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Tag: JAMA

  • Positive Medical News About Marijuana And Moms

    Positive Medical News About Marijuana And Moms

    Federally funded medical research reveals marijuana not tied to autism.

    Drinking, smoking and consuming marijuana while pregnant is never recommended. Over the course of history, woman have consumed liquor, especially during the period when clean water was hard to find, but child mortality was high. With advances in medicine, it has been discovered some activities, like drinking and smoking cigarettes, can cause harm to the baby. No one is saying expectant women should have booze, buds, or cigarettes. But early on, when a woman doesn’t know she is expecting, she might have engaged in these habits

    RELATED: Science Says Medical Marijuana Improves Quality Of Life

    One of the concerns circling around cannabis is how it can affect a baby’s development.  While more research needs to be done, two new studies have been published in the Journal of the American Medical Association (JAMA) which provides some good news. The first study  focused on discovering if maternal cannabis use during early pregnancy associated with risk of child autism spectrum disorder (ASD).

    Photo by Anastasiia Chepinska via Unsplash

    This  study included 178 948 mother-child combinations. The children were born between 2011 and 2019 to pregnant Kaiser Permanente Northern California members screened for prenatal cannabis use during pregnancy. Statistical analysis was conducted February 2023 to March 2024. The findings suggest maternal cannabis use during early pregnancy was not associated with child ASD, but additional research should be conducted to replicate the findings.

    Another study released this week found maternal cannabis use during early pregnancy was not associated with speech and language disorders, global delay, or motor delay. The investigation into marijuana and childhood development and included 119 976 pregnancies among 106 240 unique pregnant individuals.

    RELATED: Couples Using Cannabis Can Increase Intimacy

    A reason for the study is with legal marijuana increased, this is increased discussion around it being a cause of developmental development among babies. But  documented associations between maternal prenatal cannabis use and adverse birth outcomes, including preterm birth and low birthweight have not be in a study. There has been little research assessing the association of maternal prenatal cannabis use and childhood developmental outcomes, this study was done to provide a scientific fact around the information.

    More research needs to be done, and like alcohol and cigarettes which are harmful for the body, not one is saying it is good to use why expecting, but it is good to have information grounded in facts.

    Amy Hansen

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  • Medical Marijuana Reduces Opioid Use

    Medical Marijuana Reduces Opioid Use

    Opioids and fentanyl driving a crisis in recent years, with the COVID-19 pandemic exacerbating the public’s abuse of the drug. The crisis has also become a major U.S. foreign policy issue.  Massive lawsuits have been filling the courts due to the addictive and damaging nature of some opioids and patients have been left in shambles.  Now, data shows medical marijuana reduces opioid use.

    RELATED: 8 Ways to Enjoy Marijuana Without Smoking It

    A new study from New York State and CUNY researchers suggests receiving medical cannabis for thirty days or more may help patients on long-term opioid treatment to lower their dose over time.

    Photo by beusbeus/Getty Images

    Another study conducted by the American Medical Association showed positive data.  The study, published in JAMA Oncology, analyzed the results of thousands of patients with different types of cancer. ound an association between receiving medical cannabis for chronic pain for a longer duration and a reduction in prescription opioid dosages among patients on long-term opioid therapy. Patients who were on higher baseline dosages of prescription opioids when they started receiving medical cannabis experienced larger reductions in opioid dosages.

    Researchers explained that the study was conducted in order to explore the links that exist between marijuana legalization and opioid use. They concluded that medical marijuana curbed opioid use and provided an alternate route for treatment.

    RELATED: Marijuana And Prostate Cancer

    “Findings of this cross-sectional study suggest that medical marijuana legalization implemented from 2012 to 2017 was associated with a lower rate of opioid dispensing and pain-related hospital events among some adults receiving treatment for newly diagnosed cancer,” they wrote.

    “The nature of these associations and their implications for patient safety and quality of life need to be further investigated,” researchers added.

    Medical marijuana has less of an impact on the body and mind. Cannabis can be an effective treatment for pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to opioid-based medications. Medical cannabis patients report that cannabis is just as effective, if not more, than opioid-based medications for pain.

    With medical marijuana available in 40 states, this is indeed good news for most patients.

    Amy Hansen

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  • Patients Less Likely to Experience Death at Academic and High-Volume Hospitals When Treated with Immunotherapy for Metastatic Cancers

    Patients Less Likely to Experience Death at Academic and High-Volume Hospitals When Treated with Immunotherapy for Metastatic Cancers

    Newswise — A new study led by Yale Cancer Center researchers at Yale School of Medicine revealed a significant increase in patients starting immunotherapy within one month of death. Using a national clinical database, the researchers focused on patients with metastatic melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC). They were treated with immune checkpoint inhibitors from the point of FDA approval, through to 2019. The melanoma cohort began treatment in 2012 and the RCC and NSCLC cohorts in 2016.

    The findings were published in JAMA Oncology on January 4.

    “Immunotherapy has revolutionized the field of oncology over the last decade,” said Sajid Khan, MD, senior author of the study and section chief of Hepato-Pancreato-Biliary (HPB) and Mixed Tumors at Yale School of Medicine. “Because survival is substantially improved for many patients treated with these drugs, it’s application has increased across the United States. In our study, we focused on immunotherapy initiation at the end of a patient’s life with cancer metastasis.”

    Because the therapy is relatively new, the study aimed to “offer insights into national prescribing patterns and serve as a harbinger of shifts in the clinical approach to patients with advanced cancer.”

    The study included 20,415 stage IV melanoma patients, 197,331 stage IV NSCLC patients, and 24,625 stage IV RCC patients. Researchers considered each patient’s age, sex, race, and ethnicity as well as the location of metastases and the medical facility where treatment was given.

    “We were interested in gauging how frequently immunotherapy is initiated within the last 30 days of life,” said Khan, a member of Yale Cancer Center and the co-director of Team Science at Yale Center for Clinical Investigation. “Our study found that the initiation of immunotherapy in the last month of a patient’s life has significantly increased in the last 10 years, accounting for one in 14 immunotherapy treatments overall.”

    For patients with metastatic melanoma, the increase was from 0.8% to 4.3%, for NSCLC 0.9% to 3.2%, and for RCC 0.5% to 2.6%. In 2019, these end-of-life-initiated (EOL-I) treatments represented 7.3% of all immunotherapy treatments, indicating a growing application of EOL-I immunotherapy.

    Where patients were treated with immunotherapy mattered. “There were improved survival outcomes when the therapy was administered at academic and high-volume facilities,” said Khan. While patients treated at non-academic or low-volume hospitals had higher odds of receiving EOL-I immunotherapy, patients were less likely to experience death at academic and high-volume hospitals when given immunotherapy for metastatic cancers.

    “Another noteworthy finding was that the outcome for patients receiving immunotherapy towards the end of their life was different depending on the burden of metastasis. Patients with more than three sites of distant metastases are more likely to die within one month of immunotherapy initiation than those with only distant lymph node metastasis.”

    The researchers note that immunotherapy provides a strong overall survival benefit and can salvage patients with metastasis, even those in high-risk sub-groups. The study findings highlight the need for further investigation into the implications of EOL-I immunotherapy with the hope of refining treatment guidelines for the benefit of patients facing metastatic cancer.

    Daniel Kerekes from Yale School of Medicine and Yale Department of Surgery was the study’s first author. Alexander Frey, Elizabeth Prsic, Thuy Tran, James Clune, Mario Sznol, Harriet Kluger, Howard Forman, Robert Becher, and Kelly Olino were Yale co-authors.

    Yale Cancer Center/Smilow Cancer Hospital

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  • New Case Western Reserve University study finds diabetes drug may reduce risk for colorectal cancer

    New Case Western Reserve University study finds diabetes drug may reduce risk for colorectal cancer

    Newswise — CLEVELAND—A groundbreaking study by researchers at Case Western Reserve University suggests a class of medications used to treat type 2 diabetes may also reduce the risk of colorectal cancer (CRC).

    The findings, published today (Dec. 7) in the journal JAMA Oncology, support the need for clinical trials to determine whether these medications could prevent one of the deadliest types of cancers. Eventually, the medications may also show promise in warding off other types of cancer associated with obesity and diabetes.

    “Our results clearly demonstrate that GLP-1 RAs are significantly more effective than popular anti-diabetic drugs, such as Metformin or insulin, at preventing the development of CRC,” said Nathan Berger, the Hanna-Payne Professor of Experimental Medicine at the Case Western Reserve School of Medicine and the study’s co-lead researcher.

    Glucagon-like peptide-1 receptor agonists, or GLP-1 RAs, are medications to treat type 2 diabetes. Usually given by injection, they can lower blood-sugar levels, improve insulin sensitivity and help manage weight. They’ve also been shown to reduce the rates of major cardiovascular ailments.

    Importantly the protective effect of GLP-1 RAs are noted in patients with or without overweight/obesity.

    “To our knowledge,” said co-lead researcher Rong Xu, a professor at the School of Medicine, “this is the first indication this popular weight-loss and anti-diabetic class of drugs reduces incidence of CRC, relative to other anti-diabetic agents.”

    Berger and Xu are members of the Case Comprehensive Cancer Center.

    National health problem

    Being overweight or obese or having diabetes are risk factors for increasing incidence of CRC and for making its prognosis worse.

    The National Institutes of Health (NIH) defines being overweight and obese as an increase in size and amount of fat cells in the body above certain levels. These conditions are common nationally and are caused by several factors—among them diet, lack of sleep or physical activity, genetics and family history.

    Healthcare providers use body mass index to measure body fat based on height and weight. Nearly 75% of adults ages 20 or older in the United States are either overweight or obese, and nearly 20% of children and teens ages 2 to 19 have obesity, according to the NIH.

    Obesity is a chronic health condition that raises the risk for heart disease—the leading cause of death in the United States—and is linked to many other health problems, including type 2 diabetes and cancer.

    The American Cancer Society estimates CRC is the third-leading type of cancer in both sexes, with 153,000 new cases per year. It is also the second-leading cause of cancer mortality with 52,550 deaths per year.

    The study

    Since GLP-1 RAs have been shown to be effective anti-diabetic and weight-loss agents, the researchers hypothesized they might reduce incidence of CRC.

    Using a national database of more than 100 million electronic health records, the researchers conducted a population-based study of more than 1.2 million patients. These individuals had been treated with anti-diabetic agents from 2005-19; the CWRU team examined the effects of GLP-1 RAs on their incidence of CRC, as compared to those prescribed other anti-diabetic drugs.

    Population-based research means matching as many people as possible with the same characteristics—sex, race, age, socio-economic determinants of health and other medical conditions—to accurately compare the drug’s effects.

    Among 22,572 patients with diabetes treated with insulin, there were 167 cases of CRC. Another 22,572 matched patients treated with GLP-1 RAs saw 94 cases of CRC. Those treated with GLP-1 RAs had a 44% reduction in incidence of CRC.

    In a similar comparison of 18,518 patients with diabetes treated with Metformin, compared to 18,518 patients with diabetes treated with GLP-1 RAs, had a 25% reduction in CRC.

    “The research is critically important for reducing incidence of CRC in patients with diabetes, with or without overweight and obesity,” Berger said.

     

                                                                ***

    (Initial data for this manuscript was developed last summer by Lindsey Wang and William Wang, Orange High School students whose work was sponsored by the Case Comprehensive Cancer Center and National Cancer Institute-funded Scientific Enrichment Opportunity/Youth Engaged in Science Program. Lindsey Wang is now a first-year undergraduate at Case Western Reserve in the pre-professional scholars program, planning to enroll at the Case Western Reserve School of Medicine.)

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    Case Western Reserve University is one of the country’s leading private research institutions. Located in Cleveland, we offer a unique combination of forward-thinking educational opportunities in an inspiring cultural setting. Our leading-edge faculty engage in teaching and research in a collaborative, hands-on environment. Our nationally recognized programs include arts and sciences, dental medicine, engineering, law, management, medicine, nursing and social work. About 6,200 undergraduate and 6,100 graduate students comprise our student body. Visit case.edu to see how Case Western Reserve thinks beyond the possible.

     

    Case Western Reserve University

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  • Acne sufferers encounter social and professional stigma, study reveals.

    Acne sufferers encounter social and professional stigma, study reveals.

    • Brigham researchers found that individuals with darker skin tones and more severe acne were likely to face greater stigma 

    • Researchers note the importance of treating acne as a medical problem and ensuring access to treatment 

     
    Newswise — A new study highlights how stigmatizing attitudes about individuals with acne may influence social and professional perceptions. Led by investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, the study found that individuals with acne face stigmatizing attitudes from the general public in professional and social scenarios. The researchers also found that more severe acne and darker skin tones were associated with a greater degree of stigma. These results, published in JAMA Dermatology, highlight the need to identify ways to reduce stigmatizing attitudes and increase access to care in order to improve the experience of individuals with acne. 
     

    “Our findings show that stigmatizing attitudes about acne can impair quality of life, potentially by affecting personal relationships and employment opportunities,” said corresponding author John Barbieri, MD, MBA, of the Department of Dermatology. “Acne is often wrongly perceived as merely a cosmetic issue. It’s important that people with this medical problem get access to treatment, just like any other condition.” 

    Most teenagers and many adults experience acne at some point in their lifetimes. While previous studies have examined how acne impacts the psychological well-being of individuals, not much is known about public perception and attitudes towards them. 

    ​​​For this study, Barbieri and his team obtained stock portraits of four adults, including males and females of either light or dark skin tone. The researchers digitally altered these pictures to create two additional versions of each with mild and severe acne, resulting in a total pool of 12 portraits. They then performed a cross-sectional internet survey of 1357 participants, who were randomly shown one of the 12 images and asked a set of questions regarding stigmatizing attitudes about the pictured individual. The answer scores for images with acne were compared with the corresponding original image without acne as baseline.  

    The team found that participants were less likely to want to be friends, have close contact, or post a photograph on social media with individuals with severe acne, compared to those without acne. Participants reported a greater desire to socially distance themselves from individuals with acne, particularly if the pictured individual had a darker skin tone. 

    The authors also observed that respondents were more likely to agree with stereotypes about individuals with severe acne, tending to perceive them as unhygienic, unattractive, unintelligent and untrustworthy. This stereotype endorsement was also higher in individuals with darker skin. 

    Participants with past or current acne had less stigmatizing attitudes and only 26.4% believed that acne was a cosmetic issue. Most agreed that acne does not affect only teenagers. 

    The study has some limitations. It was not possible to control for comparisons between images with differences in sex or skin tone (for example, female with light skin tone with severe acne versus male with dark skin tone and no acne). Therefore, the results regarding differences by skin tone could be due to other factors and should be interpreted cautiously. The survey population was mostly white and highly educated, limiting the generalizability of the results.  

    Further studies are required to better understand if the relationship between darker skin tones and stigmatizing attitudes result from underlying structural racism or other factors.  

    “Many insurers poorly cover acne and rosacea treatments, claiming that it’s cosmetic,” Barbieri said. “Our study highlights the need for that narrative to change and for ​​identifying approaches to reduce stigmatizing attitudes in the community.” 

    Authorship: Additional Mass General Brigham co-authors include Ali Shields (BWH), Sophia Ly (BWH), Priya Manjaly (BWH) and Arash Mostaghimi (BWH). 

    Other authors include Michael R. Nock. 

    Disclosures: Dr Mostaghimi reported personal fees from hims & hers, AbbVie, Sun Pharmaceutical Industries, Pfizer, Digital Diagnostics, Lilly, Equillium, ASLAN Pharmaceuticals, Boehringer Ingelheim, Fig.1 Beauty, Acom Healthcare, and Olaplex outside the submitted work. Dr Barbieri reported personal fees from Dexcel Pharma for consulting outside the submitted work. Dr Barbieri is Associate Editor and Evidence-Based Practice Editor of JAMA Dermatology but was not involved in any of the decisions regarding review of the manuscript or its acceptance. 
     
    Funding: This study was supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health. 

    Paper cited: Shields, Ali et al. “Evaluation of Stigma Toward Individuals With Acne” JAMA Dermatology DOI:10.1001/jamadermatol.2023.4487 

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    Brigham and Women’s Hospital

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  • Adolescent fitness may not provide as much future cardiovascular health benefit as believed.

    Adolescent fitness may not provide as much future cardiovascular health benefit as believed.

    Newswise — There is a well-known relationship between good physical fitness at a young age and a lower risk of cardiovascular disease later in life. However, when researchers adjusted for familial factors by means of sibling analysis, they found a weaker association, although the link between high body mass index (BMI) and cardiovascular disease remained strong. The study, which was conducted by researchers from Karolinska Institutet and other universities, is published in JAMA Network Open.

    “This does not mean that fitness is irrelevant,” says the study’s last author Viktor Ahlqvist, doctoral student at the Department of Global Public Health, Karolinska Institutet. “We could still see an association, although it was weaker after taking into account factors shared by full siblings. We also think that adolescence is an important time in life for establishing good habits such as exercising and having a healthy diet.”

    Challenging to prove causal associations

    Many observational studies have previously demonstrated links between various risk factors at a young age and cardiovascular disease in adulthood. However, whether the associations are causal is challenging to prove because of the potential influence of unaccounted genetic and environmental factors. A collaborative team including researchers from Karolinska Institutet in Sweden has therefore tried to examine if a large proportion of cardiovascular diseases in adulthood could indeed be prevented with a lower BMI, lower blood pressure, improved physical fitness or improved muscle strength in adolescence.

    Sourcing data from the Swedish Military Conscription Register and other Swedish registries, the researchers identified over a million 18-year-old males and followed them for 60 years. Almost half of them were full brothers.

    “The strength of our study, which makes it more reliable than many other conventional observational studies, is that we have used sibling analyses,” says the study’s first author Marcel Ballin, researcher at Uppsala University and analyst at Region Stockholm’s Centre for Epidemiology and Community Medicine. “By doing so we could examine how the relationship changes when controlling for all shared sibling factors. This includes environmental factors such as childhood environment and half of the genetics.”

    High BMI is a strong risk factor

    The results show that a high BMI in late adolescence was strongly associated with future cardiovascular disease, even after the researchers had controlled for shared familial factors. However, the association between physical fitness and cardiovascular disease was considerably weaker in the sibling analysis, suggesting that many previous observational studies might have overestimated the relevance of adolescent fitness to cardiovascular health later in life.

    “Our conclusion is that of the risk factors studied, high BMI is the strongest individual risk factor for cardiovascular disease, and that efforts to tackle the obesity epidemic should continue to be given high priority,” says co-author Daniel Berglind, docent at the Department of Global Public Health, Karolinska Institutet. “A good level of fitness and muscle strength in adolescence doesn’t seem as crucial, but physical activity still remains important for public health, as it can bring other health benefits.”

    Several limitations

    The study examined the association between risk factors at a young age and future cardiovascular disease; other disease outcomes were not investigated. The researchers had no data on whether the participants’ risk factors varied later in life, and they only studied men, which makes it difficult to extend their findings to women. The Military Conscription Register also lacks details on certain risk factors for future cardiovascular disease, such as diet, alcohol consumption, smoking, blood lipids and blood glucose.

    The researchers received no specific grant for this study. Co-author Martin Neovius is on the advisory panels for Ethicon, Johnson & Johnson and Itrim and has been a consultant for the Swedish armed forces outside the scope of this study. No other conflicts of interest have been reported.

    Publication: “Genetic and environmental factors and cardiovascular disease risk in adolescents”, Marcel Ballin, Martin Neovius, Francisco B. Ortega, Pontus Henriksson, Anna Nordström, Daniel Berglind, Peter Nordström, Viktor H. Ahlqvist, JAMA Network Open, online 17 November 2023, doi: 10.1001/jamanetworkopen.2023.43947.

    Karolinska Institute

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  • UM School of Medicine Researchers Provide First Statewide Prevalence Data on Two New Emerging Pathogens in Healthcare Settings

    UM School of Medicine Researchers Provide First Statewide Prevalence Data on Two New Emerging Pathogens in Healthcare Settings

    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

    University of Maryland School of Medicine

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  • Study: health equity an important aspect of improving quality of care provided to children in emergency departments

    Study: health equity an important aspect of improving quality of care provided to children in emergency departments

    Newswise — INDIANAPOLIS—A new multi-site study led by Indiana University School of Medicine found increasing pediatric readiness in emergency departments reduces, but does not eliminate, racial and ethnic disparities in children and adolescents with acute medical emergencies.

    The study also involved researchers from Oregon Health and Science University and UC Davis Health. They recently published their findings in JAMA Network Open.

    “Ours is a national study group focused on pediatric emergency department readiness,” said Peter Jenkins, MD, associate professor surgery at IU School of Medicine and first author of the study. “We have been very productive in demonstrating that the more prepared an ED is to take care of kids, the better their chances of survival, and that includes children with traumatic injuries and medical emergencies.”

    “Readiness” can include a variety of factors for an ED, including staffing, materials, training and protocols. Jenkins said the more prepared the hospital, and the more protocols in place, then the more likely a child is to survive a traumatic injury or acute medical emergency. But until now, it was unclear whether children of all races and ethnicities benefit the same from increased levels of readiness.

    “We believe that treatment protocols help to overcome biases and racism because if a child meets criteria, then we do one thing or another,” Jenkins said. “We saw that for kids with traumatic injuries, whose care is largely determined by such protocols, there weren’t significant differences in survival based on race and ethnicity. But for children with medical emergencies, where treatment protocols are often lacking, we found significant disparities in mortality between Black and White kids. Importantly, the higher the level of readiness of the ED, the lower the level of disparity between racial and ethnic groups.”

    Researchers looked at 633,536 pediatric patients at hospitals in 11 states from 2012-2017, making this one of the largest studies of racial and ethnic disparities among children to date.

    “A lot of times when we talk about health equity, people are concerned that improving the condition of one group may result in another group losing out,” Jenkins said. “This study shows the opposite to be true. All groups benefit from improved readiness, and we also have this extra layer of social justice woven into the narrative of improved health care quality. These findings only strengthens the case to provide resources to hospitals so they’re prepared to take care of all sick kids.”

    In the future, the group plans to look at updated surveys of hospitals to determine if there have been changes in pediatric readiness over time. Jenkins said they also plan to promote the importance of health equity into the national platform for pediatric readiness.

    Other lead collaborators include Nathan Kuppermann, MD, MPH from UC Davis and Craig Newgard, MD, MPH from OHSU. Read the full publication in JAMA Network Open.

    About Indiana University School of Medicine

    IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

    Indiana University

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  • Sepsis: Common as Cancer, Deadly as Heart Attack

    Sepsis: Common as Cancer, Deadly as Heart Attack

    Newswise — In 2016, the research team conducted an initial study in southern Sweden (Skåne) where they revealed that sepsis is much more common than previously believed. The incidence turned out to be 750 adults per 100,000 individuals. In the latest study in the same region, the results showed that more than four percent of all hospitalizations involved the patient suffering from sepsis, and 20 percent of all sepsis patients died within three months.

    “This makes sepsis as common as cancer with similar negative long-term consequences, and as deadly as an acute myocardial infarction. Among sepsis survivors, three-quarters also experience long-term complications such as heart attacks, kidney problems, and cognitive difficulties”, says Adam Linder, sepsis researcher and associate professor at the Department of infection medicine at Lund University, as well as a senior physician at Skåne University Hospital.

    The European Sepsis Alliance has assigned the researchers with assessing how common sepsis is in the rest of Europe. Given the differing healthcare systems across countries, it wasn’t immediately clear how they should proceed to obtain accurate figures. Consequently, the researchers conducted a pilot study southern Sweden to determine if their methods were applicable to other European hospitals.

    “Doctors classify patients using diagnostic codes. Since sepsis is a secondary diagnosis resulting from an infection, the condition is significantly underdiagnosed, as the primary disease often dictates the diagnostic code. This makes it challenging to find a way to accurately determine the number of sepsis cases”, says Lisa Mellhammar, sepsis researcher at Lund University and assistant senior physician at Skåne University Hospital.

    In the study, which is now published in JAMA Network Open, it was revealed that 7,500 patients in Skåne were associated with sepsis in 2019. During the pandemic, the incidence increased to six percent. However, even without Covid-19, the researchers believe that sepsis should be viewed as an epidemic.

    The aim is to use the publication to influence the EU to establish a common surveillance system for sepsis. The team are in contact with authorities and researchers from around thirty European countries and hope that the research project can secure sufficient funding to start soon. There is no indication that the number of sepsis cases would be lower in other parts of Europe than in Sweden. In Swedish hospitals, only two percent of all sepsis patients are antibiotic-resistant, and the researchers speculate that the proportion of resistant cases is higher in many other European countries.

    “Although sepsis care has improved in recent years, we need to enhance our diagnostic methods to identify patients earlier and develop alternative treatment methods beyond antibiotics to avoid resistance. Increasing awareness about sepsis among the public and decision-makers is crucial to ensure that resources are allocated appropriately”, concludes Adam Linder.

    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808870?resultClick=1

    Lund University

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  • Remote learning during pandemic aids medical students with disabilities

    Remote learning during pandemic aids medical students with disabilities

    BYLINE: Patricia DeLacey

    Newswise — Medical students who reported a disability to their school increased by more than 25% during the COVID-19 pandemic, a study shows.

    The proportion of students reporting attention deficit hyperactivity disorder or chronic health and/or psychological disabilities has increased between 2015 and 2021.

    Despite the increase in medical students reporting these conditions, the requests for more inclusive preclinical testing accommodations, like extra time for test completion or a less distracting environment, decreased during the pandemic between 2019 and 2021.

    According to authors of the new research letter in JAMA Network Open, the remote curriculum delivery during the pandemic may have allowed students to create an optimal learning and testing environment, decreasing the need for accommodation.

    “Medical education was at its most flexible during COVID,” said Lisa Meeks, Ph.D., clinical associate professor of learning health sciences and family medicine at the University of Michigan Medical School.

    She adds that this could have reduced the need for testing accommodations, but it is unclear whether the need for accommodations will rise again after the recent return to in-person lectures and testing.

    Documenting the rise

    The study results are part of a long-term research project led by Meeks that follows the prevalence of medical students in the United States who disclose disabilities to their respective schools.

    This study on disability disclosure in medicine was the first large scale study of its kind, encompassing all types of disability, including psychological, learning, sensory, physical and chronic health conditions.

    Since 2015, researchers have seen an increase of medical students reporting a disability to their institution from 2.8% in 2015 to 4.7% in 2019, and to 5.9% in 2021.

    When asked to describe why we see such large increases in the population of medical students with disabilities, Meeks posited that “growth in this population could mean that we are reducing bias and stigma, and therefore people who were already in medicine are more willing to disclose.”

    “It could also mean that our research sparked a conversation to change policies, which then led to individuals with disabilities who didn’t think they could make it in medical school choosing to apply to these schools.”

    Doctors with disabilities improve patient care

    According to Meeks, there is still significant work to be done to increase the representation of doctors with disabilities in medicine.

    Only 5.9% of medical school students report a disability, but 27% of adults in the U.S. currently live with some type of disability.

    As the population ages, this number is expected to increase.

    “Physicians in the U.S. and many other countries report that they do not feel confident in their ability to provide equal quality of care to patients with disabilities as they provide to patients without disabilities,” said Karina Pereira-Lima, Ph.D., a research fellow in the Michigan Medicine neurology department.

    “The inclusion of professionals with disabilities in medicine can greatly improve the care for patients with disabilities and the health of the population overall.”

    Retaining medical trainees with disabilities

    Increasing the number of physicians with disabilities requires both the recruitment and retention of medical trainees.

    “Anonymous research with medical trainees with disability shows that about one in every five medical students and more than half of resident physicians do not request accommodations when they need them,” said Pereira-Lima.

    The two main reasons for not requesting needed accommodation were fear of stigma or bias and lack of a clear institutional process.

    “Program access, or simply having the ability to access accommodations should they need them, improves medical trainees with disabilities performance in relation to testing and patient care. It also reduces the likelihood of reporting depressive symptoms or burnout,” added Pereira-Lima.

    Meeks advocated for “standardization in support for students with disabilities in medical education.”

    “Medical education strives for parity and continuity between medical schools, but when it comes to disability services and reasonable accommodations, there’s no standardization whatsoever,” said Meeks.

    “One school could have an incredible specialized disability support services with a qualified disability resource professional running the office, while another school does not have a specialized disability support service at all.”

    ‘A wave of change’

    The team notes that addressing the second common barrier to attaining needed disability accommodations and fear of stigma or bias requires a continued culture shift in medicine.

    “Disability is still incredibly stigmatized, and ableism is rampant in medicine and medical education. At the same time, I think the work from our lab, the Association of American Medical Colleges, the Accreditation Council for Graduate Medical Education and others in medicine started a wave of change that is extraordinarily strong,” said Meeks.

    This work is bolstered by the matriculation of individuals that Meeks calls the post Americans with Disabilities Act generation into medical school.

    “This generation has a lot of disability pride. They’ve had accommodations their entire lives, they know the law, they know their rights and they’re not ashamed of being disabled,” said Meeks.

    Next steps

    As this long term study continues, the research team plans to assess how other identities interact with the disability identity.

    “People with disabilities have different racial and ethnic backgrounds, sexual orientations and socio-economic statuses. We want to learn more about how the interaction between these different identities impacts the performance and mental health of medical students with disabilities,” said Pereira-Lima. 

    Meeks adds that thanks to new funding from the Robert Wood Johnson Foundation the DocsWithDisabilities team is doing just that.

    “We’re also developing methods to measure the efficacy of accommodations. We need to do more research on the quality of received accommodations and how easy the process was for them to receive the accommodations they needed” added Pereira-Lima.

    “Investing in a culture that acknowledges disability as a valuable form of diversity will improve patient care.”

    Michigan Medicine – University of Michigan

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  • Assessment of Lung Cancer Risk Among Smokers for Whom Annual Screening Is Not Recommended

    Assessment of Lung Cancer Risk Among Smokers for Whom Annual Screening Is Not Recommended

    Abstract

    Importance: The US Preventive Services Task Force does not recommend annual lung cancer screening with low-dose computed tomography (LDCT) for adults aged 50 to 80 years who are former smokers with 20 or more pack-years of smoking who quit 15 or more years ago or current smokers with less than 20 pack-years of smoking.

    Objective: To determine the risk of lung cancer in older smokers for whom LDCT screening is not recommended.

    Design, settings, and participants: This cohort study used the Cardiovascular Health Study (CHS) data sets obtained from the National Heart, Lung and Blood Institute, which also sponsored the study. The CHS enrolled 5888 community-dwelling individuals aged 65 years and older in the US from June 1989 to June 1993 and collected extensive baseline data on smoking history. The current analysis was restricted to 4279 individuals free of cancer who had baseline data on pack-year smoking history and duration of smoking cessation. The current analysis was conducted from January 7, 2022, to May 25, 2022.

    Exposures: Current and prior tobacco use.

    Main outcomes and measures: Incident lung cancer during a median (IQR) of 13.3 (7.9-18.8) years of follow-up (range, 0 to 22.6) through December 31, 2011. A Fine-Gray subdistribution hazard model was used to estimate incidence of lung cancer in the presence of competing risk of death. Cox cause-specific hazard regression models were used to estimate hazard ratios (HRs) and 95% CIs for incident lung cancer.

    Results: There were 4279 CHS participants (mean [SD] age, 72.8 [5.6] years; 2450 [57.3%] women; 663 [15.5%] African American, 3585 [83.8%] White, and 31 [0.7%] of other race or ethnicity) included in the current analysis. Among the 861 nonheavy smokers (<20 pack-years), the median (IQR) pack-year smoking history was 7.6 (3.3-13.5) pack-years for the 615 former smokers with 15 or more years of smoking cessation, 10.0 (5.3-14.9) pack-years for the 146 former smokers with less than 15 years of smoking cessation, and 11.4 (7.3-14.4) pack-years for the 100 current smokers. Among the 1445 heavy smokers (20 or more pack-years), the median (IQR) pack-year smoking history was 34.8 (26.3-48.0) pack-years for the 516 former smokers with 15 or more years of smoking cessation, 48.0 (35.0-70.0) pack-years for the 497 former smokers with less than 15 years of smoking cessation, and 48.8 (31.6-57.0) pack-years for the 432 current smokers. Incident lung cancer occurred in 10 of 1973 never smokers (0.5%), 5 of 100 current smokers with less than 20 pack-years of smoking (5.0%), and 26 of 516 former smokers with 20 or more pack-years of smoking with 15 or more years of smoking cessation (5.0%). Compared with never smokers, cause-specific HRs for incident lung cancer in the 2 groups for whom LDCT is not recommended were 10.54 (95% CI, 3.60-30.83) for the current nonheavy smokers and 11.19 (95% CI, 5.40-23.21) for the former smokers with 15 or more years of smoking cessation; age, sex, and race-adjusted HRs were 10.06 (95% CI, 3.41-29.70) for the current nonheavy smokers and 10.22 (4.86-21.50) for the former smokers with 15 or more years of smoking cessation compared with never smokers.

    Conclusions and relevance: The findings of this cohort study suggest that there is a high risk of lung cancer among smokers for whom LDCT screening is not recommended, suggesting that prediction models are needed to identify high-risk subsets of these smokers for screening.

    JAMA – Journal of the American Medical Association

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  • New Research by Sylvester Cancer Shows Unmet Support Needs Can Lead to Worse Clinical Outcomes

    New Research by Sylvester Cancer Shows Unmet Support Needs Can Lead to Worse Clinical Outcomes

    Newswise — MIAMI, FLORIDA (June 27, 2023) – Cancer patients with unmet supportive care needs are more likely to experience worse clinical outcomes, including more emergency department (ED) visits and hospitalizations, according to new research from Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.

    The study, published June 21 in JAMA Network Open, also found that Black race, Hispanic ethnicity and factors such as anxiety, depression, pain, poor physical function and low health-related quality-of-life scores were associated with greater number of unmet needs, leading to increased risk for ED visits and hospitalizations.

    This retrospective analysis involved 5,236 patients treated at Sylvester’s various ambulatory cancer sites who used its My Wellness Check, an electronic health record-based system, that monitors patients’ emotional, physical and psychosocial needs.

    “This study, to our knowledge, is the most comprehensive assessment to date that links unmet supportive care needs to ED visits and hospitalizations among ambulatory oncology patients,” said Frank J. Penedo, PhD, Sylvester’s associate director for Cancer Survivorship and Translational Behavioral Sciences and corresponding author of the research. “It included a very diverse group of patients treated at our various cancer clinic locations and across multiple phases of the cancer care continuum.”

    Other key takeaways from this study included:

    • 940 or 18% of patients reported one or more unmet supportive care needs, with about a third of them noting two or more unmet needs.
    • Almost one quarter of patients with unmet support needs had ED visits, compared with 14% for those without unmet needs.
    • For hospitalizations, the differences were 23% and 14%, respectively.
    • Support for coping with cancer and financial concerns were the most reported unmet needs, followed by general cancer education and information.
    • Diverse representation with Hispanics comprising almost 48% of study patients while other racial groups included Blacks, Caucasians, Asians, American Indians, Native Alaskans, Native Hawaiians and other Pacific Islanders.

    “Our findings offer strong evidence that unmet supportive care needs are associated with unfavorable clinical outcomes, particularly higher risk for ED visits and hospitalizations,” Penedo said. “Addressing these unmet needs is crucial to improve clinical outcomes and particularly in racial and ethnic minority populations where the needs are greatest.”

    Authors

    The complete list of authors is noted in the research article.

    Funding

    This study was funded in part by grant P30 CA240139 from the National Cancer Institute. Sara Fleszar-Pavlovic, PhD, is funded by The Ruth L. Kirschstein NRSA Institution Research Training Grant (T32; 5T32CA251064-03) in Cancer Training in Disparities and Equity (C-TIDE).

    Conflicts of Interest Disclosure

    Penedo reported receiving personal fees from BlueNote Therapeutics outside the submitted work. No other disclosures were reported.

    DOI: 10.1001/jamanetworkopen.2023.19352

    # # #

    Sylvester Comprehensive Cancer Center

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  • The expanded Child Tax Credit led to improved health and nutrition among adults

    The expanded Child Tax Credit led to improved health and nutrition among adults

    EMBARGOED FOR USE UNTIL:

    1:30 p.m. (EDT) on June 24, 2023

    Newswise — Monthly cash payments to eligible families under the temporary pandemic-era expansion of the federal Child Tax Credit led to better adult health and food security, new UCLA-led research suggests.

    The policy, which expired at the end of 2021, has not been renewed due to concerns among legislators over the credit being overly generous, particularly to lower-income families with limited tax liability, and the lack of an associated work requirement. The findings, to be published June 24 in JAMA Health Forum, could inform the debate over the policy’s future, said Dr. Jordan Rook, a fellow in the National Clinician Scholars Program at UCLA and the study’s lead author.

    “Cash transfer programs like the 2021 Child Tax Credit expansion may be powerful tools in improving the health, wellbeing, and nutrition of families,” said Rook, who is also a general surgery resident at the David Geffen School of Medicine at UCLA.  “Evidence like this can help guide the public, the media, and politicians as they advocate for and debate the policy’s future.

    Currently about one in six U.S. families with children lives in poverty, leading to poorer health and shorter life expectancy, according to the research team.

    Prior to the pandemic, the Child Tax Credit provided up to $2,000 per child ages 16 or younger for families with eligible incomes. Under the pandemic-era American Rescue Plan signed into law on March 11, 2021, the credit increased to $3,600 per child ages five or younger, and $3,000 per child ages 6 to 17. Families were eligible to receive half of this amount in the form of monthly checks, which each month were worth between $250 to $300 per child. The credit was fully refundable, meaning that all low-income families with children were eligible to receive the entire credit, regardless of their work status or income.

    These monthly payments reduced poverty by 40% in households with children, according to the researchers. But the policy, a temporary measure to assist families during the pandemic, expired on December 31, 2021.

    The researchers used data taken from about 39,500 respondents to the National Health Interview Survey from January 2019 to December 2021. They found that prior to initiation of the monthly payments, 60% of credit-eligible adults reported excellent or very good health and 88% reported having food security– that is, access to sufficient food to meet normal dietary needs. Among ineligible adults, 55% said they had excellent or very good health and 89% reported food security.

    They then used a study design known as a “difference-in-differences” technique to compare changes in health and food security between credit-eligible families and credit-ineligible families to estimate the impact of the Child Tax Credit monthly payments. Based on this technique, they estimate that following the start of the payments, eligible adults were 3 percentage points more likely to report excellent or very good health and 1.9 percentage points more likely to report food security than ineligible adults.

    “Assuming the conservative estimate of one adult per household, this represents improved health for 1.08 million adults, and newfound food security for 684,000 households,” Rook said. “These changes potentially represent important gains in health and nutrition for hundreds of thousands of US families because of this pandemic-era policy.”

    The study has some limitations, among them the possibility that job losses and expansions to other social programs such as unemployment and SNAP during the pandemic might have affected the findings.

    Additional study authors are Dr. Cecile Yama, Dr. Adam Schickedanz, Dr. Steven Lee, and Lauren Wisk of UCLA; and Dr. Alec Feuerbach of SUNY Downstate /Kings County.

    The study was funded by the VA Office of Academic Affiliations and the Los Angeles County Department of Health Services, both through the National Clinician Scholars Program Fellowship; the National Institute of Diabetes and Digestive and Kidney Diseases (K01 DK116932 and R03 DK132439); the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD099308); and the Health Resources and Services Administration of the U.S. Department of Health and Human Services (UA6MC32492, the Life Course Intervention Research Network). The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

    University of California, Los Angeles (UCLA), Health Sciences

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  • Hospital Infection Control Experts Question Validity of Public Reporting Metrics, New Study Finds

    Hospital Infection Control Experts Question Validity of Public Reporting Metrics, New Study Finds

    Newswise — Infections spread in hospitals and other healthcare settings cause over 680,000 infections and 72,000 patient deaths in the U.S. every year. Surveillance and reporting of these infections to government entities has become a key part of hospital infection control programs, yet infection control experts question the effectiveness of these measures at protecting public health. That is the finding of a new survey led by researchers at the University of Maryland School of Medicine. Results were recently published in the journal JAMA Network Open.

     

    The UMSOM researchers analyzed results from survey respondents from 43 U.S. hospitals that are part of the Healthcare Epidemiology Research Network, a consortium focusing on research in infection control and antibiotic misuse. The respondents reported that many metrics, such as surgical site infections and antibiotic-resistant (MRSA) bloodstream infections, were important measures of infection control that should be reported to the federal government. The vast majority of respondents, however, said that two metrics — related to sepsis management and ventilator-associated infections — were not useful measures of infection control efforts.

    “These infection control metrics are intended to reflect the quality of care at each institution, but some of the metrics don’t take into account the complex care provided by academic institutions as compared to community hospitals,” said study lead author Gregory Schrank, MD, Assistant Professor of Medicine at UMSOM. “Some have infections that can’t be prevented, while other metrics we are required to report aren’t indicative of an infection and don’t lead to an improvement in the quality of care that patients receive. Our survey found that tracking these metrics can detract from other important infection prevention work.”

    Even more surprising, 84 percent of respondents said they believed hospitals and staff “intentionally manipulate” hospital-associated infection rates publicly reported on the government’s Centers for Medicare & Medicaid Services (CMS) Hospital Care Compare website. The federal government sets reimbursement rates for Medicare and Medicaid patients based on these metrics. The data are also used in hospital rankings published by US News & World Report and others.  Survey respondents stated that they feel pressure to find ways to avoid reporting cases.  

    “We found that survey respondents did not believe the metrics reported on these websites were well understood by the public,” said study co-author Daniel Morgan, MD, Professor of Epidemiology & Public Health at UMSOM. “They also did not think reimbursements should be tied to these metrics, given all the caveats to collecting and reporting them.”

    While the study researchers pointed out that reporting of hospital-acquired infections has led broadly to an improvement in care, they concluded that the survey highlighted the need for adjustments to these metrics to create less of an incentive for hospitals to game the system.

    “While requirements to collect and report hospital metrics were implemented with the best of intentions, improvements clearly can be made to the system,” said UMSOM Dean, Mark T. Gladwin, MD, who is also Vice President for Medical Affairs, University of Maryland, Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor. “For example, there is a need for a more robust use of risk adjustment tools in these models to create national benchmarks for hospitals that treat the most complicated cases and sickest patients.”

    Other co-authors on this study who were UMSOM Epidemiology & Public Health faculty members include Surbhi Leekha, MBBS, Jonathan Baghdadi, MD, Lisa Pineles MA, and Anthony Harris, MD. A researcher from VA Boston Healthcare System and Harvard Medical School was also a study co-author.

     

    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 $1.3 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 nearly $600 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 combined School of Medicine and Medical System (“University of Maryland Medicine”) has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. 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 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent (#27) 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

    University of Maryland School of Medicine

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  • Real-World Data Suggests Stopping Immunotherapy after Two Years is Reasonable in Patients with Advanced Lung Cancer

    Real-World Data Suggests Stopping Immunotherapy after Two Years is Reasonable in Patients with Advanced Lung Cancer

    Newswise — CHICAGO – Over the past decade, the approval of immune checkpoint inhibitors has revolutionized treatment for patients with advanced lung cancer, helping many live longer lives and improving overall survival for the disease. However, an important question has remained unanswered: How long should a patient with advanced non-small cell lung cancer (NSCLC), who receives immunotherapy as part of their initial treatment, continue with treatment?

    A new retrospective cohort study, published today in JAMA Oncology and presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 9101) by researchers from Penn Medicine’s Abramson Cancer Center, suggests that it’s reasonable to stop immunotherapy treatment at two years as long as their cancer hasn’t progressed. The researchers found no statistically significant difference in overall survival between patients who stopped treatment at two years and those who continued treatment indefinitely.

    “We hope this data provides reassurance that stopping treatment at two years is a valid treatment strategy that does not seem to compromise overall survival,” said lead author Lova Sun, MD, an assistant professor of Hematology-Oncology at the Perelman School of Medicine at University of Pennsylvania. “In the absence of definitive prospective data about the duration of therapy – which will take years to accumulate – our goal was to use real-world observational data to provide guidance on this important clinical question.”

    The appropriate length of treatment remains an open question because pivotal clinical trials have used different treatment durations, and as therapies have been approved and become widely available, many patients have continued therapy beyond the one to two years tested in clinical trials. The longer a patient continues treatment, the higher the health care costs become – both to the patient and to the health care system – and there is ongoing risk of immune-related side effects.

    In this study, the researchers analyzed de-identified data from a national electronic health record that included patients with advanced NSCLC who were treated in both academic and community settings. Of the 1,091 patients who received an immune checkpoint inhibitor as part of their initial therapy (either alone or in combination with chemotherapy) and whose cancer had not continued to grow, only one in five stopped immunotherapy at two years and were considered the “fixed duration” group for this analysis. The vast majority who continued treatment beyond two years were considered the “indefinite duration” group.

    The team analyzed the data and found similar overall survival probabilities between the two groups: 79% for fixed duration and 81% for indefinite duration.

    “Ultimately, the field is still on the leading edge of determining the most appropriate duration for these immunotherapies that have been so effective for patients with advanced lung cancer,” said senior author Charu Aggarwal, MD, MPH, the Leslye M. Heisler Associate Professor for Lung Cancer Excellence in Hematology-Oncology at Penn. “This study provides important data that we hope will help patients feel less worried about potential risks of coming off therapy and more confident if they decide to discontinue treatment after two years.” 

    Sun will share the results in a poster session on Sunday, June 4, at 8 a.m. CT in Hall A.

    ###

    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.

    Perelman School of Medicine at the University of Pennsylvania

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  • Multiple Sclerosis More Prevalent in Black Americans Than Previously Thought

    Multiple Sclerosis More Prevalent in Black Americans Than Previously Thought

    Newswise — Multiple sclerosis has traditionally been considered a condition that predominantly affects white people of European ancestry. However, a new analysis conducted by a North American team led by University of Maryland School of Medicine (UMSOM) researchers suggests that the debilitating neurological condition is more prevalent in Black Americans than once thought. It is also far more prevalent in Northern regions of the country including New England, the Dakotas, and the Pacific Northwest.

    Findings from the new study were recently published in the journal JAMA Neurology.

    “We found a much higher prevalence of multiple sclerosis in Black Americans than previously thought,” said study corresponding author Mitchell Wallin, MD, MPH, Associate Professor of Neurology at UMSOM. “This helps to confirm the profound impact that healthcare inequities and lack of representation in clinical research have had in terms of driving misconceptions about the prevalence of this disease on historically underserved and underrepresented populations.”

    Multiple sclerosis (MS) causes the immune system to attack the central nervous system, specifically the protective layer of myelin that insulates nerve fibers. Symptoms include numbness, tingling, mood changes, memory problems, pain, fatigue, and, in severe cases, blindness or paralysis. In 2019, Dr. Wallin led a team that found the prevalence of multiple sclerosis (MS) in the U.S. to be nearly 1 million people, twice as many as previous estimates.

    In the current study, he and his colleagues evaluated three years’ worth of de-identified health insurance claims of 96 million adults to locate adults living with multiple sclerosis. They estimated in more detail how many individuals who are age 18 or older are living with MS in various states and the MS prevalence among people of different races or ethnicities living in specific regions.

    The study found strong evidence of a higher prevalence of MS in northern regions of the U.S. compared to southern regions. “Although we don’t know for certain why this is the case, it may have something to do with the spread of viruses in colder climates where people remain indoors more or lower vitamin D levels from less sun exposure,” said Dr. Wallin.

    Numerous observational studies have linked low vitamin D levels with an increased risk of MS and with more progressive disease. Other landmark research published in Science found that the common Epstein-Barr virus infection greatly increased the risk for developing MS with a new study out this week demonstrating that antibodies made by the body against the virus attack a vital protein in the brain and spinal cord.

    In terms of prevalence of MS within certain sub-groups of Americans, the researchers found a higher prevalence of MS in white people, followed by Black people, “other races,” and then people with Hispanic/Latinx ethnicity. MS occurs in about 4 in 1,000 white people, about 3 in 1,000 Black people, about 2 in 1,000 people of “other races” including Asians, Native Americans, Alaska natives and multi-race individuals, and about 1.5 in 1,000 people of Hispanic/Latinx origin.

    The study was funded by the National Multiple Sclerosis Society.

    William J. Culpepper, PhD, Adjunct Assistant Professor of Neurology at UMSOM and Associate Director of the Department of Veteran Affairs Multiple Sclerosis Center of Excellence, was a co-author of the study. Faculty at Stanford University School of Medicine, Southern California Permanente Medical Group, University of Manitoba, and University of Alabama also served as co-authors on this study.

    “The findings could have a significant impact on public policy makers to help them determine a more equitable allocation of resources towards populations that have been historically under-represented in MS research, and under-recognized when targeting prevention methods and treatment options,” said UMSOM Dean Mark T. Gladwin, MD, Vice President for Medical Affairs, University of Maryland, Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor. “Considering the very diverse patients that we care for across Maryland and in Baltimore, we also have a unique opportunity through the new UM Institute for Health Computing to bring new advances in MS treatment to African American patients who are eligible for the many new biological therapies available.”

    University of Maryland School of Medicine

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  • NJ Medicaid Reforms Tied to Increased Use of Opioid Addiction Treatment

    NJ Medicaid Reforms Tied to Increased Use of Opioid Addiction Treatment

    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:

    • Removed prior authorization requirements for buprenorphine prescriptions
    • Increased reimbursement rates for in-office opioid addiction treatment
    • Established regional centers of excellence for addiction treatment

    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.

    Rutgers University-New Brunswick

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  • University of Kentucky physicians push for standard-of-care opioid treatment for incarcerated patients

    University of Kentucky physicians push for standard-of-care opioid treatment for incarcerated patients

    Newswise — In a recently published commentary, UK HealthCare physicians call for standard-of-care treatment for opioid use disorder (OUD) among patients who are incarcerated.

    The viewpoint article by Anna-Maria South, M.D., Laura Fanucchi, M.D., and Michelle Lofwall, M.D., published in JAMA April 24 highlights the barriers to initiating medication for opioid use disorder (MOUD) among people who are incarcerated.

    For patients with opioid use disorder, medications such as buprenorphine and methadone are considered by the medical community as standard of care treatments, as they alleviate withdrawal symptoms, reduce cravings and pain, decrease infections, and lower the risk of mortality. However, the use of these medications is often restricted in U.S. prisons and jails, with only a few states mandating their use in the carceral system. 

    The physicians’ article draws attention to the significant moral distress experienced by doctors when patients who are incarcerated need to be hospitalized due to serious medical complications resulting from untreated opioid use disorder, but they are unable to provide them with the best treatment.

    The article also highlights the fact that denying patients standard-of-care treatments because they are incarcerated violates medical ethics, constitutional amendments and the Americans with Disabilities Act (ADA) and emphasizes the need for physician advocacy.

    “Incarcerated people with opioid use disorder are among the most vulnerable patient populations that also have the least ability to advocate for themselves,” said South, an assistant professor in UK College of Medicine’s Division of Hospital Medicine and an attending physician on the Addiction Consult and Education Services. “We as physicians have a powerful voice for advocacy to make substantial change. We need to educate ourselves on the rights that our patients have and where we can go to advocate for them.”

    South is the paper’s first author and UK’s 2022 Bell Addiction Medicine Scholar. South’s work on this article was supported by the Bell Alcohol and Addictions Scholar Program.

    Read the full JAMA article here.

    UK HealthCare is the hospitals and clinics of the University of Kentucky. But it is so much more. It is more than 10,000 dedicated health care professionals committed to providing advanced subspecialty care for the most critically injured and ill patients from the Commonwealth and beyond. It also is the home of the state’s only National Cancer Institute (NCI)-designated cancer center, a Level IV Neonatal Intensive Care Unit that cares for the tiniest and sickest newborns, the region’s only Level 1 trauma center and Kentucky’s top hospital ranked by U.S. News & World Report.  

    As an academic research institution, we are continuously pursuing the next generation of cures, treatments, protocols and policies. Our discoveries have the potential to change what’s medically possible within our lifetimes. Our educators and thought leaders are transforming the health care landscape as our six health professions colleges teach the next generation of doctors, nurses, pharmacists and other health care professionals, spreading the highest standards of care. UK HealthCare is the power of advanced medicine committed to creating a healthier Kentucky, now and for generations to come. 

    University of Kentucky

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  • Poststroke Recovery Hinges on Physical Activity, Study Finds

    Poststroke Recovery Hinges on Physical Activity, Study Finds

    Newswise — After a stroke, physical activity can be pivotal to successful recovery. People who spend four hours a week exercising after their stroke achieve better functional recovery within six months than those who do not, a University of Gothenburg study shows.

    The study, now published in the scientific journal JAMA Network Open, is based on data concerning 1,500 stroke patients in 35 Swedish hospitals. The participants were grouped according to their poststroke patterns of physical activity.

    The results show that increased or maintained physical activity, with four hours’ exercise weekly, doubled the patients’ chances of recovering well by six months after a stroke. Men and people with normal cognition kept up an active life relatively more often, with better recovery as a result.

    Positive programming from exercise

    The researchers have previously succeeded in demonstrating a clear inverse association between physical activity and the severity of stroke symptoms at the actual onset of the condition. These new findings highlight the importance of maintaining a healthy, active lifestyle after a stroke.

    The first and corresponding author of the study, Dongni Buvarp, is a researcher in clinical neuroscience at Sahlgrenska Academy, University of Gothenburg. Besides her research internship, she is a resident doctor at an initial stage of specialist training at Sahlgrenska University Hospital.

    “Physical activity reprograms both the brain and the body favorably after a stroke. Exercise improves the body’s recovery at the cellular level, boosts muscle strength and well-being, and reduces the risk of falls, depression, and cardiovascular disease. Regardless of how severe the stroke has been, those affected can derive benefits from exercising more,” she says.

    Knowledge and support vital

    “Being physically active is hugely important, especially after a stroke. That’s a message that health professionals, stroke victims and their loved ones should all know. Women and people with impaired cognition seem to become less active after stroke. The study results indicate that these groups need more support to get going with physical activity,” Buvarp says.

    One weakness of the study is that, with a few exceptions, the researchers were unable to study the participants’ degree of activity before the stroke. The patients included were treated in Sweden in the period from 2014 to 2019.

    University of Gothenburg

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  • Enhancing survival odds in elderly with head, neck cancer

    Enhancing survival odds in elderly with head, neck cancer

    Newswise — As a result of demographic change, more older people need cancer treatment, doctors must treat them differently than younger people due to their other health problems, frailty, and decreased physical ability. Doctors need to think about how the treatment could affect their quality of life. To treat head and neck cancer, doctors usually remove the tumor with surgery and then use radiation therapy, or they use radiation therapy and chemotherapy together to preserve the affected organ. Using chemotherapy at the same time can be risky for older patients because of its side effects. However, there isn’t much information about the best treatment for older people yet.

    A research project was carried out by twelve university hospitals in Europe and the US to study the effectiveness of different treatments for older people with head and neck cancer. They looked at combining radiotherapy and chemotherapy or using a drug that targets a growth factor receptor called EGFR. The study found that adding chemotherapy to radiotherapy improved survival rates compared to radiotherapy alone. This was especially true for patients aged between 65 and 79 who were in good general health and had fewer other health problems. Professor Nils Nicolay, who led the study, explained that fit older patients with minor health problems should not be denied this effective treatment simply because of their age. However, using the growth factor antibody drug alongside radiotherapy did not improve survival rates compared to radiotherapy alone.

    The researchers examined the medical records of 1,044 older patients with head and neck squamous cell carcinoma, a type of cancer that affects the mouth, throat, or voice box. These patients were treated with radiotherapy, sometimes with the addition of a drug, between 2005 and 2019. The study was led by Leipzig University Hospital, and they are now creating an international registry for older patients diagnosed with head and neck cancer. More than 20 centres from Europe, the US and Australia have shown an interest in taking part. This registry will not only record oncological data but also include other information, such as a comprehensive geriatric assessment, health-related quality of life data, and the frequency of patients regretting their treatment decisions. Dr Alexander Rühle, the lead author and co-leader of the study, said that they will work with other international research groups to further understand which older patients will benefit from combined radiotherapy and chemotherapy. They will also create tools to help doctors make joint therapy decisions based on individual patient data.

    Professor Nils Nicolay and Dr Alexander Rühle began the study while they were working at the University of Freiburg Medical Center and finished it after they moved to Leipzig. Nicolay is currently a Professor of Radiotherapy and Radiooncology at Leipzig University’s Faculty of Medicine, starting from September 1, 2022. This appointment also involves leading the Department of Radiooncology at Leipzig University Hospital.

    Universitat Leipzig

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