ReportWire

Tag: Patient Safety

  • Long Island Hospitals ranked among Healthgrades’ best | Long Island Business News

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    THE BLUEPRINT:

    • evaluated over 4,500 hospitals based on risk-adjusted mortality and complication rates.

    • Stony Brook, , and Mather recognized for consistent high-quality patient care.

    Hospitals on Long Island have been named among Healthgrades’ best hospitals in the nation, ranking within the top 5 percent for .

    and NYU Langone—Long Island were among those named one of Healthgrades’ America’s 50 Best Hospitals. , part of the Northwell system, was ranked among the top 250.

    A platform for finding doctors and healthcare information, Healthgrades aims to help millions of consumers each month locate and schedule appointments and access treatment-focused content. Its 2026 hospital ranking list was released earlier this week.

    “This honor speaks to the shared focus across Stony Brook Medicine on providing exceptional care for each and every patient,” Dr.  William Wertheim, executive vice president of Stony Brook Medicine, which earned this recognition for the fourth consecutive year, said in a written statement. “Receiving this achievement for the fourth year in a row reflects the daily collaboration of our teams in maintaining an exemplary standard of care throughout the organization.”

    To determine America’s 50 Best Hospitals for 2026, Healthgrades evaluated risk-adjusted mortality and complication rates for more than 30 of the most common conditions and procedures at approximately 4,500 hospitals nationwide.

    “This year’s America’s Best Hospitals list gives patients a clearer picture of where high-quality care is delivered most consistently,” Dr. Alana Biggers, medical advisor at Healthgrades, said in a written statement.

    Dr. Ilseung Cho, chief quality officer for NYU Langone Health, highlighted the health system’s approach to providing care.

    “NYU Langone Health has consistently provided our patients with one high standard of care across all of our locations, delivering the best outcomes in a system with the lowest mortality rate in the country among comprehensive academic medical centers,” Cho said in a written statement. “This recognition is another validation of the fantastic work performed by our exceptional teams, who have developed trust and confidence in so many communities that have selected NYU Langone as their trusted healthcare provider.”

    Mather President Kevin McGeachy described the hospital’s patient care, safety and clinical quality following the recognition.

    “This recognition is not just an award; it’s a testament to the fact that Mather consistently delivers top-tier patient care, safety, and clinical excellence across the board,” Mather President Kevin McGeachy said in a written statement. “Four years of consecutive recognition is only possible due to our exceptionally dedicated staff who continuously provides compassionate, high-quality care.”

    Healthgrades’ full list is available here.


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    Adina Genn

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  • UC registered nurses ratify contract that guarantees a minimum 18.5% increase in pay

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    Registered nurses who work at 19 University of California facilities have ratified a new contract after voting concluded Saturday.

    The contract will cover some 25,000 registered nurses and includes protections to improve patient safety and nurse retention through Jan. 31, 2029, according to the California Nurses Assn.

    The pact includes a minimum 18.5% increase in pay, caps on healthcare increases, restrictions on UC floating RNs between facilities, improvements to meal and rest breaks and workplace violence-prevention policies, the association said.

    “University of California RNs organized for and won important patient protections at the bargaining table, like curbing the rampant misuse of floating and ensuring safeguards on artificial intelligence,” said Kristan Delmarty, an RN and member of the UC bargaining team.

    “As a result of the commitment of all CAN members, we won a contract that will improve outcomes for nurses and our patients,’’ said Marlene Tucay, an RN at UC Irvine and member of the bargaining team.

    Under the contract, RNs were guaranteed a central role in selecting, designing and validating new technology, including AI systems, the CNA stated.

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    City News Service

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  • HHS moves to shut down major organ donation group in latest steps to reform nation’s transplant system

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    As part of its efforts to strengthen the country’s organ transplant system, the U.S. Department of Health and Human Services says it is moving to decertify a major organ procurement organization – essentially shutting it down and removing it from the nation’s network of organ donation groups.HHS Secretary Robert F. Kennedy Jr. called the move a “clear warning” to other groups that also work to coordinate organ donations.HHS officials are moving to close the Life Alliance Organ Recovery Agency, a division of the University of Miami Health System, after an investigation uncovered unsafe practices, staffing shortages and paperwork errors, Kennedy said Thursday.“We are acting because of years of documented Patient Safety Data failures and repeated violations of federal requirements, and we intend this decision to serve as a clear warning,” he said.The Life Alliance Organ Recovery Agency is one of 55 organ procurement organizations that are federally designated nonprofits responsible for managing the recovery of organs for transplantation in the United States, in which they focus on specific geographic regions and work with hospitals.The Association of Organ Procurement Organizations (AOPO) said in a statement Thursday that the Life Alliance Organ Recovery Agency serves 7 million people across six counties in South Florida and the Commonwealth of the Bahamas.“Through this process, AOPO pledges that we and our members will keep saving lives nationwide. We will continue to support the team at Life Alliance to ensure South Florida organ donors, transplant patients and their families have access to organ donation and transplantation services,” AOPO President Jeff Trageser said in a statement, while thanking federal health officials for recognizing the importance of organ donation.“Because there is only one OPO per donation service area, it’s critical for CMS/HHS to manage the situation carefully and work with Life Alliance, hospitals & the wider donation community to ensure there are no lapses in donation during this process so lives can continue being saved,” he added in an email.There is a process by which the Life Alliance Organ Recovery Agency could appeal the decertification. Neither the organization nor the University of Miami Health System immediately responded to CNN’s request for comment.“The Life Alliance Organ Recovery Agency based in Miami, Florida, has a long record of deficiencies directly tied to patient harm,” Kennedy said Thursday.“Staffing shortfalls alone may have caused – it was a 65% staffing shortage consistently across the years – and may have caused as many as eight missed organ recoveries each week, roughly one life lost each day,” he said. “Our goal is clear: Every American must trust the nation’s organ procurement system. We will not stop until that goal is met.”Kennedy also plans to direct organ procurement organizations to appoint full-time patient safety officers to monitor safety practices, report incidents and ensure that corrective actions are implemented, among other responsibilities.“This officer will be responsible for coordinating responses across clinical operational teams, ensure compliance with federal priorities and take corrective action whenever patients are at risk,” Thomas Engels, administrator of the federal Health Resources and Services Administration, said Thursday.These moves are part of an ongoing initiative to reform the organ transplant system after a federal investigation earlier this year found what Kennedy called “horrifying” problems, including medical teams beginning the process of harvesting organs before patients were dead.‘We are sending a tough message’Each year in the United States, more than 28,000 donated organs go unused and are discarded because of inefficiencies in the system, Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said Thursday.“We are sending a tough message to all the other nonprofit organ procurement agencies, organizations, so they know we’re serious,” Oz said. “We want them to know there’s a new sheriff in town, and we’re coming for them if they don’t take care of the American people.”Organ transplant programs are certified under the Centers for Medicare & Medicaid Services, and they must meet certain requirements to be approved by Medicare.“We’re going to crack down on noncompliance with Medicare requirements,” Oz said, adding that more action could be coming.“We’re going to be tougher than ever before, because if we lose trust in the organ transplantation system of this country, tens of thousands of people are going to die yearly whose lives could be saved,” he said.Public trust of the organ donation system is essential since the system relies on people to volunteer to donate their organs when they die. Most sign up when they’re getting their driver’s license.As of 2022, about 170 million people in the U.S. have signed up to donate their organs, but there is always more demand than there are organs available.Last year, there were more than 48,000 transplants in the U.S., but more than 103,000 people were on waiting lists. About 13 people in the United States die every day waiting for a transplant, according to the Health Resources and Services Administration.Investigations into organ procurementIn July, HHS announced its intention to fix the nation’s organ donation system. The agency directed the Organ Procurement and Transplantation Network, the public-private partnership that runs the complex donation system in the United States, to improve safeguards and monitoring at the national level and to find ways to strengthen safety protocols and transparency.An investigation by the Health Resources and Services Administration – detailed in a hearing in July and a memo from March – found problems with dozens of transplant cases involving incomplete donations, when an organization started the process to take someone’s organs but for, some reason, the donation never happened.The cases were managed by a procurement organization that handles donations in Kentucky and parts of Ohio and West Virginia; formerly called Kentucky Organ Donor Affiliates, it has merged with another group and is now called Network for Hope.Network for Hope said on its website in July, “We are equally committed to addressing the recent guidance from the HRSA and we are already evaluating whether any updates to our current practices are needed.”Of the 351 cases in the federal investigation, more than 100 had “concerning features, including 73 patients with neurological signs incompatible with organ donation,” HHS said in a July news release.The investigation was launched after one Kentucky case came to light during a congressional hearing last year. In that case, 33-year-old TJ Hoover woke up in the operating room to find people shaving his chest, bathing his body in surgical solution and talking about harvesting his organs. Staffers had been concerned that he wasn’t brain-dead, but the concerns were initially ignored, according to the federal investigation.Staff told CNN that the procedure to take Hoover’s organs stopped after a surgeon saw his reaction to stimuli.The federal investigation found “concerning” issues in multiple cases, including failures to follow professional best practices, to respect family wishes, to collaborate with a patient’s primary medical team and to recognize neurological function, suggesting “organizational dysfunction and poor quality and safety assurance culture” in the Kentucky-area organization, according to a federal report.Since the federal review, the Health Resources and Services Administration said, it has received reports of “similar patterns” of high-risk procurement practices at other organizations.

    As part of its efforts to strengthen the country’s organ transplant system, the U.S. Department of Health and Human Services says it is moving to decertify a major organ procurement organization – essentially shutting it down and removing it from the nation’s network of organ donation groups.

    HHS Secretary Robert F. Kennedy Jr. called the move a “clear warning” to other groups that also work to coordinate organ donations.

    HHS officials are moving to close the Life Alliance Organ Recovery Agency, a division of the University of Miami Health System, after an investigation uncovered unsafe practices, staffing shortages and paperwork errors, Kennedy said Thursday.

    “We are acting because of years of documented Patient Safety Data failures and repeated violations of federal requirements, and we intend this decision to serve as a clear warning,” he said.

    The Life Alliance Organ Recovery Agency is one of 55 organ procurement organizations that are federally designated nonprofits responsible for managing the recovery of organs for transplantation in the United States, in which they focus on specific geographic regions and work with hospitals.

    The Association of Organ Procurement Organizations (AOPO) said in a statement Thursday that the Life Alliance Organ Recovery Agency serves 7 million people across six counties in South Florida and the Commonwealth of the Bahamas.

    “Through this process, AOPO pledges that we and our members will keep saving lives nationwide. We will continue to support the team at Life Alliance to ensure South Florida organ donors, transplant patients and their families have access to organ donation and transplantation services,” AOPO President Jeff Trageser said in a statement, while thanking federal health officials for recognizing the importance of organ donation.

    “Because there is only one OPO per donation service area, it’s critical for CMS/HHS to manage the situation carefully and work with Life Alliance, hospitals & the wider donation community to ensure there are no lapses in donation during this process so lives can continue being saved,” he added in an email.

    There is a process by which the Life Alliance Organ Recovery Agency could appeal the decertification. Neither the organization nor the University of Miami Health System immediately responded to CNN’s request for comment.

    “The Life Alliance Organ Recovery Agency based in Miami, Florida, has a long record of deficiencies directly tied to patient harm,” Kennedy said Thursday.

    “Staffing shortfalls alone may have caused – it was a 65% staffing shortage consistently across the years – and may have caused as many as eight missed organ recoveries each week, roughly one life lost each day,” he said. “Our goal is clear: Every American must trust the nation’s organ procurement system. We will not stop until that goal is met.”

    Kennedy also plans to direct organ procurement organizations to appoint full-time patient safety officers to monitor safety practices, report incidents and ensure that corrective actions are implemented, among other responsibilities.

    “This officer will be responsible for coordinating responses across clinical operational teams, ensure compliance with federal priorities and take corrective action whenever patients are at risk,” Thomas Engels, administrator of the federal Health Resources and Services Administration, said Thursday.

    These moves are part of an ongoing initiative to reform the organ transplant system after a federal investigation earlier this year found what Kennedy called “horrifying” problems, including medical teams beginning the process of harvesting organs before patients were dead.

    ‘We are sending a tough message’

    Each year in the United States, more than 28,000 donated organs go unused and are discarded because of inefficiencies in the system, Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said Thursday.

    “We are sending a tough message to all the other nonprofit organ procurement agencies, organizations, so they know we’re serious,” Oz said. “We want them to know there’s a new sheriff in town, and we’re coming for them if they don’t take care of the American people.”

    Organ transplant programs are certified under the Centers for Medicare & Medicaid Services, and they must meet certain requirements to be approved by Medicare.

    “We’re going to crack down on noncompliance with Medicare requirements,” Oz said, adding that more action could be coming.

    “We’re going to be tougher than ever before, because if we lose trust in the organ transplantation system of this country, tens of thousands of people are going to die yearly whose lives could be saved,” he said.

    Public trust of the organ donation system is essential since the system relies on people to volunteer to donate their organs when they die. Most sign up when they’re getting their driver’s license.

    As of 2022, about 170 million people in the U.S. have signed up to donate their organs, but there is always more demand than there are organs available.

    Last year, there were more than 48,000 transplants in the U.S., but more than 103,000 people were on waiting lists. About 13 people in the United States die every day waiting for a transplant, according to the Health Resources and Services Administration.

    Investigations into organ procurement

    In July, HHS announced its intention to fix the nation’s organ donation system. The agency directed the Organ Procurement and Transplantation Network, the public-private partnership that runs the complex donation system in the United States, to improve safeguards and monitoring at the national level and to find ways to strengthen safety protocols and transparency.

    An investigation by the Health Resources and Services Administration – detailed in a hearing in July and a memo from March – found problems with dozens of transplant cases involving incomplete donations, when an organization started the process to take someone’s organs but for, some reason, the donation never happened.

    The cases were managed by a procurement organization that handles donations in Kentucky and parts of Ohio and West Virginia; formerly called Kentucky Organ Donor Affiliates, it has merged with another group and is now called Network for Hope.

    Network for Hope said on its website in July, “We are equally committed to addressing the recent guidance from the HRSA and we are already evaluating whether any updates to our current practices are needed.”

    Of the 351 cases in the federal investigation, more than 100 had “concerning features, including 73 patients with neurological signs incompatible with organ donation,” HHS said in a July news release.

    The investigation was launched after one Kentucky case came to light during a congressional hearing last year. In that case, 33-year-old TJ Hoover woke up in the operating room to find people shaving his chest, bathing his body in surgical solution and talking about harvesting his organs. Staffers had been concerned that he wasn’t brain-dead, but the concerns were initially ignored, according to the federal investigation.

    Staff told CNN that the procedure to take Hoover’s organs stopped after a surgeon saw his reaction to stimuli.

    The federal investigation found “concerning” issues in multiple cases, including failures to follow professional best practices, to respect family wishes, to collaborate with a patient’s primary medical team and to recognize neurological function, suggesting “organizational dysfunction and poor quality and safety assurance culture” in the Kentucky-area organization, according to a federal report.

    Since the federal review, the Health Resources and Services Administration said, it has received reports of “similar patterns” of high-risk procurement practices at other organizations.

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  • Experts available to discuss potential harm to patients from AI-based software in doctor’s offices

    Experts available to discuss potential harm to patients from AI-based software in doctor’s offices

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    In a new commentary published in the Journal of the American Medical Association (JAMA), University of Maryland School of Medicine faculty warn against the use of AI-driven software tools and other large language models to summarize patient medical data without proper review and oversight from the US Food and Drug Administration (FDA). Without proper regulation, the commentary authors say these new tools could lead to biased decision-making and misdiagnosis. That could lead to severe harm to patients.

    Katherine Goodman, PhD, JD, Assistant Professor of Epidemiology and Public Health at UMSOM, Core Investigator at the University of Maryland Institute for Health Computing (UM-IHC) and lead author of the opinion, along with her colleagues point out that there are currently “no comprehensive standards for large language model-generated clinical summaries beyond the general recognition that summaries should be consistently accurate and concise.” They add that the FDA’s “final guidance for clinical decision support software – published two months before ChatGPT’s release – provides an unintentional ‘roadmap’ for how large language models can avoid FDA medical device regulation”.

    Dr. Goodman and Daniel Morgan, MD, MS, Professor of Epidemiology and Public Health and senior author on the commentary, are available for interviews to discuss concerns about how AI software tools could lead to narrative errors and bias in a patient’s electronic health record and recommendations to improve these tools.

    To request an interview, please contact UMSOM media relations.

    Full commentary can be found here. 

     

    MEDIA CONTACTS:

    Holly Moody-Porter

    Senior Media & Public Relations Specialist

    University of Maryland School of Medicine

     

    Deborah Kotz

    Senior Director of Media Relations

    University of Maryland School of Medicine



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    University of Maryland School of Medicine

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  • From Lecture to Dialogue: How Brief Training Improves Med Students’ Communication

    From Lecture to Dialogue: How Brief Training Improves Med Students’ Communication

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    Newswise — (Boston)—Teaching is an integral communication skill central to the practice of medicine. The art of teaching extends beyond disseminating information. The skill directly translates to health provider-patient communication, the success of which is positively correlated with improved patient outcomes.

     

    “Teaching is a large part of medicine – patient education is critical to providing high quality patient centered care. Education helps patients understand the ‘why’ and ‘what’ of their treatments and allows them to be better participants in their own care, and in shared decision making,” said author Susan White, MD, assistant professor of obstetrics & gynecology at Boston University Chobanian & Avedisian School of Medicine.

     

    In an effort to foster near-peer inter-professional teaching and teamwork, the school has developed a curriculum using medical students as teaching assistants, called Educational Fellows, to work with students studying to become physician assistants (PA).

     

    “Our Educational Fellows curriculum allows medical students to learn the art of teaching (pedagogy) and learning theory and to practice what they had learned in working with PA students in the classroom,” explains White, who also is director of the Physician Assistant  program at the school. “We expect that the Educational Fellow experience will make those medical students better prepared for patient education.”

     

    White and her colleagues present their experiences and lessons learned from establishing this program that 1) introduces select medical students to PA students in the context of a near-peer teaching framework during pre-clinical training; 2) trains the medical students in best practices of teaching and learning; and 3) provides an additional source of instructors for basic science courses.

     

    White believes the program could be modified for other training programs that use peer-peer or near-peer teaching for tutoring or as teaching assistants. For example, PA students might work with students in nursing or physical therapy to provide tutoring or assistance in lab setting, or PhD graduate students might be teaching assistants for undergraduate courses. He hopes that all graduate level programs in medicine will adopt the curriculum to better prepare their graduates to teach and educate their patients, whether it be bedside nurses teaching patients home care skills or surgeons explaining a complex procedure.

     

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    Boston University School of Medicine

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  • Analysis Group Researchers Evaluated Long-Term Patient Experience with Dupilumab Using Groundbreaking Method for Generating Real-World Data

    Analysis Group Researchers Evaluated Long-Term Patient Experience with Dupilumab Using Groundbreaking Method for Generating Real-World Data

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    Newswise — BOSTON, Dec. 12, 2023 /PRNewswire/ — Researchers from Analysis Group, a global leader in health economics and outcomes research (HEOR), have coauthored a follow-up analysis of patient-reported outcomes (PROs) that evaluated outcomes three years after initiation of dupilumab among adults with atopic dermatitis (AD). The study, published in the journal Dermatology and Therapy, extends the one-year results of the previously published RELIEVE-AD study in JAMA Dermatology, which was based on a groundbreaking method for generating real-world data (RWD).

    The study methodology, Longitudinal Surveys of Patients with Recruitment Through Patient Support Programs (LEAP), represents an advance over other RWD approaches, as it engages patients in patient support programs from the time of treatment initiation and tracks individual patient responses to follow-up surveys administered at pre-defined time intervals. This approach provides a true baseline against which to compare longitudinal data over time. This latest edition of the study provides RWD generated through an online survey given at 30–36 months after initiation of treatment, adding to the existing body of data collected at one, two, three, six, nine, and 12 months.

    “Generating real-world data is particularly challenging for conditions like atopic dermatitis that require long-term therapy extending beyond the initial study period. For such chronic conditions, it is important to determine whether long-term treatment creates sustained benefits from the patient’s perspective,” said the study’s senior author, Dr. Alexa B. Kimball, President and CEO at Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center and Professor of Dermatology at Harvard Medical School. “With the LEAP methodology, we were able to effectively identify and evaluate flare-ups, fluctuations in symptoms, and a host of other invaluable RWD points tied to a true baseline with impressive patient participation and, over time, retention.”

    “While clinical trials remain the gold standard for product approval, they are widely recognized as  lacking the type of RWD that regulators, payers, clinicians, and patients want, or require, after a drug’s approval,” said study investigator Min Yang, Vice President at Analysis Group. “LEAP was created to address this problem by generating patient-centric data early after a launch, grounded by a baseline tied to the clinical trial with the ability for longitudinal follow-up and strong retention rates. It’s exciting to be at the forefront of efforts to fill such an important gap, along with Sanofi and Regeneron HEOR researchers, and the clinical experts who were so integral to the success of the LEAP approach.”

    While the methodology, first published in 2021 by JAMA Dermatology following rigorous peer review, was used to better understand patient outcomes with dupilumab – a monoclonal antibody used to treat diseases such as uncontrolled moderate-to-severe AD, certain types of uncontrolled moderate-to-severe asthma, and inadequately controlled chronic rhinosinusitis with nasal polyposis – LEAP is widely applicable across many diseases and condition types.

    “Collecting and synthesizing RWD to generate high-quality evidence is a complex and challenging process, especially when regulators, payers, and clinicians are interested in patient-reported outcomes about diseases and associated therapies,” commented coauthor Eric Q. Wu, Managing Principal at Analysis Group. “Leveraging manufacturers’ programs, such as patient support programs, has proven to be a breakthrough solution for generating early and long-term high-quality RWD.”

    The study, “Long-Term Effectiveness of Dupilumab in Patients with Atopic Dermatitis: Results up to 3 Years from the RELIEVE-AD Study,” was published in August by Dermatology and Therapy. In addition to Dr. Kimball, Dr. Yang, and Dr. Wu, investigators included Dr. Bruce Strober of the Yale School of Medicine; Manager Bruno Martins of Analysis Group; Gaëlle Bégo-Le-Bagousse, Chien-Chia Chuang, and Debra Sierka of Sanofi; and Zhixiao Wang, Brad Shumel, Jingdong Chao, and Dimittri Delevry of Regeneron Pharmaceuticals. Funding was provided by Sanofi and Regeneron.

    To learn more about Analysis Group’s HEOR capabilities, visit www.analysisgroup.com/healthoutcomes. 

    About Analysis Group’s HEOR, Epidemiology & Market Access Practice
    Founded in 1981, Analysis Group is one of the largest international economics consulting firms, with more than 1,200 professionals across 14 offices. Analysis Group’s health care experts apply analytical expertise to health economics and outcomes research (HEOR), clinical research, market access and commercial strategy, and health care policy engagements, as well as drug safety-related engagements in epidemiology. Analysis Group’s internal experts, together with our network of affiliated experts from academia, industry, and government, provide our clients with exceptional breadth and depth of expertise and end-to-end consulting services globally.

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  • ASH: Novel combination therapy significantly reduces spleen volume in patients with myelofibrosis

    ASH: Novel combination therapy significantly reduces spleen volume in patients with myelofibrosis

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    Newswise — SAN DIEGO ― Combining the JAK inhibitor ruxolitinib with the BCL-xL inhibitor navitoclax was twice as effective in reducing enlarged spleens – a major indicator of clinical improvement – compared with standard-of-care ruxolitinib monotherapy for adult patients with intermediate or high-risk myelofibrosis, a rare bone marrow cancer, according to results of the Phase III TRANSFORM-1 trial reported by researchers from The University of Texas MD Anderson Cancer Center.

    Data from the global, randomized, placebo-controlled clinical trial were presented today at the 2023 American Society of Hematology (ASH) Annual Meeting by Naveen Pemmaraju, M.D.,  professor of Leukemia. At the time of data cut-off, 63.2% of patients who received ruxolitinib and navitoclax achieved a spleen volume reduction of at least 35% within 24 weeks, compared to 31.5% of patients receiving ruxolitinib plus placebo, meeting the study’s primary endpoint.

    “By adding a second drug to an approved therapy, we were able to improve spleen volume reduction compared to the current standard of care. This is an important measurement of the clinical benefits of this novel drug combination because treatments can be less effective when the spleen remains enlarged,” Pemmaraju said. “If we can treat myelofibrosis earlier on in the disease course, we may have an opportunity to impact overall disease modificationimprove patient outcomes and reduce symptom burden.”

    Currently, there are few Food and Drug Administration-approved drugs for the treatment of myelofibrosis. Available options provide patients with spleen and symptom improvement, but a substantial unmet need remains for therapies that provide durable spleen size reduction and other longer-term clinical. Allogenic stem cell transplants are an effective treatment option, but not all patients qualify.

    This international trial enrolled 252 patients with intermediate or high-risk myelofibrosis and measurable spleen enlargement who had not received prior JAK inhibitor treatment. The trial randomized 125 patients to receive the navitoclax and ruxolitinib combination and 127 patients to receive ruxolitinib plus placebo. Most patients were male (57%) and the median age was 69.

    The trial met its primary endpoint of spleen volume reduction at 24 weeks. Spleen volume reduction at any time was achieved by 77% of patients on the combination arm and 42% of patients on the control arm. The median time to first spleen volume reduction response was 12.3 weeks with the combination and 12.4 weeks with monotherapy. At 24 weeks, there were no significant differences between the groups in a myeloproliferative neoplasm symptom assessment, a secondary endpoint of the study.

    Patients treated with the combination therapy, patients experienced side effects that were manageable and consistent with previous trials. The most common treatment-related side effects were thrombocytopenia, anemia, diarrhea and neutropenia. Serious adverse events were experienced by 26% of patients on the combination arm and 32% on the control arm.

    “This study marks a notable achievement in the field of myelofibrosis, as one of the first reported global Phase III frontline randomized combination clinical trials in our field,” Pemmaraju said. “This dataset now opens the door for additional research and investigation into combination therapies to treat myelofibrosis and, importantly, highlights a potential new era of investigating disease modification for patients. Additional data from the TRANSFORM-1 study is being evaluated.”

    The trial was funded by AbbVie. Pemmaraju receives research support from AbbVie. A full list of co-authors and their disclosures may be found here.

    Read this press release in the MD Anderson Newsroom.

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    University of Texas MD Anderson Cancer Center

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  • ASH: Novel menin inhibitors show promise for patients with advanced acute myeloid leukemias

    ASH: Novel menin inhibitors show promise for patients with advanced acute myeloid leukemias

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    Newswise — Two clinical trials led by researchers from The University of Texas MD Anderson Cancer Center demonstrated early positive results from novel therapies targeting menin for the treatment of relapsed or refractory acute leukemias with specific genetic alterations. Results from the studies were shared today in oral presentations at the 2023 American Society of Hematology (ASH) Annual Meeting. More information on all ASH Annual Meeting content from MD Anderson can be found at MDAnderson.org/ASH.

    Menin inhibitor monotherapy reduces disease burden in majority of relapsed or refractory acute leukemia patients (Abstract 57) According to data from a Phase I trial led by Elias Jabbour, M.D., professor of Leukemia, the menin inhibitor JNJ-75276617 showed early clinical activity in patients with relapsed or refractory acute leukemias and genetic alterations in KMT2A or NPM1, which are associated with poor clinical outcomes.

    Among 66 patients able to be evaluated after one month of treatment, JNJ-75276617 monotherapy reduced bone marrow disease burden in 71%, and 33 of those patients had a decrease in bone marrow blasts of more than 50%. Median time to first response was less than two months. Similar response rates were observed across patient groups with both genetic alterations.  

    “Patients with relapsed or refractory leukemias and KMT2A or NPM1 alterations often do poorly on currently available therapies, so there is a need to advance more effective options,” Jabbour said. “We are encouraged by the antileukemic activity of this monotherapy, which mimics what we saw in the preclinical setting.”

    In the multi-center clinical trial, researchers took a stepwise approach in evaluating the safety and efficacy of JNJ-75276617, a potent and selective inhibitor of the interaction between the scaffolding protein menin and the methyltransferase KMT2A. Eighty-six patients who had acute leukemias with NPM1 & KTM2A genetic alterations were included in the trial.

    Patients received the therapy orally on a 28-day cycle. Fifty-six percent of evaluable patients had AML with KMT2A alterations and 43% of evaluable patients had NPM1 alterations. The median age of trial participants was 63 years, while the median number of prior therapies was two.

    Differentiation syndrome was the most common side effect in patients, but was overcome with step-up dosing. The trial is ongoing to determine the recommended Phase II dose.

    The trial is sponsored by Janssen Pharmaceuticals. A complete list of collaborating authors and their disclosures can be found with the abstract.

    Oral therapy combination shows promising results for advanced acute leukemias (Abstract 58) The Phase I/II SAVE trial, led by Ghayas Issa, M.D., assistant professor of Leukemia, combined the menin inhibitor revumenib with venetoclax and hypomethylating agent ASTX727, yielding encouraging responses in adult and pediatric patients with relapsed or refractory advanced acute myeloid leukemia (AML) with KMT2A or NUP98 rearrangements or NPM1 mutations.

    The overall response rate among nine evaluable patients was 100%. Three patients achieved complete remission, one patient achieved complete remission with partial hematologic recovery, and three patients had complete remission with incomplete platelet count recovery. In addition, one patient had a partial response and one had a morphologic leukemia-free state. Measurable residual disease was undetectable in six of the patients. 

    “These advanced and acute leukemias often are very difficult to treat and currently have no approved targeted therapies. We believe these early results suggest this treatment will be highly effective in advanced leukemias,” Issa said. “This is our first look at an entirely oral combination therapy using menin inhibitors, and the results are very encouraging. If sustained in further trials, this could lead to a change in the standard of care for this patient population, with great potential to improve their quality of life.”

    Revumenib is a potent, oral, selective inhibitor of the menin-KMT2A interaction. To date, nine patients aged 12 years and older have been enrolled in the trial. Of those, five patients had KMT2A rearrangements, three had NUP98 rearrangements and one had mutant NPM1. On average, patients had received three prior lines of therapy.

    Side effects were manageable and consistent with previous studies. The trial is ongoing, with plans to establish the recommended Phase II dose and optimize delivery of the combination before enrolling patients in the Phase II cohort.

    This investigator-initiated study was supported by Syndax and Astex. A complete list of collaborating authors and their disclosures can be found with the abstract.

    Read this press release in the MD Anderson Newsroom.

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  • Advances in Knee Replacement Surgery Enable More Patients to Go Home the Same Day

    Advances in Knee Replacement Surgery Enable More Patients to Go Home the Same Day

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    Newswise — Knee replacement surgery in the morning, and back home that evening? Many patients are surprised to learn it is an option. Forgoing a night in the hospital has become increasingly common, and improvements in knee replacement technology, surgical technique and pain management make it possible, says Martin W. Roche, MD, an orthopedic surgeon and director of joint replacement at HSS Florida in West Palm Beach.

    Many patients are pleased to spend the first night after surgery in the comfort of their own home, he says. “We’ve come a long way in terms of being able to get people up and out of the hospital quickly, and that motivates them mentally, as well,” he explains.

    Dr. Roche points to advances over the past five years or so that benefit patients and can lead to a faster recovery: a CT scan before surgery to create a 3D model of the patient’s knee to plan a highly personalized procedure; the use of surgical robotics and sensors that allow for a high degree of precision and accuracy; less invasive, muscle-sparing surgery performed with smaller incisions; and a program called “pre-habilitation,” in which patients begin physical therapy to get stronger prior to knee replacement.

    A longer-lasting regional nerve block and a technique known as multimodal analgesia result in better pain control after surgery − another advantage for patients wishing to leave the hospital the same day, according to Dr. Roche. The technique uses various medications that target multiple pain pathways, as needed, and generally lessens the need for opioid medications.

    The best candidates for outpatient knee replacement are highly motivated individuals in good general health who have the right home environment, including support from family, a friend or a caregiver. 

    Seventy-three-year-old Robert Fleetwood fit the bill. He was motivated to have joint replacement in both knees not only to relieve arthritis pain, but to get back to the athletic activities that were once his passion. He said he was happy to learn he was a candidate for ambulatory surgery. He had two knee replacements several months apart last year and each time went home the same day.

    Dr. Fleetwood, who lives in Stuart, says it changed his life. This year, he participated in a 1K Navy SEAL memorial open water swim, competing with many people half his age. He came in second out of participants ages 60 and up, and 30th out of about 150 swimmers. He is also back to running for exercise for the first time in more than 20 years.

    Dr. Fleetwood, who has a PhD in clinical and industrial organization psychology, travels to Atlanta about 12 times a year for work. Before the knee replacements, he dreaded all the walking at the airport. He is thrilled that he can now travel pain-free.

    “It changes your perspective on life. It makes you feel so much more alive and dynamic when you’re not living with chronic pain that becomes debilitating,” he explains. “I’m very happy now.” 

    About HSS

    HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 14th consecutive year), No. 2 in rheumatology by U.S. News & World Report (2023-2024), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

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  • Cardiologists Dr. Carlos Ince and Dr. Kate Elfrey of The Heart Center at Mercy are Featured Guests for the November 2023 edition of “Medoscopy”

    Cardiologists Dr. Carlos Ince and Dr. Kate Elfrey of The Heart Center at Mercy are Featured Guests for the November 2023 edition of “Medoscopy”

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    Newswise — (Baltimore, MD) – Carlos Ince, M.D., FACC, board certified in Adult Cardiovascular Disease, and M. Kate Elfrey, D.O., board certified by the American Osteopathic Board in Cardiology and Internal Medicine, are the featured guests on Mercy Medical Center’s monthly talk show, “Medoscopy,” airing Wednesday and Thursday, Nov. 15th and 16th at 5:30 p.m. EST (www.facebook.com/MercyMedicalCenter).

    Both Drs. Ince and Elfrey see patients at The Heart Center at Mercy, which specializes in the diagnosis, treatment and prevention of heart disease including coronary artery disease (CAD), heart attack and high blood pressure.

    A 30-minute pre-taped program exploring the background and lives of Mercy clinicians, patients and others, Medoscopy was launched in spring 2021 and airs in two 15-minute segments. To view past episodes, visit the Medoscopy playlist on the Mercy Medical Center YOUTUBE channel.

    Dr. Ince explained his work with the Association of Black Cardiologists and efforts to address the ongoing issue of racial disparity in medicine. Dr. Elfrey noted how medicine for her is a family affairs, as her father, Stephen J. Plantholt, M.D., FACC, is not only a cardiologist as well, but is her colleague at The Heart Center at Mercy.

    Medoscopy is filmed on the campus of Mercy Medical Center in downtown Baltimore with video, sound, and lighting by Zinnia Film. 

    Founded in 1874 by the Sisters of Mercy, Mercy Medical Center is located in downtown Baltimore City, about six blocks from Baltimore’s famed Inner Harbor. A university-affiliated teaching facility, Mercy is a Catholic hospital with a national reputation for women’s health care, orthopedics, and other specialties. Mercy is home to the renowned Weinberg Center for Women’s Health & Medicine, and the $400+ million Mary Catherine Bunting Center. For more information, visit www.mdmercy.com, and MDMercyMedia on Facebook and Twitter, or call 1-800-M.D.-Mercy.

    -30-

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  • MD Anderson announces Institute for Data Science in Oncology to advance mission to end cancer

    MD Anderson announces Institute for Data Science in Oncology to advance mission to end cancer

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    Newswise — HOUSTON ― The University of Texas MD Anderson Cancer Center today announced the launch of its Institute for Data Science in Oncology (IDSO), which integrates the most advanced computational and data science approaches with the institution’s extensive scientific and clinical expertise to significantly improve patient’s lives by transforming cancer care and research.

    Bringing top data scientists from a variety of fields together with clinicians and cancer scientists, the institute builds on MD Anderson’s culture of collaboration and connectivity to tackle the field’s most pressing needs in new and innovative ways. IDSO’s efforts have been catalyzed by philanthropic and institutional support of more than $61 million, representing significant progress toward an initial fundraising goal of $100 million.

    “The answers to overcoming cancer are within our reach, and we owe it to our patients and their families to move beyond traditional approaches to find those answers quickly,” said David Jaffray, Ph.D., director of IDSO and chief technology and digital officer at MD Anderson. “The institute is changing the way we work, incorporating the next generation of computational approaches and team data science across MD Anderson. By making data part of every decision, we will ensure progress for our patients and their families at the pace needed to address the urgent problem of cancer.”

    MD Anderson generates an immense amount of data annually, including complex clinical information and expansive laboratory datasets. Building on the most advanced data and computational scientific methods available, IDSO is revolutionizing how the institution leverages data to fuel new discoveries, optimize the patient experience and personalize cancer care.

    “At MD Anderson, we are intimately familiar with the urgent needs and challenges facing our patients, and we will find the best solutions possible by unlocking the full power of the growing and increasingly complex data,” said Caroline Chung, M.D., director of Data Science Development and Implementation for IDSO and chief data officer at MD Anderson. “The institutional commitment to this effort enables us to build an unmatched oncology data ecosystem that fuels effective collaborations across MD Anderson and around the world.”

    Through its work, IDSO not only allows for better analysis of existing data but also changes how MD Anderson generates, collects and manages data. This comprehensive approach enables research and clinical teams to derive new and deeper insights that can be applied to accelerate drug discovery and development, to improve scheduling and access for patients, to enhance the safety and quality of care, and to allow for personalized treatment decisions based on results and predictions from diagnostic tests.

    “The Institute for Data Science in Oncology positions MD Anderson as a leader in data science for cancer care, discovery and clinical operations. Its innovative programs will be, in many cases, the first generation of data science applied to the challenge of ending cancer,” said Peter WT Pisters, M.D., president of MD Anderson. “The institute is a critical element of our institutional strategy, and it will transform how MD Anderson uses data to advance discoveries and make the greatest impact on humanity.”

    Teaming up on focused areas of opportunity

    The institute unites MD Anderson’s clinical and research communities in transformative data efforts, offering new opportunities for collaborations across the institution and with external researchers and industry colleagues. Located in the Texas Medical Center’s Helix Park and housed in the TMC3 Collaborative Building, IDSO brings together experts in medicine, science, academia and industry.

    Led by Jaffray and Chung, IDSO is engaging top data science experts to direct established focus areas. Current co-leads who already have joined IDSO include Bissan Al-Lazikani, Ph.D., professor of Genomic Medicine; Heiko Enderling, Ph.D., professor of Radiation Oncology; Jeffrey Siewerdsen, Ph.D., professor of Imaging Physics; and Yinyin Yuan, Ph.D., professor of Translational Molecular Pathology.

    IDSO is focused on five initial priority areas, selected based on alignment with clinical practice and the existing technology required for meaningful progress. These include:

    • Quantitative Analysis and Insights from Pathology and Medical Imaging
      Led by Chung and Yuan, this focus area is advancing automated tools and AI algorithms to tap into the information within medical imaging data, including radiology and pathology, creating tools to more rapidly diagnose and characterize cancer and to provide effective, predictive measures of treatment response to guide personalized treatments.
    • Multi-Cell Interactions Informed Through Single Cell Analytics and Data Science
      Aligning with MD Anderson’s strong basic science and bioinformatics community, IDSO is driving a deeper fundamental understanding of cancer biology to uncover new therapeutic opportunities. IDSO is collaborating with the James P. Allison Institute to strengthen data science capabilities in order to extract insights from the explosion of single cell and spatial transcriptomics data.
    • Computational Modeling for Discovery, Development and Optimization of Precision Medicine
      Led by Al-Lazikani and Enderling, this focus area is applying advanced computer modeling, novel AI techniques and digital twin approaches to discover, design and advance novel therapeutics and regimens. These efforts integrate with canSAR, the world’s largest public cancer drug discovery resource, now hosted at MD Anderson to benefit the research community worldwide.
    • Equitable Decision Analytics for the Health of the Person and Society
      IDSO is advancing data-driven, computationally informed approaches to support personal and societal decision making. By developing a more complete understanding of the multi-dimensional impact of cancer — personal, economic, and societal — we can explore innovations across the continuum of health to identify those with the greatest potential for impact.
    • Development of Automated Approaches to Increase Access, Safety and Quality
      Under the leadership of Siewerdsen, this focus area is building data-science expertise to optimize the patient experience for those seeking care at MD Anderson. Efforts include improving patient access, optimizing the quality of care, and maximizing the safety of our treatment environments.

    The institute continues to recruit top scientists from around the world and is training the next generation of pioneers in the field, creating a diverse and inclusive environment that facilitates seamless engagement with MD Anderson’s clinicians and researchers. The IDSO Fellows program, led by Christopher Gibbons, Ph.D., associate professor of Symptom Research, is designed to offer postdoctoral training opportunities for junior clinicians and researchers that will empower them to become leaders in data science for oncology.

    Together with Dan Shoenthal, chief innovation officer at MD Anderson, IDSO is engaging with leaders in the field to establish relationships that can advance priority initiatives, including ongoing initiatives with industry collaborators as well as The University of Texas at Austin Oden Institute for Computational Engineering and Sciences and the Texas Advanced Computing Center, Rice University and Break Through Cancer. 

    Philanthropic support accelerates the impact of data science

    Generous support from dedicated donors across the nation is accelerating the far-reaching, long-term possibilities of IDSO. Philanthropic investments enable the institute to hire and train exceptional talent and to rapidly build the necessary infrastructure to carry out its work, resulting in meaningful improvements for patients and their families.

    IDSO has received significant commitments from the Commonwealth Foundation for Cancer Research, Lyda Hill Philanthropies, the Hackett Family, the Laura and John Arnold Endowment and more, including an anonymous donor. Matching funds are expected from multiple organizations, including the Commonwealth Foundation.

    “The inspired actions of our donors speak volumes about the potential of this institute to make meaningful impacts on the next era of cancer research and care,” Jaffray said. “We are grateful for their boundless generosity and their dedication to our mission to end cancer.”

    Read this press release in the MD Anderson Newsroom.

    – 30 –

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  • Pathologic Scoring Shows Promise for Assessing Lung Tumor Therapy Response

    Pathologic Scoring Shows Promise for Assessing Lung Tumor Therapy Response

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    **EMBARGOED UNTIL 8 P.M. ET SATURDAY, NOV. 4**

    Newswise — A new pathologic scoring system that accurately assesses how much lung tumor is left after a patient receives presurgical cancer treatments can be used to predict survival, according to new research led by investigators at the Bloomberg~Kimmel Institute for Cancer Immunotherapy at the Johns Hopkins Kimmel Cancer Center and the Mark Foundation Center for Advanced Genomics and Imaging at the Johns Hopkins University.

    The study shows that pathologic assessment of residual viable tumor (RVT) in patients treated with immunotherapy and chemotherapy before lung cancer surgery provides a robust and efficient evaluation of patient treatment response that may be useful to guide patient therapy and predict survival. This latter finding supports pathologic evaluation of tumors as an early clinical trial endpoint and a surrogate of survival for potential accelerated regulatory approvals.

    The results were published on Nov. 4 in the journal Nature Medicine and simultaneously presented by senior study author Janis Taube, M.D., M.Sc., director of the Division of Dermatopathology at the Johns Hopkins University School of Medicine and a member of the Kimmel Cancer Center, at the Society for Immunotherapy of Cancer annual meeting in San Diego.

    Immunotherapies harness a patient’s immune system to target their tumors. These powerful drugs are often paired with conventional chemotherapies to help shrink a patient’s tumors before surgery, increasing the likelihood of successfully eliminating the cancer. To gauge treatment success, oncologists typically rely on radiologic imaging of the remaining tumor, but the results aren’t always as accurate in early-stage tumors as they are for more advanced cancers. More recently, circulating tumor DNA (ctDNA) clearance, which uses genetic sequencing to detect lung cancer-associated mutations in patient blood samples, has also shown promise, but is not yet widely available.

    For the new study, investigators performed a new analysis on data from the randomized, phase 3 CheckMate 816 study. That study found that treating presurgical non-small cell lung cancer patients with immunotherapy (nivolumab) plus chemotherapy improved event-free survival. This important surrogate endpoint can help predict long-term survival and pathologic complete response, which measures whether any tumor is left.

    “Most studies have focused on whether you have no tumor left or less than or equal to 10% of the tumor left, which is called a major pathologic response,” says lead study author Julie Stein Deutsch, M.D., an assistant professor of dermatology at Johns Hopkins.

    During the study, the investigators used a new approach, which measures residual tumor in patients who received neoadjuvant therapy, to predict outcomes in patients with a greater range of treatment responses. They used immune-related pathologic response criteria (irPRC) to look for pathologic changes that indicated the tumor had been present in the tissue before immunotherapy but was destroyed by the treatment, allowing them to measure what percentage of the tumor was left, or the RVT, ranging from 0% to 100%.

    As a result, they were able to separate patients into three groups based on how much tumor was left. In the future, data such as these may help guide the next round of clinical trials and ultimately help oncologists decide how to treat individuals in these subgroups, Deutsch says. For example, patients with no tumor left may be able to skip postsurgical immunotherapy or have a relatively limited amount, while individuals in the intermediate group may need to continue immunotherapy for longer. Those who showed a very limited response may need to switch to a new therapy or add a new therapy to their regimen. The team’s next steps will include identifying the most clinically meaningful cutoffs for RVT.

    They also looked beyond the primary tumor and used RVT to assess the immunotherapy effect on tumor in the lymph nodes, which showed additive value with the primary tumor for predicting survival. Long term, it may also be possible to strategically combine pathology, radiology and ctDNA results for the longitudinal monitoring of treatment efficacy.

    Already, the investigators demonstrated the pathologic scoring system can assess 10 types of tumors, including lung, skin and colorectal cancers, which could be another advantage over other tumor scoring systems.

    “The common features seen across these multiple tumor types means that pathologists don’t have to switch to different scoring systems for assessing pathologic response. This is similar to what already exists in radiology, where the RECIST system is used across all tumor types for determining objective response to therapy,” Taube says, noting that pathologists already are completing the necessary workflows as part of standard procedures when assessing surgically removed tumors. Assessing RVT is inexpensive and uses tools and supplies commonly used by pathologists, Deutsch says, which may also make it accessible for those working in low-resource settings.

    “It is important that as these immunotherapies move into clinical trials and become standard of care, pathologists worldwide have a standard scoring system for the assessment of treatment response,” Taube says. 

    Study co-authors were Ashley Cimino-Mathews, Elizabeth Thompson, Patrick M. Forde, Daphne Wang, Robert A. Anders, Edward Gabrielson, Peter Illei, Jaroslaw Jedrych, Ludmila Danilova and Joel Sunshine of Johns Hopkins. Other authors were from the Hospital Universitario Puerta de Hierro in Madrid, Spain; McGill University Health Center in Montreal, Canada; Institut du Thorax Curie-Montsouris in Paris, France; Aberdeen Royal Infirmary in the United Kingdom; Bristol Myers Squibb in Princeton, New Jersey; and Queen’s University in Kingston, Canada.

    The study was supported by Bristol Myers Squibb, Ono Pharmaceutical Company Ltd., the Bloomberg~Kimmel Institute for Cancer Immunotherapy, The Mark Foundation for Cancer Research and the National Institutes of Health (grant R01 CA142779).

    Deutsch is named on a patent for system and method for annotating pathology images to predict patient outcome (U.S. Provisional Patent Application 63/313,548, filed in Feb. 2022). Taube receives support for this study from Bristol Myers Squibb; receives consulting fees from AstraZeneca, Bristol Myers Squibb, Merck and Roche; participates on advisory boards from AstraZeneca; and is named on a patent for a machine learning algorithm for irPRC. These relationships are being managed by The Johns Hopkins University in accordance with its conflict-of-interest policies.

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  • Does Your Neighborhood Affect Your Care After a Stroke?

    Does Your Neighborhood Affect Your Care After a Stroke?

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    EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, WEDNESDAY, NOVEMBER 1, 2023

    Newswise — MINNEAPOLIS – People who live in neighborhoods with lower socioeconomic status are less likely to receive clot-busting medications or undergo clot-removing procedures after they have a stroke than people who live in neighborhoods with higher socioeconomic status, according to a study published in the November 1, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.

    “These treatments can greatly reduce death and disability from stroke, but previous studies have shown that few people actually receive the treatments,” said study author Amy Ying Xin Yu, MD, of the University of Toronto in Canada. “We wanted to see how socioeconomic disparities play a role, especially in an area where everyone has access to universal health care.”

    The study looked at all people living in Ontario, Canada, who had an ischemic stroke during a five-year period, for a total of 57,704 people. Ischemic stroke is caused by a blockage of blood flow to the brain and is the most common type of stroke.

    The study looked to see how many of those people were treated with clot-busting drugs or surgery to remove blood clots.

    Researchers also looked at participants’ neighborhoods and divided them into five groups based on their neighborhoods’ socioeconomic status, which was determined by factors such as the percentage of adults without a high school diploma, unemployment rate and income level.

    A total of 17% of those living in the neighborhoods with the lowest socioeconomic status were treated, compared to 20% of those living in the neighborhoods with the highest socioeconomic status.

    When researchers took into account other factors that could affect treatment, such as age, high blood pressure and diabetes, they found that people in the neighborhoods with the lowest socioeconomic status were 24% less likely to be treated than people in the neighborhoods with the highest socioeconomic status. There was no difference in treatment between the neighborhood with the lowest status and the middle three neighborhoods.

    “Our study underscores the need for tailored interventions to address socioeconomic disparities in access to acute stroke treatments, including educational and outreach programs to increase awareness about the signs and symptoms of stroke in various languages and efforts to distribute resources more equitably across neighborhoods,” Yu said. “Further research is needed to examine the specific causes of these disparities, so we can find ways to address the larger systemic issues that need to be improved to better serve people from under-resourced neighborhoods.”

    A limitation of the study was that researchers did not have information on other factors that could affect stroke treatment, such as the time symptoms started or how severe the stroke was.

    The study was supported by ICES, a health research institute in Ontario; the Heart and Stroke Foundation of Canada; PSI Foundation; and Ontario Health Data Platform.

    Learn more about stroke at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

    When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

    The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

    For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

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  • Wake Forest University School of Medicine Launches $100 Million Philanthropic Campaign for Research

    Wake Forest University School of Medicine Launches $100 Million Philanthropic Campaign for Research

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    Newswise — WINSTON-SALEM, N.C. – Nov. 1, 2023 – Wake Forest University School of Medicine and Atrium Health Wake Forest Baptist, the academic core of Advocate Health, are launching their largest campaign for research. Designed with health equity at the forefront, funds raised in this campaign will transform health care for patients, communities and the next generation of health care leaders by integrating research with clinical care while enhancing the speed with which new ideas move from research labs to patients’ bedsides and beyond.

    The campaign – called ENVISION, now in its public phase, will take place over the next two years. The goal is to raise at least $100 million to support research and accelerate the discoveries which provide hope and, ultimately, improved care.

    Philanthropic funds raised during the ENVISION campaign will support research throughout an individual’s lifespan with key focus areas in health equity; Alzheimer’s disease; cancer; cardiovascular disease; diabetes, obesity and metabolism; healthy aging and mobility; neurosciences; and regenerative medicine.

    “Our research and discoveries serve as a catalyst for improved patient care in the communities we serve and far beyond,” said Dr. Ebony Boulware, dean of Wake Forest University School of Medicine and chief science officer and vice chief academic officer of Advocate Health. 

    “Investing in this campaign today is an investment in the future of medicine,” said Dr. Julie Ann Freischlag, CEO and chief academic officer of Atrium Health Wake Forest Baptist, chief academic officer and executive vice president of Advocate Health and executive vice president for health affairs at Wake Forest University. “Through research, equipment, technology, community outreach and funding to support research, we will make new discoveries and translate those findings to the bedside to help patients have the best outcomes possible.”

    The ENVISION campaign provides opportunities to support research and the future of medicine from investing in startup research, upfitting research space and supporting student scholarship to endowing positions to further advance research and attract the best researchers and faculty members to Wake Forest University School of Medicine.

    Examples of philanthropic support include the Jarrahi Family Endowed Research Scholars Fund in Geroscience Innovation at Wake Forest University School of Medicine and a recent partnership with The Ambrose Monell Foundation.

    Dr. Ali Jarrahi, a retired psychiatrist, established a fund to support early-career, research-intensive faculty focused on geroscience, which is the study of the biology of aging and aging-related diseases. An initial emphasis of Jarrahi’s fund is on research into aging on a cellular level and Alzheimer’s disease.

    “It’s been a blessing to do,” Jarrahi said. “This was $1 million, and who knows what we might find out? The success of research is not always just in the amount of money. Young researchers have a lot of ideas and a lot of enthusiasm, but not always the funds and resources they need.”

    Maia Monell, with The Ambrose Monell Foundation and co-founder and chief revenue officer at Nav.it, recently supported the ENVISION campaign focusing on Wake Forest University School of Medicine’s Geroscience Healthspan Initiative. The Ambrose Monell Foundation focuses on early stage research and social initiatives that have the opportunity to build a more creative, equitable and innovative society.

    “We are thrilled to support the Geroscience Healthspan Initiative. We have a longstanding commitment to supporting initiatives that are working to advance medical breakthroughs,” said Maia Monell of The Ambrose Monell Foundation. “We profoundly believe in the power of geroscience and its potential to revolutionize our understanding of mortal diseases. By focusing on aging, we hope this work will start to better anticipate and potentially prevent conditions such as cancer, reaffirming our dedication to promoting longevity and health.”

    “We have all been impacted by research in some way and knowing we have teams of researchers here working on the future delivery of health care is part of who we are as the city of innovation,” said Winston-Salem Mayor Allen Joines. “The growth of the research established at Wake Forest University School of Medicine positively impacts our city, the communities of Advocate Health and, indeed, health care across the country.”

    “Philanthropic support allows research to happen at a faster pace, and we are grateful for the support of our region and beyond as we launch our ENVISION campaign,” said Lisa Marshall, chief philanthropy officer and vice president at Atrium Health Wake Forest Baptist.  “With the inspiring support from corporations, foundations and individuals across the country, we have successfully raised over $50 million of the $100 million goal in the campaign to date.

    Those who would like more information and would like to contribute to ENVISION may visit Giving.WakeHealth.edu/ENVISION or contact the Office of Philanthropy and Alumni Relations at 336-716-4589. 

     

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  • Older adults from distressed communities attend less cardiac rehab after heart procedures

    Older adults from distressed communities attend less cardiac rehab after heart procedures

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    BYLINE: Noah Fromson

    Newswise — Older adults who live in disadvantaged communities are less likely to attend cardiac rehabilitation after common heart procedures, a Michigan Medicine-led study finds.

    The study aimed to calculate how many Medicare beneficiaries attended cardiac rehabilitation, a medically supervised program exercise and education program, after coronary revascularization between mid-2016 and 2018.

    Patient communities were categorized using the Distressed Community Index, which analyzes economic well-being and social determinants of health, such as educational disparities and poverty rate, of United States zip codes.

    Only 26% of patients from distressed communities use cardiac rehab, compared to 46% of patients from areas deemed prosperous. Any patient who attended cardiac rehab, no matter where they lived, had a reduced risk of death, hospitalization and heart attack, according to results published in Circulation: Cardiovascular Quality and Outcomes.

    “Addressing barriers to participation in cardiac rehabilitation in distressed communities may improve outcomes for these patients and reduce longstanding disparities in such outcomes,” said first author Michael P. Thompson, Ph.D., assistant professor of cardiac surgery at University of Michigan Medical School.

    “While some individuals who face geographic barriers to participation may benefit from transportation services or virtual options for cardiac rehab, there is a critical need to address socioeconomic barriers that prevent so many patients from attending this lifesaving therapy.”

    Additional authors include, Hechuan Hou, Francis D. Pagani, M.D., Ph.D., Robert B. Hawkins, M.D., Devraj Sukul, M.D., and Donald S. Likosky, Ph.D., all of University of Michigan, James W. Stewart II, M.D., of Yale School of Medicine, and Steven J. Keteyian, Ph.D., of Henry Ford Health.

    This study was funded as part of a career development award Thompson received from the Agency for Healthcare Research and Quality (AHRQ, Grant no. 1K01HS027830).

    Paper cited: “Relationship Between Community-Level Distress and Cardiac Rehabilitation Participation, Facility Access, and Clinical Outcomes After Inpatient Coronary Revascularization,” Circulation: Cardiovascular Quality and Outcomes. DOI: 10.1161/CIRCOUTCOMES.123.010148

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  • Opioid use disorder treatment associated with decreased risk of overdose after surgery, suggests first-of-its-kind study of over 4 million surgeries

    Opioid use disorder treatment associated with decreased risk of overdose after surgery, suggests first-of-its-kind study of over 4 million surgeries

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    Newswise — SAN FRANCISCO — Although people with opioid use disorder (OUD) are significantly more likely to overdose or have a complication after major surgery than those without the disorder, using medications for the treatment of OUD before surgery may eliminate that extra risk, suggests a large, first-of-its-kind study presented at the ANESTHESIOLOGY® 2023 annual meeting.

    Patients with OUD who didn’t use an OUD medication (such as buprenorphine or methadone) were over four times more likely to overdose after having surgery, yet those who used evidence-based OUD medication before surgery were essentially at no greater risk than those who didn’t have OUD, according to the study. Taken orally, OUD medications reduce withdrawal and cravings and prevent opioids from producing the feeling of euphoria that drives addiction.

    “We know that OUD treatments are very effective in helping to prevent relapse, overdose and death in nonsurgical patients, but our research is the first to show that they also may be remarkably effective in at-risk patients facing surgical stress and recovery pain that often is addressed with opioids,” said Anjali Dixit, M.D., MPH, a pediatric anesthesiologist at Stanford University, California. “This is helping us learn more about how to optimally treat OUD patients so that their surgical and post-surgical pain is well-controlled, while also making sure we are minimizing their risk of relapse and overdose.”

    Researchers analyzed 4,030,032 surgeries performed between 2008 and 2020 from the Merative MarketScan Commercial Database, a nationwide sample of data from patients with both employer-sponsored and Medicare Advantage insurance. The analysis reviewed overdoses and other complications (such as OUD-related hospitalization or infection) that occurred in the three months after surgery for the 25 most common surgeries, including knee and hip replacement, hysterectomy and gallbladder removal.

    Of the over 4 million surgeries, 26,827 were performed on patients who had a history of OUD, 9,699 (36%) of whom used OUD medications in the month before surgery and 17,128 (64%) who did not. OUD patients who did not use OUD medications were 4.2 times more likely to overdose or have an OUD-related infection or hospitalization than those who did not have the disorder, according to the study. OUD patients who used OUD medications did not experience a statistically different risk of opioid-related adverse events compared to those who did not have the disorder.

    As many as 7.6 million people in the U.S. live with OUD, according to research, and that number continues to grow. Only 20% of people with OUD currently use OUD medications, said Dr. Dixit. She noted the number of people in the study who used OUD medications was likely higher, because they had access to commercial insurance and therefore, better access to care. The researchers also want to look at other populations such as those on Medicaid, because they may be sicker and have less access to care.

    “The national efforts to increase access to OUD medications is good news for people with OUD, including those who need surgery,” said Dr. Dixit. “The next step is to determine if a particular medication or regimen is better than another.”

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

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  • Anesthesiologist-led blood management programs save hospitals significant amounts of blood and reduce costs with same or better patient outcomes

    Anesthesiologist-led blood management programs save hospitals significant amounts of blood and reduce costs with same or better patient outcomes

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    Newswise — SAN FRANCISCO — Blood management programs that reduced or avoided transfusions saved a health system millions of dollars annually, with a return on investment of more than $7 for every dollar spent, while achieving the same or better outcomes, suggests research presented at the ANESTHESIOLOGY® 2023 annual meeting. 

    Over the past 10 years, the Johns Hopkins Health System established a comprehensive blood management program with two primary goals: 1) to reduce unnecessary transfusions across the five-hospital health system, and 2) to provide specialized care that avoids transfusions in patients who decline them. Together these efforts save blood and reduce costs, making more blood available for those who really need it, such as trauma patients. Transfusions are routinely used for emergencies and trauma, but also are needed in heart, transplant, hip or knee replacement, spine, vascular, liver and pancreatic surgery. Nonsurgical patients also need blood, for example those with cancer (leukemia, lymphoma), sickle cell anemia or gastrointestinal bleeding.

    “Since we are always dealing with blood shortages, doing more with less is critically important,” said Steven M. Frank, M.D., lead author of the study and professor in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins Medicine, Baltimore. “We like to say that blood saves lives when you need it, but only increases risks and costs when you don’t. Our results showed that a comprehensive blood management program can substantially help the bottom line — for every dollar spent, we received $7.50 in return.”

    Starting in 2012, two anesthesiologist-led, multidisciplinary blood management programs were run side by side. 

    • The Patient Blood Management Clinical Community program was designed to reduce unnecessary transfusions using several methods. The methods include evidence-based transfusion triggers, a “Why Give 2 When 1 Will Do?” single unit of blood transfusion campaign, and other anesthesiology-led before, during or after surgery measures of “keeping blood in the patient” such as using medications or intentionally lowering blood pressure to reduce bleeding and using smaller tubes to collect blood for lab tests. Over a 10-year period, the annual blood acquisition cost reduction was $2.9 million, a 10.9% decrease and a 9.6-fold return on investment.
    • The Center for Bloodless Medicine and Surgery program was designed to avoid transfusions entirely for those who don’t accept them, primarily Jehovah’s Witness patients. The program brings in revenue by attracting patients who are often turned down by other hospitals. Over 10 years, the program brought in approximately $5 million a year (after subtracting the direct cost of care), representing a 6.6-fold return on investment. 

    Clinical outcomes such as infection, blood clots, kidney injury, heart attack or stroke were the same before and after the Patient Blood Management Clinical Community program was instituted. Clinical outcomes were the same or better for the Center for Bloodless Medicine and Surgery program, as the incidence of hospital-acquired infection was significantly lower when transfusions were avoided. 

    “By reducing unnecessary medical procedures, we are actually doing more with less and providing higher value care,” said Dr. Frank. “Since clinical outcomes are either the same or better while giving less blood, the patients benefit from reduced risks and costs.”

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

     

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  • Two easy fixes could reduce bleeding after cesarean delivery

    Two easy fixes could reduce bleeding after cesarean delivery

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    Newswise — SAN FRANCISCO — Two simple solutions could help prevent severe bleeding (postpartum hemorrhage) after cesarean delivery, suggests research presented at the ANESTHESIOLOGY® 2023 annual meeting. As the leading cause of maternal mortality in the U.S. at the time of birth, postpartum hemorrhage is more common after cesarean deliveries than vaginal births.

    Both solutions help address uterine atony, which causes up to 80% of postpartum hemorrhage. Uterine atony is when, after delivery, the uterus remains soft and weak instead of contracting to compress the blood vessels that had been attached to the placenta. One solution involves infusing a medication to help the uterus contract after delivery. The other is an early warning system that prompts an assessment of how well the uterus is contracting after delivery to quickly alert the health care team when a woman is at risk for heavy bleeding and requires treatment.

    “Bleeding during a cesarean delivery is a high-stakes, high-risk situation, and when it occurs, the obstetrics and anesthesia teams must work together to rapidly prevent and treat ongoing bleeding,” said James Xie, M.D., lead author of the early warning study and clinical assistant professor of anesthesiology, perioperative and pain medicine at Stanford University, California. “Studies have shown that rapid recognition and management are essential to improving outcomes.”

    “The ultimate goal is to decrease maternal mortality and morbidity,” said Jessica Ansari, M.D., M.S., senior author for both studies and an obstetric anesthesiologist at Stanford University. “Recent estimates show a new mother dies of postpartum hemorrhage about every seven minutes, mostly in low-resource settings. If our findings can be confirmed in larger studies, it could transform the way we prevent and treat postpartum hemorrhage.”

    Calcium chloride infusion

    The researchers looked at using calcium chloride to help prevent bleeding in women with uterine atony because it is inexpensive, simple, safe and doesn’t require refrigeration like other treatments. Consequently, it can be used even in very low-resource settings, where women are much more likely to die from pregnancy-related bleeding. They found that calcium chloride reduced the amount of bleeding that patients experienced during their cesarean delivery by nearly a measuring cup (more than 200 mL).

    The double-blind, randomized, controlled trial included 120 women who required a cesarean delivery after labor with an oxytocin infusion (which increases contraction of the uterus during labor), placing them at much higher risk of suffering from uterine atony and bleeding after the birth. Researchers randomly assigned 60 women to receive 1-gram infusions of calcium chloride and 60 women to receive a placebo. The infusion was administered slowly after the baby was delivered, and the study was blinded, meaning the patients and their doctors were unaware if they received calcium or the placebo. Of the women who received the placebo, 57% had postpartum hemorrhage and 15% required a blood transfusion, while 40% of those who received calcium chloride had postpartum hemorrhage and 8.3% required a blood transfusion.

    The last Food and Drug Administration-approved drug to treat uterine atony was released in 1979.

    “New treatments to treat uterine atony are desperately needed,” said Alla Yarmosh, M.D., lead author of the study and clinical assistant professor in anesthesiology at Stanford University. “This is the first time an infusion of calcium chloride has been studied as a possible treatment to help the uterus contract after cesarean delivery and decrease bleeding in those patients. If our findings are confirmed by larger studies, it would be an easy technique for institutions to implement since anesthesiologists run infusions during surgery regularly.”

    Early warning system

    For the early warning study, researchers created an alert that pops up on the anesthesiologist’s electronic health record (EHR) module two minutes after the baby is marked as delivered, asking for a uterine score from 1-10. The anesthesiologist prompts the obstetrician to assess the uterine tone (by manually feeling it) and provide the score, which the anesthesiologist records. Scores of 6 or lower mean the uterus is not contracting well and the woman is at higher risk for postpartum hemorrhage.

    This real-time communication that a woman is at risk alerts the treatment team, which can then determine the best solution. Physicians can give the woman medications to help the uterus contract better or put stitches or balloons in the uterus to compress the vessels to prevent further bleeding, said Dr. Xie. They also can anticipate and prepare for hemorrhage, which can be addressed by giving the woman medications to stabilize blood clotting or ordering blood products to be ready for transfusion.

    The study assessed more than 1,000 consecutive cesarean deliveries by 70 different obstetricians over eight months. The uterine tone score was assessed three times for each patient and was documented reliably; two minutes after delivery (recorded 87% of the time), seven minutes after delivery (recorded 97% of the time), and 12 minutes after delivery (recorded 98% of the time). At 12 minutes, 179 women (18%) had scores of 6 or lower, meaning they were at higher risk for severe bleeding. Of those with scores of 6 or lower, 77% experienced hemorrhage, 46% experienced major hemorrhage and 25% needed a blood transfusion.

    “Our research shows that this simple scoring system is a very meaningful, easy way to ensure that if the uterus is contracting poorly and there is a risk of hemorrhage, it will be recognized by their health care team early,” said Dr. Xie. “In the future we can further refine models that predict when women are at high risk of bleeding around the time of delivery to help physicians be prepared to manage bleeding caused by poor uterine tone.”

    The United States has the highest maternal mortality rate among high-income countries.

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

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  • More Patients Go Home Instead of to Long-Term-Care Facility When Sedation for Common Procedures Is Administered or Directed by Anesthesiologist

    More Patients Go Home Instead of to Long-Term-Care Facility When Sedation for Common Procedures Is Administered or Directed by Anesthesiologist

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    Newswise — SAN FRANCISCO — Patients who had common procedures performed outside of the operating room (OR) were more likely to go home instead of to a long-term care facility when they were discharged from the hospital if their sedation was administered or directed by an anesthesiologist, rather than by a physician who is not a trained anesthesiologist, according to a first-of-its-kind study presented at the ANESTHESIOLOGY® 2023 annual meeting.

    Patients who need catheters placed in a vein, angiograms (X-ray of the blood vessels), image-guided biopsies and many other procedures typically are treated in the interventional radiology (IR) suite instead of the OR and given sedation. Sedation is a type of anesthesia that relieves anxiety, controls pain and discomfort, and sometimes makes them fall asleep. One in 10 patients admitted to the hospital requires an IR procedure and many are at increased risk for complications due to health issues or having more complex procedures.

    The study was the first to directly compare the hospital discharge outcomes of patients who received sedation administered by an anesthesiologist, or by a nurse anesthetist under the direction of an anesthesiologist, to the discharge outcomes of patients whose sedation was administered or directed by a physician who was not an anesthesiologist, such as a radiologist or cardiologist. Anesthesiologists are physicians who are experts in ensuring the safety and comfort of patients undergoing surgery and other procedures and are highly trained in critical care to manage medical emergencies if there is a complication. 

    “We focused on patients undergoing IR procedures as they often have health issues such as heart disease or diabetes and some of the procedures are high risk,” said Matthias Eikermann, M.D., Ph.D., senior author of the study and chair of the department of anesthesiology at Montefiore Medical Center, Bronx, New York. “We found anesthesiologists add value to patients undergoing interventional radiology procedures. That’s especially true for complex neurovascular procedures such as angiograms for the treatment of aneurysms or the creation of an arteriovenous (AV) fistula, a connection between an artery and a vein, for people on dialysis and those that typically take longer than an hour.”

    In the study, 9,682 patients had sedation in the IR suite and 1,639 (16.93%) were discharged from the hospital to a long-term care facility (such as a nursing home) because of complications that they may be more likely to experience due to their disease. Anesthesiologists have the training to identify these complications early and address them.

    Of those who were not discharged home, 1,429 (87%) had their sedation administered or directed by a physician who was not an anesthesiologist, often with the assistance of a nurse, and 210 (13%) had their sedation administered or directed by an anesthesiologist.

    “The anesthesiologist is not just providing sedation, but life support for the patient during the entire procedure,” said Dr. Eikermann. “The difference in outcomes is because anesthesiologists are trained to identify early complications and treat them immediately. Physicians who are not anesthesiologists are not trained to do that.”

    Anesthesiologists administered or directed sedation for higher-risk patients, such as those with more health issues or who had more invasive procedures. Despite being at higher risk, the patients who received sedation administered or directed by an anesthesiologist were nearly 70% more likely to be discharged home than those whose sedation was administered or directed by a physician who was not an anesthesiologist.

    “Increasingly, high-risk patients are undergoing procedures outside of the OR,” said Vilma Joseph, M.D., MPH, FASA, co-author of the study and director of procedural sedation at Montefiore Medical Center. “The presence of physician anesthesiologists as part of the anesthesia care team model has been associated with improved outcomes.”

    “Patients should know that they can ask for an anesthesiologist if they are concerned about excessive pain, anxiety or their safety during diagnostic procedures,” said Dr. Eikermann. “Our research suggests rethinking anesthesia assignments to ensure anesthesiologists provide sedation when patients are at higher risk due to their health or are having more complex, longer or more-invasive procedures.”

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

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  • 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

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    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.

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