School of Medicine

Wayne State University School of Medicine
St. Baldrick's grant keeps childhood oncology research moving forward
In Headlines on December 16, 2014
Joanne Wang, M.D.

Joanne Wang, M.D.

A childhood cancer research program conducted by a Wayne State University School of Medicine professor at Children’s Hospital of Michigan will be able to continue its work without setbacks thanks to a grant from the St. Baldrick’s Foundation.

Joanne Wang, M.D., assistant professor of pediatrics, and her team within the Children’s Oncology Group, or COG, secured a third consecutive St. Baldrick’s Infrastructure Grant. The $50,000 grant covers the salary of a clinical research associate and supports the attendance of oncology nurses at essential research conferences.

The St. Baldrick’s Foundation is a Monrovia, Calif.-based, volunteer-driven nonprofit founded in 1999. The foundation coordinates worldwide head-shaving events in which volunteers raise donations to support childhood cancer research. To date, the foundation has awarded $154,552,703 in research grants.

With the latest grant, Dr. Wang said, “We have the potential to enroll more patients, including an increased number of underrepresented minorities who comprise a significant proportion of our patient population. However, we have barriers to greater clinical trial participation due to a lack of funding for research personnel to open and maintain clinical studies. Due to the critical support we have received from the St. Baldrick’s Foundation, we have made great progress.”

That progress includes hiring an additional clinical research associate to open additional clinical trials, significant improvement in regulatory and data reporting requirements demonstrated by successfully passing the Children’s Oncology Group re-audit and maintaining a data currency score of 99 percent to 100 percent, and continuing the neuropsychology testing essential to participating in the COG cancer control studies.

In addition, nursing involvement in clinical trials has been increased. Two additional oncology nurse practitioners, in addition to the four oncology nurses, joined the COG membership in 2014.

“We have made great progress with the support we received from the St. Baldrick’s Foundation, and will be able to maintain and further improve it with the Infrastructure Award,” Dr. Wang said. “With our increased participation, the Children’s Oncology Group will have increased representation of African-American and other minority populations because of the unique population we serve.”

Clinical research assistants provide a variety of services related to clinical research trials, including collecting, recording and reporting study data. Maintaining the position through the grant allows research progress to continue, Dr. Wang said, rather than stall or stretch existing staff further.

WSU-led Michigan Stroke Network hub at St. Joe's wins national distinction for care
In Headlines on December 16, 2014
Stroke Center and St. Joe's leaders, including Ramesh Madhavan, M.D., second from left, accept the Stroke Gold Plus Achievement Award.

Stroke Center and St. Joe's leaders, including Ramesh Madhavan, M.D., second from left, accept the Stroke Gold Plus Achievement Award.

St. Joseph Mercy Oakland Hospital’s Stroke Center, a hub of the Michigan Stroke Network led by Wayne State University School of Medicine Associate Professor of Neurology Ramesh Madhavan, M.D., was recognized this week with the American Heart and Stroke Association’s highest national distinction pertaining to quality of care.

The Stroke Gold Plus Achievement Award was given to the center for consistent adherence to the association’s seven treatment and quality of care guidelines for at least 24 consecutive months. The Get With The Guidelines-Stroke Achievement Measures is a collaborative program to improve adherence to evidence-based care of patients hospitalized with stroke. Hospitals are required to achieve, document and benchmark measures based on scientific guidelines known to improve stroke care.

“When a patient suffers a stroke, about 2 million neurons, 7.5 miles of myelinated nerves and 14 billion synapses are destroyed without treatment. The patient’s brain ages three and a half years per hour compared to a normal brain. This is what we have prevented by our united team effort,” Dr. Madhavan said. “Are we going to stop with this achievement? Absolutely not.”Dr. Madhavan, the Wayne State University Physician Group’s associate chief medical officer of Informatics, estimates that the network has treated thousands of stroke patients and has consistently given tissue plasminogen activator, or tPA, a clot-busting medication, in less than 60 minutes. The St. Joseph-based team also was named to the Target: Stroke Award’s honor roll for achieving at least one calendar quarter of 50 percent or higher achievement of door-to-treatment times within 60 minutes in applicable stroke patients.

The Michigan Stroke Network is an initiative of Trinity Health. The network is one of the largest stroke networks in the country that use the “hub and spoke” model for providing comprehensive stroke care. The WSU stroke team, consisting of vascular and critical care fellowship-trained neurologists, provides acute stroke coverage at St. Joseph Mercy Oakland and other hospitals in the area that serve as hub hospitals and “spoke” care to about 35 hospitals in Michigan. When a stroke pager is activated, the patient is assessed on site. The same principle is applied at off-site community hospitals using telemedicine as a bridge. The patient is examined by a physician with the help of a remote robot and the onsite emergency department physician. Images and results are viewed remotely by the stroke neurologist.

“The credit goes to the change in the emergency department process. We have provided cutting-edge treatment and management of these very sick patients due to the tireless efforts of the Wayne State University Physician Group’s fellows, stroke and interventional neurologists,” he said.

Dr. Madhavan, the school’s director of telemedicine, also talked at the awards presentation about taking the Michigan Stroke Network’s efforts to the field in the near future.

“We are ready to do a trial of telemedicine in ambulances, roll out a universal image repository for the partner hospital image storage and mobile apps to improve the transition of care in these patients and, last but not the least, apply the process to other diseases. Our dream is to progress and make the Michigan Stroke Network … the Michigan Specialty Network,” he said.

Dr. Jinping Xu, collaborators to develop online education module for physicians treating prostate cancer survivors
In Headlines on December 16, 2014
Jinping Xu, M.D.

Jinping Xu, M.D.

Primary care physician Jinping Xu, M.D., has secured a two-year, $100,000 grant from the Blue Cross Blue Shield of Michigan Foundation and the Michigan Department of Community Health to develop, promote and maintain a statewide online education module for primary care providers on care guidelines for prostate cancer survivors.

Dr. Xu is an associate professor in the Wayne State University School of Medicine’s Department of Family Medicine and Public Health Sciences. She will collaborate on the project with School of Medicine Assistant Dean of Continuing Medical Education David Pieper, Ph.D., and WSU College of Education Associate Professor of Instructional Technology Monica Tracey, Ph.D.

“Our online Continuing Medical Education module will be accessible from anywhere in the world, and will serve as an innovative example for developing and delivering other online CME courses to improve health care quality for all,” she said.

The one-hour module will be based on the Michigan Cancer Consortium’s recommendations for prostate cancer survivorship care, which Dr. Xu helped write. She will also evaluate the module using evidence-based methodology.

Dr. Xu is a board-certified, Rochester, Mich.-based practicing family physician with a strong interest in the continuum of prostate cancer care, from screening, treatment decision-making and quality of life to survivorship care. She has a master’s degree in clinical research design and statistical analysis.

In her role as an active member of the MCC Prostate Cancer Action Committee since 2008, Dr. Xu helped develop and update the MCC Recommendations. She also helped update and disseminate the MDCH’s prostate cancer treatment “Decision Aid” to primary care physicians and patients.

She is the principal investigator of a five-year, multisite, $1.75 million Research Scholar Grant from the American Cancer Society to identify the determinants of the treatment decision for patients diagnosed with low-risk prostate cancer from both patient and urologist perspectives.

Long-term survival is common after prostate cancer treatment, Dr. Xu said, and the high prevalence of deleterious consequences of prostate cancer treatment is recognized as a critical issue in caring for survivors.

“Prostate cancer survivors approach 2.8 million in number and represent one in five of all cancer survivors in the United States,” she said. “Primary care providers are integral to the care of men with prostate cancer, yet few primary care physicians feel comfortable managing prostate cancer treatment side effects.”
Hindu student organization hosts health fair at local temple
In Headlines on December 15, 2014
A man listens to a volunteer at the health fair.

A man listens to a volunteer at the health fair.

A student takes a woman’s blood pressure at the temple.

A student takes a woman’s blood pressure at the temple.

Wayne State University medical students from the Associated Students for Hinduism Awareness student organization hosted a community health fair at a Pontiac, Mich., temple Oct. 12.

Fifteen students from all four classes screened and counseled 55 people who attended the event at Parashakti (Eternal Mother) Temple.

“We screened for obesity, hypertension and diabetes, and we also counseled each patient regarding improving health and wellness,” said second-year medical student Suhas Devangam, the student organization’s activities coordinator.

He coordinated the fair with a physician on the temple board to organize the health fair, manage logistics and gather supplies. The event was the student organization’s first health fair and attracted temple members and Hindu-temple devotees from southeast Michigan.

“We wanted to conduct a health fair at a temple because we knew that there is a high prevalence of obesity, hypertension and diabetes among the temple-going population,” Devangam said. “We chose to do it at Parashakti Temple because they were eager to conduct such an event in the hopes of benefitting their devotees, and were willing to educate the volunteers about the temple.”

Participating health professionals included WSU Internal Medicine residents Arunkumar Muthusamy, M.D., and Navin Durairajan, M.D.

Students earned five hours of co-curricular credit for participating. They plan to repeat the event next spring.

“We were very surprised at how well the fair went and how much of an impact it had. We had 55 participants, of which we were able to newly-diagnose 16, making it a highly effective and rewarding event,” Devangam said.

ASHA has held several events in the last year, including a discussion on the myths and misconceptions of Hinduism, and conducted dance lessons for a traditional Hindu festival. Members also co-hosted a Diwali dinner with the American Association of Physicians of Indian Origin student organization.

In 2015, the group will host a seminar discussion on the significance of yoga, decorate kites during the Makar Sankranti holiday and host a Holi (festival of colors) celebration.

“Each event is educational and is associated with a presentation/discussion that brings about awareness of Hinduism as it pertains to the event,” Devangam said.

WSU study finds Affordable Care Act increases reliance upon emergency rooms
In Headlines on December 15, 2014
Alexander Janke

Alexander Janke

The Patient Protection and Affordable Care Act may have provided health care insurance to an estimated 20 million Americans who lacked coverage, but it has not eased the demand on the nation’s emergency departments. In fact, since the law’s passage, reliance upon the nation’s emergency rooms for non-emergency care has increased.

That’s the finding of a study published online in the American Journal of Emergency Medicine by a second-year medical student at the Wayne State University School of Medicine and his colleagues.

In “Access to care issues and the role of EDs in the wake of the Affordable Care Act,” lead author Alexander Janke notes that Americans who received public insurance under the Affordable Care Act now use the emergency room more frequently than before they were insured. The overwhelming reason: Many urban and rural areas of the nation lack primary health care providers, so the emergency department becomes the only source of health care.

“Of course, we are not the first to highlight the significance of the general problem of lack of access to primary care,” said Janke, originally from Grand Rapids, Mich. “Part of the challenge is political: We need more resources in communities with many un- and underinsured, as in Detroit. Managed care approaches to health care delivery, and especially case management, have found success reducing emergency department utilization for high-frequency users. The Patient Centered Medical Home is a great example of an innovative care delivery model that makes primary care relevant to patients, high-frequency emergency department users or not, who might otherwise visit the emergency department. These kinds of innovations are certainly part of the overall solution. Emergency departments, which remain very much at the front lines of this problem, can also play a role.”

Co-authors and study researchers include Daniel Overbeek, a fourth-year student graduating in May and applying to residency programs in emergency medicine; Justin Bedford, a second-year student and a coordinator for the student Emergency Medicine Interest Group; Aaron Brody, M.D., clinical assistant professor of Emergency Medicine; Robert Welch, M.D., M.Sc., associate professor of Emergency Medicine; and Phillip Levy, M.D., M.P.H., associate professor of Emergency Medicine.

The team reviewed data from the 2013 National Health Interview Survey, administered by the U.S. Department of Health and Human Services. Their analysis utilized 7,233 respondents who reported at least one emergency department visit in the preceding 12 months.

Among emergency room users who reported no usual source of care and who reported relying on the emergency room, 27.7 percent and 35.1 percent, respectively, said lack of access forced them to the emergency room. None of those said their issue was a true emergency.

Patients lacking a stable usual source of health care were more likely to report using the emergency room because it was their “usual place to get care,” it was their “closest provider” or because they “didn’t have another place to go.”

Previous research has shown that Americans who lack access to a usual source of care, such as a family physician, use emergency departments more frequently. This study, the authors said, is the first population-level study to demonstrate their propensity for turning to emergency rooms in the face of a dearth of primary care access.

Emergency departments, the study said, will need to “evolve into outlets that service a wider range of health care needs rather than function in their current capacity, which is largely to address acute issues in isolation.” Otherwise, the overcrowding of emergency rooms for non-emergency issues will remain problematic.

“We found that insurance status is a far less significant predictor of lack of access-based emergency department utilization than usual source of care,” Janke said. “As health care services utilization increases in the era of the Affordable Care Act, the shortcomings of primary care accessibility will become increasingly salient. Many patients will simply present to our nation’s emergency departments. Policymakers should consider providing resources for emergency departments in under-resourced communities to address the full range of health care needs for patients lacking a stable usual source of care.”

The study also points out that if newly insured patients cannot access primary care and instead rely upon the emergency rooms, they may not enjoy the full benefits of health care services provided under the act.

Research has shown that poor health and disruptions in access to primary health care providers are key predictors of emergency room use. The study authors predict that reliance upon emergency rooms will increase as enrollment under the ACA continues. The trend is troubling because prior research indicates stable access to primary care providers is critical for effective health care services utilization. Moreover, studies have found that Americans with an established usual source of care are more likely to follow recommended preventive care measures, and demonstrate better rates of awareness, treatment and control of chronic conditions such as hypertension and elevated cholesterol levels.

The authors recommend the emergency department serve as a case study in accessibility, as well as a “fulcrum to contain costs through improved resource utilization.” They recommend new policies that provide incentives for emergency departments to participate in more holistic care for patients lacking a stable usual source of care.

“We are moving toward a more patient-centered and integrated health care system,” Janke said. “The emergency department has many desirable qualities for patients: accessibility, diagnostic testing, procedures and a full range of provider expertise. In the paper we say ‘policymakers should provide emergency departments with resources and incentives to better address the full range of their patients' health care needs, especially as utilization picks up under the Affordable Care Act.’ Emergency departments can coordinate better referral and follow-up, and address health issues not related to patients' acute or emergent conditions, for example, as a checkpoint in long-term hypertension management. Ultimately, though, we will need substantial financial investment to do these things. Emergency department staff already has plenty to do.”

Janke said he helped conduct the study after volunteering at Detroit Receiving Hospital with the emergency medicine research team during his first year of medical school. “I had a few conversations on this general topic with great folks I worked with there. I approached Dr. Levy with a vague idea about high-frequency emergency department users and primary care access. He promptly connected me with his research team, set us on track, and helped me turn my vague idea into a real research project,” said Janke, who is interested in a career in family medicine and emergency medicine. “Dr. Brody and Dr. Welch happily obliged to render their own expertise. Justin Bedford and Daniel Overbeek, friends and fellow medical students, invested time on analysis and drafting the paper. I owe a debt of gratitude to Dr. Levy, who taught me a lot throughout the research process.”

Medical students join white coat 'die-in' to protest police killings
In Headlines on December 10, 2014
Students lay on the ground in front of the entrance to Scott Hall.

Students lay on the ground in front of the entrance to Scott Hall.

Protesting students join hands.

Protesting students join hands.

A passerby navigates the protest.

A passerby navigates the protest.

Vice Dean for Medical Education Maryjean Schenk joined the silent protest.

Vice Dean for Medical Education Maryjean Schenk joined the silent protest.

Wayne State University medical students participated in a national “white coat die-in” Wednesday afternoon to protest recent decisions by grand juries to not issue indictments against police officers in the killings of Michael Brown in Ferguson, Mo., and Eric Garner in New York.

At 3 p.m. Dec. 10, international Human Rights Day, WSU medical students joined their medical student peers across the nation in staging the silent protests.

“It’s important that we, who are going into health care, unite with the community that we intend to serve,” said Osamuede Iyoha, a fourth-year medical student who intends to practice psychiatry. “We enter into medicine because we want to serve the public, much like those in law enforcement. But when an injustice is being done or abuse is taking place, you have to work to correct that issue. So it should be addressed. We are proud Wayne State University students and we are proud of our faculty, who teach us to be a part of the community, so we peacefully joined this national effort.”

Approximately 30 students and some faculty and staff, including Vice Dean for Medical Education Maryjean Schenk, M.D., M.P.H., M.S., lay quiet and motionless on the ground just outside the entrance doors to Scott Hall for 10 minutes. Some joined hands as they lay on the cement in temperatures that dipped to 30 degrees. They did not block the entrance.

Some passersby joined the protest; others stopped to take photographs. A cameraman from Fox 2 Detroit television recorded the protest and interviewed students afterward.

“We support our students in their civil protest of what many perceive as an unfair system,” said Jack Sobel, M.D., interim dean of the Wayne State University School of Medicine. “We teach our students to become sensitive, culturally aware and culturally competent physicians. That entails speaking out against culturally insensitive actions and working to correct disparities, both in health care and in our communities.”

Several of the “die-in” participants echoed that sentiment.

“If we are going to become doctors, we have to stand up and say that certain things are wrong, and that includes police brutality,” said second-year medical student Dana Sugar. “We have to fight on these issues.”

“You have to stand up to injustice,” agreed Lea Selitsky, also a second-year medical student.

Students at more than 50 medical schools across the nation conducted the silent protests to spotlight racial bias as a public health issue.

“Racial bias and violence are not exclusively a problem of the criminal justice system. As we have seen in Ferguson, New York and countless other places, bias kills, sickens and provides inadequate care,” said fourth-year medical student Reginald Ramirez, who helped organize the event. “As medical students, we must take a stand against the oppression of our black and brown patients, colleagues, friends and family. By standing together at medical schools nationwide, we hope to demonstrate that the medical student community views racial violence as a public health crisis.

“We, as medical students, feel that this is an important time for medical institutions to respond to the violence and race-related trauma that affects our communities and the patients we serve,” said Ramirez, who is considering a career in anesthesiology or obstetrics and gynecology. “We feel it is essential to begin a conversation about our role in addressing the explicit and implicit discrimination and racism in our communities and reflect on the systemic biases embedded in our medical education curricula, clinical learning environments and administrative decision-making. We believe these discussions are needed at academic medical centers nationwide.”

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