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Facilities Management honored for excellence

The University of Colorado Anschutz Medical Campus has received the 2017 Award for Excellence in Facilities Management from APPA: Leadership in Educational Facilities, an organization that promotes leadership in educational facilities for professionals seeking to build their careers, transform their institutions, and elevate the value and recognition of facilities in education.

The Award for Excellence, which highlights the essential role of facilities operations in the overall institutional mission and vision, is APPA’s highest institutional honor.  Recipient institutions gain national and international recognition for their outstanding achievements in facilities management. The Award for Excellence designation is valid for a period of five years.

Anschutz Medical Campus
CU Anschutz Medical Campus

“The institutions that receive the Award for Excellence are true leaders in educational facilities management,” said Paul Wuebold, vice president of Professional Affairs for APPA and the chair of the Awards and Recognition Committee.  “In the span of twenty years, the University of Colorado has converted a 233 acre former military hospital in Aurora, Colo., into a world-class research medical campus.  The CU Anschutz Facilities Management department emphasizes communication within its staff, with the administration and with its customers to positively respond to and remedy any issues that are raised.”

The APPA Award for Excellence is designed to recognize and advance excellence in the field of educational facilities.  Award for Excellence nominations address the areas of: leadership; strategic and operational planning; customer focus; information and analysis; development and management of human resources; process management; and performance results. Nominated institutions also submit to a site review conducted by an awards evaluation team.

“It is an honor to receive APPA’s Award for Excellence,” said David Turnquist, associate vice chancellor, Facilities Management at CU Anschutz. “To be considered the Best of the Best is a tribute to the work, dedication and professionalism of the Facilities Management staff and the incredible support of the executive leadership at the University of Colorado Anschutz Medical Campus.”

Universidad Panamericana Mexico also was honored with the 2017 Award for Excellence.

Leadership from CU Anschutz Facilities Management was recognized on July 22 during the awards banquet at the 2017 APPA Annual Conference in San Francisco.

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Senior Executives from Film and Virtual Reality Industries Join NBHIC

The National Behavioral Health Innovation Center announced today that Rick Rekedal, a former senior executive with DreamWorks Animation, and Dr. Walter Greenleaf, a pioneer and leading authority on virtual reality for medical use, have joined its staff.

Rick Rekedal joins NBHIC as Senior Creative Advisor
Rick Rekedal joins NBHIC as Senior Creative Advisor

“Walter and Rick are recognized internationally as leaders in their fields,” said Matt Vogl, executive director of NBHIC at the University of Colorado Anschutz Medical Campus. “Their knowledge and insight are powerful assets to our mission of finding bold new solutions to the country’s mental health crisis.”

In 2016, Rekedal completed over 20 years with DreamWorks as Chief Creative of franchise development and the global franchise director of the hit movie “Trolls.” Rekedal has also worked on properties such as “How To Train Your Dragon,” “Shrek,” “Kung Fu Panda,” and “The Lost World: Jurassic Park,” developing merchandising, interactive and licensing programs. Rekedal’s work has been recognized with two Annie Awards, two Kids Choice Awards and Toy of the Year. He is a frequent speaker and serves on advisory boards for The Wedgwood Circle; Michael W. Smith Group and Seabourne Pictures; and Belmont University’s film school.

Dr. Walter Greenleaf is NBHIC’s new Director of Technology Strategy
Dr. Walter Greenlef joins NBHIC as Director of Technology Strategy

Rekedal joins NBHIC as Senior Creative Advisor, consulting on how to elevate an open and urgent national conversation on mental health.

Greenleaf is a behavioral neuroscientist and a medical product developer who has been on the cutting edge of virtual reality and augmented reality applications in healthcare for more than 30 years.

In his role as NBHIC’s Director of Technology Strategy, Greenleaf brings his considerable knowledge to the Center’s approach to digital initiatives. He continues to work as a Visiting Scholar at the Stanford University Virtual Human Interaction Lab.

He has developed several clinical product streams, founded medical companies, and served as a scientific advisor and reviewer for the U.S. Public Health Service, National Science Foundation, National Institutes of Health, NASA and the U.S. Department of Education. He holds a PhD in Neuro and Bio-behavioral Sciences from Stanford University.

“Our approach is to seek out unexpected partners as we look beyond the current mental health system for new solutions,” said Vogl. “Walter and Rick fit that approach. Walter’s depth of knowledge in virtual reality and Silicon Valley are leading us to work with new technology partners in developing cutting edge tools for mental health treatments. Rick’s extraordinary creative abilities can help steer powerful human connections to combat the awful stigma that is so harmful to many people in need.”

Guest contributor: Lauren Baker, marketing and communications strategist for the National Behavioral Health Innovation Center at CU Anschutz.

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Dr. Jonathan Samet is new dean of Colorado School of Public Health

Following an extensive national search, the chancellor of the University of Colorado Anschutz Medical Campus, Don Elliman, announced Tuesday the hiring of Dr. Jonathan Samet, MD, MS, as the new dean of the Colorado School of Public Health.

Dr. Samet, an accomplished medical professional and administrator, has occupied top positions in leading universities around the country.

Dr. Jonathan Samet, new dean of the Colorado School of Public Health
Dr. Jonathan Samet is the new dean of the Colorado School of Public Health

He is currently distinguished professor and chair of the Department of Preventive Medicine at the Keck School of Medicine at the University of Southern California. He also directs both the USC Institute for Global Health and the Workforce Development and KL2 Program of the Southern California Clinical and Translational Science Institute.

“I am honored by being selected as the third dean of the Colorado School of Public Health,” Dr. Samet said.  “A key goal will be to enhance the school’s impact on public health in the state and region through our research and training activities.”

Previously, he chaired the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health and was clinical division chief for Pulmonary and Critical Care Medicine at the University of New Mexico.

Chancellor Elliman said the new dean will strengthen and deepen the impact of the Colorado School of Public Health (ColoradoSPH).

“Since its establishment just nine years ago, the ColoradoSPH – a partnership of CU Anschutz, Colorado State University and the University of Northern Colorado – has made remarkable strides toward becoming one of the country’s premier institutions of public health,” Elliman said. “As its third dean, Dr. Samet, who brings the experience of a long and distinguished career in academic medicine and public health, is uniquely qualified to take the ColoradoSPH to new heights.”

Dr. Samet comes to ColoradoSPH with nearly 40 years of experience in education, health care and research.

Throughout his career, he’s fostered and mentored faculty members, created new lines of research, initiated curricular advances and maintained fiscal stability.

Along with teaching everyone from undergraduate to postdoctoral students, Dr. Samet has conducted a wide array of research into health issues.  In many cases, he’s translated that research into action. His work led to advancing tobacco controls nationally and around the world, tightening air quality regulations and winning compensation for underground uranium miners suffering health problems.

The new dean is past-president of the American College of Epidemiology and the Society of Epidemiologic Research. He was elected to the National Academy of Medicine, one of the highest honors in medicine, and holds a bachelor’s degree from Harvard College, an MD from the University of Rochester and a master’s degree from the Harvard School of Public Health.

“We are fortunate to have someone as accomplished and versatile as Dr. Samet taking the helm of the Colorado School of Public Health at this critical juncture in its growth,” Chancellor Elliman said. “I am grateful to Dr. Elaine Morrato who, as interim dean since December, has helped the school continue to build on its momentum while ensuring we are set up for a smooth handoff to new leadership.”

Dr. Morrato, DrPH, MPH, will continue as interim dean until Dr. Samet assumes his new post in October.

 

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Researchers to study neurological effects of Zika virus in young children

Researchers at the University of  Colorado Anschutz Medical Campus and the Baylor College of Medicine will join with Guatemalan investigators in a major study examining the clinical outcomes of children infected with the Zika virus after being born, focusing on long-term brain development.

“We now know the severe effects of Zika in the fetus and the unborn child if the mother gets the infection during pregnancy,” said Edwin Asturias, MD, co-principal investigator of the study and director of Latin American Projects at the Center for Global Health at the Colorado School of Public Health. “But if the virus is able to affect the developing brain of an infant or a child, this will have enormous consequences to a generation of children in areas where the virus has spread.”

Dr. Edwin Asturias of the Center for Global Health at the Colorado School of Public Health.

 

The study, funded by the National Institutes of Health, has been approved by the Ministry of Health in Guatemala and will take place in the rural southwestern coast of that country. Along with the Zika virus, the region is also endemic for the dengue and chikungunya virus transmitted by the same mosquito that carries Zika.

“We are enrolling infants in the first year of life and children up to 5 years of age who will be followed over one year to see if they become infected with Zika virus, and then we will be looking at the effects of the infection in the infants’ and children’s neurodevelopment,” said Dr. Flor M. Muñoz, associate professor of pediatrics in the section of infectious diseases at Baylor and principal investigator of the study. “We will look for neurologic or neurodevelopmental effects specifically, including effects on hearing and eye problems, because we know that the virus has the potential to cause central nervous manifestations.”

Zika virus has been known to affect babies in utero when the mother is infected during pregnancy, but little is known about what happens when infants are infected in early life, Muñoz said.

“Our concern is that a developing brain in early life can be impacted significantly,” she said. “It’s an important question to address not just for children that live in the endemic areas, but also for children who travel to these areas.”

Recruitment for the study will take place through a clinic created by the University of Colorado’s Center for Global Health in Guatemala. The goal is to follow 500 infants and their mothers for one year to determine if they become infected by the Zika virus. Neurologic exams and age-appropriate neurodevelopmental testing will be run for the duration of the study to identify changes in children infected with Zika virus.

Researchers will also be enrolling 700 children between the ages of 1 and 5 years, including 300 children known to have been exposed to dengue or Zika viruses while participating in a previous dengue study, and 400 who are siblings of the infants in this study. They will be tested periodically and evaluated for symptoms of flavivirus-like illness to determine if they have been infected by Zika, dengue or chikungunya viruses. Investigators will monitor serial neurologic examinations and developmental milestones in the children to determine if the Zika virus infection is associated with any neurologic or developmental changes.

Dr. Edwin Asturias examining children in Guatemalan clinic.
Dr. Edwin Asturias examining a child in Guatemalan clinic.

Muñoz and Asturias will collaborate with colleagues from the Fundacion para la Salud Integral de los Guatemaltecos (FUNSALUD) clinic in Guatemala. The clinic, affiliated with the Colorado School of Public Health and Children’s Hospital Colorado, is led by Dr. Antonio Bolaños. It has a full complement of local investigators, nurses and laboratory technicians along with Emory University’s Vaccine Treatment and Evaluation Unit (VTEU) research laboratory led by Dr. Mark Mulligan.

Neurodevelopmental testing will be conducted by three local psychologists under the leadership of Dr. Amy Connery of Children’s Hospital Colorado in Aurora, Colo. The study will last three years and results will be reported throughout the study. More information can be found at the NIH Zika website.

 

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States can lower risk of measles outbreak by strengthening exemption policies

States with weaker non-medical exemption policies for vaccinations can reduce the likelihood of a measles outbreak 140 to 190 percent by strengthening them, a new study from the University of Colorado Anschutz Medical Campus shows.

Researchers said the magnitude of those outbreaks can also be cut in half by strengthening exemption policies for children.

“In the year 2000 measles was no longer being transmitted in the U.S.,” said the study’s lead author Melanie Whittington, PhD., a health services researcher. “Compare that to 2015 when we had over 150 cases in the first three months. Suddenly measles is an issue again despite having an effective vaccine.”

Jonathan Campbell, associate professor at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences
Jonathan Campbell, associate professor at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences, is senior author of the paper.

Whittington and her colleagues, including the study’s senior author Jonathan Campbell, PhD, associate professor of clinical pharmacy at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences, wanted to find out why.

Using mathematical models, they simulated the magnitude, likelihood and cost of a measles outbreak under different non-medical vaccine exemption policies.

Every state has such policies. Those with “easy” exemption policies typically only require a parent signature on a standardized form. States with “medium” exemption policies require parents to obtain a form from a health department and/or attend an educational session on vaccinations, or write a statement of objection. Finally, states with “difficult” exemption policies require parents to get a standardized form or statement of objection notarized.

The researchers, using data from the Centers for Disease Control and Prevention’s National Immunization Study, found easier non-medical vaccine exemption policies to be associated with a greater risk for outbreaks of vaccine-preventable diseases.

The state they modeled was Colorado, which has one of the lowest vaccination rates for measles. Only 87.4 percent of children between the ages of 19-35 months are covered. And 5 percent of kindergartners report an exemption.

“We modeled an environment where the population had low vaccination coverage and then simulated measles outbreaks under different exemption policies,” said Whittington. “We found that a state like Colorado is 140 to 190 percent more likely to experience an outbreak with an easy exemption policy than if it had a medium or difficult non-medical exemption policy.  The outbreak size can also be reduced nearly by half with stronger policies.”

While the researchers focused on measles, strengthening exemption policies could benefit other vaccine-preventable diseases, such as mumps.

“There is a tradeoff here,” said Campbell, who specializes in pharmaceutical outcomes research. “It’s a trade between freedom and risk. Are we willing to give up a small piece of freedom that nudges us toward vaccination in order to halve the risk of a detrimental outbreak of a preventable disease?  I think Colorado should be willing to make that trade.”

The researchers urged the strengthening of non-medical exemption policies as a way to increase vaccination coverage.

“We are not saying you can’t have non-medical exemptions,” Campbell and Whittington said. “But if we strengthen them, we can improve health and reduce the economic impact of a potential outbreak.”

The study was published online this month in Academic Pediatrics.

The co-authors include Allison Kempe, MD, MPH; Amanda Dempsey, MD, PhD and Rachel Herlihy, MD, MPH.

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Even after treatment, brains of anorexia nervosa patients not fully recovered

Even after weeks of treatment and considerable weight gain, the brains of adolescent patients with anorexia nervosa remain altered, putting them at risk for possible relapse, according to researchers at the University of Colorado Anschutz Medical Campus.

Dr. Guido Frank, associate professor of psychiatry and neuroscience, is an expert in eating disorders

The study, published last week in the American Journal of Psychiatry, examined 21 female adolescents before and after treatment for anorexia and found that their brains still had an elevated reward system compared to 21 participants without the eating disorder.

“That means they are not cured,” said Guido Frank, MD, senior author of the study and associate professor of psychiatry and neuroscience at the University of Colorado School of Medicine. “This disease fundamentally changes the brain response to stimuli in our environment. The brain has to normalize and that takes time.”

Brain scans of anorexia nervosa patients have implicated central reward circuits that govern appetite and food intake in the disease. This study showed that the reward system was elevated when the patients were underweight and remained so once weight was restored.

The neurotransmitter dopamine might be the key, researchers said.

Dopamine mediates reward learning and is suspected of playing a major role in the pathology of anorexia nervosa. Animal studies have shown that food restriction or weight loss enhances dopamine response to rewards.

With that in mind, Frank, an expert in eating disorders, and his colleagues wanted to see if this heightened brain activity would normalize once the patient regained weight.

Study participants, adolescent girls who were between 15 and 16 years old, underwent a series of reward-learning taste tests while their brains were being scanned.

The results showed that reward responses were higher in adolescents with anorexia nervosa than in those without it. This normalized somewhat after weight gain but still remained elevated.

At the same time, the study showed that those with anorexia had widespread changes to parts of the brain like the insula, which processes taste along with a number of other functions including body self-awareness.

The more severely altered the brain was, the harder it was to treat the illness, or in other words, the more severely altered the brain, the more difficult it was for the patients to gain weight in treatment.

“Generalized sensitization of brain reward responsiveness may last long into recovery,” the study said. “Whether individuals with anorexia nervosa have a genetic predisposition for such sensitization requires further study.”

Frank said more studies are also needed to determine if the continued elevated brain response is due to a heightened dopamine reaction to starvation and whether it signals a severe form of anorexia among adolescents that is more resistant to treatment.

In either case, Frank said the biological markers discovered here could be used to help determine the likelihood of treatment success. They could also point the way toward using drugs that target the dopamine reward system.

“Anorexia nervosa is hard to treat. It is the third most common chronic illness among teenage girls with a mortality rate 12 times higher than the death rate for all causes of death for females 15-24 years old,” Frank said. “But with studies like this we are learning more and more about what is actually happening in the brain. And if we understand the system, we can develop better strategies to treat the disease.”

The study co-authors include Marisa DeGuzman, BA, BS, Megan Shott, BS, Tony Yang, MD, PhD and Justin Riederer, BS.

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Common antioxidant may guard against development of liver disease

A common antioxidant found in human breast milk and foods like kiwi fruit can protect against nonalcoholic fatty liver disease (NAFLD) in the offspring of obese mice, according to researchers at the  University of Colorado Anschutz Medical Campus.

“Pyrroloquinoline quinone, or PQQ, is a natural antioxidant found in soil and many foods and enriched in human breast milk,” said the study’s lead author Karen Jonscher, PhD, an associate professor of anesthesiology and a physicist at CU Anschutz. “When given to obese mouse mothers during pregnancy and lactation, we found it protected their offspring from developing symptoms of liver fat and damage that leads to NAFLD in early adulthood.”

Dr. Karen Jonscher
Karen Jonscher, PhD, associate professor of anesthesiology and a physicist at CU Anschutz.

The study, published online last week in the Journal of the Federation of American Societies for Experimental Biology, is the first to demonstrate that PQQ can protect offspring of obese mothers from acceleration of obesity-induced liver disease.

NAFLD is the most common liver disease in the world, affecting 20-30 percent of all adults in the U.S. and over 60 percent of those who are obese. It heightens the risk of cardiovascular disease, type 2 diabetes and liver cancer.

Scientists have found that mice fed a high fat, Western-style diet give birth to offspring with a higher chance of getting the disease.

“We know that infants born to mothers with obesity have a greater chance of developing NAFLD over their lifetime, and in fact one-third of obese children under 18 may have undiagnosed fatty liver disease that, when discovered, is more likely to be advanced at the time of diagnosis,” Jonscher said. “The goal of our study, which we carried out using a mouse model of obese pregnancy, was to determine whether a novel antioxidant given to mothers during pregnancy and breastfeeding could prevent the development of NAFLD in the offspring.”

Jonscher and her colleagues fed adult mice healthy diets or Western-style diets heavy on fat, sugar and cholesterol. They gave a subset of both groups PQQ in their drinking water.

Their offspring were kept on the diets for 20 weeks. Those fed a Western diet gained more weight than those on a healthy diet. PQQ did not change the weight gain but it did reduce the fat in the livers, even before the mice were born. The antioxidant also reduced inflammation in the livers of mice fed the Western diet. The researchers found that PQQ protected adult mice from fatty liver, even when it  was stopped after three weeks when the mice quit breastfeeding.

Jonscher believes the antioxidant may work by impacting pathways critical to the early onset of diseases associated with maternal obesity, high fat diets and inflammation.

PQQ is found in human breast milk, soy, parsley, celery, kiwi and papaya. It’s also found in soil and interstellar dust. Jonscher said it could possibly be used as a prenatal or lactation supplement to protect children of obese mothers from developing liver and cardiovascular disease in adulthood, but cautioned that pregnant women should always consult their doctor before taking any supplement.

“Perhaps supplementing the diet of obese pregnant mothers with PQQ, which has proven safe in several human studies, will be a therapeutic target worthy of more study in the battle to reduce the risk of NAFLD in babies,” Jonscher said.

 

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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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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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Researchers find association between gene mutation and rare heart disease

A strong association between a genetic mutation and a rare kind of heart muscle disease has been discovered by researchers at the University of Colorado Anschutz Medical Campus.

The finding, published this week in the Journal of the American College of Cardiology, could improve understanding of the disease and lead to new treatments.

Teisha J. Rowland, PhD, a post-doctoral fellow in the lab of Luisa Mestroni, MD, and Matthew R. G. Taylor, MD, PhD, at the University of Colorado School of Medicine
Teisha J. Rowland, PhD, a post-doctoral fellow in the lab of Luisa Mestroni, MD, and Matthew R. G. Taylor, MD, PhD, at the University of Colorado School of Medicine.

“There are many kinds of cardiomyopathies that can lead to heart failure so this is a serious problem,” said Teisha J. Rowland, PhD, a post-doctoral fellow in the lab of Luisa Mestroni, MD, and Matthew R. G. Taylor, MD, PhD, at the University of Colorado School of Medicine and first author of the study.

The Mestroni and Taylor lab sequenced nearly 5,000 genes in 335 patients with a family history of heart muscle disease, looking for mutations that could cause a variety of cardiomyopathies.

“Many kinds of heart disease are caused by genetics. When that happens, the disease is often more severe and happens at an earlier age,” said Rowland, who studies genetics and cardiology. “So we look at the DNA in entire families to see what sort of genetic variants those with the illness have in common.”

They found that several people with left ventricular noncompaction (LVNC) had a mutation in a gene called Obscurin. Obscurin is part of the sarcomere, the basic unit of striated muscles that pull and glide past each other when muscles contract.  That includes the heart muscle. If there is a mutation in Obscurin that process may not function properly.

Image of human heart
A strong association between a genetic mutation and a rare kind of heart muscle disease has been discovered by CU Anschutz researchers.

“We found a strong association between this gene, which has not been studied much, and this rare form of genetic heart disease,” Rowland said. “Left ventricular noncompaction is thought to happen during early human development. It would be interesting to see if mutated Obscurin affects heart formation during development.”

Rowland said the findings point to areas warranting further attention.

“We expect this will ultimately improve our understanding of the disease,” she said.

The other authors include: Sharon L. Graw, PhD; Mary E. Sweet, BA; Matthew R.G. Taylor MD, PhD and Luisa Mestroni, MD all of the Cardiovascular Institute and Adult Medical Genetics Program at the University of Colorado Anschutz Medical Campus.

And Marta Gigli, MD, of the collaborating research group at the Cardiovascular Department, University of Trieste Hospital and SOM, Trieste, Italy.

 

 

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