Epigenetic Dysregulation in Human Brain Cancer: Pten Promoter Methylation and Microrna Upregulation in Glioblastoma

Noncompliance with follow-up appointments has been demonstrated in numerous studies of Glaucoma and Age-related Macular Degeneration (AMD), and can lead to irreversible blindness. To better understand barriers to follow-up, we conducted a cross-sectional survey of 119 Glaucoma patients attending Stanford Eye Center and 86 AMD patients at California VitreoRetinal Center between June and November 2009. Eligibility criteria included (1) Glaucoma or AMD (2) follow-up visits for the prior 12 months (3) age >18 years. Using a modified form of the Aravind questionnaire, patients were asked questions concerning demographics, travel, insurance, education, and knowledge of glaucoma or AMD. Patients rated their visual function using the Visual Functioning Questionnaire-25. Finally, patients were surveyed on strategies to improve compliance with follow-up. The protocol was approved by Stanford University’s IRB. Data analysis was completed using SAS Enterprise. Patients were determined to have poor follow-up if they no-showed to any appointment or cancelled at least 3 appointments in the past year. Prevalence percentages were calculated in the primary analysis, and unadjusted OR for poor follow-up were investigated using a univariate logistic regression model. Forty-eight percent of Glaucoma and fifty-six percent of AMD patients had poor follow-up. They were more likely to be non-whites and lack private insurance. In AMD, poor follow-up patients were more likely to need an escort to the clinic, and were uncertain if AMD requires treatment for life. Compared to good follow-up patients, a greater percentage of glaucoma poor follow-up patients had a high school degree or less, had missed their eyedrops in the past week, were unsure if vision loss from glaucoma was permanent, and felt like they would benefit from knowing other people with glaucoma or an eye condition. While this study was limited in sample size and in demographics, future larger studies are needed especially to better analyze minority populations. Funding provided by the Stanford Medical Scholars Fellowship Program*CO-PRESENTED WITH MATTHEW THOMPSON References1. Lee, PP, Feldman ZW, Ostermann J, Brown DS, Sloan FA. Longitudinal rates ofannual eye examinations of persons with diabetes and chronic eye diseases.Ophthalmology. 2003;110:1952-1959.2. Lee, PP, Feldman ZW, Ostermann J, Brown, Derek, Sloan FA. LongitudinalPrevalence of Major Eye Diseases. Arch Ophthalmol. 2003;121:1303-1310. 3. Lee BW, Sathyan P, John RK, Singh K, Robin AL. Predictors of and barriersassociated with poor follow-up in patients with glaucoma in South India. ArchOphthalmol. 2008;126(10):1448-1454.4. Schwartz GF. Compliance and persistency in glaucoma follow-up treatment.Current Opinion in Ophthalmology. 2005;16:114-121.5. Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD.Development of the 25-item National Eye Institute Visual Function Questionnaire.Arch Ophthalmol. 2001;119:1050-1058. BARRIERS TO EYE CARE SERVICE UTILIZATION AND POTENTIAL STRATEGIESTO IMPROVE FOLLOW-UP IN PATIENTS WITH DIABETIC RETINOPATHY* Authors: Matthew Thompson, Atalie Thompson, Michael Hurley, Dr. Kuldev Singh,Dr. Richard Lin, Dr. Mark Blumenkranz, Dr. Darius Moshfeghi, Dr. Steven Sanislo Department: Ophthalmology Abstract:According to the American Diabetes Association, diabetic retinopathy (DR) hasbecome the leading cause of blindness in America. While numerous studies ofdiabetics have demonstrated poor compliance with annual eye screenings, recentdata shows that patients continue to have inconsistent follow-up when diagnosed withDR. To better understand barriers to follow-up, we conducted a cross-sectional surveyof 33 DR patients attending appointments at California VitreoRetinal Center betweenJune and November 2009. Eligibility criteria included (1) proliferative or nonproliferativeDR (2) follow-up visits for the prior 12 months (3) age >18 years. Using a modified formof the Aravind questionnaire, patients were asked questions concerning demographics,travel, insurance, education, and knowledge of DR. Patients rated their visual functionusing the Visual Functioning Questionnaire-25. Finally, patients were surveyed onstrategies to improve compliance with follow-up.The protocol was approved by Stanford University’s IRB. Data analysis wascompleted using SAS Enterprise. Patients were determined to have poor follow-up ifthey no-showed to any appointment or cancelled at least 3 appointments in the pastyear. Prevalence percentages were calculated in the primary analysis, and unadjustedOR for poor follow-up were investigated using a univariate logistic regression model.Sixty-nine percent of DR patients had poor follow-up. They were more likely to benon-whites, older than 80 years, have a high school degree or less, and havenonproliferative DR. A larger percentage thought their eye disease was less severe. Yet35% more patients reported need for an escort to the clinic in the poor follow-up group.Thirty-five percent of poor follow-up patients believed they would benefit from knowingother people with DR or an eye condition, compared with 0% of good follow-up patients.While this study was limited in sample size and in demographics, future larger studiesare needed especially to better analyze minority populations.According to the American Diabetes Association, diabetic retinopathy (DR) hasbecome the leading cause of blindness in America. While numerous studies ofdiabetics have demonstrated poor compliance with annual eye screenings, recentdata shows that patients continue to have inconsistent follow-up when diagnosed withDR. To better understand barriers to follow-up, we conducted a cross-sectional surveyof 33 DR patients attending appointments at California VitreoRetinal Center betweenJune and November 2009. Eligibility criteria included (1) proliferative or nonproliferativeDR (2) follow-up visits for the prior 12 months (3) age >18 years. Using a modified formof the Aravind questionnaire, patients were asked questions concerning demographics,travel, insurance, education, and knowledge of DR. Patients rated their visual functionusing the Visual Functioning Questionnaire-25. Finally, patients were surveyed onstrategies to improve compliance with follow-up.The protocol was approved by Stanford University’s IRB. Data analysis wascompleted using SAS Enterprise. Patients were determined to have poor follow-up ifthey no-showed to any appointment or cancelled at least 3 appointments in the pastyear. Prevalence percentages were calculated in the primary analysis, and unadjustedOR for poor follow-up were investigated using a univariate logistic regression model.Sixty-nine percent of DR patients had poor follow-up. They were more likely to benon-whites, older than 80 years, have a high school degree or less, and havenonproliferative DR. A larger percentage thought their eye disease was less severe. Yet35% more patients reported need for an escort to the clinic in the poor follow-up group.Thirty-five percent of poor follow-up patients believed they would benefit from knowingother people with DR or an eye condition, compared with 0% of good follow-up patients.While this study was limited in sample size and in demographics, future larger studiesare needed especially to better analyze minority populations. Funding provided by the Stanford Medical Scholars Fellowship Program*CO-PRESENTED WITH ATALIE THOMPSON References1. Fong DS, Aiello L, Gardner TW, et al. Position statement: Diabetic retinopathy.Diabetes Care. 2003;26(1): 226-229.2. Medline Plus, A publication of the NIH. Summer 2008.http://www.nlm.nih.gov/medlineplus/magazine/issues/summer08/articles/summer08pg14-15.html3. Lee, PP, Feldman ZW, Ostermann J, Brown, Derek, Sloan FA. LongitudinalPrevalence of Major Eye Diseases. Arch Ophthalmol. 2003;121:1303-1310. 4. Lee, PP, Feldman ZW, Ostermann J, Brown DS, Sloan FA. Longitudinal rates ofannual eye examinations of persons with diabetes and chronic eye diseases.Ophthalmology. 2003;110:1952-1959.5. Saadine JB, Fong DS, Yao J. Factors associated with follow-up eyeexaminations among persons with diabetes. Retina. 2008;28:195-200.6. Schoenfeld ER, Greene JM, Wu SY, Leske C. Patterns of adherence to diabetesvision care guidelines. Ophthalmology. 2001;108:563-571.7. Rani PK, Raman R, Subramani S, Perumal G, Kumaramanickavel G, Sharma T.Knowledge of diabetes and diabetic retinopathy among rural populations in India,and the influence of knowledge of diabetic retinopathy on attitude and practice.Rural and Remote Health. 2008;8(3):838 (Epub 2008 Jul 24).8. Lee BW, Sathyan P, John RK, Singh K, Robin AL. Predictors of and barriersassociated with poor follow-up in patients with glaucoma in South India. ArchOphthalmol. 2008;126(10):1448-1454.9. Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD.Development of the 25-item National Eye Institute Visual Function Questionnaire.Arch Ophthalmol. 2001;119:1050-1058. SALIVARY CORTISOL INCREASES AFTER BARIATRIC SURGERY IN WOMEN Authors: Ashley R. Valentine, Hershel Raff, Hau Liu, Michael Ballesteros, Jennifer M. Rose, Gregg H. Jossart, Paul Cirangle, Dena M. Bravata Departments: Center for Primary Care and Outcomes Research, Stanford University School of Medicine. Background and Methods: Cortisol increases have been associated with psychological and physiological stress; however cortisol dynamics after weight loss (bariatric) surgery have not been defined. Obese participants not using exogenous glucocorticoids were eligible to participate. Female participants (N = 24) provided salivary cortisol samples at bedtime, upon awakening the following morning, and 30 minutes after awakening before and at 6 or 12 months after bariatric surgery. The Medical Outcomes Study Short Form-12 version 2 questionnaire regarding health-related quality of life