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News Article | March 2, 2017
Site: www.eurekalert.org

Since the discovery of penicillin in 1928, antibiotics have made the world a much safer and healthier place. But Shakespeare was onto something when he asked if it's possible to have too much of a good thing. In the case of antibiotics, the answer is increasingly "yes." As a result, Case Western Reserve University School of Medicine and Louis Stokes Cleveland VA Medical Center are teaming up to take on the rising problem of antibiotic resistance. A new entity, Case VA CARES, will combine firepower from both organizations in the battle against antibiotic resistance. Staff will carry out new research, work to modify existing antibiotics, try and discover new ones, and use decoys to trick uncooperative bacteria. More and more, bacteria and other microorganisms are developing resistance to antibiotics which used to kill them off. This resistance, which evolves via natural selection through random mutation, is usually caused by excessive use of antibiotics, including in livestock animals raised as human food. In turn, infections which used to yield to antibiotics can persist and even worsen, putting patients in danger. Not only does antibiotic resistance imperil health, it also adds to healthcare costs as doctors try different medicines to find ones bacteria haven't become resistant to. Sometimes the stronger substitute antibiotics cause serious side effects such as kidney damage. More than two million people develop antibiotic-resistant infections in the U.S. ever year, leading to more than 23,000 deaths. Some experts say that without new inroads, the death toll could top that from cancer by mid-century. The financial costs are already enormous: as much as $20 billion in extra healthcare costs annually. Case VA CARES (CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology) will be located in the CWRU School of Medicine and Cleveland VA with collaborating partner laboratories located around the world. "An immediate goal of this initiative is to boost research into multidrug-resistant Gram negative organisms such as Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae and mycobacteria, which can cause tuberculosis and many other infections," said Pamela B. Davis, MD, PhD, dean of CWRU School of Medicine. "Understanding the mechanistic and molecular bases of resistance is crucial to properly treating patients with serious infections." In addition to research and drug discovery, experts at the center will work with scientists throughout the world to track outbreaks of resistant organisms, discover new drugs, and develop training for physicians, medical students, and residents to recognize and prevent overuse of antibiotics. The director of the center will be Robert A. Bonomo, MD, medicine service chief at the Louis Stokes Cleveland VA Medical Center. Faculty members of the new center will come from throughout both organizations including experts in infectious diseases, microbiology, molecular biology, biochemistry, pharmacology, proteomics, and bioinformatics. Experienced scientists with expertise in bacterial genome sequencing and bioinformatics analyses will be recruited to augment experts from the CWRU Department of Genetics. "In the search for new antibiotics and fresh strategies for existing ones, Case VA CARES will play a prominent role in leading and conducting research needed to design and conduct clinical trials, which will take place at the VA , University Hospitals, MetroHealth, and the Cleveland Clinic Foundation," said Dr. Bonomo, who is a member of the NIH-funded Antimicrobial Resistance Leadership Group (ARLG). The latter group is addressing national priorities for clinical research on antibiotic resistance. Case VA CARES will also benefit from strong working relationships with industry partners of both the School of Medicine, University Hospitals of Cleveland, MetroHealth, the Cleveland Clinic and the VA Medical Center. Founded in 1843, Case Western Reserve University School of Medicine is the largest medical research institution in Ohio and is among the nation's top medical schools for research funding from the National Institutes of Health. The School of Medicine is recognized throughout the international medical community for outstanding achievements in teaching. The School's innovative and pioneering Western Reserve2 curriculum interweaves four themes--research and scholarship, clinical mastery, leadership, and civic professionalism--to prepare students for the practice of evidence-based medicine in the rapidly changing healthcare environment of the 21st century. Nine Nobel Laureates have been affiliated with the School of Medicine. Annually, the School of Medicine trains more than 800 MD and MD/PhD students and ranks in the top 25 among U.S. research-oriented medical schools as designated by U.S. News & World Report's "Guide to Graduate Education." The School of Medicine is affiliated with University Hospitals Cleveland Medical Center, MetroHealth Medical Center, the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, and the Cleveland Clinic, with which it established the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in 2002. For more information, visit http://case. . The Louis Stokes Cleveland VA Medical Center is the hub of the Northeast Ohio VA Healthcare System, providing and coordinating primary, acute and specialty care for Veterans. Focusing on treating the whole Veteran through health promotion and disease prevention, the Northeast Ohio VA Healthcare System delivers comprehensive, seamless healthcare and social services for Veterans at 18 locations across Northeast Ohio. The Northeast Ohio VA Healthcare System contributes to the future of medicine through education, training and research programs. For more information visit http://www. .

PubMed | University of Minnesota, Metrohealth, University of Pennsylvania, Sun Yat Sen University and 9 more.
Type: Journal Article | Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation | Year: 2016

Unlike the case with creatinine, conditions affecting the non-glomerular filtration rate (GFR) determinants of low-molecular-weight serum proteins, -trace protein (BTP), Pooled cross-sectional analysis of 3 studies.3,156 persons with chronic kidney disease from the MDRD (Modification of Diet in Renal Disease) Study, AASK (African American Study of Kidney Disease and Hypertension), and CRIC (Chronic Renal Insufficiency Cohort) Study.Demographic and clinical factors hypothesized to be associated with non-GFR determinants of the filtration markers, selected from literature review and physiologic and clinical considerations.Serum creatinine, BTP, B2M, and cystatin C levels.In multivariable-adjusted errors-in-variables regression models that included adjustment for measured GFR (mGFR) and mGFR measurement error, creatinine level had stronger associations with male sex, black race, and higher urine creatinine excretion than the other filtration markers. BTP was associated less strongly with age, similar in direction with sex, and opposite in direction with race than creatinine level. Like cystatin C, B2M level was associated less strongly with age, sex, and race than creatinine level. BTP, B2M, and cystatin C levels were associated more strongly than creatinine level with other factors, including urine protein excretion and weight for BTP, smoking and urine protein excretion for B2M, and smoking for cystatin C.Findings may not be generalizable to populations without chronic kidney disease, and residual confounding with GFR due to incomplete adjustment for GFR measurement error.Like creatinine, serum levels of low-molecular-weight proteins are affected by conditions other than GFR. Knowledge of these conditions can aid the interpretation of GFR estimates and risk using these markers and guide the use of these filtration markers in developing GFR estimating equations.

News Article | November 22, 2016
Site: www.eurekalert.org

Hypertension and prehypertension in children often go undiagnosed, according to a new study published today in Pediatrics. The study focused on children with abnormal blood pressures across the United States, and is the first to show a widespread underdiagnosis of these conditions by pediatricians in children ages 3 to 18. Researchers analyzed the electronic health records of 400,000 children from nearly 200 pediatric primary care sites across the country, between 1999 and 2014. They found that only 23 percent of those who had blood pressures consistent with hypertension at multiple primary care visits were diagnosed with the disease, and only 10 percent of patients with symptoms of prehypertension were diagnosed. Of those children and adolescents with diagnoses of hypertension for at least a year, only 6 percent of those who needed anti-hypertension medication received a prescription. "Although over 95 percent of children and adolescents are checked for high blood pressure, doctors taking care of children are not putting all of the pieces of the puzzle together in terms of interpreting the results and following the appropriate guidelines for treatment," said lead author David Kaelber, MD, professor of pediatrics, internal medicine, epidemiology and biostatistics at Case Western Reserve University and chief medical informatics Officer of The MetroHealth System. He is also the co-chair of the American Academy of Pediatrics task force that is rewriting the pediatric blood pressure guidelines. Pediatricians were more likely to diagnose hypertension and prehypertension in children who were tall, male, overweight or obese. Additionally, they were more likely to recognize the diseases in children with more abnormal blood pressure values and/or more frequent blood pressure reads. The researchers found that underdiagnosis could still occur in these populations. "The new reality for pediatricians is that we're taking care of more and more children who are winding up with chronic conditions, such as hypertension, that were previously seen primarily in adults," said senior author Alexander Fiks, MD, MSCE, a pediatrician at Children's Hospital of Philadelphia (CHOP), faculty member at CHOP's PolicyLab and director of the Pediatric Research in Office Settings network at the American Academy of Pediatrics that coordinated this research. "This study shows that many pediatricians are not responding to this new reality - not only are we underdiagnosing hypertension, but we're often not providing recommended treatment to children with the condition in order to minimize health risks." Hypertension (high blood pressure) is one of the ten most common chronic diseases in childhood, and predisposes children to adult hypertension. Children with hypertension can also show early signs of cardiovascular disease, that if left untreated can increase long-term morbidity and mortality. In 2007, Dr. Kaelber found that within one health care system, studying approximately 15,000 pediatric patients, less than 25 percent with hypertension were diagnosed. The current study used "big data," combining electronic health record data from almost 200 practices around the U.S. to show a very similar result at the national level. The authors said this demonstrates the importance of combining electronic health record data across many practices and health systems to examine treatments and outcomes that rarely occur. This study, which was also conducted by Weiwei Liu, MS; Michelle Ross, PhD; A. Russell Localio, PhD; Janeen Leon, MS, RDH, LD; Wilson Pace, MD; and Richard Wasserman, MD, will appear in the December issue of Pediatrics. Ross and Localio are from the Perelman School of Medicine at the University of Pennsylvania. The Health Resources and Services Administration (grants R40MC24943, UB5MC20286 and UA6MC15585) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development supported this research. Limitations: Researchers relied on standard clinical (non-research), in-office blood pressure measurements, as well as electronic health records to identify prescribing of antihypertensive medications. David Kaelber et al, "Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study," Pediatrics, published online Nov. 22, 2016, to appear in print Dec. 2016. About The MetroHealth System: The MetroHealth System is an essential health system committed to providing health care to everyone in Cuyahoga County, Ohio, and improving the health of the community overall. Its 7,300 employees deliver care to everyone at its main campus, just west of downtown Cleveland, and at more than 25 other MetroHealth locations. It also provides health care at more than 40 additional sites in Cuyahoga County through community partnerships such as the School Health program. MetroHealth is home to Cuyahoga County's only verified Level I Adult Trauma Center and Level II Pediatric Trauma Center, and it is one of two adult and pediatric burn centers in the state of Ohio verified by the American Burn Association and the Committee on Trauma of the American College of Surgeons. In the past year, MetroHealth provided more than one million patient visits in its hospital and health centers. MetroHealth also is an academic medical center committed to teaching and research; each of its active physicians holds a faculty appointment at Case Western Reserve University School of Medicine. MetroHealth has earned Magnet status, which places it in the top six percent of all hospitals nationwide for nursing excellence. MetroHealth's mission is, "Leading the way to a healthier you and a healthier community through service, teaching, discovery and teamwork." For more information, visit metrohealth.org. About PolicyLab at Children's Hospital of Philadelphia: PolicyLab at Children's Hospital of Philadelphia (CHOP) is dedicated to achieving optimal child health and well-being by informing program and policy changes through interdisciplinary research. Founded in 2008, PolicyLab is a Center of Emphasis within the CHOP Research Institute, one of the largest pediatric research institutes in the country. With more than 25 highly-regarded faculty and 35 passionate staff who bring expertise from myriad of fields covering health, research and health policy, our work focuses on improving public systems, improving health care delivery and improving child health outcomes. For more information, visit http://www. . About Children's Hospital of Philadelphia: Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 535-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www. .

News Article | November 29, 2016
Site: www.prweb.com

Leading construction services firm Gilbane Building Company has been selected as one of the winners of the prestigious 2016 Build Ohio Award. One of seven award winners, Gilbane was honored in the Renovation Over $10 Million category for the MetroHealth System Critical Care Pavilion Vertical Expansion project, which was completed in July 2016. Gilbane received its bronze and green marble Build Ohio award during the 24th annual Build Ohio Celebration earlier this month at the Hilton Columbus Downtown. “It is an honor to receive the Build Ohio award and be recognized by the AGC for completing this complex renovation in an operational hospital with the highest levels of patient safety, quality and customer satisfaction,” said Melanie Townshend, Senior Project Executive at Gilbane Building Company “I am very proud of our team and their continued commitment to project excellence throughout this challenging renovation.” Designed by CBLH Design, the Critical Care Pavilion (CCP) is one of the nation’s most technologically advanced centers for emergency medicine, trauma and surgical care, and reflects MetroHealth’s standing as Cleveland’s highest-accredited trauma center. The project included the vertical expansion of two additional floors over existing active operating rooms and the active emergency department, with 85 new critical care rooms that are designed with maximum flexibility for the future. Patient rooms are used for intensive care, critical care, or surgery step down, while two of the rooms are equipped as Special Disease Containment Units, one of the few facilities in the country with this capability. “From the start, the team was all about getting this project done. We didn’t dwell on the barriers; we just focused on making it happen,” said Walter Jones, Senior Vice President of Campus Transformation at MetroHealth With the expansion occurring over existing operating rooms that remained operational throughout construction, the project team coordinated extensively with hospital staff. Throughout the duration of the project, there were 27,000 ambulance visits, 20,800 surgeries completed, and four life flights per day, all of which occurred without disruption. The team completed 105 Methods of Procedure (MOP) to proactively coordinate every shutdown with hospital employees and patient care was never compromised. The Associated General Contractors of Ohio hosts Build Ohio annually to celebrate the commercial construction industry and recognize contractors for excellence in construction. A panel of retired construction professionals selected the Build Ohio winners based on the following criteria: excellence in client service, meeting the challenge of a difficult job, excellence in project management, and innovations in construction techniques and materials. Gilbane provides a full slate of construction and facilities-related services – from pre-construction planning and integrated consulting capabilities to comprehensive construction management, close-out and facility management services – for clients across various markets. Founded in 1873 and still a privately held, family-owned company, Gilbane has more than 50 office locations around the world. For more information, visit http://www.gilbaneco.com. Gilbane has been providing construction management services in Ohio Since 1959 and has served clients including Cleveland Clinic, MetroHealth System, University Hospitals, Cleveland State University, Kent State University, Cleveland Indians, Lakeland Community College, The Andersons, Cuyahoga Community College, Goodyear Tire & Rubber Company, Cleveland Museum of Art, Case Western Reserve University and Cleveland Museum of Natural History. Gilbane is an active participant in the ACE Mentor Program, Rebuilding Together, Providence House and Greater Cleveland Partnership.

Lee H.J.,MetroHealth | Hota P.K.,MetroHealth | Chugha P.,MetroHealth | Guo H.,Rammelkamp Research | And 8 more authors.
Structure | Year: 2012

The sterile alpha motif (SAM) for protein-protein interactions is encountered in over 200 proteins, but the structural basis for its interactions is just becoming clear. Here we solved the structure of the EphA2-SHIP2 SAM:SAM heterodimeric complex by use of NMR restraints from chemical shift perturbations, NOE and RDC experiments. Specific contacts between the protein surfaces differ significantly from a previous model and other SAM:SAM complexes. Molecular dynamics and docking simulations indicate fluctuations in the complex toward alternate, higher energy conformations. The interface suggests that EphA family members bind to SHIP2 SAM, whereas EphB members may not; correspondingly, we demonstrate binding of EphA1, but not of EphB2, to SHIP2. A variant of EphB2 SAM was designed that binds SHIP2. Functional characterization of a mutant EphA2 compromised in SHIP2 binding reveals two previously unrecognized functions of SHIP2 in suppressing ligand-induced activation of EphA2 and in promoting receptor coordinated chemotactic cell migration. © 2012 Elsevier Ltd.

Segraves R.T.,MetroHealth
Academic Psychiatry | Year: 2010

Objective: This article examines the positive and negative aspects of psychiatry encompassing sexual medicine within its purview. Methods; MEDLINE searches for the period between 1980 to the present were performed with the terms "psychiatry," "sexual medicine," and "sexual dysfunction." In addition, sexual medicine texts were reviewed for chapters relevant to this topic. Results; Psychiatry, the only medical discipline trained to integrate both biological and psychological factors in making treatment decisions, has been minimally involved in the evolution of the multidisciplinary field known as sexual medicine. Conclusion; If psychiatry is to maintain a role in the diagnosis and treatment of sexual disorders, it is critical that its training programs include training in sexual medicine. Copyright © 2010 Academic Psychiatry.

PubMed | MetroHealth
Type: Journal Article | Journal: Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists | Year: 2016

The objective of this systematic review is to summarize data from published randomized controlled trials (RCTs) on the efficacy of stimulants for psychiatric symptoms in individuals with traumatic brain injury (TBI).A literature search was conducted of 5 major databases (PubMed, MEDLINE, PsycINFO, Embase, and Cochrane Collaboration) that identified RCTs on the use of stimulants for human patients with a diagnosis of TBI.A total of 176 articles were identified, of which 18 matched the inclusion criteria and were reviewed in their entirety. The majority (17) of studies assessed methylphenidate (MPH), 1 assessed dextroamphetamine and MPH, and 1 assessed modafinil. One study showed significant improvement in depressive symptoms with MPH. Seven studies showed significant improvement in reaction time, whereas 4 studies showed significant improvement in accuracy with MPH compared with placebo. Of the 2 studies that included follow-up, only 1 found significant differences in disability ratings, attention-concentration, and motor memory at 30 days but not 90 days between the stimulant and placebo groups. The majority of studies demonstrated significant treatment effects immediately (ie, within minutes to hours) after first-time stimulant administration. Five of the 18 studies (3 adult, 2 pediatric) did not find benefit for stimulants when compared with placebo. Two studies that evaluated self-reported side effects found no significant difference between treatment groups, although 1 study showed a significant increase in mean arterial pressure in the stimulant group.There is limited evidence to suggest efficacy of stimulants for psychiatric symptoms in individuals with TBI. However, stimulants appear to improve attention after first-time administration and for short time periods in these individuals.

PubMed | Saint Francis Medical Center College of Nursing and MetroHealth
Type: Journal Article | Journal: American journal of Alzheimer's disease and other dementias | Year: 2016

The aim of this systematic review is to identify published randomized controlled trials (RCTs) that evaluated the use of acetylcholinesterase inhibitors for delirium in older adults (60 years).A literature search was conducted of PubMed, MEDLINE, EMBASE, PsycINFO, and Cochrane collaboration databases for RCTs in any language that evaluated the use of acetylcholinesterase inhibitors for delirium in older adults (60 years). Also, bibliographic databases of the published articles were searched for additional studies.A total of 7 RCTs that evaluated the use of acetylcholinesterase inhibitors for delirium in older adults (60 years) were identified. In 5 of the 7 studies, there was no benefit for the acetylcholinesterase inhibitor in either the prevention or the management of delirium. In one study, there was a trend toward benefit for the active drug group on the incidence of delirium and the length of hospital stay, but both outcomes did not attain statistical significance. One study found a longer duration of delirium and a longer length of hospital stay in the active drug group when compared to the placebo group. The acetylcholinesterase inhibitors were well tolerated in 4 of the 7 studies. In 1 study, the mortality rate was found to be almost 3 times higher in the group receiving haloperidol and rivastigmine when compared to the group receiving haloperidol and placebo.Current evidence does not suggest efficacy of acetylcholinesterase inhibitors for the prevention or management of delirium in older adults.

PubMed | Saint Francis Medical Center College of Nursing, MetroHealth and Vice Chairman for Education and Program Director
Type: Review | Journal: Therapeutic advances in psychopharmacology | Year: 2017

The aim of this systematic review is to identify published randomized controlled trials (RCTs) that evaluated the use of oxytocin in individuals with frontotemporal dementia (FTD).A literature search was conducted of PubMed, MEDLINE, EMBASE, PsycINFO and Cochrane collaboration databases for RCTs in any language that evaluated the use of oxytocin in individuals with FTD. Bibliographic databases of published articles were also searched for additional studies.A total of two RCTs that evaluated the use of oxytocin in individuals with FTD were identified. In one study, the use of oxytocin in individuals with FTD produced a reduction in identification of negative facial expressions (anger and fear) which can be hypothesized to improve trust and increase cooperation in these individuals. Both studies noted oxytocin was well tolerated and showed short term benefits on behavioral symptoms in individuals with FTD.Oxytocin appears to improve social aspects of cognition and behavioral symptoms in individuals with FTD and is well tolerated. However, positive data from larger and longer duration RCTs are needed before the routine use of oxytocin in individuals with FTD can be recommended.

News Article | November 29, 2016
Site: www.prweb.com

PMMC, a leading revenue cycle management company, launched online patient estimates for The MetroHealth System to provide its patients with next-level price transparency. The MetroHealth System, a 762 bed hospital in Cleveland, OH has been providing patient estimates for years, but now offers estimates of services on its website with an easy to use, self-service estimator solution. “We want to encourage price shopping and remove financial barriers because we believe we can bring value to patients if they come to us for care,” said Donna Graham, Senior Director of Revenue Cycle at MetroHealth. “PMMC’s expertise was critical in making the system appear simple while the financial calculations occur in the background.” MetroHealth began its initiative to increase connectivity to patients in 2014 with the goal of providing patients and community members the ability to obtain an accurate out of pocket estimate for healthcare services. With online estimates, patients simply enter their co-pay and co-insurance amount to create an accurate cost estimate. MetroHealth System is a leader in patient communications and is the nation’s first adopter of HFMA’s Patient Financial Communications Best Practices, for implementing best practices, such as providing convenient access to information about financial assistance programs and taking steps to ensure that patients understand their financial responsibility for care. The next phase of the project will be to increase visibility to the online estimates by training staff to communicate the option more frequently to current and prospective patients. MetroHealth is also closely monitoring House Bill 52 in Ohio, which may require hospitals to provide the actual insurance payment along with the estimated out-of-pocket expenses. MetroHealth recently presented a case study session on navigating these price transparency requirements. The recording of that session is available here. A Spanish version of the online estimate solution is in development and scheduled for release in 2017. PMMC provides high value revenue cycle software and services to improve the financial performance of healthcare organizations. PMMC’s unique combination of software with 30 years of revenue cycle expertise reveals greater financial accuracy and missed revenue opportunities in the areas of underpayments and denials, pricing transparency, and value-based reimbursement – resulting in a 10 to 1 client return on investment. Visit http://www.pmmconline.com for more information.

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