Clinical Scholars

The Laryngoscope, a premier journal in Ear, Nose, and Throat specialty, published a study (May 2, 2012) by VA Scholar Gordon Sun, MD (’11), showing that the current evidence does not support olfactory/smell tests to diagnose Alzheimer’s. Although this is a relatively new approach—less than 3 decades old—and the research is not conclusive, some individuals and websites are promoting smell tests alone as predictors for Alzheimer’s disease. The authors, who include VA Scholar James Burke, MD, (’10) argue that based on the current evidence, the commercialization and promotion of this diagnostic tool is dangerously premature. The study received media coverage in WebMD, Medical News Today, Health Day, and others.

Read More Research Roundup

• Clinical Scholars
• Executive Nurse Fellows
• Harold Amos Medical Faculty Development Program
• Health & Society Scholars
• Investigator Awards in Health Policy Research
• New Connections
• Nurse Faculty Scholars
• Physician Faculty Scholars

Clinical Scholars

In a study published in Annals of Neurology, James Burke, MD, (’10) found that most stroke patients undergo both CT and MRI brain scans, an unnecessary duplication that contributes to the rising costs of stroke care in the United States. Burke and his study received media coverage in Health Day, U.S. News and World Report, Health.com, MSN Health, and others.

A study by Clinical Scholars alumnus Colin Cooke, MD, (’09) found that while more Americans are suffering from acute respiratory failure, a dangerously low level of oxygen in the blood, Black Americans are at the greatest risk for developing the condition. The study was published in the May 2012 issue of Critical Care Medicine.

Ryan Greysen, MD, MHS, MA, (’09) published a research brief in the Journal of the American Medical Association titled, “Physician Violations of Online Professionalism and Disciplinary Actions: A National Survey of State Medical Boards” (March 21, 2012). Greysen and colleagues, including Clinical Scholar alumnus and Yale program director Carry Gross, MD, (’97) who is senior author on the paper, surveyed the 68 executive directors of all medical and osteopathic boards in the United States and its territories about violations of online professionalism reported to them and the subsequent actions taken. Most U.S. medical licensing authorities reported incidents of these violations by physicians, many of which resulted in serious disciplinary actions. Greysen and his co-authors argue that the findings 1) highlight the need to promote online professionalism among physicians, and 2) the need to create consensus-driven, broadly-disseminated principles to guide physicians toward high-integrity interactions online. This work led the Federation of State Medical Boards to release new guidelines for doctors about the proper use of social media and social networking in May. The study received media coverage in Health Day, U.S. News & World Report, Slate, and other outlets.

VA Clinical Scholars alumnus Danil V. Makarov, MD, MHS, (’08) and colleagues published a study in the April 2012 issue of Health Affairs addressing the problem of cost containment vs. loss of quality in the area of imaging for prostate cancer. They found that policy-makers interested in containing health care costs are targeting regional variation in the use of advanced imaging, and trying to encourage a lower imaging rate. But according to the study, regions that use imaging too often, even when it is not appropriate, also have higher rates of appropriate imaging. In regions where use of imaging is low across the board, some patients who need it are missed. The authors recommend more clearly defined quality metrics and supportive systems. The study received media coverage in Cardiovascular Business, Health Imaging & IT and Advance for Imaging & Radiation Oncology, among other trade press outlets.

In an article published in the Annals of Emergency Medicine (April 2012), three Clinical Scholars alumni propose an agenda for researchers and health care providers to consider comparative effectiveness research and patient-centered outcomes research methods and results to improve the care for patients who seek, use, and require emergency care. In the article, Zachary Meisel, MD, MPH, MS, (’08), Brendan Carr, MD, MA, MSHP, (’06) and Patrick Conway, MD, MS (’05) explore the definitions, frameworks, and nomenclature for comparative effectiveness research and patient-centered outcomes research; describe a conceptual model for comparative effectiveness research in emergency care; identify specific opportunities and examples of emergency care-related comparative effectiveness research; and categorize current and planned funding for comparative effectiveness research and patient-centered outcomes research that can include emergency care delivery. Read the RWJF story about the work of these alumni.

In a study published in JAMA on April 30th, Stephen Patrick, MD, MPH, (’10) found that the number of babies born with drug withdrawal (medically known as Neonatal Abstinence Syndrome) increased threefold between 2000 and 2009, and the number of mothers using opiates has increased fivefold in that same time period. This increase is associated with national trends in the abuse of opiate pain relievers, which has quadrupled in the United States in recent years. Health care costs associated with this problem have almost quadrupled in the same time frame (from $190 million in 2000 to $720 million in 2009). This is the first study to look at this syndrome and its effect on the health care system over time. Patrick received significant media attention for this work, including the New York Times, USA Today, NPR-Online, and the PBS News Hour, among others. Patrick also received the 2012 Academic Pediatric Association Research Award: Best Abstract by a Fellow of the Pediatric Academic Societies for “Federal Medical Assistance Percentage Policy and Medicaid/CHIP Enrollment for Children.”

At the American Academy of Neurology’s 64th Annual Meeting in New Orleans, Clinical Scholar Amy Tsou, MD, MA, (VA Scholar ’09) presented her study demonstrating that patients with amyotrophic lateral sclerosis (ALS) fare better when they have feeding tubes placed before an emergency situation occurs. Those having surgeries in non-emergent settings were much less likely to die within one month after surgery, compared to ALS patients receiving their feeding tubes under duress. “Timing is crucial for placement of feeding tubes in ALS patients,” said Tsou, MD, MSc, in a press release from the University of Pennsylvania. “We’ve shown that waiting too long can be detrimental and happens too often. In general, it is important for clinicians and patients to proactively prepare and re-evaluate treatment decisions as ALS patients enter into different phases of the disease.”

Executive Nurse Fellows

Mary Lou Manning, PhD, RN, CPNP, (’03) co-authored the article, “Infection Preventionists’ Job Descriptions: Do They Reflect Expanded Roles and Responsibilities?” published in the American Journal of Infection Control. The article examines the scope of practice of infection preventionists, which has expanded beyond the traditional roles of solo practitioners and expert data collectors to roles of interventionists and crucial leaders in successful patient safety initiatives.

Julie Willems Van Dijk, PhD, RN, (’99) associate scientist at the University of Wisconsin’s Population Health Institute, was part of the survey team that recently released the County Health Rankings & Roadmaps, produced by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The annual survey ranks the health of counties in all 50 states according to how healthy people are and how long they live. The survey release received extensive national media coverage.

Harold Amos Medical Faculty Development Program

Daryl Thornton, MD, MPH, (’07) published a study in the April 3 issue of the Annals of Internal Medicine. The study found that watching a brief video featuring organ transplant recipients and donor testimonials on an iPod before obtaining a drivers license increased consent to donate organs. Among the participants randomly assigned to watch the video, 84 percent signed up to be organ donors. In comparison, 72 percent of participants who did not watch the video signed up to be donors, according to the study, “Effect of an iPod Video Intervention on Consent to Donate Organs.” These findings suggest that the video was effective in changing negative perceptions regarding donation. “Common sentiment is that barriers to organ donation are so entrenched that they cannot be easily changed,” Thornton said in an April press release. “However, we video-recorded organ transplant recipients, organ donors, and their families speaking freely about how the process had changed their lives. That information resonated with our study participants, who were faced with the difficult decision of whether to donate.”

Health & Society Scholars

A study co-authored by James Broesch, PhD, (’10) and Albert Gunther, PhD, professor in the Department of Life Sciences Communication and the School of Journalism and Mass Communication at the University of Wisconsin, examined how individuals with different political views can read non-partisan, non-biased information and come to opposite conclusions. Researchers crafted articles about the possible or perceived connection between childhood vaccines and autism. The articles were produced in different formats, including as a major news story, a student article, a point-of-view piece, and an informational pamphlet. The study, “Partisan Evaluation of Partisan Information,” was released April 10 by the Communication Research journal.

Molly Martin, PhD, MS, (’03) authored a study in the March issue of Social Science and Medicine finding that mothers who struggle financially to provide food for their families put themselves at risk for obesity. Mothers, who are often the food managers in the household, may take several actions to ensure that their children are fed, including skipping meals and eating cheaper but less nutritious foods, according to the study, “Feeding Her Children, but Risking Her Health: The Intersection of Gender, Food Insecurity and Obesity.” Martin, assistant professor of sociology and demography at Penn State University, said, “We often forget that food insecurity is happening in a country as rich as ours. Trying to protect children from food insecurity is not as rare as it once was, and it’s been on the rise for the last two years, if not the last five years.” The researchers examined data on 7,931 participants in the Panel Study of Income Dynamics, which has collected information on health and income levels of Americans since 1968, and began collecting data on weight and food insecurity in 1999.

Alexander Tsai, MD, PhD, (’10) released findings in the April 10 issue of PLoS Medicine that show that in sexually active women in Brazil, severe food insecurity with hunger was positively associated with symptoms potentially indicative of sexually transmitted infection and with reduced odds of condom use. “Our findings suggest that interventions targeting food insecurity may have beneficial implications for HIV prevention. Individual-level cognitive and/or behavioral interventions targeting HIV risk avoidance or risk reduction behaviors are likely to be less than optimally effective if structural factors such as food insecurity are not taken into account,” the researchers said. The study, “Is Food Insecurity Associated with HIV Risk? Cross-Sectional Evidence from Sexually Active Women in Brazil,” is available online.

Investigator Awards in Health Policy Research

The American Journal of Epidemiology published a study by Sandro Galea, MD, DrPH, (’06), Gelman Professor and Chair of the Department of Epidemiology at the Mailman School of Public Health at Columbia University, demonstrating new evidence on the link between suicide and the economy. The study found that the monthly suicide rate in New York City from 1990 to 2006 was 29 percent higher at the economic low point in 1992 than at the peak of economic growth in 2000. The study, and Galea, received media coverage in UPI, iStockAnalyst, and others.

The May 2012 issue of Health Affairs published the following five articles by Investigator awardees:

• “Authoritarian Physicians and Patients’ Fear of Being Labeled ’Difficult’ Among Key Obstacles to Shared Decision Making” by 2006 awardee Dominick Frosch, PhD, and co-authors Suepattra May, Katharine Rendle, Caroline Tiethbohl and Glyn Elwyn. The study received media coverage in the SF Chronicle, Fierce Healthcare, and others.
• “Setting Doctors’ Medicare Fees, CMS Almost Always Accepts the Relative Value Update Panel’s Advice on Work Values” by 2009 awardee, Miriam Laugesen, PhD, and co-authors, Roy Wada and Eric Chen. The study received media coverage in Medical News Today, mediLexicon, and others.
• “A Tale of Dollars, Pediatrics, and Late-Night Calls About Infant Constipation” by 2006 awardee John Lantos, MD.
• “Medicare and Medicaid Spending Variations are Strongly Linked Within Hospital Regions, But Not at Overall State Level” by 1998 awardee, Richard Kronick, PhD, and Todd Gilmer.
• “State Spending on Dual Eligibles Under Age 65 Shows Variations, Evidence of Cost Shifting from Medicaid to Medicare” by 2005 awardee Jonathan Skinner, PhD, and co-authors Thomas Bubolz and Constance Emerson.

Also in this issue of Health Affairs, 2000 awardee Theodore Marmor, PhD, reviewed Stuart Altman and David Schactman’s latest book, Power, Politics, and Universal Health Care: the Inside Story of a Century-Long Battle. And 2008 Awardee, Alberto Palloni, PhD, contributed a letter in response to an article by Jason Fletcher and Michael Richards (January 2012) that forwarded the hypothesis that individuals with early onset diabetes are more likely to have lower academic and labor outcomes.

New Connections

Amy Adamczyk, PhD, (’09) New Connections alumna, recently published the findings from her New Connections-funded project in the Journal of Social Science Research. The study reveals that youth are less likely to consume alcohol when they participate in extracurricular activities sponsored by faith-based organizations. The findings hold true regardless of the teens’ religious beliefs.

Could a text message help relieve depressive symptoms? Yes—according to research findings uncovered by Adrian Aguilera, PhD, (’11). Depressed patients are likely to feel more connected and cared for when “they receive text messages asking them to track their moods, reflect on positive interactions, and take their prescribed medications.”

Do nutrition policies at childcare centers result in caregivers role-modeling healthy eating behaviors to children? Temitope Erinosho, PhD, (’11) Healthy Eating Research-New Connections grantee, finds that centers with explicit nutrition policies do not necessarily experience healthier eating behaviors among caregivers. Read more about her published findings in the Journal of the Academy of Nutrition and Dietetics.

New Connections alumna Karen Winters, PhD, (’08) recently co-authored a book, Community Health Advisor Training: A Transformational Learning Experience, which discusses the role of adequate community health advisor (CHA) trainings as a tool for promoting health behaviors in community settings.

Nurse Faculty Scholors

Alison Holman, PhD, FNP, (’10) assistant professor in the Program of Nursing Science at the University of California, Irvine, co-authored the study “The Neurogenics of Nice.” The study examined the behavior of study subjects who have versions of receptor genes for two hormones that, in laboratory and close relationship research, are associated with niceness. The study, originally published in the journal Psychological Science, was well-received in the media. Among the stories it generated was a Science Illustrated article, “Niceness May Be Predicted by Our Genes.”

Physician Faculty Scholars

Renee Hsia, MD, MSc, (’12) published “Health Care as a ‘Market Good’? Appendicitis as a Case Study” in the May issue of Archives of Internal Medicine. The study examines the wide variation of hospital charges—both across hospitals and in the same hospital—by comparing treatment charges for an identical diagnosis. Hsia and colleagues examined charges for 19,368 adult patients hospitalized with appendicitis. Only included were visits for patients aged 18 to 59 years old with hospitalization that lasted fewer than four days with routine discharges. The median hospital charge among all patients was $33,611, with the lowest charge being $1,529 and the highest $182,955. When analyzed for patient factors, there were slightly increased charges for Medicaid patients (+2.3%) and the uninsured (+1.4%). Within geographic areas, the lowest and highest charge still differed by more than $46,000. “Consumer-driven health care has emerged as a new paradigm in allowing patients to have a stronger say in how their health care dollars are spent,” the authors write. “Yet health care is a unique industry where many traditional market principles fail. Consumers of health care do not always have good information about their condition and rely on the advice of professionals.” The study was widely covered in the media: ABC World News, CBS Evening News, ABC News Radio, The New York Times, The Huffington Post, and an Associated Press story that appeared in USA Today and Salon.com, among many others.