Category Archives: Clinical research

Oct 30 2014
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RWJF Scholars in the News: Scapegoating EHRs, Ebola fears, children fighting cancer, and more.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

In an article published in Healthcare IT News, David Blumenthal, MD, MPP, writes that health care providers may be too quick to blame Electronic Health Records (EHR) for medical errors. Blumenthal notes that EHRs are still imperfect and that improvements will take time, but argues: “There is no going back in the electronic health information revolution. No physician or hospital, however loud their complaints, has ever thrown out their EHR and returned to paper. The dissatisfaction with the technology will recede as EHRs improve, and as a new generation of young clinicians, raised in the electronic world, populates our health care system.”  Blumenthal is president of The Commonwealth Fund, former National Coordinator for Health Information Technology, and an RWJF Investigator Award in Health Policy Research recipient.

In a blog published by the Washington Post’s “Monkey Cage,” Shana Gadarian, PhD, and her co-author write that Ebola anxiety, while potentially misplaced and harmful, is likely to have an impact on whom Americans trust to handle the disease and what kinds of policies they will support to fight it. The authors have studies society’s reactions to small pox and H1N1 flu. “In general we find that anxiety makes people more supportive of government playing an expansive role in protecting them during a health crisis ... we think our study and the current Ebola outbreak both emphasize that people will rally around experts and increase their support for policies that fight the contagion, even if they hurt civil liberties. Let us hope that the U.S. health system is ultimately worthy of the confidence the public has in it.” Gadarian is an RWJF Scholars in Health Policy Research alumna.

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Oct 14 2014
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Crusader Against Cancer

For the 25th anniversary of the Robert Wood Johnson Foundation’s Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Jacqueline Barrientos, MD, a member of the 1994 class.

Jacqueline Barrientos Jacqueline Barrientos, MD

As far back as Ancient Egypt, cancer has frustrated medical practice. Papyri written around 1600 BC describe various cases, with one concluding that “there is no treatment.”

But there’s hope for patients diagnosed with chronic lymphocytic leukemia (CLL)—a cancer that attacks the blood and bone marrow—thanks to Jacqueline Barrientos, MD, who isn’t intimidated by the history surrounding the disease.

She’s busy helping to rewrite it.

Barrientos is part of a team researching new CLL therapies at the North Shore-LIJ Cancer Institute’s CLL Research and Treatment Center on Long Island. In clinical trials, the pioneering drug treatments produced unprecedented results—considerably better than those achieved with chemotherapy, and minus the brutal side effects.

“We’ve never seen response rates like this before,” says Barrientos. “It’s astonishing.” When the FDA approved the use of the new treatments earlier this year, she and her team were elated. “We’re giving life to patients who once had no hope of surviving because the cancer was so aggressive.”

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Oct 2 2014
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RWJF Scholars in the News: Autism and birth order, nurse staffing and underweight infants, long-term care insurance, and more.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

There is an increased risk of Autism Spectrum Disorders (ASD) among children born less than one year or more than five years after the birth of their next oldest sibling, Forbes reports. The study, led by RWJF Health & Society Scholars program alumna Keely Cheslack-Postava, PhD, MSPH, analyzed the records of 7,371 children born between 1987 and 2005, using data from the Finnish Prenatal Study of Autism. About a third of the children had been diagnosed with ASD by 2007. Researchers found that the risk of ASD for children born less than 12 months after their prior sibling was 50 percent higher than it was for children born two to five years after their prior sibling. “The theory is that the timing between pregnancies changes the prenatal environment for the developing fetus,” Cheslack-Postava said. 

The health outcomes and quality of care for underweight black infants could greatly improve with more nurses on staff at hospitals with higher concentrations of black patients, according to a study funded by RWJF’s Interdisciplinary Nursing Quality Research Initiative (INQRI). The study, led by Eileen Lake, PhD, RN, FAAN, found that nurse understaffing and practice environments were worse at hospitals with higher concentrations of black patients, contributing to adverse outcomes for very low birthweight babies born in those facilities, reports Health Canal. More information is available on the INQRI Blog. The study was covered by Advance Healthcare Network for Nurses, among other outlets.

Because of a “medical-industrial complex” that provides financial incentives to overuse and fragment health care, patients nearing the end of their lives need an advocate to fight for their interests, Joan Teno, MD, MS, writes in an opinion piece for the New York Times. Teno encourages readers to “find a family member or friend who can advocate for the health care that you want and need. Find someone to ask the hard questions: What is your prognosis? What are the benefits and risks of treatments? Find someone not afraid of white coats.” Teno is an RWJF Investigator Award in Health Policy Research recipient. 

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Sep 24 2014
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Helping ‘Care Partners’ Help Patients with Diabetes

Ann-Marie Rosland, MD, MS, is a research scientist at the VA Ann Arbor Center for Clinical Management Research, an assistant professor at the University of Michigan Medical School, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (2006-2009). She recently received a U.S. Department of Veterans Affairs Merit Award to test a family engagement intervention for patients with diabetes.

Ann Marie Rosland

Human Capital Blog: Congratulations on your Veterans Health Administration (VA) Merit Award! The award recognizes your research into a family engagement intervention in the context of the VA’s patient-centered medical home program. How did your study work, and what did you find?

Ann-Marie Rosland: This study is unique in that we work with family member/patient pairs in managing diabetes. We call these family members “care partners.” This study asks the question:  “How we can best recognize and support the vital roles that patients’ family members often take in the care of chronic illnesses, so these care partners can have the largest positive impact on patients’ health and medical care?”

Our prior work has shown that the majority of people with diabetes, heart disease and other chronic conditions have a family member who is regularly involved with the care of these conditions. Some help to keep track of medications and refill them, some help to track and manage symptoms or sugar readings, many come to medical appointments and help patients communicate with their medical teams, and some help patients navigate the health care system. In general, patients who have support from family members tend to be more successful at managing chronic illness, particularly with eating healthier and exercising more. Yet patients and family tell us that care partners face barriers in helping with the medical side of care; for example, they can’t easily find out what medications or tests the patient’s medical team is recommending, or what health system programs are available to the patient.

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Sep 15 2014
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Breakthroughs in Treating Spinal Cord Injury

Roderic I. Pettigrew, PhD, MD, is director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) at the National Institutes of Health (NIH). He was a member of the inaugural class of the Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Program.

Roderic Pettigrew

On a fateful day in 2006, 20 year-old Rob Summers, a standout collegiate baseball pitcher at Portland State with aspirations to play in the big leagues, was a victim of a hit-and-run accident while standing in his own driveway. His injuries left him paralyzed below the chest, and his doctors informed him he would never move his legs again.

I first met Rob at NIBIB’s ten-year anniversary celebration. It had been just four years since his accident, and he had already broken new ground in spinal cord injury recovery. During the event, Rob shared his incredible story about the experimental procedure he had recently undergone as part of an NIBIB-funded research trial. In the trial, Rob became the first human to have an electrical stimulator implanted on his spinal cord with the goal of restoring some function to previously paralyzed muscles.  

Rob spoke about how, in just weeks after implantation, the stimulation enabled him to hold himself in a standing position for the first time since his injury. In addition, he began to sense when he was uncomfortable in his wheelchair. Rob went on to describe how, seven months into the trial, he discovered he was able to move his toes, ankles, and legs on command, a feat that shocked the researchers, as they never expected Rob to regain voluntary movement. 

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Jul 14 2014
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Study Highlights Role for Non-Physicians in Preventing Childhood Blindness

A leading cause of preventable blindness in premature babies can be successfully identified by trained non-physician evaluators working remotely, according to a study published online by JAMA Ophthalmology. The number of ophthalmologists who conduct screenings for the condition, retinopathy of prematurity (ROP), has declined in the United States, while countries in parts of Latin America, Asia, and Eastern Europe have long-standing ophthalmologist shortages that contribute to high rates of childhood blindness caused by ROP.

“This study provides validation for a telemedicine approach to ROP screening and could help prevent thousands of kids from going blind,” lead investigator Graham E. Quinn, MD, MSCE, said in a news release from the Children’s Hospital of Philadelphia, where he is a pediatric ophthalmologist.

The study involved retinal images taken by neonatal intensive care unit nurses and transmitted to trained image readers at a central location. Ophthalmologists had also examined the infants, and the image readers identified 90 percent of the infants the ophthalmologists had flagged as needing further evaluation.

“Telemedicine potentially gives every hospital access to excellent ROP screening,” said Quinn. 

Read the study in JAMA Ophthalmology

Jun 17 2014
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Recent Research About Nursing, June 2014

This is part of the June 2014 issue of Sharing Nursing’s Knowledge.

Research Compares Nurse and Physician Prescription Practices

A newly published systematic review of more than four decades of research on nurse prescribing finds that in the U.S. states and foreign countries in which nurses are allowed to prescribe, their prescription practices are similar to those of physicians, but their patients report higher satisfaction with their care and are more likely to return for follow-up visits.

The review was conducted by a team of researchers in the Netherlands—one of several countries in which nurses may prescribe. The team screened all studies they could find on the subject dating back to 1974, finally identifying 35 studies that met their criteria, including 13 from the United States, 12 from the United Kingdom, five from the Netherlands, two from Canada, two from Norway, and one from Colombia. The studies’ methods and specific topics varied, but the team conducting the review identified a number of trends in the research. They wrote:

  • “Our findings suggest that nurses prescribe for a wide range of patients and in comparable ways to physicians. Overall, nurses appear to prescribe for just as many patients as physicians do, nurses prescribe comparable numbers of medicines per patient visit and there appear to be few differences between nurses and physicians in the type and dose of medication prescribed and in clinical outcomes.

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Jun 16 2014
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Should There Be Public Access to Data from Clinical Trials?

Michelle Mello, JD, PhD, is a professor of law and public health at the Harvard School of Public Health, and a fellow with the Edmond J. Safra Center for Ethics at Harvard University. She is a recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.

Michelle Mello

For years, pharmaceutical companies have been lambasted in the media and government prosecutions for concealing information about the safety and efficacy of their products. In one particularly splashy example, GlaxoSmithKline (GSK) agreed to pay $3 billion in 2012 to settle criminal charges that it failed to report safety data concerning its antidepressant drug, Paxil, and its diabetes drug, Avandia, and engaged in unlawful marketing of these products and one other drug. One mechanism proposed for avoiding such problems is to establish a system through which participant-level data from clinical trials, stripped of identifying information about patients, would be available to the public.

A potential benefit of sharing clinical trial data would be that independent scientists could re-analyze data to verify the accuracy of reports prepared by trial sponsors, which might deter sponsors from mischaracterizing or suppressing findings. Data sharing would also allow analysts both within and outside drug companies to pool data from multiple studies, creating a powerful database for exploring new questions that can’t be addressed within any given trial because the sample is too small to support such analyses. 

The potential value of shared data in improving our understanding of the safety and efficacy of drugs, medical devices, and biologics has sparked considerable discussion about how to make data sharing happen. Earlier this year, the European Medicines Agency—the counterpart to the U.S. Food and Drug Administration (FDA) in the European Union—decided to start making data from trials of approved products available in 2014. This begs the question, should the FDA follow suit?

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Jun 4 2014
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The Effect of Cultural Stereotypes on Mental and Public Health

Lorenzo Lorenzo-Luaces graduated from the University of Puerto Rico–Rio Piedras, where he studied cross-cultural differences in suicidality. He is currently a graduate student in the University of Pennsylvania clinical psychology PhD program. Lorenzo-Luaces is an alumnus of Project L/EARN, a project of the Robert Wood Johnson Foundation, the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.

Lorenzo Lorenzo-Luaces

The population of groups referred to as “minority” is growing at a faster rate in this country than Caucasians, with estimates suggesting that by 2060, 57 percent of the U.S. population will be non-White. This demographic shift could create a public health concern if racial/ethnic minorities remain underrepresented in mental health research. At present, these populations are less likely to receive mental health care than Whites. When they do receive care, it is usually of lesser quality.

Stereotypes among racial/ethnic minority communities regarding mental health are complex. Research suggests that they tend to have more negative beliefs about mental illnesses than White communities; for example, they are more likely to believe that mental illnesses occur due to factors outside of the individual’s control (e.g., spiritual or environmental reasons). However, despite generally holding more negative views about mental illnesses, research shows that racial/ethnic minorities tend to have less punitive attitudes about the mentally ill. Moreover, they tend to be more accepting about mental health treatments, although they express a clear preference for psychological services over medications.

Differences in access to care, rather than attitudes, likely explain the racial/ethnic gap in service use. Besides the obvious discrepancies in socioeconomic status (SES) between Caucasians and racial/ethnic minorities, the latter’s preference for psychological services may be one barrier to access. This is because, even among the insured, psychological services are more expensive in the short term and harder to access than psychotropic medications. There also are questions as to whether psychological interventions tested largely on White populations are effective for minorities. 

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Jun 3 2014
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CDC Study: Nurses, Physician Assistants More Likely to Provide Education in Chronic Disease Management than Doctors

Proper patient management of chronic diseases is increasingly important to the nation’s health care system, as the Baby Boom generation reaches the stage of life where such conditions are common. From diabetes, arthritis, and asthma to obesity, hypertension, and depression, the health care system is looking to train patients to take steps mapped out for them in discussions with their health care providers. A new study from the Centers for Disease Control and Prevention (CDC), however, finds that a minority of patients with chronic conditions receive education in managing their problems, and that some practitioners—nurses and physician assistants (PAs), in particular—are considerably more likely to provide such education than others.

“Disease self-management is an essential component of care for patients with most chronic conditions,” writes a team of researchers led by Tamara S. Ritsema, MPH, MMSc, PA-C. “Patients cannot perform daily self-management tasks if they have poor understanding of the disease process, medications used, or the practical tasks they need to accomplish to care for themselves. Health education is, therefore, a vital preventive element in the patient visit.”

The researchers examined five years of CDC data, accounting for more than 136,000 patients who had been diagnosed with asthma, chronic obstructive pulmonary disease (COPD), depression, diabetes, hyperlipidemia, hypertension, ischemic heart disease, or obesity. The records indicated whether the patients’ doctors, nurse practitioners (NPs), or PAs had provided education to the patients in the self-management of their conditions during each visit. 

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