The Johns Hopkins University
The Johns Hopkins University
News Article | April 28, 2017
In an analysis of Medicare billing data submitted by more than 2,300 United States physicians, researchers have calculated the average number of surgical slices, or cuts, made during Mohs micrographic surgery (MMS), a procedure that progressively removes thin layers of cancerous skin tissue in a way that minimizes damage to healthy skin and the risks of leaving cancerous tissue behind. The study, the researchers say, serves as a first step towards identifying best practices for MMS, as well as identifying and informing physicians who may need re-training because their practice patterns deviate far from their peers. A report of the study, published in the journal JAMA Dermatology April 28, suggests that identifying and informing high outlier physicians of their extreme practice patterns can enable targeted re-training, potentially sparing patients from substandard care. The analysis is part of a medical quality improvement project called "Improving Wisely," funded by the Robert Wood Johnson Foundation and based at The Johns Hopkins University. The initiative focuses on developing and using individual physician-level measures to collect data and improve performance. The U.S. Centers for Medicare and Medicaid Services provided broad access to their records for the study. "The project aims to work by consensus, encouraging outliers to seek educational and re-training tools offered by their professional society," says Martin Makary, M.D., M.P.H., professor of surgery at the Johns Hopkins University School of Medicine and the paper's co-senior author. "That's the spirit of medicine's heritage of learning from the experience of other physicians." He estimates that the initiative could result in Medicare savings of millions of dollars. Ideally, says Makary, those who perform MMS make as few cuts or slices as possible to preserve as much normal tissue as possible while ensuring complete removal of cancers. As each layer of skin is removed, it is examined under a microscope for the presence of cancer cells. However, there can be wide variation in the average number of cuts made by a physician. Measuring a surgeon's average number of cuts was recently endorsed by the American College of Mohs Surgery (ACMS) as a clinical quality metric used to assess its members. "Outlier practice patterns in health care, and specifically Mohs surgery, can represent a burden on patients and the medical system," says John Albertini, M.D., immediate past president of the American College of Mohs Surgery and the paper's other senior author. "By studying the issue of variation in practice patterns, the Mohs College hopes to improve the quality and value of care we provide our patients." Taking their cue from that support, Makary and his research team analyzed Medicare Part B claims data from January 2012 to December 2014 for all physicians who received Medicare payments for MMS procedures on the head, neck, genitalia, hands and feet. These regions of the body account for more than 85 percent of all MMS procedures reimbursed by Medicare during those years. A total of 2,305 physicians who performed MMS were included in the analysis. The researchers also gathered the following data for each physician: sex, years in practice, whether the physician worked in a solo or group practice, whether the physician was a member of ACMS, whether the physician practiced at an Accreditation Council for Graduate Medical Education site for MMS, volume of MMS operations, and whether the physician practiced in an urban or rural setting. Physicians had to perform at least 10 MMS procedures each year to be included in the analysis. The researchers found that the average number of cuts among all physicians was 1.74. The median was 1.69 and the range was 1.09 to 4.11 average cuts per case. Of the 2,305 physicians who performed MMS during each of the three years studied, 137 were considered extremely high outliers during at least one of those years. An extremely high outlier was defined as having a personal average of greater than two standard deviations, or 2.41 cuts per case, above all physicians in the study. Forty-nine physicians were persistently high outliers during all three years. Physicians in solo practice were 2.35 times more likely to be a persistent high outlier than those in a group practice; 4.5 percent of solo practitioners were persistent high outliers compared to 2.1 percent of high outlier physicians who performed MMS in a group practice. Volume of cases per year, practice experience and geographic location were not associated with being a high outlier. Low extreme outliers, defined as having an average per case in the bottom 2.5 percent of the group distribution, also were identified. Of all physicians in the study, 92 were low outliers in at least one year and 20 were persistently low during all three years. Potential explanations for high outliers include financial incentive, because the current payment model for MMS pays physicians who do more cuts more money, Makary says. These charges are ultimately passed on to Medicare Part B patients, who are expected to pay 20 percent of their health care bill. Low outliers may be explained by incorrect coding, overly aggressive initial cuts, or choice of tumors for which MMS is not necessary, he says. Although the study was limited by lack of information about each patient's medical history, or the diameter or depth of each cut, Makary says it's a meaningful step toward identifying and mitigating physician outliers. "Developing standards based on physicians' actual experience and practices is the home-grown approach needed now to improve health care and lower costs of care," says Makary. Other authors on this paper include Aravind Krishnan, Tim Xu, Susan Hutfless and Angela Park of the Johns Hopkins University School of Medicine; Thomas Stasko of the University of Oklahoma; Allison T. Vidimos of the Cleveland Clinic; Barry Leshin of The Skin Surgery Center; Brett M. Coldiron of the University of Cincinnati Hospital; Richard G. Bennett of Bennett Surgery Center in Santa Monica, California; and Victor J. Marks and Rebecca Brandt of the American College of Mohs Surgery. Funding for this study was provided by a grant from the Robert Wood Johnson Foundation (grant No. 73417) and the American College of Mohs Surgery.
News Article | April 17, 2017
On April 18 and 19, the Levy Economics Institute of Bard College will gather top policymakers, economists, and analysts at the 26th Annual Hyman P. Minsky Conference on the State of the U.S. and World Economies to discuss, among many issues, the implications of the new administration’s “America First” policies, focusing on the outlook for trade, taxation, fiscal, and financial regulation measures to generate domestic investments capable of moving the growth rate beyond the “new normal” established in the aftermath of the Great Recession, without jeopardizing financial stability. The conference, “‘America First’ and Financial Stability,” is being organized by the Levy Institute and will take place Tuesday and Wednesday, April 18–19, at the Levy Economics Institute of Bard College in Annandale-on-Hudson, New York. Participants include Esther L. George, president and chief executive officer, Federal Reserve Bank of Kansas City; Eric S. Rosengren, president and chief executive officer, Federal Reserve Bank of Boston; Thomas M. Hoenig, vice chairman, Federal Deposit Insurance Corporation; Peter Praet, chief economist and executive board member, European Central Bank; Michael E. Feroli, chief U.S. economist, JPMorgan Chase & Co.; Arturo O’Connell, formerly, member of the board of governors, Central Bank of Argentina; Lakshman Achuthan, cofounder and chief operations officer, Economic Cycle Research Institute; Rana Foroohar, global business columnist, Financial Times, and global economic analyst, CNN; Michael S. Derby, special writer, The Wall Street Journal; Christian Plumb, Latin America business editor, Reuters; and Yalman Onaran, senior writer, Bloomberg News. The 2017 Minsky Conference will assess, among other issues, the impact of different financing schemes on both infrastructure investment and the return of central bank monetary policies to more neutral interest rates. Since these new policy proposals will have a global impact, the conference will focus on their implication for the performance of European and Latin American economies. The conference will include presentations by Jan Kregel, director of research, Levy Institute; Robert J. Barbera, codirector, Center for Financial Economics, The Johns Hopkins University; Fernando J. Cardim de Carvalho, senior scholar, Levy Institute, and emeritus professor of economics, Federal University of Rio de Janeiro; Scott Fullwiler, professor of economics, University of Missouri–Kansas City; Arturo Huerta González, professor of economics, Universidad Nacional Autónoma de México; Stephanie A. Kelton, research associate, Levy Institute, and professor of economics, University of Missouri–Kansas City; Paolo Savona, formerly, Italian minister of industry and president, Banco di Roma and the Fondo Interbancario di Tutela dei Depositi; Edwin M. Truman, nonresident senior fellow, Peterson Institute for International Economics; Michalis Nikiforos, research scholar, Levy Institute; and L. Randall Wray, senior scholar, Levy Institute, and professor of economics, Bard College. The Levy Economics Institute of Bard College, founded in 1986 through the generous support of the late Bard College trustee Leon Levy, is a nonprofit, nonpartisan, public policy research organization. The Institute is independent of any political or other affiliation, and encourages diversity of opinion in the examination of economic policy issues while striving to transform ideological arguments into informed debate. Press registrations should be made by calling Mark Primoff at 845-758-7412 or by sending an e-mail to primoff(at)bard.edu.
News Article | May 8, 2017
In an analysis of medical records gathered from more than 300 hospitalized patients, a team of researchers reports that routine imaging scans used to help diagnose heart attacks generated "incidental findings" (IFs) in more than half of these patients. The investigators say only about 7 percent of these IFs were medically significant and urged imaging experts and hospitals to explore ways to safely reduce the added costly -- and potentially risky -- days in the hospital the IFs generate. "Incidental findings present clinical and financial challenges," says Venkat Gundareddy, M.D., M.P.H., a director of the Collaborative Inpatient Medicine Service at Johns Hopkins Bayview Medical Center in Baltimore. "In our new study, we saw an association between the presence of incidental findings and longer length of stay in the hospital, in some cases because of further tests to explore those findings." "Because this was an observational study, we can't conclusively attribute the added hospital days to one case, but we believe we have added to evidence that IFs are a factor," he adds. It's long been the case, Gundareddy notes, that people experiencing chest pain are usually admitted to a hospital and undergo CT or other forms of imaging. In their review, they discovered that findings unrelated to chest pain kept patients in the hospital an average of 26 percent longer than people without IFs. Results of the retrospective study appear in the May issue of the Journal of Hospital Medicine. The higher sensitivity and accuracy of X-rays, MRIs, ultrasound examinations, and especially CT scans, has led to more incidental findings such as kidney cysts, renal stones, thyroid nodules, enlarged lymph nodes, bone lesions, lung nodules and masses. Unexpected incidental findings are very common in patients hospitalized with chest paint thought to be cardiac related, the investigators say. Chest CT scans done to image the heart can end up showing lung or thyroid nodules or enlarged lymph nodes. Chest X-rays often show more than heart size, when bone lesions and arthritic changes are noted. The new study analyzed the medical records of 376 patients admitted to Johns Hopkins Bayview Medical Center, an urban academic medical center, over a two-year timeframe. Some 197 of them had unexpected incidental findings in diagnostic images, findings that were not related to their chest pain complaints. Fifty percent of the unexpected findings were deemed medically minor, 42 percent moderate and seven percent of major clinical significance. The unexpected findings are associated with a 26 percent increase in length of hospital stay. When unexpected findings such as nodules or bone lesions are discovered after diagnostic imaging, further tests are generally ordered. If the finding was of major clinical significance, often that workup takes place during the same hospitalization, increasing the length of stay, adding to provider workload, and increasing expenses for testing, imaging, surveillance, consults and labor. Clearly, the researchers say, such additional time and costs are needed for some patients, but nationwide efforts to reduce unnecessary costs could benefit from closer study of and attention to the best setting for dealing with incidental findings. "Choosing wisely what tests are needed for each patient, based on presenting complaints and pertinent history, would prevent unnecessary use of imaging and detection of incidental findings," notes Gundareddy. "Establishing a robust outpatient care pathway to further workup incidental findings, as needed, would also decrease inpatient length of stay," he adds. Gundareddy says radiologists' groups and associations already have some guidance related to follow up for certain incidental findings, such as the American College of Radiology's guidance on managing incidental findings from abdominal CT scans. However, no clear follow up guidelines exist for most incidental findings appearing in hospitalized patients. "It's important for patients and providers to understand that as imaging gets more sensitive, it will pick up more things that are unrelated to the main problem for which imaging is done," Gundareddy says. "These findings might or might not be clinically significant, and although they may need attention, they don't necessarily need inpatient hospital attention." Other authors on this paper include Nisa M. Maruthur, M.D., M.H.S. (co-first author), Abednego Chibungu, M.D., Regina Landis, M.S., and Shaker M. Eid, M.D., M.B.A., of The Johns Hopkins University; and Preetam Bollampally, M.D., of Saint Vincent Hospital.
News Article | April 26, 2017
In a preclinical study in mice and human cells, researchers report that selectively removing old or 'senescent' cells from joints could stop and even reverse the progression of osteoarthritis. The findings, published April 24 in Nature Medicine, support growing evidence that senescent cells contribute to age-related diseases and demonstrate that using drug therapies to remove them from the joint not only reduces the development of post-traumatic osteoarthritis, but creates an environment for new cartilage to grow and repair joints. Senescent cells accumulate in tissues as we age and are a normal part of wound healing and injury repair. They secrete important signals that call immune cells and other cell types into damaged tissue so they can clean up and rebuild. However, in articular joints such as the knee, and cartilage tissue in particular, these senescent cells often are not cleared from the area after injury. Their prolonged presence causes a cascade of events, which starts the development of osteoarthritis. "Combine age-related increases in senescent cells, plus trauma, and it's a double whammy," says Jennifer Elisseeff, Ph.D., director of the translational tissue engineering center and Morton Goldberg Professor of Ophthalmology at the Johns Hopkins Wilmer Eye Institute. The researchers took young mice and performed surgery on them, cutting their anterior cruciate ligaments (ACL) to mimic injury. The researchers then administered injections of an experimental drug named UBX0101, which was recently identified to kill senescent cells in laboratory studies. Researchers injected UBX0101 into the mice's joints 14 days after trauma, when degradation was already starting, and observed that the presence of senescent cells was reduced by roughly 50 percent. In addition, the researchers monitored gene expression in treated mice and found that genes associated with reparative cartilage growth were activated in the joint after treatment. Similar experiments were conducted in older mice, which showed some key differences from the treatment in younger mice. The older mice had thinner cartilage in the joint and increased pain levels before the experiment. After treatment with UBX0101 injections, the older mice exhibited reduced pain like their more youthful counterparts, but did not exhibit signs of cartilage regeneration. To gauge the potential for UBX0101 to be translated to a human treatment, researchers tested the drug in cultures of human cartilage cells taken from donors with clinically severe osteoarthritis (i.e. patients who had undergone a total knee replacement surgery due to damage from osteoarthritis). Elisseeff's group then grew these cartilage cells into 3D structures in the lab. The 3D structures mimic how cartilage tissues grow in the body, Elisseeff explains. They then exposed these cells to UBX0101 for four days. The researchers observed that not only were the number of senescent cells dramatically reduced, but the tissue derived from these patients began forming new cartilage after the elimination of senescent cells. "What was most striking about the results in human tissue is the fact that removal of senescent cells had a profound effect on tissue from very advanced osteoarthritis patients, suggesting that even patients with advanced disease could benefit," says Elisseeff. Although the treatment appears promising, Elisseeff says one limitation in the current study is the short time that UBX101 remains in the joint. However, Unity Biotechnology, who co-developed UBX0101, is working on single-injection formulations. The researchers are hopeful that with further development, UBX0101 may one day offer a one-dose treatment for osteoarthritis. Elisseeff explains, "Because the drug targets and kills the senescent cells directly, once they are eliminated, patients will not need to return for frequent treatments." Prior to this study, Johns Hopkins Technology Ventures (JHTV), the commercialization arm of The Johns Hopkins University, licensed intellectual property around the senescent cell technology to Unity Biotechnology Inc., a company aiming to develop therapeutics that address age-related diseases; both jointly own the patent. "The promising results from this collaboration between Johns Hopkins and Unity showcase how industry and academia can work together to develop innovative therapies," says Neil Veloso, JHTV's executive director of technology transfer. "We are excited that the results from this collaboration may develop into a product that will positively impact people around the world." Other researchers involved in this study include: Ok Hee Jeon, Sona Rathod, Jae Wook Chung and Do Hun Kim from the Johns Hopkins University School of Medicine; Alain P. Vasserot, Yan Poon and Nathaniel David of Unity Biotechnology; Darren J. Baker and Jan M. Van Deursen of the Mayo Clinic College of Medicine; Judith Campisi of the Buck Institute for Research on Aging; Chaekyu Kim of the Johns Hopkins University School of Medicine and the Ulsan National Institute of Science and Technology; Remi-Martin Laberge of the Buck Institute for Research on Aging and Unity Biotechnology; and Marco Demaria of the Buck Institute for Research on Aging and the University Medical Center Groningen. This research was supported by Unity Biotechnology, the Morton Goldberg professorship, the National Cancer Institute (R01CA96985, the Paul F. Glenn Foundation, a Fulbright scholarship from the Institute of International Education, and the Bloomberg-Kimmel Institute for Cancer Immunotherapy. Jennifer Elisseeff owns equity in Unity Biotechnology. Johns Hopkins University and Unity Biotechnology own intellectual property related to the research. Ok Hee Jeon, Chaekyu Kim and Jennifer Elisseeff are inventors of JHU intellectual property licensed to Unity. This arrangement has been reviewed and approved by The Johns Hopkins University in accordance with its conflict of interest policies.
News Article | April 28, 2017
According to a new multicenter study, nearly half of previously employed adult survivors of acute respiratory distress syndrome were jobless one year after hospital discharge, and are estimated to have lost an average of $27,000 in earnings. A summary of the research was published on April 28 in the American Journal of Respiratory and Critical Care Medicine. Acute respiratory distress syndrome (ARDS) is a lung condition often caused by severe infection or trauma, and marked by fluid build up in the lungs' air sacs. The resulting damage leads to a substantial decrease in oxygen reaching the bloodstream and rapidly developing difficulty with breathing. Patients are usually hospitalized and placed on a life-supporting ventilator. ARDS affects approximately 200,000 Americans every year. ARDS survivors often have long-lasting impairments such as cognitive dysfunction, mental health issues and physical impairments, all of which may affect employment. "This study is important and novel given its comprehensive evaluation of joblessness among almost 400 previously employed ARDS survivors from multiple sites across the U.S.," says Dale Needham, F.C.P.A, M.D., Ph.D., professor of medicine and of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine and senior author of the study. "Multiple studies have suggested that joblessness is common in people who survive ARDS, but to our knowledge, none have carefully tracked those who returned to work or subsequently lost their jobs, performed an in-depth analysis of risk factors for joblessness, and evaluated the impact of joblessness on lost earnings and health care coverage," adds Biren Kamdar, M.D., M.B.A., M.H.S., assistant professor of medicine at the David Geffen School of Medicine at UCLA and the study's first author. One important goal of the research, the scientists say, is to better identify specific risk factors for joblessness and to inform future interventions aimed at reducing joblessness after ARDS. The new study was conducted as part of the ARDS Network Long-Term Outcome Study (ALTOS), a national multicenter prospective study longitudinally evaluating ARDS survivors recruited from 2006 to 2014, including patients from 43 hospitals across the U.S. For the analysis, the investigators recruited 922 survivors and interviewed them by telephone at six months and 12 months after the onset of their ARDS. Each survivor was asked about employment status, hours working per week, how long before they returned to work following hospital discharge, perceived effectiveness at work and major change in occupation. The research team estimated lost earnings using age- and sex-matched wage data from the U.S. Bureau of Labor Statistics. Individual survivors' matched wages were multiplied by the number of hours worked prior to hospitalization to determine potential earnings and by current hours worked to determine estimated earnings. Estimated lost earnings were calculated as the difference between estimated and potential earnings. Of the 922 survivors, 386 (42 percent) were employed prior to ARDS. The average age of these previously employed survivors was 45 years, 56 percent were male and 4 percent were 65 years or older. Overall, previously employed survivors were younger, predominantly male and had fewer pre-existing health conditions compared with survivors not employed before ARDS. Of the 379 previously employed patients who survived to 12-month follow-up, nearly half (44 percent) were jobless a year after discharge. Some 68 percent of survivors eventually returned to work during the 12-month follow-up period, but 24 percent of these survivors subsequently lost their jobs. Throughout the 12-month follow-up, non-retired jobless survivors had an average estimated earnings loss of about $27,000 each, or 60 percent of their pre-ARDS annual earnings. The research team also saw a substantial decline in private health insurance coverage (from 44 to 30 percent) and a rise in Medicare and Medicaid enrollment (33 to 49 percent), with little change in uninsured status. For the 68 percent of ARDS survivors who returned to work by the end of the follow-up year, the median time to return was 13 weeks after discharge. Of those, 43 percent never returned to the number of previous hours worked, 27 percent self-reported reduced effectiveness at work, and 24 percent later lost their jobs. The team found that older, non-white survivors, and those experiencing a longer hospitalization for their ARDS had greater delays in returning to work. Severity of illness and sex, however, did not affect time to return to work. "These results cry out for those in our medical field to investigate occupational rehabilitation strategies and other interventions to address the problem of post-discharge joblessness," Needham says. "Health care providers need to start asking themselves, 'What can we do to help patients regain meaningful employment,' and not just concern ourselves with their survival." "We believe that ARDS survivors are often jobless due to a combination of physical, psychological and cognitive impairments that may result, in part, from a culture of deep sedation and bed rest that plagues many ICUs. Perhaps if we can start rehabilitation very early, while patients are still on life support in the intensive care unit, getting them awake, thinking and moving sooner, this may result in greater cognitive and physical stimulation and improved well-being. This change in culture can occur and is part of regular clinical practice in our medical ICU at The Johns Hopkins Hospital." Other authors on this paper include Minxuan Huang, Victor D. Dinglas and Elizabeth Colantuoni of The Johns Hopkins University, Till M. von Wachter of the University of California at Los Angeles, and Ramona O. Hopkins of Intermountain Medical Center in Utah. Funding for this study is provided by the National Heart, Lung and Blood Institute (N01HR56170, R01HL091760 and 3R01HL091760-02S1), the ARDS Network trials (contracts HHSN268200536165C to HHSN268200536176C and HHSN268200536179C) and the UCLA Clinical and Translational Science Institute (CTSI) (NIH-National Center for Advancing Translational Science (NCATS) UCLA UL1TR000124 & UL1TR001881).
News Article | May 8, 2017
PITTSBURGH--(BUSINESS WIRE)--Brian Leshko, HDR’s bridges and structures inspection program leader, has been inducted into the University of Connecticut’s Academy of Distinguished Engineers. Each year, the School of Engineering commends exceptional engineering alumni whose careers are characterized by their exemplary contributions to the engineering profession through research, practice, education, policy or service. “I am truly grateful to be honored for my contributions to the engineering profession,” Leshko said. “I am humbled to join the talented group of UConn graduates who have distinguished themselves and positively impacted society through their engineering achievements.” Leshko’s engineering career began at the United States Air Force Academy, where he received a bachelor’s degree in civil engineering. He would later earn a master’s degree in structural engineering at UConn, and a master of civil engineering degree with an emphasis on structural dynamics from The Johns Hopkins University. Leshko’s education led to a fascination with inspection and evaluation techniques for bridges and tunnels. His professional commitment to this specialized area, as well as his diverse experience, has been instrumental in growing HDR’s bridges and structures inspection program into a national leader. What started as a cadre of six bridge engineers/inspectors has grown to a staff of more than 100 certified personnel. “It’s no surprise that Brian is receiving this well-deserved honor,” said Pat Hickox, HDR’s bridges and structures director. “It is through his commitment and dedication that we have been able to enhance our bridge and tunnel inspection services for our transportation clients. We are pleased others recognize the greatness we see each day.” Leshko shares his expertise through professional writings and presentations, and is contributing to several ongoing research projects for the Federal Highway Administration and National Cooperative Highway Research Program. He has been recognized as an Inaugural Fellow of the Structural Engineering Institute and a Fellow of the American Society of Civil Engineers—a prestigious honor held by fewer than five percent of ASCE members. About HDR’s bridge experience We have a passion for all types of bridges, and offer every bridge-related service you can think of and a few you might not. We work on some of the largest and most complex bridge programs in the United States, including leading the Hoover Dam Bypass design team, winner of the prestigious 2012 ACEC Grand Conceptor Award; serving as lead designer for both the New NY Bridge replacing the Tappan Zee Bridge and the Pennsylvania Rapid Bridge Replacement Program public-private partnership; and co-managing the Oregon Transportation Investment Act III Bridge Delivery Program. About HDR For more than a century, HDR has partnered with clients to shape communities and push the boundaries of what’s possible. Our expertise spans 10,000 employees, in more than 225 locations around the world—and counting. Our engineering, architecture, environmental and construction services bring an impressive breadth of knowledge to every project. Our optimistic approach to finding innovative solutions defined our past and drives our future.
News Article | May 22, 2017
GREENWICH, Conn.--(BUSINESS WIRE)--Berkley Insurance Company, a Berkley company, today announced the appointments of each of Naomi B. Kinderman and Beth Zaro Green as vice president – claims senior counsel. The appointments are effective immediately. Ms. Kinderman joined Berkley in 2011 and has over 20 years of legal experience. Prior to joining the Company, she directed extra-contractual and coverage litigation for a leading multi-line U.S. insurer. Both an insurance professional and an attorney, Ms. Kinderman was in the private practice of law in Connecticut for 7 years prior to her insurance career, handling general commercial litigation. She earned a Bachelor of Arts degree in English and Psychology from Washington University in St. Louis and a Juris Doctorate from Boston University School of Law. Ms. Green joined Berkley in 2014 and has over 25 years of experience in claims litigation management in the insurance industry. Prior to joining Berkley, she served as senior vice president and managing attorney of a multinational insurer’s centralized defense of global professional liability errors and omissions, other extra contractual claims and coverage. Previously she worked as a trial lawyer admitted in New York and New Jersey. She is a graduate of The Johns Hopkins University and earned her Juris Doctorate from Boston College Law School. Berkley Insurance Company is the lead insurance company subsidiary of W. R. Berkley Corporation, which is among the largest commercial lines writers in the United States and operates worldwide in two segments of the property casualty insurance business: Insurance and Reinsurance. For further information, please visit www.wrberkley.com.
News Article | May 17, 2017
Over three decades of research suggest that depression increases the odds of death. However, a new research paper throws doubt on this presumed link after finding no evidence of a direct association between depression and all-cause mortality. The paper, authored by a research team from The Johns Hopkins University, Federation University Australia and the University of Amsterdam (UvA), involved the largest ever analysis on the topic and is published in the latest edition of World Psychiatry. Since the 1980s, numerous studies have appeared which suggest a high risk of mortality among people suffering from depression. This has generally been taken as evidence that depression directly causes death. As part of their study, researchers Beyon Miloyan and Eiko Fried re-evaluated this supposed link by reassessing 293 studies derived from 15 systematic reviews. The studies in question comprised over 3.6 million participants and 400,000 deaths. Despite the widespread suggestion that depression leads to more death, at least 95% of the studies the researchers investigated were found to be of insufficient quality. Using quantitative and qualitative methods, the researchers identified a pronounced publication bias. Specifically, studies that identified the largest associations between depression and mortality featured small samples, a low number of deaths, and short follow-up periods. Moreover, the researchers discovered that only about 5% of the 293 studies adjusted their statistical models for other mental health conditions like anxiety or substance use problems, which are very common among depressed patients: comorbidity rates exceed 50%. The researchers also found that two-thirds of the studies comprised respondents who were pre-selected on the basis of medical conditions. Many symptoms of depression like insomnia and fatigue are shared with various physical conditions or may arise as side effects of medications used to treat existing disorders. This, say Miloyan and Fried, could lead to the conclusion that depression is the cause of death, even though death may be better attributed to preexisting illnesses. To eliminate this confound, one solution is to properly control for comorbid psychological and physiological conditions, another to specifically study depressed patients without pre-existing physical illnesses. 'The studies we looked at have over the years led many people to place too easily, and perhaps mistakenly, a lot of confidence in the notion that depression is directly to blame for the high mortality', says Miloyan, a researcher at The Johns Hopkins University and faculty member at Federation University Australia. 'In fact, when we look more closely at the data from the few studies that are of acceptable quality, we do not find convincing evidence that depression is directly associated with all-cause mortality.' Instead, the results suggest that other variables, more specifically health behaviours and comorbidity, might be related to the higher rate of mortality among depressed individuals. 'For example, it is known that depression goes hand in hand with unhealthy lifestyle behaviours such as smoking, drinking and physical inactivity', says Fried, a psychologist and postdoctoral researcher at the UvA. 'Smoking in particular is associated with an increased risk of developing depression and with many causes of death. Such complex interactions among variables associated with depression and death, which have been largely ignored in the literature, imply that it is premature to draw strong causal conclusions.' Miloyan and Fried hope their findings encourage other researchers to investigate this question more carefully before designing and implementing programmes and policies aimed at curbing depression in order to substantially reduce deaths. Miloyan: 'This isn't to suggest that depression shouldn't be treated, of course, but rather that as far as the cause of overall mortality is concerned, the key factors probably lie somewhere else and warrant more rigorous future research.'
News Article | May 9, 2017
While on the PCA pump, Tyler's status was only monitored by intermittent spot checks by a nurse on shift, which respiratory experts state is not sufficient to catch a rapid deterioration in breathing before it is too late. Tyler also may have been exhibiting signs of obstructive sleep apnea, a very common condition in the adult population that Thomas Frederickson MD, lead author of the RADEO guide, identifies as a key contributing factor to opioid-related respiratory depression. "This story is a reminder that opioid-related harm can occur anywhere, even in normal, healthy patients," says Michael Wong, JD, Executive Director of PPAHS. "The sudden deaths of patients, like Tyler's, can be prevented by continuously monitoring with capnography and screening for high-risk conditions such as obstructive sleep apnea." The video can be viewed on the PPAHS YouTube channel here. PPAHS has developed several resources aimed at improving opioid safety such as the PCA Safety Checklist which is a free, downloadable resource for clinicians developed to remind caregivers of the essential steps needed to be taken to initiate PCA with a patient, and to continue to assess that patient's use of PCA. This checklist was developed after consultation with a group of 19 renowned health experts, including intensive care specialist and a leader in medical checklist development Peter J. Pronovost, MD, PhD, FCCM, Professor, Departments of Anesthesiology/Critical Care Medicine and Surgery, The Johns Hopkins University School of Medicine and Medical Director, Center for Innovation in Quality Patient; and Atul Gawande, MD, Professor in the Department of Health Policy and Management at the Harvard School of Public Health, who is a surgeon at Brigham and Women's Hospital Professor of Surgery at Harvard Medical School and author of "The Checklist Manifesto." Physician-Patient Alliance for Health & Safety is a non-profit 501(c)(3) whose mission is to promote safer clinical practices and standards for patients through collaboration among healthcare experts, professionals, scientific researchers, and others, in order to improve healthcare delivery. For more information, please go to www.ppahs.org. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/the-physician-patient-alliance-for-health--safety-releases-new-patient-story-focussed-on-patient-controlled-analgesia-300452103.html