Kristopher Joseph Abbate

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Journals/Publications

• Abbate, K. J., Armin, J., Cunningham, J. K., Giacobbi, P. R., Gordon, J. S., Hingle, M., Howe, C. L., Johnson, T., & Roe, D. J. (2017). Development and evaluation of the See Me Smoke-Free multi-behavioral mHealth app for women smokers. Translational behavioral medicine. doi:10.1007/s13142-017-0463-7
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  Women face particular challenges when quitting smoking, especially those with weight concerns. A multi-behavioral smoking cessation intervention addressing these concerns and incorporating guided imagery may assist women to engage in healthy lifestyle behaviors. An mHealth app can easily disseminate such an intervention. The goals of this pilot study were to develop and test the feasibility and potential of the See Me Smoke-Free™ mHealth app to address smoking, diet, and physical activity among women smokers. We used pragmatic, direct-to-consumer methods to develop and test program content, functionality, and the user interface and conduct a pre-/post-test, 90-day pilot study. We enrolled 151 participants. Attrition was 52%, leaving 73 participants. At 90 days, 47% of participants reported 7-day abstinence and significant increases in physical activity and fruit consumption. Recruitment methods worked well, but similar to other mHealth studies, we experienced high attrition. This study suggests that a guided imagery mHealth app has the potential to address multiple behaviors. Future research should consider different methods to improve retention and assess efficacy.
• Abbate, K. J., Armin, J., Giacobbi, P. R., Gordon, J. S., & Hingle, M. (2017). Low- and No-Cost Strategies to Recruit Women to a Mobile Health Smoking Cessation Trial. JMIR Research Protocol. doi:10.2196/preprints.7356
• Abbate, K. J., Babiker, H. M., Boiles, A. R., Elquza, E., McBride, A., Scott, A., & Vondrak, J. (2017). Clinical Risk Factors Associated with Recurrent Venous Thromboembolism and Major Bleeding in Gastrointestinal Cancer Patients Receiving Doacs for Secondary Thromboprophylaxis. Blood. doi:10.1182/blood.v130.suppl_1.4918.4918
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  Abstract Introduction Cancer associated venous thromboembolism (VTE) is associated with a significant morbidity and mortality burden in cancer care, and anticoagulation offers a survival benefit. Recurrent VTE and major bleeding complications due to secondary prophylaxis remain a salient issue in treating patients with cancer associated-VTE, regardless of validated risk assessment models. Gastrointestinal (GI) cancers confer an increased risk for recurrent VTE and bleeding. We evaluated our current institutional utilization of Direct Oral Anticoagulants (DOACs) in patients with active GI malignancies addressing both efficacy and safety profiles with these agents. We estimated the association strength between each risk factor and the outcomes to further contribute in future risk assessment tools. Methods This is a retrospective chart review of patients receiving DOACs with histologically proven GI malignancy and a symptomatic or incidental VTE treated at the University of Arizona Cancer Center from November 2013 to February 2017. Patients were excluded if DOACs were prescribed for any other reason not related to VTE: VTE was determined to be in the context of a non-GI malignancy or when anticoagulation was contraindicated. The primary efficacy outcome was defined as documented recurrent deep vein thrombosis (DVT), nonfatal pulmonary embolism (PE), or fatal PE before and after 6 months of DOAC therapy. The secondary safety outcome was defined as documented major bleeding (hemoglobin reduction of ≥2 g/dL, requirement of transfusion of ≥2 units of Packed Red Blood Cells, bleeding in a critical site, or bleeding contributing to death) before and after 6 months of therapy. Descriptive statistical analyses were utilized. The t- test was performed to compare continuous variables. Fisher exact test is used for testing the difference in categorical variables. Odds ratios were used to compare the relative odds of the occurrence of the outcome given exposure to the risk factor. The 95% confidence interval (CI) was used to estimate the precision of the OR. Results were determined to be ‘statistically significant’ when this value was less than or equal to 0.05. Results Our review included 62 patients with balanced baseline characteristics whom were prescribed apixaban (n=28) and rivaroxaban (n=34) [Table 1]. Primary outcome events at 6 months were 4.8% in total (2 DVT & 1 PE); 7.4% (2 DVT) for patients on apixaban and 2.9% (1 PE) for those taking rivaroxaban. Beyond 6 months on DOACs therapy, 6.4% of patients experienced recurrent VTE (1 DVT event in the apixiban subgroup). Secondary outcome events at 6 months were 11.2% total (7 major bleeds), 7.1% (n=2) and 14.7% (n=5) for apixaban and rivaroxaban respectively. There were 2 bleeds contributing to death (hemopericardium and upper GI bleed) and 2 other bleed in critical sites (subarachnoid hemorrhage and retroperitoneal) in the rivaroxaban group, with all other adverse outcomes being upper or lower GI bleeds. Including those events beyond 6 months, 17.7% of patients had recorded bleeding events (2 additional major bleeds for each therapy). Significant predictors of a primary or secondary outcome were pancreatic cancer (OR, 9.6, 95% CI, 1.48 to 62.16, p =0.017), stage IV disease (OR, 15, 95% CI, 7.55 to 297.63, p = 0.0075) and high Khorana Score [≥3] (OR, 7.5, 95% CI, 1.3 to 43.92, p= 0.0238). Those who suffered a primary or secondary outcome were 67 times more likely to die within a month period, compared to those who completed their therapy (CI, 5.33 to 854.82, p = 0.0011). Conclusions Cancer associated VTE remains a challenging clinical scenario with a lack of data for utilization of DOACs in the setting of secondary prophylaxis. The utilization of DOACs in cancer patients provides another therapy for VTE secondary prophylaxis treatment, which must be weighed, based on safety profiles in our study population. The utilization of rivaroxaban led to a higher bleeding rate in patients, with both apixaban and rivaroxaban showing similar efficacy for prophylaxis. This study warrants further exploration of DOACs in the setting of VTE treatment for patients on active chemotherapy who are at high risk of recurrent VTE. In addition, further evaluation of clinical predictors that may influence the risk of VTE recurrence and major bleeding is warranted. Wide confidence intervals reflect of our sample size and future studies may benefit from multi-center participation to maximize sample size. Download : Download high-res image (344KB) Download : Download full-size image Disclosures No relevant conflicts of interest to declare.
• Klitzman, R., Abbate, K., Chung, W., Marder, K., Ottman, R., Taber, K., Leu, C., & Appelbaum, P. (2014). Psychiatrists' views of the genetic bases of mental disorders and behavioral traits and their use of genetic tests. Journal of Nervous and Mental Disease, 202(7). doi:10.1097/NMD.0000000000000154
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  We examined how 372 psychiatrists view genetic aspects of mental disorders and behaviors and use genetic tests (GTs). Most thought that the genetic contribution was moderate/high for bipolar disorder, schizophrenia, depression, Alzheimer's, intelligence, creativity, anxiety, and suicidality. In the past 6 months, 14.1% ordered GTs, 18.3% discussed prenatal testing with patients, 36.0% initiated discussions about other GTs, 41.6% had patients ask about GTs, and 5.3% excluded GT results from patient records. Many thought that GTs; were available for schizophrenia (24.3%) and major depression (19.6%). Women were more likely to report that patients asked about GTs; and were less certain about the degree of genetic contribution to several disorders. Psychiatrists perceive strong genetic bases for numerous disorders and traits, and many have discussed and ordered tests for GTs, but have relatively limited knowledge about available tests. These data suggest possible sex differences in psychiatrists' beliefs about genetic contributions to disorders and have implications for future research, education, policy, and care. Copyright © 2014 by Lippincott Williams & Wilkins.
• Klitzman, R., Abbate, K., Chung, W., Ottman, R., Leu, C., & Appelbaum, P. (2014). Views of preimplantation genetic diagnosis among psychiatrists and neurologists. Journal of Reproductive Medicine, 59(4).
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  OBJECTIVE: To examine key aspects of neurologists’ and psychiatrists’ views and approaches regarding prenatal genetic testing (GT) and preimplantation genetic diagnosis (PGD). STUDY DESIGN: We surveyed attitudes and practices among 163 neurologists and 372 psychiatrists. RESULTS: A total of 24.9% of neurologists and 31.9% of psychiatrists had discussed prenatal GT with patients, but 95.3% did not feel comfortable discussing PGD; only 2.9% discussed it, and only 1.8% had patients ask about PGD. Most would refer for PGD for Huntington’s disease and Tay-Sachs disease, fewer for cystic fibrosis, and fewer still for autism, Alzheimer’s disease, or gender selection for family balancing; in each of these cases, psychiatrists’ percentages were higher than those of neurologists. Providers who would refer for PGD for Huntington’s disease, cystic fibrosis, or gender selection differed from others in proportions of patients with insurance and were more likely to have undergone a GT themselves and be concerned about discrimination. CONCLUSION: These data, the first to examine how neurologists and psychiatrists view PGD, suggest that they do not feel comfortable discussing PGD but have strong views about its use. Potential PGD use is associated with concerns about discrimination and less experience with GT. These data highlight the need for enhancing education about these technologies among various providers.
• Salm, M., Abbate, K., Appelbaum, P., Ottman, R., Chung, W., Marder, K., Leu, C., Alcalay, R., Goldman, J., Curtis, A., Leech, C., Taber, K., & Klitzman, R. (2014). Use of genetic tests among neurologists and psychiatrists: Knowledge, attitudes, behaviors, and needs for training. Journal of Genetic Counseling, 23(2). doi:10.1007/s10897-013-9624-0
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  This study explores neurologists' and psychiatrists' knowledge, attitudes, and practices concerning genetic tests. Psychiatrists (n∈∈5,316) and neurologists (n∈∈2,167) on the American Medical Association master list who had agreed to receive surveys were sent an email link to a survey about their attitudes and practices regarding genetic testing; 372 psychiatrists and 163 neurologists responded. A higher proportion of neurologists (74 %) than psychiatrists (14 %) who responded to the survey had ordered genetic testing in the past 6 months. Overall, most respondents thought that genetic tests should be performed more frequently, but almost half believed genetic tests could harm patients psychologically and considered legal protections inadequate. Almost half of neurologists (49 %) and over 75 % of psychiatrists did not have a genetics professional to whom to refer patients; those who had ordered genetic tests were more likely than those who did not do so to have access to a genetic counselor. Of respondents, 10 % had received patient requests not to document genetic information and 15 % had received inquiries about direct-to-consumer genetic testing. Neurologists reported themselves to be relatively more experienced and knowledgeable about genetics than psychiatrists. These data, the first to examine several important issues concerning knowledge, attitudes and behaviors of neurologists and psychiatrists regarding genetic tests, have important implications for future practice, research, and education. © 2013 National Society of Genetic Counselors, Inc.

Presentations

• Abbate, K. (2023, October).

  Clinical and Legal Status of Gender Affirming Care in Arizona

  . ACP Arizona Chapter Annual Scientific Meeting. Phoenix, AZ: American College of Physicians, Arizona Chapter.

Poster Presentations

• Abbate, K. (2023, November).

  Breast Cancer Screening Among the Uninsured at a Student-Run, Free Clinic 

  . AMA Poster Showcase at Interim Meeting of the AMA House of Delegates. National Harbor, MD: American Medical Association.
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  Retrospective review of breast cancer screening rates in student-run free clinic in preparation for quality improvement intervention to bolster screening rates by leveraging community resources. 
• Scott, C., & Abbate, K. (2023, November). Breast Cancer Screening Among the Uninsured at a Student-Run, Free Clinic. 2023 Interim Meeting of the AMA House of Delegates. National Harbor, Maryland: American Medical Association.

Other Teaching Materials

• Bulger, J., & Abbate, K. (2024.

  Bulger Beck, Joy; Abbate Kristopher. 2024. "Responding to Microaggressions - Peds." In The TTR Compendium - Responding to Microaggressions Edition 2, edited by Anna Neumeier, www.ttreducators/compendium. Transition To Residency Educators.

  . Transition to Residency Educators Compendium.
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  Curriculum for Transition to Residency courses across medical schools.