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C-P.A.W.W. to study veterans and shelter dogs walking together

The Canines Providing Assistance to Wounded Warriors team (C-P.A.W.W.), a small nonprofit veterans’ health research initiative based at the University of Colorado College of Nursing at the Anschutz Medical Campus, recently received funding to conduct an innovative study to evaluate how shelter dogs physically and psychologically impact veterans with post-traumatic stress disorder.

Dr. Cheryl Krause-Parello, PhD, RN, FAAN
Dr. Cheryl Krause-Parello, PhD, RN, FAAN, Director of C-P.A.W.W.

A robustly developing body of work suggests that interacting with animals, particularly dogs, benefits human physiological and psychological health.

The research team will work with the WYCO Vet-to-Vet Alliance, a support and advocacy organization for veterans based in Fort Collins and embedded into to the local community, to reach out to area veterans for participation in this investigation.

“Our study’s findings have the potential to contribute physiological and psychosocial evidence indicating that volunteering at a dog shelter can decrease stress and enhance quality-of-life indicators in reintegrating veterans with PTSD,” said principal investigator Cheryl Krause-Parello, PhD, RN and associate professor at the CU College of Nursing. “This study may also give us some valuable insights regarding how shelter dogs themselves are impacted by being socialized with and exercised by veterans. In the future, this investigation could help shape the development of policies and volunteer programs at dog shelters implemented specifically for veterans coping with PTSD.”

Veterans in the study will walk shelter dogs at Animal House Rescue and Grooming in Fort Collins in an eight-week intervention aimed at reducing stress levels and improving psychological outcomes. Researchers will collect various measures of physiological stress from veterans, including heart rate variability, blood pressure and salivary cortisol and alpha amylase levels. Additionally, they will examine stress levels in the shelter dogs themselves by collecting the heart rate variability of the dogs involved in the study. Importantly, the investigation will examine the reciprocal nature of human-animal interaction and may help to uncover mechanistic underpinnings of the effects that interacting with canines have upon veterans coping with post-traumatic stress.

According to researchers, it is of particular relevance to consider the large number of shelter dogs in the United States in the context of the potential for these dogs to be a feasible, highly economical, unique resource and intervention that combines the benefits of human-animal interaction with the benefits of the altruistic action of volunteerism. This study may help to lay the groundwork for policy changes and future studies specifically examining the effects that psychiatric service dogs have upon veterans with post-traumatic stress.

The 18-month study is funded from an International Society for Anthrozoology/WALTHAM Collaborative Research grant. WALTHAM is the fundamental research center of Mars Petcare and for over 40 years has been supporting groundbreaking research that explores the special relationship between humans and companion animals.

The American Society for the Prevention of Cruelty to Animals estimates that 3.9 million dogs currently live in shelters nationwide. The United States is home to more than 21 million veterans. In Colorado alone there are more than 413,000 veterans. In recent years, the remarkable number of veterans returning home from Operation Iraqi Freedom and Operation Enduring Freedom has highlighted the vital need for developing and enhancing effective and consistent healthcare interventions for our service members, particularly with regard to post-traumatic stress.

Up to 30 percent of veterans struggle with post-traumatic stress, dependent upon deployment era. Nonresponse to current treatments is common, and the utilization of pharmacological interventions to ameliorate symptoms associated with post-traumatic stress has skyrocketed in recent years. The development of alternative or adjunctive treatment modalities for veterans coping with post-traumatic stress will be essential in order to generate personalized, feasible, and efficacious treatment plans that help to minimize stigma and optimize the ongoing process of reintegration for service members.

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CU Pre-Health Scholars Program’s Community Strengthening Project

CUPS high-school student
CUPS high school student

A select group of young adults with an interest in pursuing health careers receive an introduction to the many diverse opportunities available to them through the CU Pre-Health Scholars Program (CUPS) at the University of Colorado Anschutz Medical Campus in Aurora while they’re still in middle school and high school. The program often takes the students beyond the classroom into the community providing some highly impactful experiences. A Community Strengthening Project provided by the CUPS students to the Comitis Crisis Center near CU Anschutz, in conjunction with the CU Anschutz Medical Campus Office of Inclusion and Outreach, CU School of Dental Medicine’s American Student Dental Association Colorado Chapter, CU Skaggs School of Pharmacy and Pharmaceutical Sciences and Walgreens Pharmacy, included a pancake breakfast, along with free flu shots and take-care bags for center clients. The Comitis Crisis Center provides a safe shelter for individuals and families that find themselves homeless. In addition, the center offers visitors ways to rebuild their lives, support with family emergency housing shelter, daily meals, emergency cold weather shelter 24/7, mental health and substance abuse treatment.

The CUPS junior & senior high school students from around the Denver/Aurora metro area had the opportunity to serve pancakes, sausage, and orange juice to over 40 guests from the Comitis Crisis Center. CUPS participants played volleyball, football, and did crafts with the children.

A Walgreens pharmacist, along with two CU Pharmacy students, administered over 25 free flu shots to guests 7 years old or older.

CUPS high-school students
CUPS high school students
CUPS high-school students
CUPS high school students

Daisy Chapa, a senior from Overland High School and the CUPS class president, said, “It’s incredibly rare that students get an opportunity to sit down with homeless individuals and learn about their background and experiences.” The primary objective for the CUPS participants is to engage them in community service while learning more about the health disparities among the homeless population. In addition to flu shots and pancakes, CUPS participants gathered and donated hygiene items and created take-care bags for children, men, and women. Bags included items such as winter socks, feminine products, soap, lotion, toothbrushes and toothpaste.

Chapa continues, “I had envisioned middle-aged men with drug problems or mentally ill dependents; instead, we met families with tiny children and single parents. Some of these children were happy with their lives despite not having a home to live in or any material goods. They improvised with what they had and saw themselves as no less than anyone else, which is a mindset that even many grown adults fail to adapt to. Having the opportunity to meet with and interact with these individuals showed me to be grateful for what I have and, one day, I will work towards helping those who have fallen on hard times.”

CUPS Program Director Abenicio Rael said, “This was an eye opening experience for many of our students as well as our staff and myself. It reminded me of my own privileges and how to be aware of them before imposing them on others unconsciously.”

“The Anschutz Medical Campus Office of Inclusion and Outreach has done many wonderful things for my pre-collegiate group from exposing us to cadaver-based anatomy to professionalism in the academic world”, said Chapa. “But, the greatest thing they have ever done is remind us to be humble and human by not getting carried away with ignorance or selfishness. The pancake breakfast served as a reality check for some of us, for others, it was a reminder that we are all humans struggling to find one thing- happiness.”

Guest Contributor: Dominic F. Martinez, Ed.D., Senior Director of the CU Anschutz Medical Campus Office of Inclusion and Outreach

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Elaine Morrato named Interim Dean for Colorado School of Public Health

On December 5, CU Denver | Anschutz Provost Roderick Nairn announced Elaine Morrato, DrPh, MPH, CPH as interim dean of the Colorado School of Public Health. Morrato steps into the role following David Goff’s departure from the school and university in November to lead the Division of Cardiovascular Sciences for the National Heart, Lung and Blood Institute in Bethesda, Maryland. Morrato will guide the school through its transitionary period while the national search for a new dean is being conducted.

Elaine Morrato
Elaine Morrato

In an email to all ColoradoSPH students, faculty and staff, Morrato said, “I am extremely honored to have been appointed to this position, and look forward to working with you all in the months ahead. My mission will be to help the school continue to build on its current momentum, while also ensuring we are set up for a smooth handoff to new leadership.”

Many already know Morrato as ColoradoSPH’s Associate Dean for Public Health Practice, a role she assumed in June 2015. As Associate Dean, Morrato is a key member of the school’s executive leadership team as well as the school’s lead liaison working with all three of ColoradoSPH’s partner universities—the University of Colorado Anschutz Medical Campus, Colorado State University and University of Northern Colorado—to strengthen external partnerships and opportunities with regional public health and health systems communities across Colorado and into neighboring states.

She is also a member of the Executive Leadership Team for the Colorado Clinical and Translational Sciences Institute (CCTSI) at the University of Colorado Anschutz Medical Campus where she directs their Pragmatic Trials and Dissemination & Implementation Research core and the new Innovation-Corps training program.

Morrato has been a faculty member on the CU Anschutz Medical Campus since 2006 and is currently a full-time tenured associate professor in the department of Health Systems, Management, and Policy at ColoradoSPH. She also has secondary appointments in Pediatrics at the University of Colorado School of Medicine and Clinical Pharmacy at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences.

Certified by the National Board of Public Health Examiners, she is an accomplished teacher, mentor, leader and lecturer with more than 25 years in experience with both public and private sector population health. She’s collaborated with Medicaid, mental health agencies, the Food and Drug Administration, and hospital and health care systems in improving the effective dissemination and implementation of evidence into practice, and was recognized as a leader who is training the next generation of leaders in clinical preventive services by the Agency for Healthcare Research and Quality.

A nationwide search is currently being conducted for the ColoradoSPH Dean and applications are being accepted until Jan. 9.

Guest Contributors: Tonya Ewers, Director of Communications & Alumni Relations, ColoradoSPH and Kara Price, Business & Communications Specialist, ColoradoSPH

 

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School of Medicine doctor tests rheumatoid arthritis prevention

People with rheumatoid arthritis sometimes liken the chronic inflammatory disorder to a fire. Rheumatoid arthritis, or RA, is caused when the immune system attacks the joints. Symptoms include pain and warm, swollen joints, and over years they often spread from fingers and toes to elbows, hips and shoulders. Severe cases can lead to deformities that leave joints gnarled and disabled, and sometimes body parts such as the eyes, lungs and skin are affected.

Dr. Kevin Deane talks with a patient about her rheumatoid arthritis
Kevin Deane, MD, PhD, talks with a patient about her rheumatoid arthritis. Deane is the principal investigator of the StopRA clinical trial, which is testing a drug that could prevent rheumatoid arthritis.

Rheumatologist Kevin Deane, MD, PhD, an associate professor at the University of Colorado School of Medicine, uses the same analogy as his patients. But he takes it one step farther.

“If a fire can be caught early, it is quite easy to extinguish, perhaps even with a simple bucket of water,” Deane said. “RA is likely like that, where if we catch it early before the ‘inferno’ stage with blood testing, even mild drugs might stop it from getting worse.”

Testing a potential prevention for rheumatoid arthritis

Deane is the principal investigator of a study researchers hope will enable doctors to do just that, which could prevent the ranks of the 1.5 million Americans with rheumatoid arthritis from growing any larger. The StopRA clinical trial, short for “Strategy for the Prevention of Onset of Clinically-Apparent RA,” is the first clinical trial of a drug that could prevent RA conducted in the U.S.

The study was designed by scientists at the CU Anschutz Medical Campus and is funded by the National Institutes of Health. CU Anschutz is the lead site for the study, with 18 other institutions working to screen up to 20,000 people who are likely to develop RA. The goal is to identify 200 people to enroll in the study, and already more than 3,000 people have been screened and 20 enrolled across the country.

Deane and a team of researchers are testing to see if hydroxychloroquine, an anti-inflammatory drug already used to treat patients experiencing RA flareups, can also be used to prevent it. For patients who are already diagnosed with RA, the medication has been shown to decrease pain and swelling, prevent further joint damage and reduce the risk of disability, according to the American College of Rheumatology.

But currently people with RA only begin taking hydroxychloroquine after they have been experiencing symptoms. In other words, the fire is raging and uncontained, and drugs like hydroxychloroquine could take several weeks or months to be effective.

Blood test predicts cases of RA

Deane said people with a high probability of developing RA can be identified by a blood test for the blood marker anti-cyclic citrullinated peptide, or anti-CCP. He said it appears in the blood several years before, on average, symptoms develop.

Learn more about how to enroll

To learn more about the StopRA study, including how to enroll, visit www.Stop-RA.org

If Deane and his colleagues’ hypothesis is correct, doctors in the future could give hydroxychloroquine to patients who test positive for anti-CCP but before arthritis occurs. The drug could reset the immune system so the joint pain, stiffness and swelling never develop.

Deane said StopRA researchers are casting a wide net to locate possible subjects because they need to find people years before they first see a doctor or feel RA’s symptoms.

“The trick is how to find people who have an abnormal blood level of anti-CCP but who don’t have joint inflammation yet,” Deane said.

Enrolling participants from around U.S.

Nationally, there are the 18 sites that includes cities from Boston to Los Angeles. Locally, CU Anschutz researchers are working with University of Colorado Hospital, UCHealth, the 9Health Fair and the Colorado chapter of the Arthritis Foundation to identify candidates.

“Because of the large number of people that we need to test for anti-CCP in order to find those who can be in our trial, we need all hands on deck, and the community at Anschutz has really stepped up to support the trial,” Deane said.

Since RA runs in families, the team is focusing on members of patients’ immediate families, although anyone can be tested and potentially enroll.

The double-blind randomized study will give half the subjects placebos and half hydroxychloroquine for one year. They will track the patients for another two years to see if the treatment had the intended effect. By the study’s end in 2020, Deane is optimistic they’ll be on the way to being able to prevent the disorder.

“We believe that this study has a strong chance at transforming how we treat RA,” Deane said.

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In Colorado, self-harm is leading cause of death in new mothers

Self-harm was the leading cause of pregnancy-associated deaths in Colorado from 2004 to 2014, ahead of car crashes, medical conditions and homicide, according to researchers at the University of Colorado Anschutz Medical Campus.

Torri Metz, MD, CU School of Medicine
Torri Metz, MD, CU School of Medicine

The study, “Maternal Deaths from Suicide and Overdose in Colorado, 2004-2012,” found that of 211 maternal deaths, 30 percent were from self-harm, defined as suicide and nonintentional overdose deaths occurring during pregnancy and the first year after giving birth. In Colorado, the mortality rate from self-harm during the period was 9.6 per 100,000 live births. About 90 percent occurred in the postpartum period.

It is not known how the demographics and characteristics of maternal deaths in Colorado compare to other states or if such self-harm deaths are becoming more common. According to the study, in 2012 suicide was overall the most common cause of death in Colorado among those age 10 to 44.

“There is focus nationally on reduction in maternal mortality, and the majority of this effort has focused on in-hospital causes of death such as postpartum hemorrhage,” said lead author Torri Metz, MD, assistant professor of maternal fetal medicine at the CU School of Medicine. “As the Colorado Maternal Mortality Review Committee reviewed the maternal deaths in Colorado, we noticed that there was a large proportion of deaths from suicide and overdose. Our data supports that self-harm is in fact the leading cause of pregnancy-associated death in Colorado, which warrants our attention.”

The findings are published in the December edition of Obstetrics & Gynecology.”

 During the study period, 63 women died of suicide or a drug overdose. Of the 26 who died of suicide, asphyxia by hanging was the most common cause of death. In overdose deaths in which toxicology testing was performed at autopsy, opioids were the most detected class of drugs, chiefly pharmaceutical painkillers but also heroin.

Substance abuse and psychiatric disorders, most often depression, were present in a majority of the women with maternal deaths. However, no risk factor was present in 22 percent of the cases.

Although about half the self-harm cases were found to be taking prescription drugs for mental health care at conception, 48 percent stopped using the medications during pregnancy, in some cases with a care provider’s recommendation but in most without. During pregnancy, selective serotonin reuptake inhibitors (SSRIs) were the most commonly discontinued drug class alongside sleep aids, mood stabilizers and other antidepressants.

“This finding speaks to the importance of an informed discussion of the risks and benefits of continuing psychiatric medications during pregnancy,” Metz said. “Ideally this would occur prior to conception. The benefit of continuing medications, especially SSRIs in women with depression, frequently strongly outweighs the risk.”

Researchers also found that many of the women had documented social stressors, most notably unemployment (64%) or being single, divorced or separated (40%). Though such stressors, also including a history of domestic violence (18%) and unstable living situation (5%), were documented in a majority of the women, only one third engaged with a social worker either during prenatal care or at delivery.

During pregnancy and after delivery, woman at risk for self-harm may encounter health care providers such as social workers, nurses and physicians. Researchers say each point of contact with such women should be considered an opportunity for intervention throughout and after pregnancy. They suggest that raising awareness, better health screening, referrals for treatment of mental health and substance use disorders in pregnancy and recognition of the need for ongoing care beyond the early postpartum period is needed to reduce pregnancy-related deaths from self-harm.

 

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Copeptin levels associated with renal and cardiac disease in type 1 diabetes patients

Type 1 diabetes patients with elevated albumin in their urine had three times the risk of life-threatening kidney and cardiac disease as those with normal levels, according to researchers at the University of Colorado Anschutz Medical Campus.

The study, led by Dr. Petter Bjornstad, MD, of the Barbara Davis Center for Childhood Diabetes at CU Anschutz, looked at 38 males with type 1 diabetes and albumin in their urine and 38 diabetic males with normal albumin levels. The subjects were recruited across the country from the Type 1 Diabetes Exchange Biobank.

Dr. Petter Bjornstad, MD, of the Barbara Davis Center for Childhood Diabetes at CU Anschutz.

Dr. Petter Bjornstad, MD, of the Barbara Davis Center for Childhood Diabetes at CU Anschutz.

Albuminuria, or the presence of elevated albumin in the urine, is a marker for kidney disease.

Bjornstad found that the copeptin was more than three times higher in patients with albuminuria.  Copeptin is secreted along with arginine vasopressin or AVP from the pituitary gland and elevated levels appear to predict risk of cardiovascular mortality.

AVP is a hormone that regulates urination, though chronically high levels may cause kidney and vascular damage. But measuring AVP is extremely difficult due to its small size and short half-life. So researchers use copeptin as a surrogate. It is more stable, derived from the same molecule as AVP and can be more easily measured.

In this study, published online today in the Journal of Diabetes and its Complications, researchers found that the men with type 1 diabetes and albuminuria had significantly greater concentrations of copeptin compared to diabetic males with normal albumin levels.

“High levels of copeptin were associated with greater odds of albuminuria and impaired glomerular filtration rate which measures kidney function and stages of kidney disease,” Bjornstad said.

The findings, he said, could open the door to new ways of treating diabetic kidney disease and other illnesses. Specifically, a family of drugs called vaptans could be used to block excess vasopressin in these patients.

“We think that vaptans or therapies targeting vasopressin can delay or stop the development of diabetic kidney disease,” Bjornstad said. “There are clinical trials undergoing with vaptans in polycystic kidney disease, but to our knowledge no one is looking at vaptans and diabetic kidney disease yet.”

The study has important limitations. The sample size was small and its design prevents determination of causality. It also focused on men and may not apply to young people or women. But the findings support earlier research done by Bjornstad in the Coronary Artery Calcification in Type 1 Diabetes Study (CACTI.)

“We think these findings may have life-saving implications for those with diabetic kidney and heart disease,” Bjornstad said.

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A grad’s journey from Cuba and conflict zones to CU Anschutz

One cold afternoon, Ivan Quintana Hijano walked through the University of Colorado School of Dental Medicine. The chilly temperature brought back memories of the first time he visited Colorado.

It was nothing like his native Cuba, where Quintana Hijano was an oral and maxillofacial surgeon before emigrating to the U.S. in 2011. Or East Timor, where he spent two years operating on patients injured during the county’s struggle for independence. He was the nation’s only oral and maxillofacial surgeon and was on call 24/7.

Ivan Quintana Hijano
Ivan Quintana Hijano in the CU Anschutz School of Dental Medicine. Quintana Hijano is a Cuban immigrant and graduated with honors from the Advanced Standing International Student Program.

On Friday, Quintana Hijano, a student in the School of Dental Medicine’s Advanced Standing International Student Program, will graduate near the top of his class. He’ll earn his Doctor of Dental Surgery degree, which is necessary for Quintana Hijano to practice in the U.S.

It also sets up his next step—getting into a four-year residency program for oral and maxillofacial surgeons. That would allow Quintana Hijano, 39, to restart a career that he has loved as long as he can remember.

“I remember I was playing on the street one day and there was a car accident. I saw this guy bleeding all over the place,” Quintana Hijano said. He wondered what doctors would do to save and heal the man, and it was the start of a career. “Since I was a kid, I wanted to be a facial surgeon. I told my mom when I was 5, ‘when I grow up, I want to do that.’”

Now, after putting on hold a career that has spanned oceans and continents so he could start a new life in America, Quintana Hijano is a big step closer to performing surgeries and helping patients. Again.

“Nothing comes without effort”

The Advanced Standing International Student Program offers dentists who have earned their degrees in foreign countries the opportunity to earn a Doctor of Dental Surgery degree at the University of Colorado School of Dental Medicine. Graduates of the two-year accelerated program are able to take any state or regional board exam, and thus are eligible for licensure to practice in the U.S. This program accepts 40 students each year.

“It was really tough decision,” Quintana Hijano said.  “I’m really attached to my folks. I didn’t know when I was going to see them again, because I would be banished for leaving Cuba.”

Quintana Hijano said Cuba produces well-trained dentists, doctors and surgeons—just not many of them, especially in the past few decades, because spots in Cuba’s top universities and medical schools are limited. Students have to compete for top scores each step of the way to have a shot at getting the few specialist jobs available each year. The path included multiple “make-or-break” national exams, where elite students are ranked and get to pick their profession.

“I said, ‘I have to excel to do this,’” Quintana Hijano said.

Quintana Hijano was ultimately accepted into the oral surgery and maxillofacial program at the Cienfuegos General Hospital, affiliated to the Higher Institute of Medical Sciences of Villa Clara, Cienfuegos’ Campus. He trained and practiced in Cuba, before its government sent him on a humanitarian mission to East Timor, a nation on an island between Indonesia and Australia. East Timor had just won independence from Indonesia after a long-running guerrilla war that ended a brutal occupation.

Quintana Hijano was the only oral and maxillofacial surgeon in East Timor. He performed reconstructive surgeries on people injured in the war or in accidents. He also trained medical students and translated the Ministry of Health’s national guidelines into Spanish to be used by the Cuban medical personnel and to help educate 1,000 new East Timorese doctors.

Additionally, he attended weekly meetings with the Minister of Health and other staff to discuss the nation’s health care strategies.

Coming to America, finding Colorado

Quintana Hijano would return to Cuba and practice for a few years before going to Venezuela in 2010 on another humanitarian mission. Over time, a feeling began growing that his future would not be in Cuba. The strain of not being able to say what you think and other stresses were taking a toll.

“It was really tough decision,” Quintana Hijano said.  “I’m really attached to my folks. I didn’t know when I was going to see them again, because I would be banished for leaving Cuba.”

The decision also could have ended his career.

“I had to put aside what I loved, doing surgeries. I didn’t know if I’d be able to do it again,” Quintana Hijano said. “But I was ready to come here, roll up my sleeves and do whatever [it took].”

In October 2011, Quintana Hijano made the stressful 40-hour trip, which took him through several countries before he arrived in the U.S. Quintana Hijano declined to give details, because Cubans still make that voyage and the authorities watch. He also declined to discuss the relationship between his new home and his old one and what the future might hold.

But Quintana Hijano is clear about his love for the people of Cuba and the beauty of the country.

“It’s a really nice society and a beautiful country. The people are friendly, people are really willing to help you at any time, and anywhere,” Quintana Hijano said.

Beginning anew at Anschutz

Quintana Hijano ended up in the Phoenix area. Although unable to practice as a doctor or dentist, he was able to help patients, working as a dental assistant and in a dialysis clinic. But he still wanted to be a surgeon and decided to restart his education. That would mean going through dental and medical school all over again. That also meant more high-stakes tests competing against other experienced professionals for admission.

But Quintana Hijano kept it in perspective. “I always look way ahead into the future. It doesn’t happen in one day, it takes forever.”

The only program for international students Quintana Hijano applied to was at the CU School of Dental Medicine. He says finding the program was a lucky break. While other dental schools have similar programs, by the time Quintana Hijano was ready to apply in 2013, CU Anschutz was the only school still taking applications. The wait since 2011 had been long enough, so he sent in his application.

“[I] was shocked and very flattered,” he said about getting admitted. “I thought there were people more prepared than me.”

“It was something random,” Quintana Hijano said. “But when I got here, I realized it was God’s will. This is a really, really good school.”

Going back to school didn’t seem to be a problem for Ivan, said Professor Elizabeth Towne, DDS. She directs the Advanced Standing International Student Program and worked closely with Quintana Hijano.

“Though he was an oral surgeon with an admirable career, he became a student again and eagerly embraced the basic level tasks of working on plastic teeth, and treating all the minor maladies we encounter in general dentistry,” Towne said. “He is supremely humble. He has been open to critique and criticism, and eagerly sought it out.”

Quintana Hijano said his classes have been a great way to learn the American system. Faculty members have been approachable and ready to offer professional and personal guidance. He also likes that American dentists are able to see patients from the start, develop a treatment plan and relationship, and see their progress.

That’s not a surprise.

“He has a big heart, and feels great empathy for all his patients,” Towne said. “He is a very kind, gracious and compassionate person.”

Colorado provided one shock, though. A life in hot climates and then Phoenix didn’t prepare him for Colorado winters. The day he came to Aurora to interview and visit was cold and snowy, which was the only downside, at least at the time.

But now, as Ivan awaits “match day” on Jan. 30 to find out where he’ll go for a residency program, he relaxes by skiing. He’s getting better, and he said he has even survived a few runs down the black diamond trails he went down “by mistake.”

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CU benefactors honored for exceptional philanthropy

Four of the University of Colorado’s distinguished and committed philanthropic leaders received honors from the Colorado Chapter of the Association of Fundraising Professionals, which celebrated National Philanthropy Day with an awards lunch in Denver on November 10, 2016.

CU President Bruce and Marcy Benson were named the joint winners of Outstanding Philanthropist for 2016, presented to an individual who has a record of exceptional personal generosity that demonstrates outstanding civic or charitable responsibility and whose leadership has encouraged others in philanthropic roles. Not only have the Bensons impacted the University of Colorado through their 8-year leadership roles, but they are influential philanthropists in the Denver community including support for the Denver Zoo, Denver Public Schools and more.

Sue Anschutz-Rodgers, a generous contributor to the CU School of Medicine at the Anschutz Medical Campus, received Lifetime Achievement honors. As an ardent supporter of the CU Eye Center, Ms. Anschutz-Rodgers has left an indelible mark on the CU Anschutz Medical Campus by fueling the innovative research efforts of Dr. Naresh Mandava and his team.

The Anschutz Foundation was presented the Outstanding Foundation Award for playing a key role in the creation of the CU Anschutz Medical Campus and supporting many other nonprofits in Colorado. At CU, support for a wide range of programs and initiatives – from the Anschutz Health and Wellness Center to the National Behavioral Health Innovation Center to the University of Colorado Cancer Pavilions – has fueled the growth of the campus as a top-tier medical destination.

The award for Outstanding Professional Grantmaker went to John H. “Jack” Alexander, Jr. of the Helen K. and Arthur E. Johnson Foundation. His advocacy was instrumental to the foundation board’s decisions to make historic gifts to CU, naming the Helen and Arthur E. Johnson Depression Center at the CU Anschutz Medical Campus and the Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences at the University of Colorado Colorado Springs.

These awards are a fitting way for the Colorado community to recognize the generosity and impact of some of its philanthropic leaders – leaders who are among the thousands of individuals and organizations that support the University of Colorado each year. The AFP Colorado Chapter began in the 1970s as the Colorado Association of Fund Raisers. Now with 300 members, the chapter presents educational luncheons, informal Coffee Chats, the annual Rocky Mountain Philanthropy Institute, and National Philanthropy Day.

“Philanthropy shows the love of humankind,” said Cory Andersen, who chaired the Nov. 10 luncheon at the Denver Performing Arts Complex. “We are blessed to have so many people in Colorado that give their time, talent and treasure to make a difference and create impact in their communities.”

Click here for this year’s full list of honorees.

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Higher death rates associated with routine handoff of hospital patients

Researchers at the University of Colorado Anschutz Medical Campus have found higher mortality rates among hospitalized patients during routine transitions of care from one medical resident to another.

The study, published today in JAMA, was led by Dr. Joshua Denson, MD, a fellow in pulmonary and critical care at the University of Colorado School of Medicine.

Denson and colleagues from New York University Langone Medical Center collected data from 2008 to 2014, and examined 230,701 patient discharges across 10 academic Veteran’s Health Administration Hospitals around the country.

Joshua Denson, MD, is a fellow in pulmonary and critical care at the CU School of Medicine.
Joshua Denson, MD, is a fellow in pulmonary and critical care at the CU School of Medicine.

They found an absolute increase of between 1.5% and 1.9% in hospital mortality rates among hospitalized patients exposed to end-of-rotation transitions in care between medical residents. This corresponded with 12% to 18% greater odds of death in the hospital for these patients.

Miscommunications during physician handoffs have been associated with problems in patient care, including medical errors. But one key understudied area is the transition in care that happens each month when resident physicians switch clinical rotations.

During this transition, hospitalized patients (often 10 to 20) are transferred to an oncoming resident physician who has never met them. The researchers tried to determine if these transitions were associated with worse patient outcomes, specifically higher mortality.

In the study, `transition’ patients were defined as those admitted before an end-of-rotation handoff who either died or were discharged within seven days of the transition.

In addition to higher death rates in the hospital, the study also found higher mortality rates among these patients long after leaving the hospital. According to Denson, patients whose hospital stay involved an end-of-rotation transition in care between interns, residents, or a combination of the two had between 10% and 21% greater odds of dying at 30 or 90 days.

“That suggests that something is happening during this transition that we need to work on, focusing on the period when the residents actually leave,” he said. “It might be that patients are getting discharged more quickly than they should be once the transition occurs. The incoming resident might not have enough information to determine when patients are actually ready to be discharged or even worse, they might have the wrong information when they are discharged.”

On July 1, 2011, the Accreditation Council for Graduate Medical Education (ACGME) limited first-year residents (interns) to 16 continuous hours of work, leading to increased handoffs in residency programs.

“Despite these changes, safety outcomes and mortality rates have remained unchanged but transition-related outcomes have not been examined,” Denson said.

He said the increased number of handoffs may have heightened the risk of miscommunication during this much more substantial transition in patient care.

“The association was stronger following the institution of ACGME duty hour regulations,” Denson said.

Denson, a former chief resident at New York University, said researchers adjusted for numerous potential confounders including age, sex, race, ethnicity, calendar month, calendar year, individual hospital site, comorbidities, and length of hospital stay.

However, the patients who underwent this type of transition tended to have more complex, longer hospital stays than others.

Denson noted that in an alternative restricted analysis, as opposed to the main unrestricted analysis, there were no significant differences in mortality between patients who experience a handoff and those who didn’t.

That’s likely because the two analyses dealt with different patient populations. The main analysis included the majority of patients who experienced a transition, especially long-stay and complex patients. However, the alternative analysis excluded those more complex, longer stay patients.

“It is therefore possible that transitions in care increase the risk of mortality only for patients who have already had a complex hospital course or prolonged length of stay,” the study said. “For these patients, incomplete information transfer or unfamiliarity with patients…may be particularly harmful, increasing mortality risk.”

Denson said the study does not suggest a `causal relationship’ between resident handoffs and increased mortality but there is a `clear association’ between the two that is concerning. .

He said there is no standardized transition process at many hospitals. Some residents communicate verbally, some do it in writing and some may not do it all.

But given the rapidly changing health care and medical education environment, he said, it is critically important to identify gaps that may cause errors like those that can happen during transitions in care.

Educators are already responding with innovative techniques to combat these gaps.

“One such approach is called the `warm handoff’ where residents do transitions in care at the patient’s bedside,” Denson said. “Although this intervention is unlikely to be harmful, it will be important to study patient outcomes related to this intervention if possible.”

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ColoradoSPH to address mental health disparities in cancer patients

The Colorado School of Public Health has been named a recipient of a  $1.9 million grant to address mental health disparities in low-income, uninsured and under-insured Coloradans who are suffering from lung, head and neck cancers. The grant is part of $152.8 million in grants that were recently allocated by the Patient-Centered Outcomes Research Institute (PCORI) Board of Governors to support studies covering a range of conditions and problems that impose high burdens on patients, caregivers, and the healthcare system.

Evelinn A. Borrayo, Ph.D.
Evelinn A. Borrayo, Ph.D.

Lung cancer is the primary cause of cancer death among men and women in the United States and often spreads as malignant tumors into patients’ heads and necks, having a severe impact on basic living activities like breathing, eating and swallowing, leaving most patients to suffer from long-term dysfunction and disfigurement. These patients often have poorer quality of life, higher frequency of distress and higher risk of suicide compared with other cancer patients – and the risk of significant psychological distress increases if patients are also medically underserved.

The clinical trial began Dec. 1 in Grand Junction.

“These types of cancers are very devastating and have a low survival rate,” said Evelinn Borrayo, principal investigator and professor of community and behavioral health at the Colorado School of Public Health at CU Anschutz and of psychology at Colorado State University. “The physical disfigurement and its impact on patients and their caregivers makes lung, head and neck cancers among the most psychologically disturbing, intensifying the need to assess and target mental health needs and interventions, especially in underserved populations.”

With increased patient dysfunction and distress, patient caregivers are also at risk for a number of psychological conditions, including depression and anxiety symptoms. Borrayo notes that the objective of the study is to adapt, implement, and evaluate an intervention that has the potential to more effectively and efficiently provide mental health treatment to medically underserved lung, head and neck cancer patients and their caregivers. Clinicians, patients, and caregiver stakeholders who represent the target population will be key partners in the development, implementation and evaluation of the intervention.

“There is a lack of mental health resources for cancer patients and their caregivers, especially in under-served communities and populations,” adds Borrayo. “They may not need a lot of support initially, but we are seeing that they need more evidence-based treatment aimed at decreasing psychological distress the further they get into their treatment regimens. With this grant, we will be able to document not only the mental health needs, but also the mental health disparities that exist in this unique cancer patient and caregiver population.”

“We don’t know how to deal with cancer,” said Joaquin Ramirez Arriaga, a Denver resident who was treated for laryngeal cancer at University of Colorado Hospital and Denver Health Hospital after being diagnosed in 2013. “After they told me I had cancer, I went from one hundred percent to forty percent – very depressed.”

Arriaga, a painter who often works outdoors, has been cancer-free for more than two years but said pain in his body, vocal problems and depression symptoms persist.

“We need to have more education on cancer,” he said.

Borrayo and her team in the Colorado School of Public Health’s Latino Policy & Research Center will work with medically underserved cancer patients and their caregivers at three Colorado hospitals over the next three years: Denver Health and Saint Joseph Hospitals in Denver, and St. Mary’s Medical Center in Grand Junction.

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