Adkins and Kwan Win Clinical Fellows Award

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Finalists for the 2019 Cedars-Sinai Clinical Fellows Award (l to r): Christopher Adkins, MD; Odayme Quesada, MD; and Alan Kwan, MD. Mariko Ishimori, MD, (far right) chairs the Clinical Fellows Award Committee. Adkins and Kwan were the award winners.

Improving patient care was a shared goal of studies by Christopher Adkins, MD, and Alan Kwan, MD, winners of the 2019 Cedars-Sinai Clinical Fellows Award for Excellence in Research.

"This award was created to foster clinical and translational research, enrich knowledge of health science and encourage the development of clinical fellows' investigative curiosity," said Mariko Ishimori, MD, who welcomed attendees to the April 15 event in Harvey Morse Auditorium. Ishimori, assistant professor of Medicine, chair of the Clinical Fellows Award Committee and associate director of the Cedars-Sinai Clinical and Translational Science Institute, thanked faculty members on hand to judge presentations by the three award finalists.

Adkins, a third-year gastroenterology fellow, shed scientific light on dysphagia, a condition with multiple causes that makes swallowing difficult and often painful. Dysphagia can be life-threatening when people become completely unable to swallow food, liquids and even saliva.

Adkins' study aimed to determine the prevalence of dysphagia among U.S. adults; common dysphagia-coping mechanisms; and the healthcare-seeking behaviors of dysphagia sufferers.

Adkins partnered with a survey research firm to recruit a diverse sample of Americans ages 18 and older who've experienced dysphagia. Nearly 5,000 people responded to an online questionnaire, resulting in what Adkins described as "the largest U.S. survey focusing on dysphagia."

Data analysis revealed that while one out of six respondents experienced dysphagia in the past, only half discussed their condition with a healthcare provider. Adkins also found that 92 percent of participants experienced dysphagia symptoms within the past week, and that the most common symptom-management techniques were drinking liquids to facilitate swallowing; cutting food into small pieces; eating slowly; and avoiding problematic foods.

Adkins noted that these findings could have significant implications for clinical practice and public health by increasing awareness about the prevalence of dysphagia and the availability of effective treatments.

Adkins' mentors were Christopher Almario, MD, assistant professor of Medicine and associate program director of the Gastroenterology Fellowship Program, and Brennan Spiegel, MD, professor of Medicine and director of Health Sciences Research.

Kwan's winning study focused on the clinical accuracy and usefulness of a new algorithm called the Ischemia Risk Score (IRS). Developed and validated in a multi-center trial by Damini Dey, PhD, associate professor of Biomedical Sciences and director of the Biomedical Imaging Research Institute's Quantitative Image Analysis Lab, IRS uses plaque measurements from computed coronary tomography angiography (CCTA) to predict the need for angioplasty or stenting.

Kwan, a second-year cardiology fellow, designed a multi-center trial of more than 350 patients who received CCTA followed by invasive coronary angiography (ICA) to determine if IRS' predictive power extends to forecasting which of these patients would also undergo coronary revascularization (stenting or coronary artery bypass graft surgery).

The investigation's overarching aim was to assess the potential of IRS to improve clinical decisions about cath lab referrals, particularly for patients at intermediate risk for coronary artery disease who could be effectively assessed via noninvasive, less expensive diagnostic tests.

Kwan's study confirmed IRS' ability to predict which patients would undergo coronary revascularization. IRS could thus potentially serve as a clinical decision support system by helping clinicians determine which patients should receive ICA following CCTA, resulting in better, more cost-effective patient care.

Kwan's mentors were Dey and Daniel Berman, MD, professor of Imaging and Medicine and director of Nuclear Cardiology and Cardiac Imaging.

Each winner received a $3,000 cash prize funded by the Burns and Allen Research Institute at Cedars-Sinai and the Cedars-Sinai site of the UCLA Clinical and Translational Science Institute.

The other award finalist was Odayme Quesada, MD, who presented "Angina and Myocardial Perfusion Improve in Women With Ischemia and No Obstructive Coronary Artery Disease at One-Year Follow-Up: A Report From the Women's Ischemia Syndrome Evaluation Coronary Vascular Dysfunction Study."

The IRB numbers for human subjects in research referenced in this article are 1752, 4424, 19424 and 47958.