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By Anthony O. Goriainoff
AstraZeneca said Thursday that its and MSD’s Lynparza cancer treatment had been approved in the U.S. for the treatment of metastatic castration-resistant prostate cancer, or mCRPC.
The Anglo-Swedish pharma giant said Lynparza, in combination with abiraterone and prednisone, reduced the risk of disease progression or…
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Newswise — MONTCLAIR, New Jersey (May 31, 2023) – Todd Huffman has been appointed as the chief financial officer for Hackensack Meridian Mountainside Medical Center, bringing with him over 10 years of valuable experience in healthcare finance. Huffman’s journey in the healthcare industry began at Portneuf Medical Center, where he initially served as the director of medical practice finance. Through his dedication and expertise, he quickly advanced to the position of controller and eventually assumed the role of assistant chief financial officer.
Huffman most recently held the position of chief financial officer for Hackensack Meridian Pascack Valley Medical Center, where his outstanding contributions laid a solid foundation for the organization’s growth in the Pascack Valley and Northern Valley region. Under his capable leadership, the hospital was honored with the prestigious 2022 MAP Awards for High Performance in Revenue Cycle by the Healthcare Financial Management Association.
Continuing his journey as a financial leader, Huffman will now serve as the CFO for Ardent Health Service’s New Jersey market. This expanded role will enable him to provide financial guidance and expertise across the network of hospitals and medical group practices.
Tim O’Brien, chief executive officer of Mountainside Medical Center, expressed his enthusiasm for Huffman’s appointment, highlighting his extensive financial acumen and the value he will bring to the organization. “Todd’s appointment signifies the hospital’s commitment to strong financial leadership and its dedication to providing exceptional healthcare services to the community.”
Huffman’s educational background includes completing his undergraduate studies at Idaho State University, where he earned a Bachelor of Business Administration in Accounting. He furthered his education by obtaining a Master of Taxation from the University of Denver, enhancing his expertise in financial management and taxation.
About Mountainside Medical Centers
Mountainside Medical Center has been serving Montclair and its surrounding New Jersey communities since 1891. The hospital provides patients immediate access to innovative and effective treatment alternatives at specialized centers within the hospital that focus on imaging, women’s health, cancer care, surgery, obesity, stroke and chronic kidney disease. Mountainside Medical Center is designated as a Primary Stroke Center by the NJ State Department of Health and Senior Services and is one of only a few community hospitals licensed by the State to perform emergency cardiac angioplasty. To learn more about Mountainside Medical Center visit www.mountainsidehosp.com.
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Hackensack Meridian Health (Mountainside Medical Center)
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Perinatal Mental Health of Indigenous Pregnant Persons and Birthing Parents During the COVID-19 Pandemic
Sawayra Owais MSc 1, Ryan J. Van Lieshout MD, PhD 1 2https://doi.org/10.1016/j.jogc.2023.04.015
Newswise — The COVID-19 pandemic has had a significant impact on Indigenous individuals during pregnancy and the postpartum (perinatal) period. Despite this, less than 1% of studies examining perinatal mental health during the pandemic included Indigenous persons. The current work examined pandemic-related stressors and depression and anxiety among Indigenous women and mothers attending an Indigenous midwifery clinic.
We found that a fear of COVID-19 infection, parenting and home-schooling children, and lack of support from female relatives and friends were particularly stressful. Despite these stressors, levels of depression (21%) and anxiety (26%) were lower than other groups surveyed during the pandemic and suggest that receiving culturally-supportive care from Indigenous midwives may have played a protective role. Exploring the aspects of culturally-consistent care that may be contributing to the well-being of these Indigenous parents, as well as following them over time could help to optimize their mental health and that of their families.
See the paper here: https://www.sciencedirect.com/science/article/pii/S1701216323003195?dgcid=author
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McMaster University
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EMBARGOED FOR USE UNTIL 5 P.M. (EDT) ON MAY 29, 2023
Newswise — New UCLA-led research suggests that patient mortality rates, readmissions, length of stay, and health care spending were virtually identical for elderly hospitalized patients who were treated by physicians with Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degrees.
While both traditional, or allopathic, medical schools and osteopathic medical schools provide the same rigorous health education, osteopathic training adds a more holistic, hands-on component involving manipulation of the musculoskeletal system – for instance, the use of stretching and massage to reduce pain or improve mobility.
“These findings offer reassurance to patients by demonstrating that they can expect high-quality care regardless of whether their physicians received their training from allopathic or osteopathic medical schools,” said senior author Dr. Yusuke Tsugawa, associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA and associate professor of health policy and management at the UCLA Fielding School of Public Health.
The study will be published May 30 in the peer-reviewed Annals of Internal Medicine.
Both types of physicians are licensed to practice medicine in every state. Currently about 90% of practicing physicians hold MD degrees and 10% have DO degrees. But the latter group is rapidly growing due to an increasing number of osteopathic medical schools, with their numbers having swelled by 72% between 2010 and 2020 compared with a 16% increase in MDs during the same period, and their ranks are expected to continue expanding.
In addition, osteopathic physicians are more likely than their MD counterparts to serve patients in rural and underserved areas.
The researchers relied on four data sources: a 20% sample of Medicare fee-for-service beneficiaries, amounting to about 329,500 people aged 65 years and older who were hospitalized between Jan. 1, 2016 and Dec. 31 2019; Medicare Data on Provider Practice and Specialty; a comprehensive physician database assembled by Doximity, and the American Hospital Association’s annual survey on hospital characteristics. Of the patients, 77% were treated by MDs and 23% were treated by DOs.
The researchers found that patient mortality rates were 9.4% among MDs vs. 9.5% among DOs, patient readmission rates were 15.7% vs. 15.6% respectively, healthcare spending was $1004 vs. $1003, and lengths of stay were 4.5 days for both.
The results are similar because both types of medical schools deliver rigorous, standardized medical education and comply with comparable accreditation standards, including four-year curriculums mixing science and clinical rotations, Tsugawa said.
The study does have some limitations, the researchers write, primarily the fact that they focused on elderly Medicare beneficiaries who were hospitalized with medical conditions, so the results may not apply to other population groups. In addition, they limited outcomes to specific measures of care quality and resource use, so these findings may not generalize to other outcomes.
But the findings “should be reassuring for policymakers, medical educators, and patients because they suggest that any differences between allopathic and osteopathic medical schools, either in terms of educational approach or students who enroll, are not associated with differences in quality or costs of care, at least in the inpatient setting,” the researchers write.
Additional study authors are Dr. Atsushi Miyawaki of UCLA and the University of Tokyo; Dr. Anupam Jena of Harvard University, Massachusetts General Hospital and the National Bureau of Economic Research; and Dr. Nate Gross of Doximity.
The study was funded by the National Institutes of Health’s National Institute on Aging (R01AG068633) and the Social Science Research Council.
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Newswise — Rosemont, Ill. (AANA) – Indiana dental patients now have increased access to safe anesthesia care with the enacting of Indiana Senate Bill 273. The American Association of Nurse Anesthesiology (AANA) applauds the new law, as it expands the scope of practice for Certified Registered Nurse Anesthetists (CRNAs), allowing CRNAs to administer moderate sedation, deep sedation, or general anesthesia to a patient in a dental office, under the direction of and in the immediate presence of a physician.
Megan Engelman, DNP, CRNA, president of the Indiana Association of Nurse Anesthetists, applauded the legislation citing, “It is an important step in advancing patient safety and providing skilled anesthesia care throughout the state.”
“As an increasing number of patients of all ages and health comorbidities seek sedation and anesthesia for dental procedures in office-based settings, patient safety is the top priority in the delivery of these services,” said Engelman.
Sedation for any dental procedure increases the complexity of care and emphasizes the importance of having sedation and anesthesia provided by an anesthesia professional, such as a CRNA, who is focused only on patient safety, monitoring, and vigilance. “Each patient has a unique response to medications utilized for sedation and anesthesia. As anesthesia experts, CRNAs are available to continuously monitor the patient, and can focus on changes in the patient’s condition and intervene as necessary in emergent situations,” said Engelman. “Even for what would be considered routine dental care like cavity fillings, a discussion of the anesthesia delivery plan is important to address any concerns and help the patient and the patient’s caregivers move forward to treat the dental health issues.”
CRNAs are highly educated, trained, and qualified anesthesia experts. They provide 50 million anesthetics per year in the United States, working in every setting in which anesthesia is delivered. CRNAs are skilled to provide safe, high-quality, and cost-effective care as members of patient-centered dental care teams in all settings, including dental offices, in accordance with state law.
As trained anesthesiology professionals, CRNAs have the education and experience to react quickly to emergency situations in dental care settings, possess the expertise to administer the anesthesia and focus solely on the patient’s condition, and intervene as necessary if critical events occur during the procedure.
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American Association of Nurse Anesthesiology
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A national obsession with a new class of weight-loss drugs is turning dangerous, doctors and researchers say, as many patients are inappropriately prescribed Wegovy, Ozempic and similar medications and supply shortages generate a market for unauthorized, potentially risky copycat versions of these drugs.
Social media buzz about the drugs has promoted the mistaken perception that the medications are appropriate for a broad swath of people who may want to shed a few pounds–with disastrous consequences for some patients, doctors say. Patients who previously recovered from eating disorders, for example, are coming in for treatment because they “have had their eating disorder reactivated by use of these medications,” said Dr. Elizabeth Wassenaar, a regional medical director at the Eating Recovery Center, which specializes in treating the disorders. Some patients have wound up in the hospital, she said, and in some cases the providers who prescribed the drugs were unaware of the patients’ eating-disorder history. “It’s a real warning to people who prescribe these medications that it’s not without risk,” she said.
Some doctors also question whether the safety of the drugs has been adequately studied in older adults, who may have an undesirable loss of lean muscle mass when taking the medications. That complicates an ongoing debate about whether Medicare should cover these drugs for weight loss.
And patients of all types are put at risk, experts say, by the illegal production of knock-off versions of the medications. The Food and Drug Administration and several state pharmacy boards in recent weeks have warned that some compounding pharmacies are producing unauthorized versions of the drugs–which poses particular safety concerns for injectable drugs such as Wegovy, said David Margraf, a pharmaceutical research scientist with the Resilient Drug Supply Project at the University of Minnesota’s Center for Infectious Disease Research and Policy. “It’s not just a victimless crime,” he said. “People can be severely injured.”
Novo Nordisk
NVO,
the maker of Wegovy and Ozempic, itself sought to tap the brakes on the craze around these drugs in a statement posted on its website this month, saying it’s concerned about reports of the drugs being used “for purely cosmetic or aesthetic weight loss,” unauthorized versions of the drugs hitting the market, and “insufficient clinical evaluations by some telehealth providers” promoting the drugs.
Drugs such as Novo Nordisk’s Wegovy, Ozempic and Rybelsus and Eli Lilly’s
LLY,
Mounjaro mimic the effects of a gut hormone known as GLP-1, which can help control blood-sugar levels and reduce appetite. (Mounjaro also affects another hormone called GIP.) Ozempic, Rybelsus and Mounjaro are FDA-approved for treatment of type 2 diabetes, while Wegovy is approved for people with obesity and certain people with excess weight combined with weight-related medical problems.
Billions of dollars in drug sales hinge on the breadth of the patient population prescribed these medications. Last year, more than 5 million prescriptions for Ozempic, Mounjaro, Rybelsus or Wegovy were written for weight management, up from just 230,000 in 2019, according to data and analytics firm Komodo Health. Obesity drugs could be a $54 billion market by 2030, up from $2.4 billion in 2022, Morgan Stanley said in a report last year. Reports of GLP-1 drug users seeing improvements in addictive behaviors such as smoking and drinking have lately amplified interest in the medications.
The drugs have become such a cultural phenomenon that Walmart during its quarterly earnings call last week blamed the medications for a shift in consumer-spending patterns that pressured its margins. In the first quarter, the company saw “a shift to health and wellness,” John Rainey, Walmart Inc.’s
WMT,
executive vice president and chief financial officer, said on the call with analysts. “And part of that is related to these GLP-1 drugs that are to treat diabetes,” he said, adding that the shift “comes at a lower margin, and so that has some impact on our business as well.”
Noom, a digital health company that for years has emphasized a behavioral approach to weight management, this week announced a new program that will make Ozempic, Wegovy, Mounjaro and other medications available to eligible patients. “Prescriptions are not the goal of our program. They’re very much an adjunct,” Dr. Linda Anegawa, Noom’s chief of medicine, told MarketWatch. Medical professionals will review patients’ entire health history, order labs to assess their metabolic health, and engage in video visits with patients as they determine what treatments might be appropriate, she said.
The reason GLP-1 drugs help control weight is pretty straightforward, said Dr. Daniel Drucker, who helped discover GLP-1 and is senior scientist at Lunenfeld-Tanenbaum Research Institute in Toronto. When people take these drugs, he said, they simply eat less because they feel more full. “GLP-1 will tell your brain that you’re not hungry,” he said, and people taking these medications may feel less stressed about food or find themselves thinking less about food. And the effects may go beyond eating, he said, as some people also see improvements in smoking, drinking, and other addictive or compulsive behaviors. “These are really interesting areas for further investigation,” he said. Drucker has been a consultant or speaker for Novo Nordisk, Pfizer
PFE,
and other pharmaceutical companies.
Novo Nordisk said in a statement to MarketWatch that it is not conducting any dedicated clinical studies to evaluate Ozempic, Rybelsus or Wegovy in patients with substance-use disorders or addiction-related illnesses, and Eli Lilly said it does not have any studies planned for investigating tirzepatide–the active ingredient in Mounjaro–for treatment of addiction.
Adolescents’ use of the drugs for weight loss is a particular concern for some doctors. Wegovy is approved for treatment of obesity in children 12 and older. “The adolescent mental health crisis is unprecedented,” said Wassenaar, with many teens suffering severe mood disorders, eating disorders, and suicidality, and teens struggling with depression may think, “if I lose weight, I’ll feel better and people will like me. There’s this magic drug, and all I have to do is inject it.” And if patients can start taking these drugs as early as 12 years of age, “we just don’t know what that’s going to do to them in 10 or 20 years,” she said, because there’s not enough long-term data.
Novo Nordisk said in a statement to MarketWatch that “teenage obesity is linked to weight-related health problems such as high blood pressure, high cholesterol and type 2 diabetes,” and that cutting calories and increasing physical activity may not be enough for some patients. “The decision to prescribe an anti-obesity medication is at the discretion of the physician and the patient/parents,” the company said.
Eli Lilly said that tirzepatide is not currently being studied for chronic weight management in children or adolescents.
Novo Nordisk via AP
Some doctors are also concerned about broad use of the drugs among older adults. Many older adults have sarcopenia, an age-related loss of muscle mass and strength that can contribute to frailty and fall risk later in life–and losing weight can mean an additional loss of muscle mass that may not be advisable for some patients, doctors and researchers say.
While “there’s a huge push to get Medicare to cover these drugs, it’s not really certain whether they would be helpful in this population or actually more harmful,” said Judy Butler, a research fellow at PharmedOut, a research and education project at Georgetown University Medical Center. Noom is not enrolling patients over age 60 in its new program, Anegawa said, partly because “we really don’t have enough data yet with many of these drugs in the geriatric population.”
In the pivotal clinical trials for Wegovy, 9% of the Wegovy-treated patients were between 65 and 75 years of age, and 1% were 75 and older, Novo Nordisk said in a statement. “No overall differences in safety or effectiveness have been observed between patients 65 years of age and older and younger adult patients,” the company said. In an ongoing cardiovascular outcomes trial, about 38% of patients are 65 or older, the company said.
By law, Medicare generally does not cover drugs prescribed for weight loss–although some drugmakers and industry groups are pushing to change that. Some of the drugs now generating intense demand also come with a hefty sticker price: Wegovy, for example, has an estimated annual net cost of about $13,600, according to the Institute for Clinical and Economic Review. If Medicare coverage rules changed and 10% of beneficiaries with obesity used Wegovy, total annual Medicare Part D spending on the drug could be as much as $26.8 billion, according to a recent study published in the New England Journal of Medicine. That’s more than 18% of the net total Part D spending by beneficiaries and the Medicare program in 2019.
There are potential physical as well as financial costs. Side effects of the drugs can range from nausea and vomiting to gallbladder problems, inflammation of the pancreas, and thyroid cancer.
More broadly, some doctors question the prescribing of drugs solely based on obesity, absent other risk factors. “If somebody is obese and has diabetes, high blood pressure, and high cholesterol, losing weight may improve those parameters, but obesity on its own does not need to be treated,” said Dr. Adriane Fugh-Berman, a professor at Georgetown University Medical Center and director of PharmedOut. “It’s cardiovascular fitness that is important, no matter what weight you are,” she said. “We should stop focusing on the weight itself as a risk factor.”
Dr. Robert Gabbay, chief science and medical officer at the American Diabetes Association, counters that “obesity is a disease, and therefore needs to be treated as such.” Although there are people with obesity who don’t have other serious conditions, he said, “that’s relatively uncommon.”
Despite the concerns, shortages of the drugs persist. Novo Nordisk says it anticipates that many patients will have trouble filling lower-dose Wegovy prescriptions through September.
For patients who are relying on GLP-1 drugs for treatment of diabetes, even a short-term interruption in access to the drugs can cause blood-glucose levels to rise and result in serious complications, Gabbay said. Patients also tend to gradually ramp up dosage of these drugs to get to the effective dose, he said, and if they lose access to the medication “they might have to start back at the beginning again,” putting them several months behind on their treatment.
The shortages can also create risks for a broader set of patients, experts say, as they spur demand for copycat versions of the drugs. The approved active ingredient in Wegovy and Ozempic is semaglutide in its base form, but some compounding pharmacies may be using salt forms of semaglutide, the FDA said in a late April letter to the National Association of Boards of Pharmacy. “We are not aware of any basis for compounding a drug using these semaglutide salts that would meet federal law requirements” restricting the types of active ingredients used in compounding, the FDA said in the letter. Boards of pharmacy in several states, including West Virginia, North Carolina and Mississippi, have also recently issued warnings about compounded semaglutide.
Novo Nordisk said in the statement posted on its website this month that it is “actively monitoring and taking action against” entities unlawfully selling compounded semaglutide, adding that no FDA-approved generic versions of semaglutide currently exist.
Unauthorized compounded versions of the drugs could raise serious concerns about sterility and other quality-control issues, the Resilient Drug Supply Project’s Margraf said. “If this drug is in high demand and there isn’t enough supply, people will find a way to get it from a gray-market source,” he said. “People are going to find ways around the laws and potentially harm patients.”
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Newswise — PHILADELPHIA – Two esteemed leaders from the Penn Medicine Abramson Cancer Center and Perelman School of Medicine at the University of Pennsylvania will be honored with 2023 Special Awards from the American Society for Clinical Oncology (ASCO), and Conquer Cancer, the ASCO Foundation, during the 2023 ASCO Annual Meeting, taking place June 2-6 in Chicago, Illinois.
Angela DeMichele, MD, MSCE, the Jill and Alan Miller Endowed Professor in Breast Cancer Excellence, co-leader of the Breast Cancer Research Program in the Abramson Cancer Center, and co-director of the 2-PREVENT Breast Cancer Translational Center of Excellence, is the 2023 recipient of the Gianni Bonadonna Breast Cancer Award. Carmen E. Guerra, MD, MSCE, FACP, the Ruth C. and Raymond G. Perelman Professor of Medicine, vice chair of Diversity and Inclusion in the department of Medicine, and associate director of Diversity and Outreach for the Abramson Cancer Center, is the 2023 recipient of the ASCO Excellence in Equity Award.
“We are delighted to see Dr. Guerra and Dr. DeMichele recognized for their impactful contributions to equity in cancer care and in breast cancer research,” said Robert Vonderheide, MD, DPhil, director of the Abramson Cancer Center. “Through bench-to-bedside research and community outreach and engagement, their work has made a difference for cancer patients and families across our community and the country. We are so grateful to have them as part of our team.”
Angela DeMichele, MD, MSCE, Gianni Bonadonna Breast Cancer Award
The Gianni Bonadonna Breast Cancer Award was created to honor the profound contributions of Dr. Gianni Bonadonna, who made several pioneering contributions to the field of oncology. The award recognizes an active clinical and/or translational researcher with a distinguished record of accomplishments in advancing the field of breast cancer and with exceptional mentoring abilities. DeMichele is recognized for her instrumental role in the development of palbociclib, one of the first CDK4/6 inhibitors—a class of targeted therapy drugs used to treat certain types of HR-positive and HER2-negative breast cancer. As a physician-scientist, her research centers on the development of experimental therapeutics, investigation of prognostic and predictive biomarkers, and design of novel approaches to identify and treat minimal residual disease to prevent recurrence for breast cancer. The 2-PREVENT Breast Cancer Translational Center of Excellence that she co-directs at Abramson Cancer Center is focused on identifying and treating dormant or “sleeper” cells that may persist after initial breast cancer treatment through innovative clinical trials. She holds leadership roles in numerous national oncology groups, including ECOG-ACRIN and the I-SPY Consortium and is the chair-elect for the ASCO Scientific Program Committee.
DeMichele’s award lecture will be available to attendees on demand for online viewing.
Carmen E. Guerra, MD, MSCE, FACP, Excellence in Equity Award
The ASCO Excellence in Equity Award, endowed by the American Cancer Society, recognizes ASCO members who have made significant and measurable contributions towards increasing equity, diversity, and inclusion within the field of oncology, or increasing access to equitable care for cancer patients. Guerra is recognized for her persistent work to advance equitable access to cancer clinical trials, cancer screenings, and care. She has led the development of several cancer screening patient navigation programs, including the Flu-FIT program, an effort that began as a drive-through event during the COVID-19 pandemic, where participants could receive both a flu shot and a FIT kit for at-home testing to screen for colorectal cancer. She has also established community outreach and engagement programs to increase participation of Black patients in cancer clinical trials, which have resulted in doubling the percentage of Black participants enrolled in clinical trials at Abramson Cancer Center. As the co-chair of two ASCO-Association of Community Cancer Centers workgroups, Guerra helped create an unconscious bias training and a self-assessment on equity, diversity, and inclusion for cancer research teams.
Guerra will participate in the Mentorship and Career Development Roundtable Discussion with ASCO’s Special Award Recipients on Sunday, June 4 at 10 a.m. CT in S103.
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Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $9.9 billion enterprise.
The Perelman School of Medicine is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $546 million awarded in the 2021 fiscal year.
The University of Pennsylvania Health System’s patient care facilities include: the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center—which are recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report—Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; and Pennsylvania Hospital, the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
Penn Medicine is powered by a talented and dedicated workforce of more than 47,000 people. The organization also has alliances with top community health systems across both Southeastern Pennsylvania and Southern New Jersey, creating more options for patients no matter where they live.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2021, Penn Medicine provided more than $619 million to benefit our community.
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Newswise — Far more older adults these days log on to secure websites or apps to connect with their health information or have a virtual health care appointment, compared with five years ago, a new poll shows.
Overall, 78% of people aged 50 to 80 have used at least one patient portal, up from 51% in a poll taken five years ago, according to findings from the University of Michigan National Poll on Healthy Aging. Of those with portal access, 55% had used it in the past month, and 49% have accounts on more than one portal.
But the poll also reveals major disparities, with some groups of older adults less likely to use patient portals, or more likely to have concerns about them. Older adults with annual household incomes below $60,000, and those who are Black or Hispanic, have lower rates of portal use, and were less likely to say they’re comfortable using a portal, than respondents who are higher-income or non-Hispanic white.
There were also differences among older adults who don’t use portals, or haven’t used one in three or more years. Those who say they’re in fair or poor health physically or mentally were much more likely to say they’re not confident about their ability to log in and navigate a portal than those with better physical or mental health.
Even among older adults who use online portals, the poll shows many still prefer phone calls for some tasks like scheduling appointments or asking a medical question. Portal users in general said they prefer the portal to the phone when it comes to tasks such as getting test results and requesting refills of their prescriptions.
The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, the University of Michigan’s academic medical center.
The jump in portal use between polls done in 2018 and 2023 likely happened in part due to the increase in use of telehealth visits, says Denise Anthony, Ph.D., the U-M School of Public Health researcher who worked on the poll.
The pandemic spurred many health systems, physician groups and hospitals to support video visits within their secure websites and apps.
“This change makes access to secure portals even more important for older adults who want to see their doctors and other health care providers virtually. It also makes the disparities we found in our poll even more troubling,” says Anthony, who chairs the Department of Health Management and Policy and studies use of telehealth and patient portals. “Improving the functionality and accessibility of portal systems, as well as providing more outreach and training to help patients understand and use portal systems, will be crucial to improving equity.”
Many portals allow patients who have created their own accounts to also grant a loved one access to some or all of their information, so they can help manage their health care. The new poll shows that 49% of portal users have done so, up from 43% in 2018. Of all portal users, 40% have given access to a spouse or partner, with 48% of men doing so compared with 32% of women.
“A growing body of evidence shows that patients who use portals to access their information are more likely to take an active role in their care and stick to the treatment plan their physicians and other providers recommend, which we know is likely to lead to better outcomes,” says poll director Jeffrey Kullgren, M.D., M.P.H., M.S., an associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System.
“Health care organizations that offer portals, and providers working in those organizations, should make an effort to engage and support patients who have not yet activated a portal account, and to offer training to increase confidence and encourage the sharing of access with trusted loved ones,” he says. “This is especially important for patients who have complex health needs or multiple conditions.”
He notes that 27% of the poll respondents who have used a patient portal in the last year expressed an interest in more training. The percentage was higher among respondents who haven’t used a patient portal recently, and those who are Black, Hispanic or have incomes below $60,000.
“Research shows that while more older Americans are embracing technology, nearly 22 million seniors still do not have wireline broadband access at home, limiting their access to essential digital health care services like patient portals,” said Indira Venkat, AARP Senior Vice President of Research. “Closing the digital divide among older adults is critical to improving their wellbeing, especially for vulnerable communities and individuals.”
Michigan Medicine launched its portal, MyUofMhealth.org, in 2012. Like many health systems, it has continued to add online functions, from rapid test result access and paperless billing, to self-scheduling some types of appointments and having asynchronous chats with providers for urgent matters. Today, 20% of all outpatient visits with University of Michigan Health providers take place via video connections hosted in the portal.
The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in January 2023 among 2,563 adults aged 50 to 80. The sample was subsequently weighted to reflect the U.S. population. For the previous patient portal poll, a different sample of older adults was asked about patient portal use, but both samples were weighted to reflect the population of U.S. adults aged 50 to 80.
Read past National Poll on Healthy Aging reports and about the poll methodology.
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Newswise — Hospital inpatients who develop an acute kidney injury (AKI) generally fare poorly after being discharged, and have few options for effective treatment.
A UW Medicine-led study published recently in American Journal of Kidney Diseases suggests that new tests might improve this narrative.
In the study, “about 30% of the patients that came into the hospital developed AKI, which means in a matter of hours or days, their kidneys might be failing because of reaction to drugs or contracting sepsis,” said lead author Dr. Pavan Bhatraju, an assistant professor of pulmonary and critical care medicine at the University of Washington School of Medicine.
Causes of AKI vary. For instance, sepsis, medication and inadequate blood supply in someone who is undergoing cardiac bypass are all potential causes of kidney injury. It’s also the case that, within the kidneys, different cell types can be injured in the process of AKI, said Dr. Jonathan Himmelfarb, a professor of nephrology at the UW School of Medicine and the study’s senior author.
“The way that we diagnose acute kidney injury today relies on a simple blood test of kidney function or a change in urine output,” Himmelfarb said. “These relatively crude diagnostic tools don’t detect the specific cause of injury or predict which individuals will be more likely to respond to a treatment or recover kidney function.”
Unfortunately, effective medical therapies do not exist for this population of patients, Bhatraju said. In their paper, the investigators proposed a way to classify subpopulations of AKI patients with the aim of identifying therapies specific patient populations.
In much the same way that distinct biomarkers inform treatments of subgroups of patients with cancer or asthma, so, too, could blood- and urine-based biomarkers help identify subgroups of patients with AKI, leading to new ideas for treatments, the authors said.
In the study, the researchers retrospectively analyzed 769 patients with AKI and 769 without the condition, and followed them for five years after hospital discharge. The researchers found two molecularly distinct AKI subgroups, or sub-phenotypes, that were associated with differing risk profiles and long-term outcomes.
Patients in one group had higher rates of congestive heart failure, while another group had higher rates of chronic kidney disease and sepsis, Bhatraju said. The patients in the second group also had a 40% higher risk for major adverse kidney events five years later, compared with the first group, he said.
Interestingly, Bhatraju added, age, sex, diabetes rate or major surgical procedure as the cause of AKI was not different across AKI subgroups. This finding suggests that commonly measured clinical factors may not predict the AKI subgroups, and that identification requires measurement of blood and urine biomarkers, he said.
“We’re attempting to better understand the clinical factors and molecular drivers of acute kidney injury so that, in the long run, we can better treat the different ways that people experience this disease process,” Himmelfarb added. “We want to better understand the individual characteristics of people who get acute kidney injury so we can establish common characteristics of subgroup populations of these patients to know whose risk is relatively higher or lower, and work toward treatments specific to their needs.
“Our paper is one step on the path to tailoring clinical trials of new therapies to the people who are most likely to respond to those therapies,” Himmelfarb said.
This study was supported by the supplemental American Recovery and Reinvestment Act funds through the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health (grants U01DK082223, U01DK082185, U01DK082192, U01DK082183, U01DK084012 and R01DK098233) and by the NIH (K23DK116967, R01DK133177, U2CDK114886, UG3TR002158, and U01DK099923).
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University of Washington School of Medicine and UW Medicine
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Newswise — LOS ANGELES — Paul B. Rothman, MD, has been appointed as a member of the USC Health System Board, which provides strategic oversight and governance over Keck Medicine of USC and university clinical services.
Rothman, former CEO of Johns Hopkins Medicine and retired dean of medical faculty for the Johns Hopkins University School of Medicine, brings his leadership acumen as well as clinical and scientific expertise in rheumatology and molecular immunology to this advisory role.
“Paul Rothman is a most-highly respected and accomplished physician-leader with a strategic vision, and we are honored to have him join the USC Health System Board,” said Steven D. Shapiro, MD, senior vice president for health affairs, University of Southern California. “His insight and experience leading one of the most preeminent academic health systems will be invaluable as we usher our innovative academic medical center into the future.”
In addition to his leadership experience, Rothman also is a member of the National Academy of Medicine, the American Academy of Arts and Sciences, the American Association for the Advancement of Science and the American Society for Clinical Investigation. He is a member of the Association of American Physicians and served as president in 2014.
“I look forward to working alongside the esteemed professionals of the USC Health System Board as we advance the mission of the health system to deliver cutting-edge care and groundbreaking research to Los Angeles and beyond,” said Rothman.
Rothman also previously served as dean of the College of Medicine at the University of Iowa and as head of medicine at the University of Iowa. Prior to this, he served as vice chairman for research and founding director of the Division of Pulmonary, Allergy and Critical Care Medicine at Columbia University College of Physicians and Surgeons, where he joined the faculty in 1990.
Rothman earned his Bachelor of Science in biology from the Massachusetts Institute of Technology and earned his medical degree from Yale University. He completed both an internal medicine residency and a rheumatology fellowship at New York-Presbyterian/Columbia University Irving Medical Center, as well as a postdoctoral biochemistry fellowship at Columbia University College of Physicians and Surgeons.
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For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.
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EMBARGOED: 08:30 hrs Australian Eastern Standard Time (AEST) Tuesday 23 May 2023 / 23:30 hrs UK (UK) Monday 22nd May
Study estimates there will be over 800 million cases of low back pain in 2050, a 36 percent increase from 2020. With an ageing population, researchers say we must ‘put the brakes’ on low back pain cases before the burden becomes too great for our healthcare system.
Analysis of over 30 years of the GBD data has shown the number of cases of low back pain is growing, with modelling suggesting by 2050, 843 million people will be affected by the condition largely due to population increases and ageing of populations.
The continued lack of a consistent approach on back pain treatment, and limited treatment options have researchers concerned that this will lead to a healthcare crisis, as low back pain is the leading cause of disability in the world.
In Australia, there will be a nearly 50 percent increase in cases by 2050. The landscape of back pain cases is set to shift, with the biggest increases in back pain cases to be in Asia and Africa.
The findings are published in Lancet Rheumatology today.
“Our analysis paints a picture of growing low back pain cases globally, putting enormous pressure on our healthcare system. We need to establish a national, consistent approach to managing low back pain that is informed by research,” says lead author, Professor Manuela Ferreira from Sydney Musculoskeletal Health, an initiative of the University of Sydney, Sydney Local Health District and Northern Sydney Local Health District.
“Currently, how we have been responding to back pain has been reactive. Australia is a global leader in back pain research; we can be proactive and lead by example on back pain prevention”, said Professor Ferreira who is based at Sydney’s Kolling Institute.
The study reveals several milestones in back pain cases. Since 2017, the number of low back pain cases has ticked over to more than half a billion people.
In 2020, there were approximately 619 million cases of back pain.
At least one third of the disability burden associated with backpain was attributable to occupational factors, smoking and being overweight.
A widespread misconception is that low back pain mostly affects adults of working age. But researchers say this study has confirmed that low back pain is more common among older people. Low back pain cases were also higher among females compared to males.
This is the most comprehensive and up-to-date available data that includes for the first time global projections and the contribution of GBD risk factors to low back pain. The work was made possible by the joint efforts of The University of Sydney, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine (healthdata.org), IHME’s international collaborators, and the Global Alliance for Musculoskeletal Health (gmusc.com).
“We also know that most available data come from high-income countries, making it sometimes hard to interpret these results for low to mid-income countries. We urgently need more population-based back pain and musculoskeletal data from countries of low to mid-income,” said senior author Professor Lyn March from Sydney Musculoskeletal Health and the Kolling Institute.
The study analysed GBD data from 1990 to 2020 from over 204 countries and territories to map the landscape of back pain cases over time. The GBD is the most comprehensive picture of mortality and disability across countries, time, age, and sex.
It is also the first study to be used for modelling the future prevalence of back pain cases.
“Health systems need to respond to this enormous and rising burden of low back pain that is affecting people globally. Much more needs to be done to prevent low back pain and ensure timely access to care, as there are effective ways of helping people in pain” said Prof Anthony Woolf, co-chair of the Global Alliance for Musculoskeletal Health which is calling for priority to be given to addressing the growing burden of musculoskeletal conditions.
“Ministries of health cannot continue ignoring the high prevalence of musculoskeletal conditions including low back pain. These conditions have important social and economic consequences, especially considering the cost of care. Now is the time to learn about effective strategies to address the high burden and to act” said Dr Alarcos Cieza, Unit Head, World Health Organization, Headquarters, Geneva
National guidelines will form basis of back pain prevention
In 2018, experts (independent to this study) voiced their concerns in The Lancet and gave recommendations, especially regarding exercise and education, about the need for a change in global policy on the best way to prevent and manage low back pain to stop the rise of inappropriate treatments.
However, since then, there has been little change. Common treatments recommended for low back pain have been found to have unknown effectiveness or to be ineffective – this includes some surgeries and opioids.
Professor Ferreira says there is a lack of consistency in how health professionals manage back pain cases and how the healthcare system needs to adapt.
“It may come as a surprise to some that current clinical guidelines for back pain treatment and management do not provide specific recommendations for older people.”
“Older people have more complex medical histories and are more likely to be prescribed strong medication, including opioids for back pain management, compared to younger adults. But this is not ideal and can have a negative impact on their function and quality of life, especially as these analgesics may interfere with their other existing medications. This is just one example of why we need to update clinical guidelines to support our health professionals.”
Co-author Dr Katie de Luca, from CQUniversity, said if the right action is not taken, low back pain can become a precursor to chronic health conditions such as diabetes, cardiovascular disease and mental health conditions, invasive medical procedures, and significant disability.
“Low back pain continues to be the greatest cause of disability burden worldwide. There are substantial socio-economic consequences of this condition, and the physical and personal impact directly threatens healthy ageing.”
-ENDS-
Declaration: The authors declare no conflicts of interest.
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University of Sydney
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Newswise — Animal-Assisted interventions (AAI) are implemented in hospitals and rehabilitation centers to produce many advantages for the patients but could expose them to pathogens transmission, a process known as zoonosis. It is therefore important to consider the possible occurrence of pathogens during the AAIs, and to define the state of the art of AAIs through a careful benefits/challenges analysis.
The review, “Human-Animal Interaction in Animal-Assisted Interventions (AAI)s: Zoonosis Risks, Benefits, and Future Directions—A One Health Approach,” was recently published in the MDPI journal Animals. The discussion points to possible future perspectives according to a One Health approach in light of the health and safety in AAIs.
Positive animal welfare, as preventative medicine to avoid incidents or transmission of pathogens, is a relevant aspect with implications for human and animal health and wellbeing. For this reason, the authors propose a synergy among veterinarians, public health professionals, and epidemiologists, who have a key role in preventing zoonotic disease transmission to safeguard the health of humans, animals, and the environment, in accordance with a One Health vision.
The efficacy of AAIs is based on interspecies interactions between an animal and the patient. Such interaction might be impacted by different factors, such as the characters of both the animal and the handler, the selection of the animal species, an appropriate animal educational protocol, the relationship between the handler and the animal, and mutual relationship among the animal, the patients, and the members of the working team.
The review is the result of an international collaboration between researchers affiliated with the Sbarro Health Research Organization (SHRO), under the direction of Antonio Giordano, M.D., Ph.D., and co-author of the paper.
“AAIs constitute a tangible representation of the One Health perspective,” says Giovanna Ligouri, lead author of the paper. “And therefore, we need a multidisciplinary, intersectoral approach between the different health professional figures who, each according to their own skills, work in a specialized team for the prevention and control of zoonoses, the health and welfare of people, the animals involved, and the environment.”
“Different international experts in the field of AAI must join forces and develop an action plan,” says Giordano, “in order to determine standardized hygiene, health, and behavioral procedures.”
“This recommendation should be aimed at establishing health and behavioral certifications for animals performing AAI services in the health sector,” says co-author Orlando Paciello, Professor, Università degli Studi di Napoli Federico II.
About the Sbarro Health Research Organization
The Sbarro Health Research Organization (SHRO) is non-profit charity committed to funding excellence in basic genetic research to cure and diagnose cancer, cardiovascular diseases, diabetes and other chronic illnesses and to foster the training of young doctors in a spirit of professionalism and humanism. To learn more about the SHRO please visit www.shro.org.
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Sbarro Health Research Organization (SHRO)
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Newswise — Lawrenceville, NJ, USA—May 22, 2023—ISPOR—The Professional Society for Health Economics and Outcomes Research (HEOR) announced today that it has published a new report on its work in low- and middle-income countries (LMICs). The report, “Advancing HEOR in Low- and Middle-Income Countries,” explores the distinctive needs LMICs have in developing their HEOR capacity, as well as the Society’s work to fulfill its mission to promote HEOR excellence to improve decision making for health globally in these regions.
ISPOR has a strong commitment to the advancement of HEOR in LMICs. More than 20% of the Society’s members, 65% of ISPOR regional chapters, and 35% of ISPOR student chapters are in LMICs. The report notes that LMICs face unique healthcare system challenges, “including limited resources for healthcare, gaps in human and infrastructure capacity, often fragmented systems, and growing burden of disease.”
Much of ISPOR’s work in LMICs is focused on supporting critical HEOR capacity building in these countries, through education and training. The Society also provides publishing opportunities for researchers in LMICs, chapter support, conference grants, educational funding, fee-waived membership grants, HEOR awards and more. Additional information can be found on the Society’s Advancing HEOR in Low- and Middle Income Countries webpage.
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ABOUT ISPOR
ISPOR—The Professional Society for Health Economics and Outcomes Research (HEOR), is an international, multistakeholder, nonprofit dedicated to advancing HEOR excellence to improve decision making for health globally. The Society is the leading source for scientific conferences, peer-reviewed and MEDLINE®-indexed publications, good practices guidance, education, collaboration, and tools/resources in the field.
Website | LinkedIn | Twitter (@ispororg) | YouTube | Facebook | Instagram
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ISPOR–The Professional Society for Health Economics and Outcomes Research
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Newswise — The American College of Cardiology has recognized all eligible Hackensack Meridian medical centers for their demonstrated expertise and commitment in treating patients with chest pain. They were recently awarded Chest Pain Center Accreditations based on rigorous onsite evaluation of the staffs’ ability to evaluate, diagnose and treat patients who may be experiencing a heart attack.
According to the Centers for Disease Control and Prevention, more than 730,000 Americans suffer a heart attack each year. The most common symptom of a heart attack for both men and women is chest pain or discomfort. However, women are more likely to have atypical symptoms. Other heart attack symptoms include, but are not limited to, tingling or discomfort in one or both arms, back, shoulder, neck or jaw, shortness of breath, cold sweat, unusual tiredness, heartburn-like feeling, nausea or vomiting, sudden dizziness and fainting.
Percutaneous coronary intervention (PCI) is also known as coronary angioplasty. It is a non-surgical procedure that opens narrowed or blocked coronary arteries with a balloon to relieve symptoms of heart disease or reduce heart damage during or after a heart attack.
Jersey Shore University Medical Center in Neptune, NJ and JFK University Medical Center in Edison, NJ, earned ACC Chest Pain Center with Primary PCI and Resuscitation Accreditation.
Hospitals that have received this accreditation have proven exceptional competency in treating patients with heart attack symptoms and have primary PCI available 24/7 every day of the year. As required to meet the criteria of the accreditation designation, they comply with standard Chest Pain Center protocols and are equipped with a robust hypothermia program for post-cardiac arrest treatment. These facilities also maintain a “No Diversion Policy” for out-of-hospital cardiac arrest patients.
Hackensack University Medical Center in Hackensack, NJ; Riverview Medical Center in Red Bank, NJ; Ocean University Medical Center in Brick, NJ; Bayshore Medical Center in Holmdel, NJ and Raritan Bay Medical Center in Perth Amboy, NJ, earned ACC Chest Pain Center with Primary PCI Accreditation. Hospitals that have received this accreditation have proven exceptional competency in treating patients with heart attack symptoms and have primary PCI available 24/7 every day of the year. As required to meet the criteria of the accreditation designation, they have streamlined their systems from admission to evaluation to diagnosis and treatment all the way through to appropriate post-discharge care and recommendations and assistance in patient lifestyle changes. In addition, they have formal agreements with other facilities that regularly refer heart attack patients to their facility for primary PCI.
Southern Ocean Medical Center in Manahawkin, NJ, earned ACC Chest Pain Center Accreditation. Hospitals with this accreditation have proven exceptional competency in treating patients with heart attack symptoms. They have streamlined their systems from admission to evaluation to diagnosis and treatment all the way through to appropriate post-discharge care and recommendations and assistance in patient lifestyle changes.
“Hackensack Meridian Health has demonstrated its commitment to providing New Jersey with excellent heart care,” said Deepak L. Bhatt, MD, MPH, FACC, chair of the ACC Accreditation Management Board. “ACC Accreditation Services is proud to award Hackensack Meridian medical centers with Chest Pain Center Accreditations.”
Hospitals receiving Chest Pain Center Accreditations from the ACC must take part in a multi-faceted clinical process that involves: completing a gap analysis; examining variances of care, developing an action plan; a rigorous onsite review; and monitoring for sustained success. Improved methods and strategies of caring for patients include streamlining processes, implementing guidelines and standards, and adopting best practices in the care of patients experiencing the signs and symptoms of a heart attack. Facilities that achieve accreditation meet or exceed an array of stringent criteria and have organized a team of doctors, nurses, clinicians, and other administrative staff that earnestly support the efforts leading to better patient education and improved patient outcomes.
“Depending on a variety of factors, patients experiencing a heart attack are treated with clot-dissolving drugs (thrombolysis), balloon angioplasty (PCI) and stenting, surgery or a combination of treatments,” said Elizabeth A. Maiorana, MBA, MSN, R.N., vice president, Cardiovascular Care Transformation Services, Hackensack Meridian Health. “I’m proud of our medical centers’ cardiac teams for achieving excellence in providing these treatments, done accordingly with their licensure.”
For information about Hackensack Meridian’s heart care services, visit
www.hackensackmeridianhealth.org/en/services/heart-care. For a free physician referral, call 844-HMH-WELL.
The ACC offers U.S. and international hospitals like Hackensack Meridian’s access to a comprehensive suite of cardiac accreditation services designed to optimize patient outcomes and improve hospital financial performance. These services are focused on all aspects of cardiac care, including emergency treatment of heart attacks.
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Hackensack Meridian Health
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Monday, May 22 marks World Preeclampsia Day. Preeclampsia is a serious condition primarily characterized by high blood pressure during or after pregnancy. Hypertensive disorders of pregnancy affect 5-10% of all pregnancies worldwide. In the U.S., Black people are 60% more likely to develop preeclampsia than white people while pregnant. If undetected, preeclampsia can lead to complications for both mother and baby and, in the worst cases, can be fatal.
Sarosh Rana, MD, MPH, University of Chicago Medicine Section Chief of Maternal-Fetal Medicine, is a leading expert on preeclampsia. Her research over the last several years has focused on the use of angiogenic biomarkers for the prediction of preeclampsia-related adverse maternal and fetal outcomes. She was part of the study that led to the recent approval of a biomarker test that can test a pregnant person’s risk of severe preeclampsia. The first-of-its-kind blood test will soon be available in the U.S.
Dr. Rana is available for interviews to discuss this game-changing development in the detection of severe preeclampsia, as well as what pregnant people need to know about preeclampsia, who’s at risk, and treatment options. She can also speak on the steps that UChicago Medicine has taken to reduce morbidity related to preeclampsia and to close the maternal health disparity gap between Black and white patients.
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University of Chicago Medical Center
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Katrina Steiling, MD, MSc
Assistant Professor of Medicine at Boston University
Dr. Steiling’s research centers on improving the diagnosis, treatment, and prevention of lung cancer and COPD.
Kevin C. Wilson, MD
Professor of Medicine at Boston University
Dr. Wilson attends in the Outpatient Pulmonary Medicine Clinic, Medical Intensive Care Unit, and Pulmonary Consultation Service at Boston Medical Center. He also serves as the Chief of Documents and Medical Affairs for the American Thoracic Society (ATS), where he oversees the development of clinical practice guidelines and other official documents for the ATS.
Nirav Bhakta, MD
Associate Professor at the University of California, San Francisco (UCSF)
Dr. Bhakta leads human trials to obtain clinical data and tissue samples to understand the molecular basis for variations in the presentation of asthma. His other work advances the application of pulmonary function testing.
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Newswise
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Newswise — A fully replicated human airway system is a new experimental tool that is overcoming limitations in studying aerosol deposition in lungs at UTHealth Houston School of Public Health.
The cutting-edge Mobile Aerosol Deposition Apparatus (MALDA), designed and 3D-printed by Wei-Chung Su, PhD, assistant professor of epidemiology, human genetics, and environmental sciences, consists of a head airway, tracheobronchial airways, and a representative section of the alveoli, the tiny air sacs of the lungs that handle gaseous exchange. The system is paired with two particle sizers that measure the particle size distribution of the aerosol of concern in human airways to study lung depositions of the harmful aerosol present in the community or workplace air.
“By further understanding the chemical composition of the aerosol, we will be able to estimate the inhalation dose of some toxic substances contained in the aerosol, then assess health risks for people who have occupational or environmental exposure,” Su said.
Aerosol is solid or liquid particles that vary in size ranging from nanometers to micrometers, and can suspend in the air for a long period of time. Those with a diameter of 10 microns or less (PM10), can come from the dust of construction sites, stone cutting, and spray painting, for example; while those with a diameter of 0.1 microns and less (ultrafine particles) can occur in the combustion of gasoline, diesel, or jet fuel. The inhalation and deposition of harmful aerosol in the respiratory tract can lead to various adverse health effects such as chronic obstructive pulmonary disease, pulmonary impairment, cardiovascular disease, and even lung cancer.
By placing the airway system and particle sizers on a lab trolley with a battery-powered vacuum pump, MALDA is fully mobile and capable of carrying out aerosol respiratory deposition experiments in any real-life environmental and occupational setting. MALDA can be used as a solution for aerosol-related health studies to gather on-site data where it may be impossible to collect human data.
“MALDA can provide useful experimental data for health research, especially for lung problems caused by aerosol exposure,” Su said.
The comprehensive replicated human airways allow passage of air into the lung section called tracheobronchial airways which are identified by numerous airway bifurcations (branches). The MALDA airways reach all the way to the 11th airway bifurcation, farther than many previous models that only extended as far as the fourth or fifth airway bifurcation. The extension in airway bifurcations allows Su and his research team to study aerosol respiratory deposition more accurately.
During his earlier research into occupational aerosol exposure, Su faced many critical limitations and began thinking about ways to improve aerosol respiratory deposition data acquisition. When he began working at the School of Public Health in 2016, he received a pilot research project award from the National Institute for Occupational Safety and Health that gave him the funds to design and 3D-print the MALDA in the UTHealth Houston 3D Printing Service Center. MALDA took nearly two years to build — from designing blueprints, to performance evaluation, to full assembly.
MALDA has already been applied to several environmental and occupational aerosol exposure studies to estimate aerosol respiratory depositions, including research on welding fumes, e-cigarette aerosol, community ultrafine particles, and aerosol generated from dental cleanings.
Su and his team are currently working on developing an upgraded MALDA experimental approach to efficiently obtain the deposited mass of aerosol in the human airways to estimate associated health risks.
“I’m thankful for UTHealth Houston for providing an amazing research environment and resources to allow my dreams to come true,” Su said. “MALDA wasn’t made at a store, but in UTHealth Houston labs with state-of-the-art technology.”
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University of Texas Health Science Center at Houston
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Newswise — Reforms to New Jersey’s Medicaid program successfully spurred ongoing increases in buprenorphine prescriptions for the treatment of opioid addiction, according to a Rutgers analysis.
Although medications such as buprenorphine effectively combat opioid addiction, less than 30 percent of potential users receive them nationwide. New Jersey sought to increase prescription numbers with three Medicaid reforms that took effect in 2019. The reforms:
Medicaid records showed steady increases in buprenorphine prescriptions before 2019, but the rate of growth increased by 36 percent after the reforms took effect, and this increased rate of growth persisted until the end of the study period in December 2020.
A similar trend affected caregiver behavior. The percentage of caregivers prescribing buprenorphine had been rising before the reforms took effect, but it increased faster after their implementation.
New Jersey also experienced faster growth in buprenorphine prescriptions to Medicaid patients than did other states, the analysis reported, a strong indication that the boosts stemmed from the state’s reforms rather than some unrelated nationwide trend.
The only disappointment came from the study’s measurement of long-term usage. The percentage of buprenorphine prescriptions that remained active for more than 180 days didn’t rise during the study period.
“Usage remains far below the ideal where virtually everyone battling opioid addiction receives an effective medical treatment like buprenorphine,” said Peter Treitler, research project manager for the Rutgers Institute for Health, Health Care Policy and Aging Research and lead author of the analysis published in JAMA Network Open. “However, our analysis suggests these reforms may get us to that point years before we would have reached it under the previous policies.”
Buprenorphine — a once-daily prescription pill sold in the United States as Suboxone, Zubsolv and Sublocade — works in two ways. First, it binds to the same brain cells as drugs such as opium, heroin, morphine, oxycodone and fentanyl. Once it’s in place, those other drugs struggle to dislodge it, bind to the target cells and produce addictive highs. Second, it stimulates a milder effect that reduces cravings for those other drugs and prevents withdrawal symptoms.
Regulators once placed extra restrictions on buprenorphine prescriptions because they worried its mood-altering effects would create more addicts than it cured. These restrictions, which forced caregivers to justify each new buprenorphine prescription at length and investigated providers who prescribed the drug “too often,” led many to avoid prescribing the drug at all, said Treitler, who added Medicaid’s low reimbursement rates for office-based addiction treatment further reduced buprenorphine availability to poor patients.
Regulators have relaxed many restrictions on buprenorphine because opioid addiction has increased. Recent research has shown buprenorphine to be both safer and more effective than previously thought. The reforms to New Jersey’s Medicaid program further reduced barriers to medication usage among its patients.
“They looked at what obstacles were blocking the usage of a valuable drug in this particularly underserved patient population,” Treitler said. “They removed several of the biggest obstacles. And the results so far suggest they’re getting the desired results.”
Indeed, the positive numbers seen in initiatives such as the one undertaken by New Jersey’s Medicaid program may finally be affecting the most important number of all: overdose deaths. After several decades of speedy increases, overdoses nationwide rose by just 500 in 2022.
The trend was even better in New Jersey. Total overdose deaths fell by 232 from 2021 to 2022, and they were 93 lower in the first three months of 2023 than in the first three months of 2022.
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Rutgers University-New Brunswick
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Newswise — PHILADELPHIA—Penn Medicine is launching a new community mental health hub at the Hospital of the University of Pennsylvania — Cedar Avenue (HUP Cedar), co-locating inpatient and outpatient psychiatric care with a new crisis response center (CRC) at the facility. The multi-year plan will put crucial psychiatric and substance use care in easy reach for West and Southwest Philadelphia residents, at a time when both mental illness and drug and alcohol dependence are surging in the city.
The project will begin with moving inpatient psychiatric and drug and alcohol detoxification units from Penn Presbyterian Medical Center to HUP Cedar in July, followed by the opening of a new crisis response center at the facility later in the summer which is expected to provide an estimated 4,000 patient visits each year. The steps will create two comprehensive, fully integrated mental health hubs at Penn Medicine facilities in Philadelphia, offering emergency mental health services and inpatient and outpatient care at both HUP Cedar and Pennsylvania Hospital, which has operated a CRC since 1999. Together, Pennsylvania Hospital and HUP Cedar will have 73 licensed inpatient psychiatric beds and 16 beds for substance use treatment. Additional space at HUP Cedar will allow for expansion of coordinated services to further care for West and Southwest Philadelphia communities over the next five years.
“The COVID-19 pandemic accelerated the mental health crisis across the nation. As COVID recedes, we have a moral imperative to tackle this suffering in our communities,” said Kevin B. Mahoney, chief executive officer of the University of Pennsylvania Health System (UPHS). “Providing easy access to care when people are in crisis changes – and saves – lives. We are committed to the investment and innovation needed to close the gaps in access to care and reverse the toll of mental health and substance use in Philadelphia.”
As one of the nation’s largest cities, Philadelphia’s mental health struggles are a microcosm of broader trends: A Pew Research Center survey from late 2022 reported that 41 percent of Americans — and nearly 60 percent of young adults — have experienced high levels of psychological distress at least once since the early stages of the pandemic. At the same time, more than two-thirds of Americans live in areas without sufficient psychiatrists and other mental health professionals. In Philadelphia, more than 20 percent of the city’s residents are coping with a diagnosed depressive disorder and substance use-related deaths have climbed to record levels.
Similar to the CRC at Pennsylvania Hospital, the HUP Cedar CRC — which will replace the CRC previously operated on the site by Mercy Philadelphia Hospital until its closure in March of 2020 — will be licensed as a crisis intervention walk-in facility and will serve as a discreet psychiatric emergency room, providing triage, evaluation, treatment and social services support for acute substance use and serious psychiatric conditions such as bipolar disorder, major depression, anxiety disorders, and schizophrenia.
The co-location of the inpatient psychiatric units with emergency care provided through the CRC will enable a seamless transition of care for patients, eliminating the wait time and additional steps required to transfer patients to inpatient units at other facilities — a common occurrence in a city where emergency psychiatric resources remain in short supply.
“We know that a lack of quality mental health support and crisis response services has a traumatic ripple effect across families and entire communities. When patients and families are coping with a mental health crisis, the last thing they need to think about is how to navigate a complex system,” said UPHS Chief Operating Officer Michele Volpe. “By putting all our services together, we can help keep patients safer, get them into treatment faster, and better support families as they begin to navigate supporting their loved ones during their hospitalization and recovery.”
Staff at both CRC locations will be connected via a real-time data system providing details on bed availability in order to ensure patients can be placed as quickly as possible and that each location has the right staffing resources. Penn Presbyterian will continue to provide select outpatient psychiatric care as well treatment for substance use disorders after the transition of inpatient services to HUP Cedar.
HUP Cedar is part of the PHMC Public Health Campus on Cedar, which opened in March 2021, transitioning the building from the former Mercy Philadelphia Hospital into a campus offering emergency and inpatient care as well as primary care and community-driven social supports.
Penn Medicine will invest $5.76M toward the opening of the CRC at HUP Cedar as part of the mental health hub project. The CRC reopening has also received funding from the Independence Blue Cross Foundation, and the City of Philadelphia Department of Behavioral Health earmarked $4.1 million in HealthChoices reinvestment funds.
In addition to Penn Medicine’s adult mental health services on the site, Children’s Hospital of Philadelphia plans to open an inpatient pediatric behavioral health facility, the CHOP Behavioral Health & Crisis Center, on the site, as well. The 46-bed acute inpatient psychiatric facility and 24/7 walk-in crisis center will create a safe, inclusive and restorative setting for children and adolescents.
The second phase of the new mental health hub plan will also increase care capacity at Penn Presbyterian Medical Center (PPMC), by converting the vacated psychiatric beds to medical surgical units. Those steps will help to improve patient movement across the hospital, reducing emergency department wait times and providing additional capacity for post-surgery recovery.
The new services at HUP Cedar are part of Penn Medicine’s wraparound commitment to bringing more mental health care support to the community across each of its mission areas. Penn Integrated Care (PIC), a program, which embeds mental health professionals in primary care practices, launched in 2018. More than 230,000 patients in 24 Penn Medicine primary clinics have access to PIC services. To date, 35,000 patients have been treated directly by PIC clinicians or connected to specialty care in the community.
Beginning this summer, the health system will add a new path for training fellows in drug and alcohol use treatment. That program, for physicians specializing in family medicine, primary care, and emergency medicine, among other disciplines, aims to ensure that providers in multiple settings are equipped to help patients take steps toward recovery and provides a much-needed addition to the existing fellowship in Addiction Psychiatry at Penn Medicine and the Corporal Michael J. Crescenz Veterans Affairs Medical Center (CMC VAMC) in Philadelphia.
In addition, a new consultation service provides psychiatric care to patients hospitalized for complex medical needs at the Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Penn Presbyterian Medical Center. Future plans include potential opening of a medical-psychiatric unit to ensure that patients with these complex needs are cared for in dedicated spaces.
“Expanding our resources to care for mental health needs in Philadelphia is a core part of our mission,” said Hospital of the University of Pennsylvania CEO Regina Cunningham, PhD, RN. “No matter where people live in the city, we aspire to provide them with support in convenient settings, and work to erase both the stigmas and access problems that stand in the way of helping people get help.”
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Perelman School of Medicine at the University of Pennsylvania
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Newswise — A new study suggests that increasing rates of induction of labour (IOL) of pregnant women and people in the UK, without considering the accompanying, real-world impact on staffing workloads and patient care, may have unintended consequences.
The study from City, University of London, the University of Edinburgh and others highlights the limited evidence around the delivery of home-based IOL services, which were seen as an important step to reducing maternity staff workload.
It finds large gaps in knowledge on how to deliver home-based care, with workload perceived to be increased in some cases, relative to hospital-based services.
Around one-third of pregnant women and people underwent IOL in the UK in 2021. Rates have surged in recent years due to new evidence on safety and efficacy, and vary considerably between maternity services, with some rates as high as fifty per-cent.
However, earlier this year, a survey reported by the Royal College of Midwives (RCM) found that UK senior midwives are relying significantly on the goodwill of staff working extra hours to ensure safe services, amidst plummeting staff retention and recruitment rates that they say have reached “boiling point”.
The RCM said that midwives are leaving the profession “because they cannot deliver the quality of care they so desperately want to because of their falling pay, and because they are exhausted, fragile and burnt-out.”
IOL, or starting labour artificially, is offered when the risks of the pregnancy continuing are believed to outweigh the risks of artificially starting labour. For those deemed at lower risk, maternity services are offering this as an ‘outpatient’ service where the woman returns home in the first stage of induction, despite limited evidence on its acceptability to pregnant women, birth partners and maternity staff, and how different approaches work in practice.
The current study explored IOL from the perspectives of 73 clinicians: including 49 midwives, 22 obstetricians and two other maternity staff from five maternity services across the UK. Specifically, it investigated the recommended first stage of induction known as “cervical ripening” (CR) and the option of the pregnant person to return home from hospital during that process.
CR is either the use of topical medication (prostaglandin) or mechanical means (balloon catheter or osmotic dilator) to help dilate the pregnant person’s cervix. Following this first stage, further steps are generally necessary to stimulate the onset of labour.
In the study, clinicians were either interviewed directly by the researchers or took part in focus groups to elicit their views, which then formed part of a thematic analysis to reveal common themes in their responses.
A wide range of practices and views regarding induction were recorded, suggesting that the integration of home CR into care is far from straightforward, and demonstrating that whether provided at hospital or home, IOL care is complex and represents a significant workload to maternity services staff.
The study follows closely on the heels of findings of a sister study which surveyed 309 women who had undergone IOL in the UK, and which was published earlier this month. The women reported receiving little information about IOL and being routinely impacted by delays at every stage of the care pathway, which they widely attributed to staffing shortages.
Professor Christine McCourt leads the Centre for Maternal and Child Health Research at City, University of London, and co-authored the study. She said:
“This study shows that well-intentioned interventions may have unintended consequences for quality of care and staff workload. Efforts are needed to target induction of labour effectively and ensure genuine informed choice; meanwhile, maternity services must be adequately resourced to ensure safe care.”
The study is published online in the journal, PLOS ONE.
ENDS
City, University of London
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City University London
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