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Opioid use disorder treatment associated with decreased risk of overdose after surgery, suggests first-of-its-kind study of over 4 million surgeries
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Newswise — SAN FRANCISCO — Although people with opioid use disorder (OUD) are significantly more likely to overdose or have a complication after major surgery than those without the disorder, using medications for the treatment of OUD before surgery may eliminate that extra risk, suggests a large, first-of-its-kind study presented at the ANESTHESIOLOGY® 2023 annual meeting.
Patients with OUD who didn’t use an OUD medication (such as buprenorphine or methadone) were over four times more likely to overdose after having surgery, yet those who used evidence-based OUD medication before surgery were essentially at no greater risk than those who didn’t have OUD, according to the study. Taken orally, OUD medications reduce withdrawal and cravings and prevent opioids from producing the feeling of euphoria that drives addiction.
“We know that OUD treatments are very effective in helping to prevent relapse, overdose and death in nonsurgical patients, but our research is the first to show that they also may be remarkably effective in at-risk patients facing surgical stress and recovery pain that often is addressed with opioids,” said Anjali Dixit, M.D., MPH, a pediatric anesthesiologist at Stanford University, California. “This is helping us learn more about how to optimally treat OUD patients so that their surgical and post-surgical pain is well-controlled, while also making sure we are minimizing their risk of relapse and overdose.”
Researchers analyzed 4,030,032 surgeries performed between 2008 and 2020 from the Merative MarketScan Commercial Database, a nationwide sample of data from patients with both employer-sponsored and Medicare Advantage insurance. The analysis reviewed overdoses and other complications (such as OUD-related hospitalization or infection) that occurred in the three months after surgery for the 25 most common surgeries, including knee and hip replacement, hysterectomy and gallbladder removal.
Of the over 4 million surgeries, 26,827 were performed on patients who had a history of OUD, 9,699 (36%) of whom used OUD medications in the month before surgery and 17,128 (64%) who did not. OUD patients who did not use OUD medications were 4.2 times more likely to overdose or have an OUD-related infection or hospitalization than those who did not have the disorder, according to the study. OUD patients who used OUD medications did not experience a statistically different risk of opioid-related adverse events compared to those who did not have the disorder.
As many as 7.6 million people in the U.S. live with OUD, according to research, and that number continues to grow. Only 20% of people with OUD currently use OUD medications, said Dr. Dixit. She noted the number of people in the study who used OUD medications was likely higher, because they had access to commercial insurance and therefore, better access to care. The researchers also want to look at other populations such as those on Medicaid, because they may be sicker and have less access to care.
“The national efforts to increase access to OUD medications is good news for people with OUD, including those who need surgery,” said Dr. Dixit. “The next step is to determine if a particular medication or regimen is better than another.”
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.
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Black and Hispanic patients much more likely to die after surgery than white patients
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Newswise — SAN FRANCISCO — About 12,000 Black and Hispanic patients who died after surgery the past two decades may have lived if there were no racial and ethnic disparities among Americans having surgery, suggests a study of more than 1.5 million inpatient procedures presented at the ANESTHESIOLOGY® 2023 annual meeting. This estimate draws attention to the human toll of disparities in surgical outcomes, with Black patients being 42% more likely and Hispanic patients 21% more likely to die after surgery compared to white patients.
Unless efforts to narrow the racial and ethnic gap in surgical outcomes intensify, preventable deaths will continue among minority patients, the researchers said. The development of equity policies to address disparity gaps can make a difference, with even a 2% reduction in projected excess mortality rates among Black patients averting roughly 3,000 post-surgery deaths in the next decade, they determined.
“This study represents the first effort to move beyond merely documenting the ongoing disparities in surgical outcomes in the U.S. by quantifying the aggregate human toll of these disparities,” said Christian Mpody, M.D., Ph.D., MBA, lead author of the study and assistant professor of anesthesiology and pediatrics at The Ohio State University College of Medicine, Columbus. “We should not become used to reading statistics about people dying. It’s essential to remember that beyond the statistics, odds ratios and p-values, these are real people — brothers, sisters, mothers and fathers.”
“The findings bring to light the deaths that may have been preventable if people of various racial and ethnic backgrounds had comparable mortality rates to white patients,” he said. “That’s important for conveying the gravity of the issue to policymakers, health care professionals and the general public.”
Researchers analyzed the Nationwide Inpatient Sample data of more than a million surgical procedures performed at 7,740 U.S. hospitals between 2000 and 2020. They determined Black patients were 42% more likely than white patients to die within 30 days of surgery, driven by higher mortality in the Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont). Hispanic patients were 21% more likely than white patients to die within 30 days of surgery, driven by higher mortality in the West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming).
Although death rates declined for all groups over the 20-year period, the disparity gaps did not narrow over time. The study did not identify causes of death.
“It’s important to note that disparities in these regions do not necessarily mean that the surgical care is inferior. It may reflect overall population health and socioeconomic conditions,” said Dr. Mpody. “Our team is currently investigating the underlying causes of these regional variations.”
Dr. Mpody said the study didn’t assess the effectiveness of specific interventions or policies, noting that addressing the problem requires a three-pronged approach involving research, education and service. Suggested interventions by the authors include increasing investment in disparity research and incorporating race and racism lectures in medical and nursing school curricula. Health systems should: provide cultural competency training; focus on diversity in grand rounds; invest in patient education and health literacy; develop personalized medicine approaches that take into account individual patients’ needs and race-sensitive protocols; and increase the number of minority providers.
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.
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Anesthesiologist-led blood management programs save hospitals significant amounts of blood and reduce costs with same or better patient outcomes
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Newswise — SAN FRANCISCO — Blood management programs that reduced or avoided transfusions saved a health system millions of dollars annually, with a return on investment of more than $7 for every dollar spent, while achieving the same or better outcomes, suggests research presented at the ANESTHESIOLOGY® 2023 annual meeting.
Over the past 10 years, the Johns Hopkins Health System established a comprehensive blood management program with two primary goals: 1) to reduce unnecessary transfusions across the five-hospital health system, and 2) to provide specialized care that avoids transfusions in patients who decline them. Together these efforts save blood and reduce costs, making more blood available for those who really need it, such as trauma patients. Transfusions are routinely used for emergencies and trauma, but also are needed in heart, transplant, hip or knee replacement, spine, vascular, liver and pancreatic surgery. Nonsurgical patients also need blood, for example those with cancer (leukemia, lymphoma), sickle cell anemia or gastrointestinal bleeding.
“Since we are always dealing with blood shortages, doing more with less is critically important,” said Steven M. Frank, M.D., lead author of the study and professor in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins Medicine, Baltimore. “We like to say that blood saves lives when you need it, but only increases risks and costs when you don’t. Our results showed that a comprehensive blood management program can substantially help the bottom line — for every dollar spent, we received $7.50 in return.”
Starting in 2012, two anesthesiologist-led, multidisciplinary blood management programs were run side by side.
- The Patient Blood Management Clinical Community program was designed to reduce unnecessary transfusions using several methods. The methods include evidence-based transfusion triggers, a “Why Give 2 When 1 Will Do?” single unit of blood transfusion campaign, and other anesthesiology-led before, during or after surgery measures of “keeping blood in the patient” such as using medications or intentionally lowering blood pressure to reduce bleeding and using smaller tubes to collect blood for lab tests. Over a 10-year period, the annual blood acquisition cost reduction was $2.9 million, a 10.9% decrease and a 9.6-fold return on investment.
- The Center for Bloodless Medicine and Surgery program was designed to avoid transfusions entirely for those who don’t accept them, primarily Jehovah’s Witness patients. The program brings in revenue by attracting patients who are often turned down by other hospitals. Over 10 years, the program brought in approximately $5 million a year (after subtracting the direct cost of care), representing a 6.6-fold return on investment.
Clinical outcomes such as infection, blood clots, kidney injury, heart attack or stroke were the same before and after the Patient Blood Management Clinical Community program was instituted. Clinical outcomes were the same or better for the Center for Bloodless Medicine and Surgery program, as the incidence of hospital-acquired infection was significantly lower when transfusions were avoided.
“By reducing unnecessary medical procedures, we are actually doing more with less and providing higher value care,” said Dr. Frank. “Since clinical outcomes are either the same or better while giving less blood, the patients benefit from reduced risks and costs.”
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.
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Two easy fixes could reduce bleeding after cesarean delivery
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Newswise — SAN FRANCISCO — Two simple solutions could help prevent severe bleeding (postpartum hemorrhage) after cesarean delivery, suggests research presented at the ANESTHESIOLOGY® 2023 annual meeting. As the leading cause of maternal mortality in the U.S. at the time of birth, postpartum hemorrhage is more common after cesarean deliveries than vaginal births.
Both solutions help address uterine atony, which causes up to 80% of postpartum hemorrhage. Uterine atony is when, after delivery, the uterus remains soft and weak instead of contracting to compress the blood vessels that had been attached to the placenta. One solution involves infusing a medication to help the uterus contract after delivery. The other is an early warning system that prompts an assessment of how well the uterus is contracting after delivery to quickly alert the health care team when a woman is at risk for heavy bleeding and requires treatment.
“Bleeding during a cesarean delivery is a high-stakes, high-risk situation, and when it occurs, the obstetrics and anesthesia teams must work together to rapidly prevent and treat ongoing bleeding,” said James Xie, M.D., lead author of the early warning study and clinical assistant professor of anesthesiology, perioperative and pain medicine at Stanford University, California. “Studies have shown that rapid recognition and management are essential to improving outcomes.”
“The ultimate goal is to decrease maternal mortality and morbidity,” said Jessica Ansari, M.D., M.S., senior author for both studies and an obstetric anesthesiologist at Stanford University. “Recent estimates show a new mother dies of postpartum hemorrhage about every seven minutes, mostly in low-resource settings. If our findings can be confirmed in larger studies, it could transform the way we prevent and treat postpartum hemorrhage.”
Calcium chloride infusion
The researchers looked at using calcium chloride to help prevent bleeding in women with uterine atony because it is inexpensive, simple, safe and doesn’t require refrigeration like other treatments. Consequently, it can be used even in very low-resource settings, where women are much more likely to die from pregnancy-related bleeding. They found that calcium chloride reduced the amount of bleeding that patients experienced during their cesarean delivery by nearly a measuring cup (more than 200 mL).
The double-blind, randomized, controlled trial included 120 women who required a cesarean delivery after labor with an oxytocin infusion (which increases contraction of the uterus during labor), placing them at much higher risk of suffering from uterine atony and bleeding after the birth. Researchers randomly assigned 60 women to receive 1-gram infusions of calcium chloride and 60 women to receive a placebo. The infusion was administered slowly after the baby was delivered, and the study was blinded, meaning the patients and their doctors were unaware if they received calcium or the placebo. Of the women who received the placebo, 57% had postpartum hemorrhage and 15% required a blood transfusion, while 40% of those who received calcium chloride had postpartum hemorrhage and 8.3% required a blood transfusion.
The last Food and Drug Administration-approved drug to treat uterine atony was released in 1979.
“New treatments to treat uterine atony are desperately needed,” said Alla Yarmosh, M.D., lead author of the study and clinical assistant professor in anesthesiology at Stanford University. “This is the first time an infusion of calcium chloride has been studied as a possible treatment to help the uterus contract after cesarean delivery and decrease bleeding in those patients. If our findings are confirmed by larger studies, it would be an easy technique for institutions to implement since anesthesiologists run infusions during surgery regularly.”
Early warning system
For the early warning study, researchers created an alert that pops up on the anesthesiologist’s electronic health record (EHR) module two minutes after the baby is marked as delivered, asking for a uterine score from 1-10. The anesthesiologist prompts the obstetrician to assess the uterine tone (by manually feeling it) and provide the score, which the anesthesiologist records. Scores of 6 or lower mean the uterus is not contracting well and the woman is at higher risk for postpartum hemorrhage.
This real-time communication that a woman is at risk alerts the treatment team, which can then determine the best solution. Physicians can give the woman medications to help the uterus contract better or put stitches or balloons in the uterus to compress the vessels to prevent further bleeding, said Dr. Xie. They also can anticipate and prepare for hemorrhage, which can be addressed by giving the woman medications to stabilize blood clotting or ordering blood products to be ready for transfusion.
The study assessed more than 1,000 consecutive cesarean deliveries by 70 different obstetricians over eight months. The uterine tone score was assessed three times for each patient and was documented reliably; two minutes after delivery (recorded 87% of the time), seven minutes after delivery (recorded 97% of the time), and 12 minutes after delivery (recorded 98% of the time). At 12 minutes, 179 women (18%) had scores of 6 or lower, meaning they were at higher risk for severe bleeding. Of those with scores of 6 or lower, 77% experienced hemorrhage, 46% experienced major hemorrhage and 25% needed a blood transfusion.
“Our research shows that this simple scoring system is a very meaningful, easy way to ensure that if the uterus is contracting poorly and there is a risk of hemorrhage, it will be recognized by their health care team early,” said Dr. Xie. “In the future we can further refine models that predict when women are at high risk of bleeding around the time of delivery to help physicians be prepared to manage bleeding caused by poor uterine tone.”
The United States has the highest maternal mortality rate among high-income countries.
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.
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More Patients Go Home Instead of to Long-Term-Care Facility When Sedation for Common Procedures Is Administered or Directed by Anesthesiologist
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Newswise — SAN FRANCISCO — Patients who had common procedures performed outside of the operating room (OR) were more likely to go home instead of to a long-term care facility when they were discharged from the hospital if their sedation was administered or directed by an anesthesiologist, rather than by a physician who is not a trained anesthesiologist, according to a first-of-its-kind study presented at the ANESTHESIOLOGY® 2023 annual meeting.
Patients who need catheters placed in a vein, angiograms (X-ray of the blood vessels), image-guided biopsies and many other procedures typically are treated in the interventional radiology (IR) suite instead of the OR and given sedation. Sedation is a type of anesthesia that relieves anxiety, controls pain and discomfort, and sometimes makes them fall asleep. One in 10 patients admitted to the hospital requires an IR procedure and many are at increased risk for complications due to health issues or having more complex procedures.
The study was the first to directly compare the hospital discharge outcomes of patients who received sedation administered by an anesthesiologist, or by a nurse anesthetist under the direction of an anesthesiologist, to the discharge outcomes of patients whose sedation was administered or directed by a physician who was not an anesthesiologist, such as a radiologist or cardiologist. Anesthesiologists are physicians who are experts in ensuring the safety and comfort of patients undergoing surgery and other procedures and are highly trained in critical care to manage medical emergencies if there is a complication.
“We focused on patients undergoing IR procedures as they often have health issues such as heart disease or diabetes and some of the procedures are high risk,” said Matthias Eikermann, M.D., Ph.D., senior author of the study and chair of the department of anesthesiology at Montefiore Medical Center, Bronx, New York. “We found anesthesiologists add value to patients undergoing interventional radiology procedures. That’s especially true for complex neurovascular procedures such as angiograms for the treatment of aneurysms or the creation of an arteriovenous (AV) fistula, a connection between an artery and a vein, for people on dialysis and those that typically take longer than an hour.”
In the study, 9,682 patients had sedation in the IR suite and 1,639 (16.93%) were discharged from the hospital to a long-term care facility (such as a nursing home) because of complications that they may be more likely to experience due to their disease. Anesthesiologists have the training to identify these complications early and address them.
Of those who were not discharged home, 1,429 (87%) had their sedation administered or directed by a physician who was not an anesthesiologist, often with the assistance of a nurse, and 210 (13%) had their sedation administered or directed by an anesthesiologist.
“The anesthesiologist is not just providing sedation, but life support for the patient during the entire procedure,” said Dr. Eikermann. “The difference in outcomes is because anesthesiologists are trained to identify early complications and treat them immediately. Physicians who are not anesthesiologists are not trained to do that.”
Anesthesiologists administered or directed sedation for higher-risk patients, such as those with more health issues or who had more invasive procedures. Despite being at higher risk, the patients who received sedation administered or directed by an anesthesiologist were nearly 70% more likely to be discharged home than those whose sedation was administered or directed by a physician who was not an anesthesiologist.
“Increasingly, high-risk patients are undergoing procedures outside of the OR,” said Vilma Joseph, M.D., MPH, FASA, co-author of the study and director of procedural sedation at Montefiore Medical Center. “The presence of physician anesthesiologists as part of the anesthesia care team model has been associated with improved outcomes.”
“Patients should know that they can ask for an anesthesiologist if they are concerned about excessive pain, anxiety or their safety during diagnostic procedures,” said Dr. Eikermann. “Our research suggests rethinking anesthesia assignments to ensure anesthesiologists provide sedation when patients are at higher risk due to their health or are having more complex, longer or more-invasive procedures.”
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.
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AI Pain Recognition System Could Help Detect Patients’ Pain Before, During and After Surgery
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Newswise — SAN FRANCISCO — An automated pain recognition system using artificial intelligence (AI) holds promise as an unbiased method to detect pain in patients before, during and after surgery, according to research presented at the ANESTHESIOLOGY® 2023 annual meeting.
Currently, subjective methods are used to assess pain, including the Visual Analog Scale (VAS) — where patients rate their own pain — and the Critical-Care Pain Observation Tool (CPOT) — where health care professionals rate the patient’s pain based on facial expression, body movement and muscle tension. The automated pain recognition system uses two forms of AI, computer vision (giving the computer “eyes”) and deep learning so it can interpret the visuals to assess patients’ pain.
“Traditional pain assessment tools can be influenced by racial and cultural biases, potentially resulting in poor pain management and worse health outcomes,” said Timothy Heintz, B.S., lead author of the study and a fourth-year medical student at the University of California San Diego. “Further, there is a gap in perioperative care due to the absence of continuous observable methods for pain detection. Our proof-of-concept AI model could help improve patient care through real-time, unbiased pain detection.”
Early recognition and effective treatment of pain have been shown to decrease the length of hospital stays and prevent long-term health conditions such as chronic pain, anxiety and depression.
Researchers provided the AI model 143,293 facial images from 115 pain episodes and 159 non-pain episodes in 69 patients who had a wide range of elective surgical procedures, from knee and hip replacements to complex heart surgeries. The researchers taught the computer by presenting it with each raw facial image and telling it whether or not it represented pain, and it began to identify patterns. Using heat maps, the researchers discerned that the computer focused on facial expressions and facial muscles in certain areas of the face, particularly the eyebrows, lips and nose. Once it was provided enough examples, it used the learned knowledge to make pain predictions. The AI-automated pain recognition system aligned with CPOT results 88% of the time and with VAS 66% of the time.
“The VAS is less accurate compared to CPOT because VAS is a subjective measurement that can be more heavily influenced by emotions and behaviors than CPOT might be,” said Heintz. “However, our models were able to predict VAS to some extent, indicating there are very subtle cues that the AI system can identify that humans cannot.”
If the findings are validated, this technology may be an additional tool physicians could use to improve patient care. For example, cameras could be mounted on the walls and ceilings of the surgical recovery room (post-anesthesia care unit) to assess patients’ pain — even those who are unconscious — by taking 15 images per second. This also would free up nurses and health professionals — who intermittently take time to assess the patient’s pain — to focus on other areas of care. The researchers plan to continue to incorporate other variables such as movement and sound into the model.
Concerns about privacy would need to be addressed to ensure patient images are kept private, but the system could eventually include other monitoring features, such as brain and muscle activity to assess unconscious patients, he said.
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook and follow ASALifeline on Twitter and use the hashtag #ANES23.
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RUDN Biochemists Found How to Weaken Cancer Cells
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Newswise — Biochemists from RUDN University described how to prevent cancer cells from becoming resistant to chemotherapy drugs. Having determined the resistance mechanism, biochemists selected a drug that can slow down it. The results were published in the International Journal of Molecular Sciences.
Chemotherapy remains the mainstay of cancer treatment in most cases. One of the most common anticancer drugs is the platinum-containing cisplatin. It is effective in the fight against sarcomas and other types of malignant tumors. The disadvantage of this treatment is the gradually emerging resistance of tumor cells to the antitumor drug. Biochemists from RUDN have described a method that allows one to “cancel” resistance to cisplatin in vitro on ovarian cancer cells.
“Platinum-based anticancer drugs, such as cisplatin, are established chemotherapeutic agents in the treatment of certain types of malignancies. However one of the main obstacles to effective chemotherapy is resistance to cisplatin. Drug resistance can develop through several mechanisms. Our goal was to understand these mechanisms and study possible ways to eliminate resistance,” said Elena Kalinina, Doctor of Biological Sciences, Professor of the Department of Biochemistry, RUDN University.
Previously, RUDN biochemists discovered that cisplatin resistance in ovarian cancer cells is affected by overexpression of several genes. The authors also showed that quercetin (a compound from the group of flavonoids) helps reduce this effect. Therefore, biochemists have suggested that treating cells with quercetin first and then with cisplatin can help avoid resistance. Biochemists tested this assumption on cancer cells of the SKOV-3/CDDP lines.
Preincubation of tumor cells with quercetin before exposure to cisplatin resulted in significantly improved outcomes. With 48 hours of preincubation at the optimal dose (60 micromoles), quercetin reduces the proportion of surviving cancer cells to approximately 25% if the action time of cisplatin is also 48 hours. Without prior exposure to quercetin, this proportion is about 80%.
“Our in vitro data show that quercetin sensitizes cisplatin-resistant cells. To confirm that, further studies are needed with other cell lines that are resistant not only to cisplatin but also to other anticancer drugs. Future experiments will be aimed at confirming the effect of preincubation with quercetin in vivo. This will allow us to evaluate its potential for eliminating resistance to cisplatin in tumor cells,” said Elena Kalinina, Doctor of Biological Sciences, Professor of the Department of Biochemistry, RUDN University.
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Targeting a coronavirus ion channel could yield new Covid-19 drugs
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Newswise — CAMBRIDGE, MA — The genome of the SARS-CoV-2 virus encodes 29 proteins, one of which is an ion channel called E. This channel, which transports protons and calcium ions, induces infected cells to launch an inflammatory response that damages tissues and contributes to the symptoms of Covid-19.
MIT chemists have now discovered the structure of the “open” state of this channel, which allows ions to flow through. This structure, combined with the “closed” state structure that was reported by the same lab in 2020, could help scientists figure out what triggers the channel to open and close. These structures could also guide researchers in developing antiviral drugs that block the channel and help prevent inflammation.
“The E channel is an antiviral drug target. If you can stop the channel from sending calcium into the cytoplasm, then you have a way to reduce the cytotoxic effects of the virus,” says Mei Hong, an MIT professor of chemistry and the senior author of the study.
MIT postdoc Joao Medeiros-Silva is the lead author of the study, which appears today in Science Advances. MIT postdocs Aurelio Dregni and Pu Duan and graduate student Noah Somberg are also authors of the paper.
Open and closed
Hong has extensive experience in studying the structures of proteins that are embedded in cell membranes, so when the Covid-19 pandemic began in 2020, she turned her attention to the coronavirus E channel.
When SARS-CoV-2 infects cells, the E channel embeds itself inside the membrane that surrounds a cellular organelle called the ER-Golgi intermediate compartment (ERGIC). The ERGIC interior has a high concentration of protons and calcium ions, which the E channel transports out of ERGIC and into the cell cytoplasm. That influx of protons and calcium leads to the formation of multiprotein complexes called inflammasomes, which induce inflammation.
To study membrane-embedded proteins such as ion channels, Hong has developed techniques that use nuclear magnetic resonance (NMR) spectroscopy to reveal the atomic-level structures of those proteins. In previous work, her lab used these techniques to discover the structure of an influenza protein known as the M2 proton channel, which, like the coronavirus E protein, consists of a bundle of several helical proteins.
Early in the pandemic, Hong’s lab used NMR to analyze the structure of the coronavirus E channel at neutral pH. The resulting structure, reported in 2020, consisted of five helices tightly bundled together in what appeared to be the closed state of the channel.
“By 2020, we had matured all the NMR technologies to solve the structure of this kind of alpha-helical bundles in the membrane, so we were able to solve the closed E structure in about six months,” Hong says.
Once they established the closed structure, the researchers set out to determine the structure of the open state of the channel. To induce the channel to take the open conformation, the researchers exposed it to a more acidic environment, along with higher calcium ion levels. They found that under these conditions, the top opening of the channel (the part that would extend into the ERGIC) became wider and coated with water molecules. That coating of water makes the channel more inviting for ions to enter.
That pore opening also contains amino acids with hydrophilic side chains that dangle from the channel and help to attract positively charged ions.
The researchers also found that while the closed channel has a very narrow opening at the top and a broader opening at the bottom, the open state is the opposite: broader at the top and narrower at the bottom. The opening at the bottom also contains hydrophilic amino acids that help draw ions through a narrow “hydrophobic gate” in the middle of the channel, allowing the ions to eventually exit into the cytoplasm.
Near the hydrophobic gate, the researchers also discovered a tight “belt,” which consists of three copies of phenylalanine, an amino acid with an aromatic side chain. Depending on how these phenylalanines are arranged, the side chains can either extend into the channel to block it or swing open to allow ions to pass through.
“We think the side chain conformation of these three regularly spaced phenylalanine residues plays an important role in regulating the closed and open state,” Hong says.
Viral targeting
Previous research has shown that when SARS-CoV-2 viruses are mutated so that they don’t produce the E channel, the viruses generate much less inflammation and cause less damage to host cells.
Working with collaborators at the University of California at San Francisco, Hong is now developing molecules that could bind to the E channel and prevent ions from traveling through it, in hopes of generating antiviral drugs that would reduce the inflammation produced by SARS-CoV-2.
Her lab is also planning to investigate how mutations in subsequent variants of SARS-CoV-2 might affect the structure and function of the E channel. In the Omicron variant, one of the hydrophilic, or polar, amino acids found in the pore opening is mutated to a hydrophobic amino acid called isoleucine.
“The E variant in Omicron is something we want to study next,” Hong says. “We can make a mutant and see how disruption of that polar network changes the structural and dynamical aspect of this protein.”
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The research was funded by the National Institutes of Health and the MIT School of Science Sloan Fund.
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Your retirement checklist: 9 steps toward a better retirement
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The U.S. is approaching “peak 65.” Are you ready for it?
The number of people who turn 65 every day will peak in 2024, and more people will be staring at the possibility of retirement, often without a plan or a roadmap to help them thrive. Given that more people are living longer, that’s a long time to spend bored, lonely or financially insecure.
Here’s a checklist to help you navigate the financial decisions, legal complications and social ramifications of retiring. Since 60% of workers retire earlier than planned, according to the Transamerica Institute and the Transamerica Center for Retirement Studies, you shouldn’t leave these tasks to the last minute. Get started now.
1. Update your will and estate-planning documents
Your will may be decades out of date and your financial accounts may have beneficiaries linked to a previous marriage. Dust off those documents and get them refreshed as soon as possible.
“Before you even start thinking about retirement, there’s some housekeeping that needs to get done,” says Eric Bond, the president of Bond Wealth Management.
On your immediate to-do list, make sure you have a will, power of attorney and healthcare power of attorney in case you become incapacitated and can’t act on your own behalf. You’ll also need a HIPAA waiver as well as a trust, says Catherine Collinson, the chief executive and president of the nonprofit Transamerica Institute and Transamerica Center for Retirement Studies.
“There’s still widespread belief that trusts are only for the affluent, but they’re for everyone,” Collinson says. “It’s amazing how small issues can take on enormous bureaucratic proportions. You want to try to avoid that.”
Nicholas Yeomans, a financial adviser and the president of Yeomans Consulting Group, says to check retirement plans, life insurance and annuity accounts to make sure you have your beneficiaries listed properly. You may have a will, but beware that beneficiaries on such accounts supersede a will, he says. Be sure to name secondary or contingent beneficiaries, as well.
2. Create a budget
“It’s really basic, but only 23% of preretirees and 19% of retirees have a written plan. Until you put the numbers into a spreadsheet, it’s impossible to come up with realistic expectations for how you’re going to live your life. Otherwise, you’re just winging it,” Collinson says.
“Life is much more complicated and challenging. You need backup plans and contingency plans,” she says. “It’s really important to plan for life’s unforeseen circumstances.”
Bond, meanwhile, cautions that people who retire in their 60s need to realize that longevity has increased and they could be retired for decades.
“Milk and eggs are not getting cheaper. You have to plan for the long haul,” he says.
Working Americans think they need an average of $1.1 million to retire, according to the Schroders 2023 U.S. Retirement Survey. Financial advisers generally recommend that people have 75% to 85% of their preretirement income for each year of their retirement.
Also read: How never to outlive your money
3. Build up your cash reserves
Once you have a budget in place, build up cash reserves to cover six to nine months of basic expenses, such as mortgage, utilities and living expenses, Yeomans says.
“People are either one of two extremes when it comes to emergency funds — too much cash or not enough,” he says.
And in the years leading up to retirement, Brandon Robinson, the president and founder of JBR Associates, recommends that you work on eliminating your “bad” debt, such as credit cards or vehicle payments. Having a mortgage, however, is not necessarily a bad thing, since a house is generally an appreciating asset, he says.
4. Consider hiring an adviser
“Most people only retire once,” Collinson says. “Financial advisers have the depth and breadth of experience to help. Many workers have a 401(k), and with that often comes access to financial guidance. Take advantage of that.”
She adds: “In today’s turbulent economy, the many people who may have felt comfortable taking a do-it-yourself approach may need help navigating uncharted territory.”
And make sure you meet with your financial adviser on an annual basis, Robinson adds.
5. Plan for healthcare and long-term-care needs
Healthcare is costly, and it can be even more so for retirees. It can cost as much as $5,100 a month for a home health aide, for instance, and an average of about $8,000 a month for a semiprivate room in a nursing home, according to the Genworth Cost of Care Survey. Genworth is a long-term-care insurance company.
By another measure, a 65-year-old retiring in 2023 could spend an average of $157,500 on health and medical expenses throughout his or her retirement, according to Fidelity Investments, which tracks retiree healthcare expenses annually.
Also think about the long-term costs of help with the activities of daily living, such as bathing, toileting and dressing — assistance that is not covered by Medicare.
When asked what their plans are for if and when their heath declined, 46% of retirees said they’d rely on family and friends, and 31% said they don’t have any plans or haven’t thought about it, Collinson says.
“People don’t want to think about needing someone to bathe and dress them. The cost and potential impact of these topics is enormous,” she says.
Collinson says it’s important to learn about long-term care — what’s available and at what price. That can help guide your decisions about long-term care insurance, but options in that market have contracted and costs have risen, putting such services out of reach for many people
Only 14% of retirees are very confident they could afford long-term care if needed, she says.
“Many people are under the impression that Medicare covers more long-term care than it actually does,” Collinson says. “And qualifying for Medicaid is extreme. It means that you’re at dire financial means, if not bankrupt. And Medicaid facilities have long waiting lists.”
6. Get the facts about Medicare
Speaking of Medicare, it’s important to learn what the program covers and what it doesn’t.
“There are so many decision criteria about the type, level and cost of care,” Collinson says. “It behooves everyone to understand the Medicare options best for them and review those plans regularly.”
Also, it’s critical to plan for Medicare when you’re 65, even if you’re not planning to retire until 67 or 70.
There’s a seven-month window to enroll in Medicare, which includes the three months before you turn 65, the month of your birthday and the three months after. If you miss that seven-month window and you don’t have health insurance from a large employer, you can face lifetime penalties for late enrollment in Medicare.
The first step is to contact the Social Security Administration — not Medicare itself — to start Medicare. And you’ll enroll only yourself — it’s not a family plan.
If you’re getting Social Security and you enroll in Medicare, your premiums will come directly out of your Social Security check. However, if you’re not getting Social Security yet, you should set up automatic payments for Medicare, because your enrollment can get canceled for nonpayment.
7. Plan your Social Security strategy
You need to know when and how to manage your Social Security claiming. The Social Security Administration website is a great starting point, but be sure to talk with a financial adviser or visit your 401(k) plan’s financial resource center to get more information.
Read: How much does my Social Security benefit increase when I delay filing?
“Ideally, you want to wait until the full retirement age or age 70, which is the maximum age,” Collinson says.
Full retirement age is 67 for those born in 1960 or later.
“When to take Social Security is a major decision that depends on your health, the health of your spouse, your jobs. Making that decision is a big one. Don’t take it lightly,” Robinson says.
Read: Inflation is already racing past next year’s Social Security COLA
8. Consider downsizing
“Consider downsizing or moving, but take your time,” Yeomans says. “People make major purchase mistakes in the first 12 to 18 months of retirement. But take your time. Consider renting before pulling that trigger.”
Aging in place is something about nine out of 10 people want to do, according to a survey from Transamerica Institute and the Transamerica Center for Retirement Studies, but Collinson says people need to prepare their homes for that.
You may need wider doorways that can accommodate a wheelchair, as well as chairlifts, grab bars and shower seats.
“If your dream home in retirement has lots of stairs, know that you may need to move when stairs become unmanageable,” she says.
9. Retire to something meaningful
Once you have the financial and legal aspects taken care of, think about how — and with whom — you want to spend your time in retirement.
“Make sure you’re not retiring from something, but instead retiring to something,” Yeomans says. “Men struggle with this the most. The average man has no close friends in their life who aren’t connected to work. And so much of our health in retirement comes from relationships.”
Now read: In retirement, time is short. Don’t waste it on things you hate.
People often don’t realize what they’ll lose when they quit working: routine, structure, social interactions, mental stimulation and in some cases physical activity, says Robert Laura, founder of the Retirement Coaches Association.
People also often don’t take their personality into account when considering retirement.
“If you’re a Type A personality, you may feel out of sorts with endless time. A lot of people don’t critically question retirement. They think it’s golden. But people often don’t want to retire — they just want to stop doing their primary job,” Laura says.
Joe Casey, managing partner of retirement-coaching company Retirement Wisdom, recommends talking to people who are thriving in retirement and learning how they spend their time and energy.
“People miss the challenge of working. What’s the new challenge that will help you keep growing? Don’t get too hung up on finding a singular new purpose. Try new things. Volunteer. Try several activities and be open to experimenting,” Casey says.
Casey suggests mapping out what a typical day or week will look like in retirement and how you plan to fill those hours. Give yourself some structure by having three things to do every day. That will provide you with a road map of how to spend your time but will also give you flexibility to let the day unfold.
Laura says the newly retired should set 30-, 60- and 90-day goals to create some structure and have small objectives to work toward.
“People suffer from choice paralysis — they have all the time in the world and so many options open to them. People go into retirement with vague ideas and don’t know where to start doing something, so they never do it,” Laura says.
“Retirement is the longest New Year’s resolution. It’s goals you have and never accomplish unless you’re focused. You don’t get extra motivation or energy in retirement, so you need to focus on what you want to accomplish,” Laura says.
A sobering statistic may spur you into action: The average retiree watches as much as 47 hours of television a week, according to AgeWave.
To avoid that, start thinking about and planning for retirement with your partner far ahead of the actual date. Learn each other’s goals and expectations for retirement and compare notes. Some adjustments might be in order.
“What if one wants to sail around the world and the other wants to see the grandkids every month?” Laura says.
Casey also recommends taking retirement for a test drive by taking a week off work. “You can get a good sense of retirement in a week trial,” he says. “It will show you how long a day can be.”
And Collinson says to prioritize physical fitness — but don’t forget about your mental health, too. Stay engaged with other people and avoid isolation.
Loneliness is as deadly as smoking up to 15 cigarettes a day and is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety and premature death, according to a recent advisory from the U.S. Surgeon General.
The takeaway: Make sure you plan how you’ll carry out your hopes and dreams in retirement to make it all feel worthwhile.
“What was the reason you worked hard for so many years?” Casey says. “It wasn’t to watch 47 hours of TV each week.”
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UM School of Medicine Researchers Provide First Statewide Prevalence Data on Two New Emerging Pathogens in Healthcare Settings
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Newswise — University of Maryland School of Medicine (UMSOM) researchers conducted a statewide survey of all patients on breathing machines in hospitals and long-term care facilities and found that a significant percentage of them harbored two pathogens known to be life-threatening in those with compromised immune systems. One pathogen, Acinetobacter baumannii, was identified in nearly 31 percent of all patients on ventilators to assist with their breathing; Candida auris was identified in nearly 7 percent of patients on ventilators, according to the study which was published this week in the Journal of the American Medical Association.
They conducted the study with colleagues at the Maryland Department of Health and presented their findings at this week’s Infectious Disease Society of America annual meeting in Boston.
“We found patients in long-term care facilities, like skilled nursing homes, were more likely to be colonized with these pathogens than those getting treated in hospitals,” said study leader Anthony Harris, MD, MPH, Professor of Epidemiology & Public Health at UMSOM and infectious disease specialist at University of Maryland Medical Center. “We were the first in the nation to get a statewide survey of all ventilated patients, and I think it points to the stringency of the infection control programs in place in the state of Maryland and the excellent collaboration between the University of Maryland and the State Health Department.”
Both A. baumannii and C. auris have been highlighted by the federal Centers for Disease Control and Prevention (CDC) as emerging pathogens that present a global health threat. C. auris is a fungus that spreads within and among local healthcare facilities–usually in those hospitalized and on breathing machines (ventilators). Older people with weakened immune systems are particularly susceptible to this infection, which resists treatment with common anti-fungal medications. A. baumannii, a bacteria, also poses a threat to these same types of patients and has become very resistant through the years to treatment with most antibiotics.
To conduct the study, Dr. Harris and his colleagues obtained culture swabs from all 482 patients receiving mechanical ventilation in Maryland healthcare facilities between March and June of this year. All eligible healthcare facilities, 51 in total, participated in the survey. They identified A. baumannii from at least one patient in one-third of the acute care hospitals and from 94 percent of the long-term care facilities. They identified C. auris in nearly 5 percent of hospitalized patients and in 9 percent of patients in long-term care facilities.
“Testing positive, however, does not mean that patients have symptoms or active infections that are potentially life-threatening,” said study co-author J. Kristie Johnson, PhD, Professor of Pathology at UMSOM whose lab did the A. baumannii testing for the study. “But knowing which patients are colonized with these pathogens can help contain their spread to other patients.”
Over the course of 2022, state and local health departments around the country reported 2,377 clinical cases, according to the CDC, nearly five times the number infections in 2019, which was less than 500 cases. Maryland alone had 46 cases in 2022. While these infections don’t normally pose much of health risk to hospital workers, they pose a significant risk of death in patients with weakened immune systems. Often the infections can be spread from patient to patient by health care workers carrying the germs on their hands, equipment or clothing.
“There is a need for more health care facilities nationwide to be aware of the extent of the problem through surveillance testing,” Dr. Harris said. Certain measures can be implemented to help reduce spread of these pathogens including more stringent use of disposable gloves and gowns between patients and the use of chlorhexidine bathing of the critically ill to disinfect their skin.
“Emerging pathogens that are resistant to available therapeutics present a growing challenge in our country, especially with a projected increased growth in our aging population entering long term care facilities,” said UMSOM Dean Mark Gladwin, MD, who is also Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor at UMSOM. “Nearly half of patients who contract C. auris infections die within 90 days, according to the CDC, and this pathogen is now found in nearly 50 states. This is why it is critical for these surveillance studies to be conducted nationwide, not just in Maryland.”
UMSOM faculty members Lisa Pineles, MA, Lyndsay O’Hara, PhD, Leigh Smith, MD, and Indira French, MS, were co-authors on this study. The study was funded by a grant from the CDC (1U54CK000450-01).
About the University of Maryland School of Medicine
Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world — with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.2 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has more than $500 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2023, the UM School of Medicine is ranked #10 among the 92 public medical schools in the U.S., and in the top 16 percent (#32) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu
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New Institute for Immunologic Intervention (3i) at the Hackensack Meridian Center for Discovery and Innovation (CDI) Drives Forward Discovery and Innovation to Combat Infections, Cancer, and Inflammatory Diseases
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Newswise — Nutley, NJ, October 12, 2023 – The Hackensack Meridian Center for Discovery and Innovation (CDI) has formed a new institute aiming to fight infections, cancer, and inflammatory diseases by finding a better way to restore and bolster the human immune system in its responses to disease.
The Institute for Immunologic Intervention (or “3i”) is searching for ways to unleash new advances in immunology to beat disease and save lives. The expert scientists in this new institute include basic researchers, physician-scientists, and leading clinicians who are working seamlessly to tackle major health problems of our time.
The Institute is dedicated to advancing the understanding of fundamental mechanisms of infectious immunity, tumor immunity, alloimmunity, and autoimmunity within clinical contexts. By fostering collaborations with the CDI, the John Theurer Cancer Center at Hackensack University Medical Center and its consortium partner Georgetown University’s Lombardi Comprehensive Cancer Center, and beyond, the 3i strives to apply this knowledge towards innovative strategies that enhance the effectiveness of cancer immunotherapy, interventions for autoimmune and alloimmune conditions, and the prevention of infections.
“We have recruited world-class talent to give this Institute critical mass,” said David Perlin, Ph.D., chief scientific officer and executive vice president of the CDI, and professor of medical sciences at the Hackensack Meridian School of Medicine. “These scientists are tackling disease at the basic level of discovery – but with an eye toward finding real-world solutions in the near future. This is what the CDI is all about.” Perlin is also a professor at Georgetown University.
“We are excited about the possibilities – and also about the collaborations already happening among this group of scientists,” said Binfeng Lu, Ph.D., the director of the 3i.
The scientists whose work is critical to the 3i, and their fields of expertise, include: Lu: cancer immunology and immunotherapy, and inflammatory biology; Yi Zhang, M.D., Ph.D.: (CAR) T cell biology, tumor immunity and alloimmunity; Hai-Hui “Howard” Xue, M.D., Ph.D.: T cell biology, tumor immunity; Johannes Zakrzewski, M.D.: cancer immunotherapy and immunosurveillance; Rachel Rosenstein, M.D., Ph.D.: inflammatory and fibrotic diseases; Sivia Lapidus, M.D., M.D.: pediatric rheumatic conditions and autoinflammatory disorders; Jigar V. Desai, Ph.D.: innate immunity, fungal infections; Benjamin Tycko, M.D., Ph.D.: genetics and epigenetics in human development and disease; Rena Feinman, Ph.D.: influence of the gut microbiome on antitumor immunosurveillance in patients with multiple myeloma (MM); Kevin Tong, Ph.D.: modeling the genetic progression of colorectal cancer for targeted therapies and personalized medicine; and Alvin Makohon-Moore, Ph.D.: evolutionary dynamics of cancer.
Virtually all of these 3i scientists also have faculty appointments at the Hackensack Meridian School of Medicine.
The research cores supporting the 3i include flow cytometry, microscopy, tissue biorepository bank, bioinformatics and statistical analysis, gene-editing, computational chemistry, and clinical immunology assays, among other expertise.
“The expertise brought together in this one Institute at the CDI is a thrilling development,” said Ihor Sawczuk, M.D., FACS, president of Academics, Research and Innovation for Hackensack Meridian Health, the founding chair of the Hackensack Meridian Health Research Institute (HMHRI) of which CDI is part, and also associate dean of clinical integration and professor and chair emeritus of urology at the Hackensack Meridian School of Medicine. “Working across an ecosystem like this is what will drive our science forward.”
The 3i laboratories are all supported by federal grants. Most recently, in support of this mission, the 3i received a philanthropic grant in the amount of $500,000 to support the Institute’s work in immunology and multiple myeloma research from the D’Aloia Family Foundation, led by G. Peter D’Aloia, an accomplished business executive who previously worked at several large national corporations, and his wife Marguerite. Mr. D’Aloia previously made a major gift to Hackensack Meridian Ocean University Medical Center.
“I believe that the CDI has a great approach to finding cures for some of today’s most difficult diseases, in particular its work on using the body’s immune system to fight cancer and its focus on treatment and cures for multiple myeloma,” said Peter D’Aloia. “It is my hope that this gift provides meaningful help in allowing the CDI to continue the good work being done within the organization.”
To make a gift in support of the Institute for Immunologic Intervention (3i) at CDI, please visit GiveHMH.org/CDI or call William Evans, executive director at the CDI, at [email protected] or 201-880-3100.
ABOUT THE CENTER FOR DISCOVERY AND INNOVATION
The Center for Discovery and Innovation, a member of Hackensack Meridian Health, translates current innovations in science to improve clinical outcomes for patients. More than 29 laboratories, 185 professional researchers and physician-scientists at the CDI have set their sights on cancer, infectious diseases, autoimmune disorders, and other acute and chronic diseases. Clinical need drives the scientific insights, and their application, for these researchers, as shown in the real-time response to the COVID-19 pandemic, resulting in new diagnostics, therapies, and surveillance abilities. The CDI leverages a new wave of scientific advances involving genetics, cell engineering of the human immune system, and imaging to better diagnose, treat and prevent disease through personalized medicine approaches. For additional information, please visit www.hmh-cdi.org.
ABOUT HACKENSACK MERIDIAN HEALTH
Hackensack Meridian Health is a leading not-for-profit health care organization that is the largest, most comprehensive and truly integrated health care network in New Jersey, offering a complete range of medical services, innovative research and life-enhancing care. The network has 18 hospitals and more than 500 patient care locations, which include ambulatory care centers, surgery centers, home health services, long-term care and assisted living communities, ambulance services, lifesaving air medical transportation, rehabilitation centers, urgent care centers, physician practice locations, and a fitness and wellness center. With more than 35,000 team members and 7,000 physicians, Hackensack Meridian Health is a distinguished leader in health care philanthropy and committed to the health and well-being of communities throughout New Jersey.
The network’s notable distinctions include having more U.S. News-ranked hospitals than any other health system in New Jersey, as ranked by U.S. News & World Report, 2022-23. Hackensack University Medical Center is nationally-ranked by U.S. News & World Report in four specialties, more than any other hospital in New Jersey. Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center, and K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center, are ranked #1 in the state and top 20 in the Mid-Atlantic Region by U.S. News & World Report’s 2022-23 Best Children’s Hospital Report. Additionally, their combined nephrology program ranks in the top 50 in the United States. To learn more, visit www.hackensackmeridianhealth.org.
ABOUT HACKENSACK MERIDIAN HEALTH RESEARCH INSTITUTE (HMHRI):
HMHRI leads and organizes a connected ecosystem bringing together clinicians, scientists, and educators to respond to the health problems of our time, in real-time. HMHRI is dedicated to accelerating discovery, innovation, and translation of scientific breakthroughs that address unmet clinical needs.
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Johns Hopkins School of Nursing Professor Bonnielin Swenor Named Inaugural Endowed Professor of Disability Health and Justice
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Newswise — Johns Hopkins School of Nursing Professor Bonnielin Swenor, PhD, MPH, BS, also founder and director of the Johns Hopkins Disability Health Research Center, has been named the inaugural Endowed Professor of Disability Health and Justice.
“Dr. Bonnielin Swenor is an incredible researcher, scientist, and educator with an unrelenting drive to ensure that people with disabilities are able to thrive,” says JHSON Dean Sarah Szanton, PhD, RN, FAAN. “Her installation as an endowed chair formally acknowledges the impact her career has made, and our trust in all there is to come.”
“Dr. Swenor and the Center are committed to training the next generation of disability equity researchers, including researchers with disabilities,” says Jermaine Monk PhD, MSW, MS Mgmt, MA Th, MA, Associate Dean of Diversity, Equity, Inclusion, and Belonging. “That is so important to build into nursing education as we prepare the next generation of nurses.”
The chair was funded by the estates of Ms. Charlotte B. Lockner, School of Nursing alumna from the Class of 1955; Mr. Ralph S. O’Connor, University Trustee and Krieger School of Arts and Sciences alumnae from the class of 1951; and Antoinette Delruelle and Joshua L. Steiner, along with The Maryland E-Nnovation Initiative Fund Authority.
Today more than 27 percent of American adults have a disability, and yet people with disabilities still face many barriers to health, equity, and inclusion.
With that in mind, the Endowed Professorship of Disability Health and Justice was established to push scientific discovery and develop innovative, evidence-based strategies to foster inclusion of people with disabilities into the workforce.
Dr. Swenor founded and directs the Johns Hopkins Disability Health Research Center, which is home to experts across disciples who test and collaborate on data-driven approaches to reduce disability inequity. It officially moved to the School of Nursing in 2022 when Dr. Swenor joined the faculty. The professorship will fund Dr. Swenor and the Center to develop novel tools that inform policy and integrate artificial intelligence (AI) and other technologies into new disability health tools.
“I am honored to be the inaugural Endowed Professor of Disability Health and Justice,” says Dr. Swenor. “We aim to shift the paradigm from ‘living with a disability’ to ‘thriving with a disability’ and maximize the health, equity, and participation of people with disabilities.”
Through this endowed chair, Dr. Swenor and the Johns Hopkins Disability Health Research Center will have significant impact on our ability to build up activism and visibility in the disability community.
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Located in Baltimore, the Johns Hopkins School of Nursing is a globally-recognized leader in nursing education, research, and practice. In U.S. News & World Report rankings, the school is No. 1 nationally for its DNP program and No. 2 for its master’s. In addition, JHSON is ranked as the No. 3 nursing school in the world by QS World University. The school is a five-time recipient of the INSIGHT Into Diversity Health Professions Higher Education Excellence in Diversity (HEED) Award and a four-time Best School for Men in Nursing award recipient. For more information, visit www.nursing.jhu.edu.
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Ford, Microsoft, Delta, Walgreens, Birkenstock, and More Stock Market Movers
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[ad_2]Stock futures posted modest gains Thursday ahead of a report likely to show that U.S. inflation fell in September as gasoline price growth slowed and used-car costs declined.
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Make diagnosing serious geriatric diseases as easy as measuring blood sugar
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Newswise — In 2023, life expectancy in Korea will be 83.6 years, the third highest among OECD countries, and it is steadily increasing every year. As the proportion of the elderly population increases, the social cost of treating various geriatric diseases is also increasing rapidly, and there is a growing interest in early diagnosis of diseases. Among the various diagnostic methods, researchers are actively conducting research on measuring glutamine as an indicator of geriatric diseases by finding that the concentration of glutamine in the cells and blood of patients with serious diseases such as cancer, diabetes, and dementia is significantly changed compared to normal people.
Dr. Seo, Moon-Hyeong of the Natural Product Research Center at the Korea Institute of Science and Technology (KIST), together with Dr. Park, Keunwan of the Natural Product Informatics Research Center, have developed a technology that can quickly and accurately measure glutamine concentrations without complicated measurement processes and expensive analytical equipment through the principle of ‘ligand-induced protein assembly’.
Glutamine is an amino acid in the blood that is used by cells to synthesize proteins or as an energy source, and its rapid fluctuation in certain situations makes it a useful biomarker for the treatment and early diagnosis of disease. For this reason, researchers are actively studying glutamine metabolism in the body to diagnose metabolic and degenerative diseases, including cancer treatment by inhibiting the metabolism of glutamine, which is also a nutrient for cancer cells.
Until now, the measurement of glutamine concentration in the body has relied on expensive specialized analytical equipment such as amino acid analyzers, which cannot measure changes in glutamine concentration in living cells in real time. In the case of relatively low-cost research kits, cumbersome pre-treatment processes such as protein removal in biological samples were required, resulting in long measurement times and low accuracy.
The team developed a sensor protein for measuring glutamine based on the principle of “ligand-induced protein assembly” that can easily measure the concentration of glutamine in the blood. By separating a glutamine binding protein into two artificial proteins and then binding to the sample, and named it Q-SHINE by combining Q, the symbol for glutamine, and SHINE, which means brightly glowing. Experiments showed that the Q-SHINE sensor was highly selective, not responding to amino acids with similar structure such as glutamic acid and D-glutamine. The lowest concentration of glutamine that can be measured is 1 micromolar (µM, one millionth of a molar), which is 20 times lower than the enzymatic assay most commonly used in research kits. In addition, the sensor protein can be easily produced in E. coli, making it possible for a research kit to analyze glutamine concentrations at the same level as analytical instruments worth hundreds of millions of dollars.
The team also used the Q-SHINE sensor to monitor changes in glutamine concentration in the cytoplasm and mitochondria of living cells in real time. In particular, by verifying the difference in glutamine concentration between cancer cells and normal cells, it is expected to speed up the development of anticancer drugs by inhibiting glutamine metabolism.
“The Q-SHINE sensor developed by KIST will enable easy monitoring of glutamine concentration, similar to the self-monitoring of blood glucose by diabetics,” said Dr. Seo, Moon-Hyeong. “If used for glutamine metabolism research, it will greatly contribute to early diagnosis and identification of causes of severe geriatric diseases such as cancer, diabetes, and dementia, as well as development of cancer drugs that regulate glutamine metabolism.”
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KIST was established in 1966 as the first government-funded research institute in Korea. KIST now strives to solve national and social challenges and secure growth engines through leading and innovative research. For more information, please visit KIST’s website at https://eng.kist.re.kr/
The research, which was supported by the Ministry of Science and ICT (Minister Lee Jong-ho) through the KIST Major Project and the Korea Research Foundation’s Excellent New Research Project, was published in the latest issue of the international journal Sensors and Actuators, B: Chemical (IF=8.4, top 0.8% in JCR).
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Family Dollar recalls dozens of P&G, J&J, Colgate products in 23 states due to incorrect temperature storage
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Family Dollar voluntarily recalled dozens of over-the-counter drugs, products and medical devices sold at its stores because they had been stored at improper temperatures, according to the Food and Drug Administration late Tuesday.
On the FDA’s website, the regulator said products affected by the recall were stored “outside of labeled temperature requirements by Family Dollar and inadvertently shipped to certain stores on or around June 1, 2023 through September 21, 2023.”
Brands affected by the recall include Procter & Gamble’s
PG,
+0.99%
Crest, Vicks and Pepto Bismol; Colgate
CL,
+0.26%
; Johnson & Johnson Inc.’s
JNJ,
-0.11%
Tylenol and Listerine; and Bayer’s
BAYN,
+3.04%
Aleve, according to a list provided by the FDA.The items were sold at stores in Alabama, Arkansas, Arizona, California, Colorado, Florida, Georgia, Idaho, Kansas, Louisiana, Mississippi, Montana, North Dakota, Nebraska, New Mexico, Nevada, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington and Wyoming, between June 1 and Oct. 4, the FDA said.
Family Dollar was acquired by Dollar Tree Inc.
DLTR,
+3.26%
in a deal that closed in July 2015.[ad_2]
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Copycat nutrient leaves pancreatic tumors starving
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Newswise — LA JOLLA, CALIF. – 2023 – A study led by scientists at Sanford Burnham Prebys suggests an entirely new approach to treat pancreatic cancer. The research shows that feeding tumors a copycat of an important nutrient starves them of the fuel they need to survive and grow. The method, described in the journal Nature Cancer, has been used in early clinical trials for lung cancer. However, the unique properties of pancreatic cancer may make the strategy an even stronger candidate in the pancreas.
“Pancreatic cancer relies on the nutrient glutamine much more than other cancers, so therapies that can interfere with tumors’ ability to access glutamine could be highly effective,” says senior author Cosimo Commisso, Ph.D., director and associate professor of the Cancer Metabolism and Microenvironment Program at Sanford Burnham Prebys.
Pancreatic cancer is relatively rare, accounting for only 3% of all cancers. However, it has one of the lowest survival rates among cancers: most people only live three to six months after being diagnosed with this disease.
“Over the course of the past decade, there has been a notable improvement in survival rates for pancreatic cancer, but they still hover around just 10%,” says Commisso. “There is a dire need for new treatments for these cancers.”
One of the challenges of treating pancreatic cancer has to do with the physical properties of the tumors themselves.
“Pancreatic tumors tend to be packed in dense connective tissue that keeps them encapsulated from the rest of the body and cuts off their supply of oxygen,” says Commisso. “As a consequence, these cancers develop unique metabolic properties compared to other tumors, and this is something we may be able to exploit with new treatments.”
One of the metabolic quirks of pancreatic cancer is that it relies heavily on glutamine to produce energy for growth and survival. In the past, scientists have tried to block access to glutamine to slow the growth of pancreatic tumors, but this is easier said than done.
The new method relies on a molecule called DON that has structural similarities to glutamine but can’t actually be used as a nutrient source. By studying mice, the research team found that DON significantly slowed pancreatic tumor growth and stopped the tumors from spreading.
Although DON was able to stop pancreatic tumors from using glutamine, pancreatic cancer cells can use other nutrients to grow in glutamine’s absence. To combat this effect, the researchers combined DON with an existing cancer treatment that blocks the metabolism of asparagine, another important nutrient. The combined treatment had a synergistic effect, helping prevent the spread of pancreatic tumors to other distant organs, such as the liver and lungs.
“With DON, the cancer cells can’t use glutamine, but they can start to depend on other nutrients as a backup, including asparagine,” says Commisso. “We thought that if we could stop them from using glutamine and asparagine, the tumors would run out of options.”
Although this is the first time this combination of treatments has been proposed for any cancer, the approach of using DON on its own has already advanced to early clinical trials in lung cancer.
“This is particularly exciting, because exploring it further for pancreatic cancer patients could be relatively simple, since the study designs exist for other solid tumors,” adds Commisso. “This could be a game changer for pancreatic cancer, and a lot of the preclinical work needed to rationalize it is already happening.”
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Additional authors on the study include Maria Victoria Recouvreux, Shea Grenier, Yijuan Zhang, Guillem Lambies, Cheska Marie Galapate, Swetha Maganti, Karen Duong-Polk, Deepika Bhullar, David A. Scott and Razia Naeem, Sanford Burnham Prebys; Edgar Esparza, Andrew M. Lowy and Hervé Tiriac, University of California San Diego.
This study was supported by an American Cancer Society Discovery Boost Grant (DBG-22-172-01-TBE) and grants from the NIH (R01CA254806, R01CA207189).
The study’s DOI is 10.1038/s43018-023-00649-1.
About Sanford Burnham Prebys
Sanford Burnham Prebys is an independent biomedical research institute dedicated to understanding human biology and disease and advancing scientific discoveries to profoundly impact human health. For more than 45 years, our research has produced breakthroughs in cancer, neuroscience, immunology and children’s diseases, and is anchored by our NCI-designated Cancer Center and advanced drug discovery capabilities. For more information, visit us at SBPdiscovery.org or on Facebook facebook.com/SBPdiscovery and on Twitter @SBPdiscovery.
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New insights into heart disease risk, prevention, and management
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Newswise — DALLAS, Oct. 9, 2023 — Health experts are redefining cardiovascular disease (CVD) risk, prevention and management, according to a new American Heart Association presidential advisory published today in the Association’s flagship journal Circulation.
Various aspects of cardiovascular disease that overlap with kidney disease, Type 2 diabetes and obesity support the new approach. For the first time, the American Heart Association defines the overlap in these conditions as cardiovascular-kidney-metabolic (CKM) syndrome. People who have or are at risk for cardiovascular disease may have CKM syndrome.
The new approach detailed in the presidential advisory includes:
- CKM syndrome stages ranging from 0, or no risk factors and an entirely preventive focus, to Stage 4, the highest-risk stage with established cardiovascular disease. Stage 4 may also include kidney failure. Each stage correlates to specific screenings and therapies.
- Screening for and addressing social factors that impact health.
- Collaborative care approaches among multiple specialties to treat the whole patient.
- Suggested updates to the algorithm, or risk calculator, that helps health care professionals predict a person’s likelihood of having a heart attack or stroke. The update adds a risk prediction for heart failure, which estimates risk for “total cardiovascular disease” — heart attack, stroke and/or heart failure.
- The writing group suggest the updated algorithm provide both 10- and 30-year cardiovascular disease risk estimates.
According to the American Heart Association’s 2023 Statistical Update, 1 in 3 U.S. adults have three or more risk factors that contribute to cardiovascular disease, metabolic disorders and/or kidney disease. CKM affects nearly every major organ in the body, including the heart, brain, kidney and liver. However, the biggest impact is on the cardiovascular system, affecting blood vessels and heart muscle function, the rate of fatty buildup in arteries, electrical impulses in the heart and more.
“The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome,” said Chiadi E. Ndumele, M.D., Ph.D., M.H.S., FAHA, writing committee chair and an associate professor of medicine and director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University in Baltimore. “Screening for kidney and metabolic disease will help us start protective therapies earlier to most effectively prevent heart disease and best manage existing heart disease.”
CKM syndrome is a consequence of the historically high prevalence of obesity and Type 2 diabetes in both adults and youth, according to the advisory. Type 2 diabetes and obesity are metabolic conditions — the “M” in CKM — that are also risk factors for cardiovascular disease. Moreover, the most common cause of death for people with Type 2 diabetes and chronic kidney disease is cardiovascular disease.
“We now have several therapies that prevent both worsening kidney disease and heart disease,” Ndumele said. “The advisory provides guidance for health care professionals about how and when to use those therapies, and for the medical community and general public about the best ways to prevent and manage CKM syndrome.”
With multiple conditions to manage, Ndumele noted fragmented care is a concern in treating patients with CKM syndrome, particularly for those with barriers to care. “The advisory suggests ways that professionals from different specialties can better work together as part of one unified team to treat the whole patient.” Additionally, the advisory emphasizes the importance of systematically screening for and addressing social factors that act as determinants, or drivers, of health, such as nutrition insecurity and opportunities for exercise, as key aspects of optimal CKM syndrome care.”
A companion article published with the presidential advisory, a new American Heart Association scientific statement, “A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome,”, documents the evidence for the writing committee’s proposed approach. The scientific statement brings together evidence from current guidelines and large research studies and describes where gaps remain in knowledge needed to further improve CKM health.
CKM screening, stages and treatment
CKM-related screening is intended to detect cardiovascular, metabolic and kidney health changes early; identify social and structural barriers to care; and prevent progression to the next stage of CKM syndrome.
The advisory addresses care for adults. However, studies suggest CKM syndrome is progressive and begins early in life. Therefore, the advisory aligns with the American Academy of Pediatrics’ recommendations for children and youth to have annual assessments of weight, blood pressure, and mental and behavioral health, starting at age 3.
Stage 0 – No CKM risk factors. The goal at this stage is preventing CKM syndrome by achieving and maintaining ideal health based on the American Heart Association’s Life’s Essential 8 recommendations. The recommendations include healthy eating, physical activity and sleep habits; avoiding nicotine; and maintaining optimal weight, blood pressure, blood sugar and cholesterol levels. The advisory suggests screening adults in Stage 0 every three to five years to assess blood pressure, triglycerides, HDL (good) cholesterol and blood sugar.
Preventing unhealthy weight gain is important for CKM syndrome prevention because of the connection of obesity to Type 2 diabetes, high blood pressure and high triglycerides. At all stages, the advisory proposes yearly measurement of waist circumference and body mass index. Healthy lifestyle behaviors are also encouraged at every stage.
Stage 1 – Excess body fat and/or an unhealthy distribution of body fat, such as abdominal obesity, and/or impaired glucose tolerance or prediabetes. Support for healthy lifestyle changes (healthy eating and regular physical activity) and a goal of at least 5% weight loss in people with Stage 1 are suggested, with treatment for glucose intolerance if needed. Screening every two to three years is advised to assess blood pressure, triglycerides, cholesterol and blood sugar.
Stage 2 – Metabolic risk factors and kidney disease. Stage 2 includes people with Type 2 diabetes, high blood pressure, high triglycerides or kidney disease, and indicates a higher risk for worsening kidney disease and heart disease. The goal of care at this stage is to address risk factors to prevent progression to cardiovascular disease and kidney failure. Treatment may include medications to control blood pressure, blood sugar and cholesterol. In those with chronic kidney disease and in some people with Type 2 diabetes, SGLT2 inhibitors are advised to protect kidney function and reduce the risk of heart failure. SGLT2 inhibitors are a class of prescription medicines that are FDA-approved for use with diet and exercise to lower blood sugar in adults with Type 2 diabetes. Glucagon-like peptide 1 (GLP-1) receptor agonists are also suggested for consideration in people with Type 2 diabetes to help reduce high glucose, facilitate weight loss and reduce risk for CVD. Other therapies to prevent worsening kidney function are also advised. Screening suggestions for Stage 2 CKM syndrome align with AHA/ACC guidelines, which include yearly assessment of blood pressure, triglycerides, cholesterol, blood sugar and kidney function.
For those with increased risk of kidney failure based on kidney function assessments, more frequent kidney screening is recommended.
Stage 3 – Early cardiovascular disease without symptoms in people with metabolic risk factors or kidney disease or those at high predicted risk for cardiovascular disease. The goal of care in Stage 3 is to intensify efforts to prevent people who are at high risk of progressing to symptomatic cardiovascular disease and kidney failure. This may involve increasing or changing medications, and additional focus on lifestyle changes. The writing committee advises coronary artery calcium (CAC) measurement in some adults to assess narrowing of the arteries when treatment decisions are unclear. CAC screening is used to guide decisions about cholesterol-lowering statin therapy. Test results indicating asymptomatic heart failure should lead to intensified therapy to prevent heart failure symptoms.
The advisory also describes CKM syndrome regression, an important concept and public health message in which people making healthy lifestyle changes and achieving weight loss may regress to lower CKM syndrome stages and a better state of health. The best opportunity for patients to experience regression is in Stages 1, 2 and 3. Some may see improvements in glucose control, cholesterol and blood pressure levels, weight, kidney function and types of heart dysfunction.
Stage 4 – Symptomatic cardiovascular disease in people with excess body fat, metabolic risk factors or kidney disease. Stage 4 CKM syndrome is divided into two subcategories: (4a) for those without kidney failure or (4b) for those with it. In this stage, people may have already had a heart attack or stroke or may already have heart failure. They also may have additional cardiovascular conditions such as peripheral artery disease or atrial fibrillation. The goal of care is individualized treatment for cardiovascular disease with consideration for CKM syndrome conditions.
Predicting Risk
A critical step in assessing risk and managing CKM syndrome is updating the risk prediction algorithm to help health care professionals predict cardiovascular disease in a way that includes CKM components: cardiovascular disease, chronic kidney disease and metabolic disorders.
The Pooled Cohort Equation, the current risk calculator for atherosclerotic cardiovascular disease, established in 2013, estimates the risk of a heart attack or stroke in the next 10 years for people ages 40-75. It includes health and demographic factors about a person and is used to guide lifestyle recommendations and treatment decisions for people at risk for cardiovascular disease. The risk factors are age, sex and race (as white, Black and other); cholesterol levels; and systolic blood pressure. The equation also includes yes/no responses to whether a person is receiving treatment for high blood pressure Type 2 diabetes, or smokes cigarettes.
The advisory proposes updating the risk calculator to include measures of kidney function, Type 2 diabetes control (using blood test results instead of a yes/no response) and social determinants of health for a more comprehensive risk estimate. Kidney function assessments include a measure of how well the kidneys filter waste from the blood and urine albumin levels, a measure of how well the kidneys reabsorb protein. Individual health measures in addition to demographic information will allow the calculator to produce an individual’s total CVD risk estimate.
The writing group recommends the risk calculator updates be expanded to assess risk in people as young as age 30 and to calculate both 10- and 30-year CVD risk. More comprehensive CVD risk assessment at younger ages will allow for earlier preventive strategies to mitigate progression to advanced stages of CKM syndrome. In the long term, this will help to reduce gaps in treatment and health equity and improve outcomes.
Calls to Action
The advisory calls for systemic changes to optimize CKM health.
“There is a need for fundamental changes in how we educate health care professionals and the public, how we organize care and how we reimburse care related to CKM syndrome,” Ndumele said. “Key partnerships among stakeholders are needed to improve access to therapies, to support new care models and to make it easier for people from diverse communities and circumstances to live healthier lifestyles and to achieve ideal cardiovascular health.”
Investing in research is important for advancing CKM care. Key research gaps include:
- better understanding the pathways leading to heart disease in CKM syndrome;
- better understanding of why some people may advance more quickly along CKM stages, while others may progress more slowly; and
- understanding the best way to use newer therapies with multiple effects on CKM syndrome, including to improve metabolic factors such as obesity and Type 2 diabetes, and to reduce worsening kidney disease and prevent heart disease.
Co-authors and their disclosures are listed in the manuscript.
This presidential advisory was prepared by the volunteer writing group on behalf of the American Heart Association. Presidential advisories and scientific statements promote greater awareness about cardiovascular diseases and stroke and help facilitate informed health care decisions. They outline what is known about a topic and what areas need additional research. While scientific statements and advisories inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide official clinical practice recommendations.
The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.
Additional Resources:
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Black Patients More Likely to Perceive Racial Bias From Orthopaedic Surgeons
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Newswise — October 9, 2023 – Black patients report more difficulties relating to their orthopaedic surgeon and are more likely to perceive bias from their surgeon, as compared with White patients, reports a study in The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.
“Black patients were six times more likely to report difficulty relating to their surgeon and 14 times more likely to report perceived racial bias compared with their White counterparts,” according to the survey study by Marsalis Brown, MD, of University Hospitals – Cleveland Medical Center, and colleagues. The research also shows race- and gender-related differences in patient preferences for orthopaedic surgeons with specific characteristics.
Survey shows racial differences in patient experiences
The study evaluated patients’ experiences, perceptions, and preferences related to diversity in orthopaedic surgery. The survey included 349 patients seen at orthopaedic clinics within the authors’ health system. About 80% of respondents were White and 18% were Black; only about three percent were Hispanic.
The results showed differences in patient experiences between racial groups. Black patients were more likely to report difficulties relating to their orthopaedic surgeon, as compared with White patients: 11.48% versus 2.29%. Black patients were also much more likely to perceive racial bias from their surgeon: 5.17% versus 0.37%.
Patients perceived low levels of diversity within orthopaedic surgery (average rating of 2.5 out of 10) with only a small difference between Black and White patients (2.10 versus 2.57). Black patients ranked race as a more important factor to consider when selecting a surgeon: average rating 3.49 compared with 1.45 for White patients.
Women report more difficulty relating to their orthopaedic surgeon
Women were about five times more likely to report difficulty relating to their surgeon. Although male and female patients had similar perceptions of diversity in orthopaedic surgery, women placed more importance on their surgeon’s gender.
The study also found some differences according to patient income and education, with more-educated patients perceiving lower diversity among surgeons. That perception is consistent with the slow rate of change in representation of racial and ethnic minorities and women in orthopaedic surgery, which lags behind other surgical specialties.
The findings are especially important in light of recent studies, which have shown that diversity leads to higher patient satisfaction, greater adherence to recommended treatment, and improvement in the patient-physician relationship. “Despite the ongoing education reforms to encourage increased diversity during trainee selection, the impact of such efforts is yet to manifest as changes in patient perceptions in current practice settings,” Dr. Brown and coauthors write. They discuss the critical need for reforms early in medical education, including early exposure to orthopaedic surgery, improving access to mentors, and steps to improve retention through each educational level.
Read Article [ Patient Preferences and Perceptions of Provider Diversity in Orthopaedic Surgery ]
Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.
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About The Journal of Bone & Joint Surgery
The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.
About Wolters Kluwer
Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory, and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.
Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,900 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.
For more information, visit www.wolterskluwer.com, follow us on LinkedIn, Twitter, Facebook, and YouTube.
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