including pharmacy and nursing.

Throughout the years, KP research has provided insights and helped shape medicine in many ways. In 1969, Irving Rasgon, MD, published a study on colon cancer screening in the journal CA: A Cancer Journal for Clinicians,1 and in 1977, Harry Ziel, MD, with Gordon et al, published a study on estrogens causing endometrial cancer in the New England Journal of Medicine.2 In 1981, Peter Mahrer, MD, with Eshoo, published his study of the safety of same-day cardiac catheterization in Catheterization and Cardiovascular Diagnosis.3 More recent examples include identifying major adverse risk with common drugs such as cox 2 inhibitors,4 questioning the overall benefit vs risk of routine colonoscopy in the elderly population,5 and informing people of the risks associated with beta blockers in pregnancy.6 In addition, we have dispelled myths about porcelain gallbladder,7 described unlikely benefits of cannabis, and helped establish guidelines for care such as with hematuria.8 We have helped provide insights on comparative outcomes for management strategies for many different diseases including cancer, and continue to describe and share our success rates for chronic disease management programs and innovations in care delivery for such conditions as hypertension, diabetes, and heart failure, to name a few.9-11 KP has become a source for health information not just on its members, but on its medical residents as well. A recent qualitative study gathered the perspectives of both residents and faculty across multiple disciplines on the causal and protective factors for burnout in residency. The results have been presented locally, as well as nationally, and are being used to develop prevention and intervention strategies across the region.9

Research is a standard for the KP community and now part of its DNA. The history of the Los Angeles Medical Center Research Week (see Sidebar: History Highlights: Los Angeles Medical Center Research Week) has reflected a changing culture where recognition, emphasis, and support of research continues to increase in the organization and training programs. If physicians are asked to change and improve on the ways they practice medicine, the evidence must be there. This has led to the fostering and growth of researchers as well as the recruitment and attraction of talented research-minded physicians to KP. This year’s work, like others in the past, will affect future care within KP and elsewhere.

KP medicine strives to continually transform and improve upon itself because of its introspective approach and willingness to study what we do from all perspectives. Thus, research is embedded in so much of how we operate. With research as a priority, we hope to continue to challenge and advance the field of medicine. Finally, the basis for why we deliver high-quality and efficient care largely lies within the information that we obtain from our own clinical practice and experience, which is based entirely on our members. For this we are infinitely grateful to the members of KP. They are truly the reason we do research and the reason we can do research.

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

How to Cite this Article

Sim JJ, Ironside K, Chien GW. The Kaiser Permanente Los Angeles Annual Research Week abstracts. Perm J 2019;23:18-233. DOI: https://doi.org/10.7812/TPP/18-233

Author Affiliations

1 Division of Nephrology and Hypertension, Los Angeles Medical Center, CA

2 Center for Medical Education, Los Angeles, CA

3 Department of Urology, Los Angeles Medical Center, CA

Corresponding Author

John J Sim, MD (john.j.sim@kp.org)

References
1. Rasgon IM. The importance of routine sigmoidoscopic examination in asymptomatic patients. CA Cancer J Clin 1969 Nov-Dec;19(6):339-43. DOI: https://doi.org/10.3322/canjclin.19.6.338.
 2. Gordon J, Reagan JW, Finkle WD, Ziel HK. Estrogen and endometrial carcinoma. An independent pathology review supporting original risk estimate. N Engl J Med 1977 Sep 15;297(11):570-1. DOI: https://doi.org/10.1056/nejm197709152971102.
 3. Mahrer PR, Eshoo N. Outpatient cardiac catheterization and coronary angiography. Cathet Cardiovasc Diagn 1981;7(4):355-60. DOI: https://doi.org/10.1002/ccd.1810070407.
 4. Cheetham TC, Graham DJ, Campen D, et al. Myocardial Infarction and its association with the use of nonselective NSAIDs: A nested case-control and time-to-event analysis. Perm J 2008 Winter;12(1):16-22. DOI: https://doi.org/10.7812/TPP/07-081.
 5. Tran AH, Man Ngor EW, Wu BU. Surveillance colonoscopy in elderly patients: A retrospective cohort study. JAMA Intern Med 2014 Oct;174(10):1675-82. DOI: https://doi.org/10.1001/jamainternmed.2014.3746.
 6. Duan L, Ng A, Chen W, et al. β-Blocker exposure in pregnancy and risk of fetal cardiac anomalies. JAMA Intern Med 2017 Jun 1;177(6):885-7. DOI: https://doi.org/10.1001/jamainternmed.2017.0608.
 7. Chen GL, Akmal Y, DiFronzo AL, Vuong B, O’Connor V. Porcelain gallbladder: No longer an indication for prophylactic cholecystectomy. Am Surg 2015 Oct 8;81(10):936-40.
 8. Loo RK, Lieberman SF, Slezak JM, et al. Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria. Mayo Clin Proc 2013 Feb;88(2):129-38. DOI: https://doi.org/10.1016/j.mayocp.2012.10.004.
 9. Kanter MH, Lindsay G, Bellows J, Chase A. Complete care at Kaiser Permanente: Transforming chronic and preventive care. Jt Comm J Qual Patient Saf 2013 Nov;39(11):484-94. DOI: https://doi.org/10.1016/s1553-7250(13)39064-3.
 10. Sim JJ, Handler J, Jacobsen SJ, Kanter MH. Systemic implementation strategies to improve hypertension: The Kaiser Permanente Southern California experience. Can J Cardiol 2014 May;30(5):544-52. DOI: https://doi.org/10.1016/j.cjca.2014.01.003.
 11. Sim JJ, Rutkowski MP, Selevan DC, et al. Kaiser Permanente Creatinine Safety Program: A mechanism to ensure widespread detection and care for chronic kidney disease. Am J Med 2015 Nov;128(11):1204-1211.e1201. DOI: https://doi.org/10.1016/j.amjmed.2015.05.037.

Keywords: chronic conditions, community health, cultural, education, epidemiology, health research, medical research

 

The Kaiser Permanente Los Angeles Annual Research Week Abstract Summaries

Top 5 from the House staff Oral Abstract Competition

First Place

Maternal Glycemic Control and Risk of Fetal Congenital Heart Disease in a Multi-Ethnic Cohort of Women with Diabetes
Marwan Qattan, MD; Lewei Duan, MS; Avetis Hekimian, MD; Ming-Sum Lee, MD, PhD

This study investigated singleton births among pregnant women with diabetes mellitus. They found that poor maternal glycemic control was associated with greater risk of fetal congenital heart disease.

Second Place

Hypothyroidism: A Potential Modifiable Risk Factor for Chronic Kidney Disease?
Cheng-Wei Huang, MD; Bonnie Li, MS; Connie Rhee, MD; John J Sim, MD

Hypothyroidism and chronic kidney disease (CKD) are both highly prevalent conditions. Whether hypothyroidism is a modifiable risk factor to CKD is unknown, although animal studies suggest a plausible mechanism for a causal relationship. This study evaluated whether hypothyroidism and different levels of hypothyroidism are associated with CKD.

Third Place

Gallbladder Polyps: Real or Imagined?
Yiping, Li, MD; Talar Tejirian, MD, FACS; J Craig Collins, MD, MBA, FACS

The finding of gallbladder polyps on imaging studies usually prompts further workup and often concern for cancer leads to surgery. Imaging results may not always correlate with final pathology. This study compared polypoid lesions of the gallbladder found on preoperative ultrasonography with final pathologic diagnosis after cholecystectomy to refine estimates of clinical risk and thus, to guide decision making.

Effects of Nonsteroidal Anti-inflammatory Drugs on Complications and Postoperative Pancreatic Fistula in Patients Undergoing Pancreatectomy
Louis Andrew DiFronzo, MD; Azure Adkins, MD; Jennifer Lee, MD; Stefanie Sueda, MD; Mayo Hotta, MD; Mohammed Al-Temimi, MD

The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on complications following pancreatic resection is important because of high postoperative morbidity and significant patient and economic costs. This study compared the rate of postoperative pancreatic fistula and other 30-day morbidity in patients who did and did not receive NSAIDs after pancreatectomy.

Clinician Prescribing Practices Associated with Antidepressant Medication Adherence. A Retrospective HMO Database Study
Rohan Hattiangadi, MD; Ellen Lorange, DO, MPH

Perceptions of weight gain among users of hormonal long-acting reversible contraception have led to early discontinuation. This study evaluated the magnitude of weight gain in reproductive-age women using either the 52-mg levonorgestrel intrauterine system, etonorgestrel subdermal implant, or copper intrauterine device during 12-, 36-, and 60-month periods.

POSTER AWARDS—Original Research

First Place: Sports Medicine

Nonsteroidal Anti-Inflammatory Drug Use, Sex, and Functional Outcomes after Achilles Tendon Rupture
Vanessa Franco, MD, PhD; Marissa Vasquez, MD; Michael Fong, MD

Second Place: Cardiology

Maternal and Fetal Outcomes in Pregnant Women with Heart Failure—A Population-Based Study
Angie Ng, MD; Lewei Duan, MS; Theresa Win, MD; Albert Y-J Shen, MD; Ming-Sum Lee, MD, PhD

Honorable Mention: Surgery

Comparing Aesthesia Modalities in Endovascular Aneurysm Repair
Michael Cheng, MD; Qiaoling Chen, MS; Linda Chun, MD; Wesley Lew, MD; Kevin Patel, MD, FACS

Honorable Mention: Allergy

Establishing the Safety and Efficacy of Higher Dose Starting Protocols for Patients with Aspirin Hypersensitivity and Coronary Artery Disease
Emily H Liang, MD; Cy Y Kim, MD; Shefali A Samant, MD; Javed Sheikh, MD

Honorable Mention: Internal Medicine

Identifying and Studying Rare Disease Using an Electronic Health Record and Machine Learning-Based Approach: The KPSC Membranous Glomerulonephritis Cohort
Amy Z Sun, MD; Yu-Hsiang Shu, PhD; Teresa N Harrison, SM; John J Sim, MD

POSTER AWARDS—Case Report

First Place: Internal Medicine

Necrotizing Neutrophilic Dermatosis of the Dorsal Hands after IV Antibiotic Therapy
Osama Hashmi, MPH; Saad Ashraf, MD; Frances Hetherington, MD

Second Place: Family Practice

Elderly-Onset Gout
Humberto Avila, MD; Bruno J Lewin, MD, DTMH; Steve S Lee, DO, FACR

Honorable Mention: Rheumatology

Case Report of Neuropsychiatric Systemic Lupus Erythematosus with Ring-Enhancing Lesion on Magnetic Resonance Imaging
Raksha Pradhan, DO; Phot Luisiri, MD

POSTER AWARDS—Quality Improvement

First Place: Internal Medicine

Multipronged Outpatient Influenza Vaccine Quality Improvement Initiative
Eric Ton, MD, MBA, MD; Christine M Panganiban MD, MS; James Evans, MD; Sangeeta Aggarwal, MD

Second Place: Family Practice

Homeless Health at Kaiser Permanente Los Angeles Medical Center
Helen Yu, MD; Jayanti Dasgupta, MD; Rima Shah, MD; Joanie Chung, MPH, MA; Neil Chawla, MD

Honorable Mention: Family Practice

Domestic Violence Screening by Ethnicity at Kaiser Permanente LAMC
Jayanti Dasgupta, MD; Chris Chung, MD; Su-Jau Yang, PhD; Tara Thacker, MD

POSTER AWARDS—Allied Health

First Place: Pharmacy

Once- Versus Twice-Daily Enoxaparin for Peri-Operative Bridging
Mane Keshishyan, PharmD; Derenik Gharibian, PharmD; Marlene Nashed, PharmD; Daniel Lang, MD

Second Place: Pharmacy

Evaluation of Renal Function in HIV-1 Patients after Switch from Tumor Degenerating Factor to Tumor Angiogenic Factor
Ruth Madievsky, PharmD; Derenik Gharibian, PharmD; Marlene Nashed, PharmD; Lindsay Gordon, PharmD; William Towner, MD

Honorable Mention: Pharmacy

Improving Efficiency and Safety of Patients during Transition from Door Time to Groin Puncture
Dinah Hernandez, MSN Ed, PHN, BSN, RN, CRN; Joseph Villafuerte, MSN, BSN, RN; Miho Richmond, RN

POSTER AWARDS—Cardiology

Characteristics and Clinical Outcomes of Patients with Spontaneous Coronary Artery Dissection
Ryan Clare, MD; Lewei Duan, MS; Michael Jorgensen, MD; Anne Ichiuji, MD; Albert Y Shen, MD; Ming-Sum Lee, MD PhD

Statin Use is Associated with Reduced Mortality in Heart Failure Patients with Preserved but not Reduced Rejection-Fraction
Avetis Hekimian, MD; Ryan Clare, MD; Lewei Duan, MS; Wansu Chen, PhD; Ming-Sum Lee, MD, PhD

Dual Antiplatelet Therapy Before Cardiac Catheterization: To Pretreat or Not
Brandon Kai, MD; Somjot Brar, MD, MPH

POSTER AWARDS—Family Medicine

A Case of Intravenous Methadone Used for the Treatment of Opioid-Induced Hyperalgesia in a Cancer Patient at the End of Life
Heather Bitar, DO; Andre Cipta, MD; Kuo-Wei Lee, MD; Wesley Woo, MD

POSTER AWARDS—Graduate Medical Education

Preventing Burnout: Perspectives of Residents and Faculty in Community-Based Training Programs
Davida Becker, PhD; Kristen Ironside, MA; Isabel Chen, MD; Adegbemisola Daniyan, MD; Ary Kian, MD; Neeta Saheba, MD; Felice Klein

POSTER AWARDS—Internal Medicine

Factors Pertaining to Statin Treatment Adherence during the First Year of Use: A Retrospective Study of a Southern California Cohort
Hardeep Aujla, MD; Edward Erlikh, MD; Arash Khalili, MD; Bradley Richie, MD

A Descriptive Study of Patients with Chronic Urticaria before and after Taking Omalizumab
Christine M Panganiban, MD, MS; Javed Sheikh, MD

Case Report of Neuropsychiatric Systemic Lupus Erythematosus with Ring-Enhancing Lesion on Magnetic Resonance Imaging
Raksha Pradhan, DO; Phot Luisiri, MD

Internal Medicine Multipronged Outpatient Influenza Vaccine Quality Improvement Initiative
Eric Ton, MD, MBA; Christine M Panganiban, MD, MS; James Evans, MD; Sangeeta Aggarwal, MD

POSTER AWARDS—Neurology

Role of Serial Electroencephalograms during Initial Management of Childhood Absence Epilepsy in Defining Treatment Failure in Patients Started on Ethosuximide or Valproic Acid
Suresh Gurbanim, MD; Sirichai Chayasirisobhon, MD; Noriko McCall, MD; Aditya Gurbani, MD; Abel Wu, MD

POSTER AWARDS—Obstetrics/Gynecology

The Use of an Alternative Measurement of Visceral Adiposity to Evaluate Endometrial Cancer Recurrence and Survival
Monica Avila, MD; Jared R Funston, MD; Allison E Axtell, MD; Scott E Lentz, MD

Racial Disparities in Knowledge of Urogynecologic Issues and Expectation of Treatment
Mabel Mora, MD; Atieh Novin, MD; Michael Weinberger, MD

Nonsurgical Patients with Advanced Gynecologic Cancer Discharged to Subacute Rehabilitation Centers Have Low Rates of Subsequent Chemotherapy
Nathan M Riley, MD; Camille L Clefton, MD; Guillermo Urzua, MD; Antonia Cotwright, DO; Christopher Bui, MD; Elena X Martinez, MD; Carolyn Lefkowits, MD

Nonmalignant Sequelae Following Unconfined Power Morcellation
Hao Mike Zhang, MD; Lee Ann Christianson, MD; Claire Templeman, MD; Scott Lentz, MD

POSTER AWARDS—Pediatrics

Exposure to Angiotensin-Converting Enzyme Inhibitors in Pregnancy and the Risk of Low Birth Weight and Congenital Cardiac Malformation
Sneha Chintamaneni, MD; Lewei Duan, MS; Avetis Hekimian, MD; Marwan Qattan, MD; Ming-Sum Lee, MD, PhD

Food Allergy Screening: A Pilot Study Using an Electronic Medical Record to Identify Candidate Patients
Victoria Eng, MD; Michael Kaplan, MD; Shefali Samant, MD; Javed Sheikh, MD

Assessment of the Asthma Medication Ratio as an Asthma Control Predictor in the Pediatric Population
Janet Trang, MD; Scott Takahashi, PharmD; Kristen Ironside, MA; Jiaxiao Shi, PhD; Binh Do

POSTER AWARDS—Radiation/Oncology

Improving Efficiency and Safety of Patients during Transition from Door Time to Groin Puncture
Dinah Hernandez, MSN Ed, PHN, BSN, RN, CRN; Joseph Villafuerte, MSN, BSN, RN; Miho Richmond, RN

POSTER AWARDS—Sports Medicine

Appearance and Performance-Enhancing Drugs among Co-Ed College Athletes in the Los Angeles Metro Area: Evaluating Prevalence and Attitudes
Oluyemi Ajirotutu, MD; Branden Turner, MD; John K Su, MD, MPH

POSTER AWARDS—Surgery

Aortic Dissection Causing Malperfusion from Stent Graft Collapse in a Patient with Previous Hybrid Repair of a Paravisceral Aortic Aneurysm: A Case Report
Marie S Tran-McCaslin, MD; Wesley K Lew, MD; Kaushal (Kevin) Patel, MD; Linda J Chun, MD

A National Review of ACGME General Surgery Resident Case Logs: Assessing the Impact of Minimally Invasive Surgery
Janice Verham, MD; Borna Mohabbatizadeh, MD; Kaushal (Kevin) Patel, MD

POSTER AWARDS—Urology

Safety and Feasibility of Outpatient Robotic-Assisted Radical Prostatectomy
Peter Elliott, MD; Pooya Banapour, MD; Ashish Parekh, MD; Apurba Pathak, MD; Madhur Merchant, MD; Kirk Tamaddon, MD

Adoption of Robotic Partial Nephrectomy: Its Effect on Renal Cancer Surgery and Kaiser Permanente Southern California Practice Patterns

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