How I Met Your D-dimer: Weight loss, pulmonary embolism, and HIV

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This week: Weight loss in colorectal cancer screening, D-dimers in Pulmonary Embolism, and Gene Editing in HIV

Nathan, Amol and Travis want you to:

1. Recognize that modifiable lifestyle factors such as inactivity, weight, diet, and alcohol consumption are under-appreciated risk factors for colorectal cancer.

2. Understand how a weight loss and lifestyle improvement intervention timed with colorectal screening was found to lead to more clinically significant weight loss and lifestyle changes compared to usual care.

3. Understand the potential implications of age-adjusted cutoffs for D-dimer levels in pulmonary embolism.

4. Understand the novel therapeutic strategy of gene editing of T-cells for HIV.

Continuing Medical Education

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The papers

Annie S Anderson et al. The impact of a bodyweight and physical activity intervention (BeWEL) initiated through a national colorectal cancer screening programme: randomised controlled trial. BMJ. 2014;348:g1823. (PubMed). 

Good stuff

Nathan – Wait for breast cancer diagnosis too long, report says, Kelly Grant, The Globe and Mail, March 26, 2014. 

Travis – Modeling 3D Facial Shape for DNA. Peter Claes et al, PLOS Genetics, March 20, 2014. 

Amol – Video: Doctor ‘Tunes I’ to Cancer Patients’ needs, The Today Show.

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  1. John Hoey

    RE: The pulmonary embolus discussion:
    This was (is) an interesting discussion of a study with rather predictable results.

    One of the difficulties with the Wells Score is the criteria of “no other disease explains the SOB”. Most elderly patients coming to the ED or in hospital have another disease that might explain the symptoms so they get 3 Well’s points. This, with one other criteria gives a score of 4 and they are in the intermediate category requiring a CT Pulmonary.

    Thus, a lot of the elderly are ‘positive’ on the Wells score. I would have thought a D-dimer that was low might make a difference in sensitivity/specificity of referrals for CT. I’ve been using intermittently (or erratically!) the revised suggestions for age (10 times age).

    For a recent example: a 70 year old woman that I saw a few nights ago in the ED with SOB by history (her reason for coming to the ED) and a prior lobectomy for lung cancer (somewhat remote). She was not SOB on the stretcher. Also had a pO2 of 95% on room air. PE is intuitively unlikely, but her Wells score of (4) obliges a CT. Which was negative.
    The ER doc ordered (and I would have too) a D-dimer, which was about 600.
    She received one dose of anticoagulation while waiting (at home) 13 hours for the CT (which was negative for PE)

    There has to be a better way to do this, especially in the elderly.

    Thanks. Enjoyed your podcast

    • Amol Verma

      Thanks for the comment, John (and very sorry for the belated reply). Your example is an excellent illustration of how this paper could be useful. Using age-adjusted cut-offs we would not have been obligated to order the CT scan for your patient.

      I think the usefulness of the “other explanation” Wells criterion is that it leaves a lot of room for physicians to exercise their own clinical judgment.

      Thanks for listening!

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