Study conducted locally by Dr. Chaturvedi published in New England Journal of Medicine

Patients at risk of developing a stroke caused by narrowed brain arteries should take aspirin rather than a well-known anti-clotting medication to prevent a stroke from occurring, according to the results of a major national study published in the New England Journal of Medicine on March 31, 2005.

Seemant Chaturvedi, M.D., Wayne State University associate professor of neurology and director of the university's stroke program, conducted the Detroit-area portion of the study and served on the study's steering committee. The research was led by Dr. Marc Chimowitz of Emory University.

Funded by the National Institute of Neurological Disorders and Stroke, a division of the National Institutes of Health, the nearly $15 million, five-year study ended early because the anti-clotting drug, warfarin (marketed under the brand name Coumadin ), was associated with more complications while showing no advantages over a high dose of aspirin. The study is known as the Warfarin-Aspirin Symptomatic Intracranial Disease study, or WASID.

Doctors describe narrowed or clogged arteries in the brain as intracranial arterial stenosis, accounting for approximately 90,000 strokes or stroke warning spells (transient ischemic attacks or TIAs) per year in the United States. Patients with this condition are at high risk for another stroke.

Warfarin or similar drugs were first suggested as a treatment for stroke caused by narrowed brain arteries 50 years ago. Previous studies had suggested that warfarin may be superior to aspirin for this cause of stroke, but this finding was inconclusive because of the limitations in the design of those studies.

The WASID study was conducted in a double-blind fashion, meaning that neither participants nor researchers knew which medication (warfarin or aspirin) was being taken until the study ended. Participants took either dose-adjusted warfarin (according to monthly blood tests) or 1300 mg. of aspirin daily (a higher dose than is usually recommended for heart disease and strokes of other causes).

The higher dose of aspirin was chosen because this was the dose for which there was the most reliable data from previous studies. There is some evidence that higher doses of aspirin may be more effective for inhibiting inflammation of blood vessels and preventing platelets (blood cells important for clotting) from sticking to the narrowed artery, although this is controversial. The concern with using higher doses of aspirin is the risk of causing stomach ulcers and bleeding from the gastrointestinal tract.

When the WASID study started in February of 1999, researchers had planned to enroll more than 800 participants over five years at more than 50 sites in the U.S. and Canada. However, after 569 participants were enrolled, NINDS stopped the study early on the recommendation of the independent Data Monitoring Committee because the warfarin group was developing complications at a higher rate than the aspirin group.

Complications included higher rates of major bleeding (8.3 percent of warfarin participants vs. 3.2 percent of aspirin participants) and death (9.7 percent of warfarin participants vs. 4.3 percent of aspirin participants) during an average follow-up time of 1.8 years. The percentages of participants having a stroke during the study were 20.7% on aspirin and 17.6% on warfarin.

“This study is likely to have a significant impact on physician practices for patients with narrowed blood vessels leading to the brain,” Dr. Chaturvedi said.

The researchers point out that warfarin is still a useful treatment for a variety of disorders, including atrial fibrillation. Patients who have questions about the use of warfarin should consult their doctors before making any decisions about altering their prescription regimens.

The researchers note that the costs to treat intracranial arterial stenosis would be reduced by using aspirin instead of warfarin. Not only is warfarin more expensive to purchase, repeated blood tests must be also done while taking the drug. Expenses climb again for treatment of increased complications of warfarin compared to aspirin. The researchers estimate that these savings could amount to at least $20 million per year.

The research group is now planning another study that will evaluate the use of stenting (using a device to hold the blocked arteries open) to treat stroke related to narrowed brain arteries, in the hope that it will prove more effective than existing therapies.

 

Wayne State University Physician Group recently introduced its Active Health Solutions initiative, a program designed to empower individuals and organizations by providing the tools they need to take charge of their both their budgets and their health.

WSU's Active Health Solutions are both good medicine and good business because they can enhance health and save money at the same time. These solutions allow employers and patients to move out of the role of passive observers to become active drivers of better approaches to managing health care.

WSU Physician Group's Active Health Solutions are grounded in a few simple premises of good medical practice:

• Improving broad health education and awareness
• Addressing individual health proactively through health-risk appraisals and screenings, targeted educational materials and customized personal counseling and treatment plans.

Finding new approaches to health care is important for both employers and individuals. Wayne State University Physician Group's Active Health Solutions include three programs to help organizations and individuals respond to these challenges.

Working Well Program:
Urgent medical care when you need it and where you need it

• Comprehensive urgent care for symptoms of cold, flu, minor infections or injuries
• Same day appointments (within 24 hours)
• On your way within an hour

House Calls for Health:
Keeping employees healthy

• Active Health Solutions on-site at your organization's facilities in a single day
• Comprehensive screenings, lifestyle consultation and more

Executive Health Care Program:
Active health strategies for senior personnel

• Providing organizations and their senior personnel the tools they need to take charge of both their budgets and their health
• The most comprehensive Executive Health Care program in Southeast Michigan
• Providing senior personnel with their own "Chief Executive Health Officer" – a leading physician who will bring together all WSU's experts, facilities and affiliates and p rovide a personal focus from intake through consultation to writing the final report

To find out more about what WSU Physician Groups Active Health Solutions can offer you or your organization, please visit http://www.wsupg.org/specialty/ahs/index.htm or call (313) 577-4803 between 7:30 a.m. and 6 p.m., Monday through Friday.

Dean Robert R. Frank hosted a discussion on research on Monday, prompting several thoughtful questions and providing a thorough update of various activities.

Topics covered included research facilities, efforts to improve research administration and ways of providing incentives to recruit and retain quality researchers.

"Research is a very important part of what we do in the medical school," said Dean Frank in opening the talk, "even to those who are mainly clinicians and even to those who are mainly teachers."

The third floor of Scott Hall will be renovated, starting with the demolition process in May. July is the targeted date for completion. The plans call for a new classroom as well as a revamped floor plan overall. Dean Frank acknowledged that the process may be difficult for some, but that it would be worth it.

School of Medicine leadership is also meeting with the WSU Office of the Vice President for Research to begin discussions about the possibility of a new, state-of-the art laboratory research facility. Such a building would cost approximately $100 million, which Dean Frank said would be a challenge, but a challenge that could be met.

Switching to the topics, Dean Frank reported the findings of a committee established by the School of Medicine to suggest ways to improve research administration. As a result of the committee's work, the following steps have been taken:

• Wayne State University has committed to modifying the Banner system to forecast salary encumbrances.
• An ad hoc committee has been established to pursue financial incentives for productive researchers with a target of having such incentives in place by October 2005.
• The School of Medicine will serve as a beta test site for a reorganized research administration office. Details of the reorganization will be announced within 60 days.
• Having a strong research emphasis was a criterion included in the WSU School of Medicine dean search position specification.

Dean Frank also announced several new leadership appointments including Dr. Dan Walz as associate dean for research and Dr. Larry Grossman as director of the Center for Molecular Medicine and Genetics. Interviews are underway for an assistant dean for clinical research.

Dean Frank also recognized the research accomplishments of several departments that recently moved up in NIH rankings and also the work of a few individual researchers. Among those honored were Dr. Eric Ayers, a WSU assistant professor of medicine who was nominated for the Association of American Medical College's Humanism in Medicine award, and Dr. Linda Hazlett, WSU chair of anatomy and cell biology who recently entered her 26th year of funding on her study, "Alteration with Age of Resistance of Eye Infections."

The discussion was followed by a 45-minute question-and-answer session that prompted discussion on several topics, including ways to recruit promising young faculty members as well as the possibility of revamping tenure guidelines.

Lower doses of estrogen alone or in combination with a progesterone-like drug increase mean bone-mineral density, according to a new Wayne State University School of Medicine study published recently in Osteoporosis International.

In a two-year study assessing the impact of hormone-replacement therapy on bone loss, women who took lower doses of estrogen alone or in combination with a progesterone-like drug suffered significantly less bone loss in their spines and hips than women who took a placebo. The study, which was conducted at four U.S. universities, was led in Detroit by Michael Kleerekoper , WSU professor of medicine in the Division of Endocrinology.

“The message of the article is that even in low doses estrogen prevents bone loss at menopause in the vast majority of women. That's exciting news when you consider that women experience up to 20 percent of their lifetime bone loss in the five to seven years after the menopause,” Dr. Kleerekoper said. “The need to give every woman the old standard, one-size-fits-all dose is gone.”

In the randomized, double-blind study, 822 healthy postmenopausal women with intact uteri received either a placebo or varying doses of conjugated estrogens alone or in combination with two different doses of medroxyprogesterone acetate. The women also took 600 mg of calcium per day.

More than 85 percent of women receiving hormone therapy experienced no additional bone-mineral density loss at one year and two years, in comparison to 30.6 percent of women on placebo at 12 months and 36.5 percent of women on placebo at 24 months.

WSU School of Medicine students were among the 14,700 U.S. medical school seniors who applied for residency positions through the National Resident Matching Program this year -- the highest number in almost 20 years. More residency positions were offered and filled in the 2005 Match than ever before: a total of 24,012 positions were available, and 22,221 of them were filled. Seventy-eight percent of all applicants matched to a first-year residency program; nearly 83 percent of the matched applicants were paired with one of their top three residency program choices. As in previous years, U.S. medical school seniors enjoyed a higher success rate than other applicants; nearly 94 percent matched and more than 86 percent of those students were assigned to one of their top three choices.

Dean Robert R. Frank will deliver the annual State of the School address Monday, March 21. Although the talk will cover the school's wellbeing as a whole, it will include a special focus on initiatives to advance research as well as the continued theme "A Year to Make a Difference." The State of the School address will be at 4 p.m. in Scott Hall's Jaffar Auditorium.

Matthew Jackson, Ph.D., associate professor of immunology and microbiology, has been appointed interim assistant dean for basic-science education. Previously, the post was held by James Hazlett, Jr., Ph.D., who died unexpectedly Feb. 22.

“Although we are still mourning the loss of Dr. Hazlett, we are dedicated to preserving the important work he led here at the School of Medicine ,” said Maryjean Schenk, M.D., M.P.H., interim associate dean for academic and student programs. “I am very grateful to have an exemplary educator and scholar such as Dr. Jackson to build on the foundation laid by Dr. Hazlett.”

In 1989, Dr. Jackson joined the WSU School of Medicine as an assistant professor of immunology and microbiology; he was promoted six years later to the rank of associate professor. His research has focused primarily on E. coli.

Dr. Jackson also has a strong interest in technology-enhanced medical education. In 2002, he led an effort to supply personal digital assistants, or PDAs, as educational tools to sophomore students. The interactive program allows course instructors to gauge in real time how well students are grasping various concepts discussed during a class.

Dr. Jackson received his Ph.D. in microbiology from Kansas State University in 1985 before completing a postdoctoral research fellowship at the Uniformed Services University Health Sciences, in Bethesda , Md. He also obtained a master's degree in microbiology as well as a bachelor's degree in biology at the University of Missouri-Kansas City.

Dr. Jackson received an Excellence in Teaching Award from the WSU School of Medicine in 2000. He has served as a member of several study sections; Dr. Jackson is currently a member of the Enteric Diseases Panel, Military Infectious Disease Research Program, in Herndon , Va.

 

The search for a new WSU School of Medicine dean continues to progress with the recent posting of position specifications. The document, which was written following extensive input from stakeholders at all levels in the school, is available at http://www.med.wayne.edu/admin/deansearch/position.asp.

The Search Committee is currently reviewing applications and nominations. For more on the process, including links to the search firm Witt/Kieffer and a list of Search Committee members, please visit the Dean Search website at http://www.med.wayne.edu/admin/deansearch/index.asp. Periodic news updates will also be featured as the search continues.

Taniform Abongwa, a WSU School of Medicine Year I student, drowned Sunday, March 6, while on a recreational outing with his fellow students during a medical relief trip in Ecuador. All other students traveling with Mr. Abongwa are safe, and families have been notified.

"I am terribly saddened to report a tragedy involving one of our medical students," wrote Maryjean Schenk, M.D., M.P.H., interim associate dean for academic and student programs, in a message yesterday to the School of Medicine community. "He was a very friendly, caring and compassionate person."

Mr. Abongwa was one of 12 Year I medical students who traveled to Ecuador on March 3 to spend a week volunteering at a local hospital as part of the World Health Student Organization's spring break relief program. Mr. Abongwa was with his fellow students at a local beach near the village of Muisne when the accident occurred.

A native of Cameroon, Africa, Mr. Abongwa resided in Ann Arbor, where he had extended family. Mr. Abongwa was highly regarded by his fellow classmates and faculty. He was an exemplary student and was involved in several voluntary, community-based student organizations.

He graduated from the University of Michigan with a Bachelor of Science in molecular biology in 2003.

Arrangements are pending and will be detailed in future issues of Prognosis.

 

Dean Robert R. Frank will deliver the annual State of the School address Monday, March 21. Although the talk will cover the school's wellbeing as a whole, it will include a special focus on initiatives to advance research as well as the continued theme "A Year to Make a Difference." The State of the School address will be at 4 p.m. in Scott Hall's Jaffar Auditorium.

Following his announcement in December to establish a Department of Medical Evaluation and Education Research for the WSU School of Medicine, Dean Robert R. Frank, M.D., announced the appointment of Patrick D. Bridge , Ph.D., to head the new initiative.

As assistant dean for medical evaluation and education research, Dr. Bridge is responsible for overseeing a school-wide program to ensure the most progressive and effective medical curriculum and faculty development.

Dr. Bridge has been closely involved in medical school curriculum development and evaluation since joining the WSU faculty in 1997. An assistant professor of family medicine, Dr. Bridge has assisted in educating faculty in the development of research and evaluation methods and the application of statistical tests and educational theory (psychometrics). His role as medical educator has guided his scholarship and research activities in the areas of program evaluation, community-based cancer education and educational theory. He was fundamental in integrating the unique use of hand-held computers, or PDAs, into the medical education curriculum.

“Pat Bridge brings a high level of expertise and scholarship to this important new initiative,” Dean Frank said. “He will do an excellent job in guiding medical education through effective use of new technology and applications in order to maintain our strength as a first-rate medical school.”

Dr. Bridge received his doctorate in evaluation and research from WSU in 1995. He holds a master's degree from the University of Detroit and earned his undergraduate degree from Eastern Michigan University. He held positions as medical software product designer with the MEDSTAT Group in Ann Arbor, as senior research administrator for SelectCare Inc., in Troy, and as quality improvement specialist/biostatistician with Sinai Hospital before joining the faculty.

 

Real, dead brains will be on display Saturday, March 19, at the Detroit Public Library as part of the WSU School of Medicine's Brain Awareness Day. Organized by graduate students in the Cellular and Clinical Neurobiology Program, the event is the culmination of a week of events in schools throughout metropolitan Detroit that teach children about the human brain and its function.

Brain Awareness Day is filled with hands-on activities and presentations, including topics such as the detrimental effects of drugs, diseases of the brain and careers in neuroscience. The event is one of the School's most popular.

"We spend our lives in the laboratories performing experiments to try to figure out how the brain functions and how diseases alter that function," said Mays Imad, one of the co-chairs of Brain Awareness Week. "It is refreshing for us to be able to take a step back and share our knowledge in another way by educating the community about the brain in a relaxed and fun atmosphere."

Brain Awareness Day will be held from 10 a.m. to 4 p.m., Saturday, March 19, in the Detroit Public Library, 5201 Woodward Ave.