University Hospitals Case Medical Center Remains Among the Elite in U.S. News & World Report Annual Survey

University Hospitals Case Medical Center (UHCMC) has again ranked among the elite in the latest U.S. News & World Report hospital rankings.  In this year’s survey, UHCMC ranked seven clinical specialties in the top 50 for hospitals and health systems nationwide.

Top among clinical departments at UHCMC, the Department of Medicine again contributed four of the specialties – Gastroenterology (28), Geriatrics (28), Cancer (34), and Pulmonology (42). This contribution by the Department of Medicine figured significantly into UHCMC joining only 152 other hospitals, or the top 3% of the nation’s 5,000 eligible healthcare organizations.

“This consistent level of excellence in compassionate, cost-effective patient care is a testament to the quality and dedication of the full time faculty in the Department of Medicine and to the leadership of our organizations.”

Richard A. Walsh, MD, Chairman, Department of Medicine

Angiotensin-Receptor Blockades (ARBs) Found to Raise Risk of Cancer

Dr. Daniel Simon M.D., Division Chief of Cardiovascular Medicine and Director of HM-Heart and Vascular Institute at UHCMC; Dr. James Fang M.D., Section Chief of Heart Failure and Medical Director of Heart Transplantation at UHCMC; IIke Sipahi M.D., Associate Director of Heart Failure & Transplantation at UHCMC at the Harrington-McLaughlin Heart & Vascular Institute of UHCMC researched the effects of Angiotensin-Receptor Blockers (ARBs) on the risk of cancer.

ARBs are a widely utilized drug class used for treatment of hypertension, heart failure, diabetic nephropathy, and recently, for cardiovascular risk reduction.

Randomized controlled trials of ARBs with a follow-up of at least 1 year, and enrolling at least 100 patients were included in this meta-analysis. Information on new cancer development (first diagnosis) was available for 61,590 patients from five trials. Cancer data on common types of solid organ cancers such as lung and prostate cancer were available for 68,402 patients from five trials, and data on cancer deaths were available for 93,515 patients from eight trials.

The meta-analysis showed that patients randomly assigned to receive ARBs had a significantly increased risk of new cancer occurrence compared with patients in control groups (7.2%vs 6.0%). Specifically, the risk of lung cancer was increased by 25%, which was also statistically significant.

“We have found the risk of new cancers was increased with these medications by 8-11 percent.  Most importantly, risk of lung cancer was increased by 25 percent,” said Dr. Sipahi. Although there was no statistically significant excess in cancer deaths (1.8% with ARBs vs 1.6% with control) the investigators pointed out that the average duration of follow-up of 4 years may be too short to capture cancer deaths.

“In medicine, physicians must balance the benefits and risks of all drug and device therapies.  We recommend that patients discuss the findings of this study with their physicians since ARBs are effective agents in the treatment of high blood pressure and heart failure,” said Dr. Simon.

They conclude that because of the limited data, it is not possible to draw conclusions about the exact risk of cancer associated with each individual ARB on the market, but they stated that their findings need further investigation.

In response to this publication from Case Western Reserve University, the European Medicines Agency (EMA) of the European Union announced that they started an investigation about the possible cancer risk of ARBs.

“This is the first time an association between ARBs and cancer development is suggested,” Dr. Sipahi continued. “While our findings are robust, they need to be replicated in other studies before they can be considered as definitive.”

The US Food and Drug Administration has not made any statement regarding this issue yet.

Correlation Between Methicillin-Resistant Staphylococcus Aureus and Cystic Fibrosis Proven

Led by Dr. Elliott Dasenbrook MD MHS, Associate Director of The Adult Cystic Fibrosis Program, a UHCMC team in the Division of Pulmonary, Critical Care, and Sleep Medicine have published the findings from a major study about cystic fibrosis (CF) survival rates in the June 16 issue of JAMA.

Specifically, the study observed patients with CF who had methicillin-resistant Staphylococcus aureus (MRSA) detected in their respiratory tract.

The team composed a study with 19,833 CF patients across the nation between ages 6 and 45.  Times until death after diagnosis with MRSA were recorded in order to compare survival between CF patients with and without respiratory tract MRSA.

The unadjusted mortality rate was 18.3 deaths (95% confidence interval [CI], 17.5-19.1) per 1000 patient-years in patients without MRSA and 27.7 deaths (95% CI, 25.3-30.4) per 1000 patient-years in those with MRSA.  The team showed that there is a significantly higher rate of death in CF in people that have MRSA.

“Our study findings may prompt many doctors to reconsider how they care for CF patients,” says Dr. Dasenbrook. He adds, “Until now, some CF doctors weren’t aggressively treating patients with MRSA.  Doctors often viewed MRSA to not be as important as other respiratory-tract infections. With our study findings, treatment patterns may changes as the risk of death is 1.3 times greater for CF patients with MRSA.”

endocrinology publications :: Q2 | 2010

Peri-operative management of Cushing’s disease
Abdelmannan D, Selman WR, Arafah BM.
Rev Endocr Metab Disord. 2010 Jun

Cushing’s syndrome: Why is diagnosis so difficult?
Aron DC.
Rev Endocr Metab Disord. 2010 Mar

Adherence to surgical care improvement project measures and the association with postoperative infections
Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM.
JAMA. 2010 Jun

Early urinary markers of diabetic kidney disease: a nested case-control study from the Diabetes Control and Complications Trial (DCCT)
Kern EF, Erhard P, Sun W, Genuth S, Weiss MF.
Am J Kidney Dis. 2010 May

Effect of Dexamethasone on Oral Glucose Tolerance in Normal Individuals
Abdelmannan D, Tahboub R, Genuth S, Ismail-Beigi F.
Endocr Pract. 2010 Mar

Supramolecular protein engineering: design of zinc-stapled insulin hexamers as a long acting depot
Phillips NB, Wan ZL, Whittaker L, Hu SQ, Huang K, Hua QX, Whittaker J, Ismail-Beigi F, Weiss MA.
J Biol Chem. 2010 Apr

An Achilles’ heel in an amyloidogenic protein and its repair: insulin fibrillation and therapeutic design
Yang Y, Petkova A, Huang K, Xu B, Hua QX, Ye IJ, Chu YC, Hu SQ, Phillips NB, Whittaker J, Ismail-Beigi F, Mackin RB, Katsoyannis PG, Tycko R, Weiss MA.
J Biol Chem. 2010 Apr

Effect of dexamethasone on insulin secretion: Examination of some underlying mechanisms
Sood A, Ismail-Beigi F.
Endocr Pract. 2010 Mar

Comparisons of different insulin infusion protocols: a review of recent literature
Krikorian A, Ismail-Beigi F, Moghissi ES.
Curr Opin Clin Nutr Metab Care. 2010 Mar

Overexpression of Bcl-2 in vascular endothelium inhibits the microvascular lesions of diabetic retinopathy
Kern TS, Du Y, Miller CM, Hatala DA, Levin LA.
Am J Pathol. 2010 May

Effects of p38 MAPK inhibition on early stages of diabetic retinopathy and sensory nerve function
Du Y, Tang J, Li G, Berti-Mattera L, Lee CA, Bartkowski D, Gale D, Monahan J, Niesman MR, Alton G, Kern TS.
Invest Ophthalmol Vis Sci. 2010 Apr

Comparisons of different insulin infusion protocols: a review of recent literature
Krikorian A, Ismail-Beigi F, Moghissi ES.
Curr Opin Clin Nutr Metab Care. 2010 Mar

cardiovascular medicine publications :: Q2 | 2010

Treatment of Pericardial Disease
Azam S, Hoit BD.
Cardiovasc Ther. 2010 Apr

Kruppel-like factor 4 inhibits epithelial-to-mesenchymal transition through regulation of E-cadherin gene expression
Yori JL, Johnson E, Zhou G, Jain MK, Keri RA.
J Biol Chem. 2010 May

Kruppellike Factor 15 Regulates Smooth Muscle Response to Vascular Injury
Lu Y, Haldar S, Croce K, Wang Y, Sakuma M, Morooka T, Wang B, Jeyaraj D, Gray SJ, Simon DI, Jain MK.
Arterioscler Thromb Vasc Biol. 2010 May

Krüppel-like factor 4 regulates pressure-induced cardiac hypertrophy
Liao X, Haldar SM, Lu Y, Jeyaraj D, Paruchuri K, Nahori M, Cui Y, Kaestner KH, Jain MK.
J Mol Cell Cardiol. 2010 Aug

Klf15 deficiency is a molecular link between heart failure and aortic aneurysm formation
Haldar SM, Lu Y, Jeyaraj D, Kawanami D, Cui Y, Eapen SJ, Hao C, Li Y, Doughman YQ, Watanabe M, Shimizu K, Kuivaniemi H, Sadoshima J, Margulies KB, Cappola TP, Jain MK.
Sci Transl Med. 2010 Apr

Fatty acid-binding protein 5 and PPARbeta/delta are critical mediators of epidermal growth factor receptor-induced carcinoma cell growth
Kannan-Thulasiraman P, Seachrist D, Mahabeleshwar G, Jain MK, Noy N.
J Biol Chem. 2010 Jun

Cardiac rehabilitation in heart failure: a brief review and recommendations
Piña IL.
Curr Cardiol Rep. 2010 May

Impact of ICD battery longevity on need for device replacements-insights from a Veterans Affairs database
Ramachandra I.
Pacing Clin Electrophysiol. 2010 Mar

Hypoxia influences the vascular expansion and differentiation of embryonic stem cell cultures through the temporal expression of vascular endothelial growth factor receptors in an ARNT-dependent manner
Han Y, Kuang SZ, Gomer A, Ramirez-Bergeron DL.
Stem Cells. 2010 Apr

The intrinsic complement regulator decay-accelerating factor modulates the biological response to vascular injury
Sakuma M, Morooka T, Wang Y, Shi C, Croce K, Gao H, Strainic M, Medof ME, Simon DI.
Arterioscler Thromb Vasc Biol. 2010 Jun

Angiotensin-receptor blockade and risk of cancer: meta-analysis of randomised controlled trials
Sipahi I, Debanne SM, Rowland DY, Simon DI, Fang JC.
Lancet Oncol. 2010 Jun

Vanoxerine, a new drug for terminating atrial fibrillation and flutter
Matsumoto N, Khrestian CM, Ryu K, Lacerda AE, Brown AM, Waldo AL.
J Cardiovasc Electrophysiol. 2010 Mar

[(Methyl)1-(11)C]-Acetate Metabolism in Hepatocellular Carcinoma
Salem N, Kuang Y, Corn D, Erokwu B, Kolthammer JA, Tian H, Wu C, Wang F, Wang Y, Lee Z.
Mol Imaging Biol. 2010 Apr

In situ fluorescence imaging of myelination
Wang C, Popescu DC, Wu C, Zhu J, Macklin W, Wang Y.
J Histochem Cytochem. 2010 Jul

Research on the effects of intensive treatment on hyperglycemia on type 2 diabetes

Dr. Faramarz Ismail-Beigi M.D., PhD., the previous Division Chief of Endocrinology, and a team of internationally renowned UHCMC diabetes specialists researched the effects of intensive treatment of hyperglycemia (or high blood sugar, a condition in which an excessive amount of glucose circulates in the blood plasma) on microvascular outcomes in type 2 diabetes in analyzing the ACCORD randomized trial.

Hyperglycemia is associated with increased risk of cardiovascular complications in people with type 2 diabetes.

The team set out to find out if reducing the blood glucose concentration to normal levels in people with established type 2 diabetes decreases the rate of microvascular complications. 10,251 patients were randomly assigned, 5,128 to the intensive glycemia control group and 5,123 to standard group. Intensive therapy was stopped before study end because of higher mortality in the glycemia group, and patients were transitioned to standard therapy. After reviewing the results, it was clear that intensive therapy did not reduce the risk of advanced measures of microvascular outcomes (such as kidney failure requiring dialysis, or advanced disease of the retina requiring surgery), but delayed the onset of albuminuria and some measures of eye complications and neuropathy.

The conclusion was made that microvascular benefits of intensive therapy should be weighed against the increase in total and cardiovascular disease-related mortality, increased weight gain, and high risk for severe hypoglycemia.

Dr. Ismail-Beigi suggests that “In elderly people with established type 2 diabetes of many years’ duration and a history of prior cardiovascular disease (such as a heart attack), or risk factors for cardiovascular disease, the benefits and risks associated with intensive blood sugar control needs to be carefully assessed on an individual basis.  The best approach is for patients to have a discussion with their health-care provider to set an appropriate blood sugar goal.”

Renowned researcher to lead transformative institute

A new initiative in translational research at Case Western Reserve University Department of Medicine and University Hospitals promises to catalyze scientific discoveries, formulate new therapies and inspire the next generation of physician-scientists.

Leading the effort will be one of the school’s newest additions: Jonathan S. Stamler, MD, who will serve as founding director of the Institute for Transformative Molecular Medicine. Dr. Stamler is also the first to hold the Robert S. and Sylvia K. Reitman Family Foundation Distinguished Chair in Cardiovascular Innovation at the Case Cardiovascular Center and University Hospitals Harrington-McLaughlin Heart & Vascular Institute.

“This newly established chair in cardiovascular investigation and its relationship to the Institute for Transformative Molecular Medicine will accelerate our scientific research to its full potential and provide new cures and therapies for the patients we serve,” says Richard A. Walsh, MD, physician-in-chief at University Hospitals and the John H. Hord Professor and chair of the Department of Medicine at Case Western Reserve University.

UH received Top Health System Award

University Hospitals named one of the Top 10 Health Systems in U.S.

For the second consecutive year, University Hospitals (UH) has been named one of the top 10 health systems in the United States based on clinical performance by Thomson Reuters, a leading business and professional information organization.

UH and the other top 10 systems outperformed their peers by a wide margin. They provided better care, followed standards of care more closely, saved more lives, had fewer patient complications, and made fewer patient safety errors.

The list was compiled in a study conducted by researchers from the Thomson Reuters 100 Top Hospitals®. They analyzed the quality and efficiency of 255 health systems based on eight metrics that gauge clinical quality and efficiency: mortality, medical complications, patient safety, average length of stay, 30-day mortality rate, 30-day readmission rate, adherence to clinical standards of care (evidence-based core measures published by the Centers for Medicare and Medicaid Services), and HCAHPS patient survey score (part of a national initiative sponsored by the U.S. Department of Health and Human Services to measure the quality of care in hospitals).

Thomson Reuters rankings are available at www.thomsonreuters.com.

University Hospitals Case Medical Center Earns Prestigious National Award for Excellence in Delivering High-Quality Care

University Hospitals (UH) Case Medical Center is one of five academic medical centers in the nation to receive the 2009 Quality Leadership Award from the University HealthSystem Consortium (UHC). The prestigious award is given to teaching hospitals that demonstrate excellence in delivering high-quality care, as measured by the UHC Quality and Accountability Study conducted annually since 2005.

This year, 93 member hospitals were ranked by UHC, a national organization representing more than 90 percent of the nation’s nonprofit academic medical centers. UHC’s distinctive study measured hospitals’ performance using the Institute of Medicine’s six domains of care—safety, timeliness, effectiveness, efficiency, equity, and patient centeredness.

“We are proud of this extraordinary achievement which reflects University Hospitals’ ongoing commitment to quality and safety for our patients,” said Fred C. Rothstein, M.D., President of UH Case Medical Center. “This is an exceptional recognition when you consider that academic medical centers across the country participated in the survey.   We are pleased that the excellence of our health care providers and staff was recognized by this prestigious organization of peer institutions.”

“National recognition is well deserved for these organizations that have distinguished themselves as high-performing organizations in a complex environment. I salute the top performers and extend congratulations to all academic medical center leaders and employees who daily demonstrate a passion for improving patient care and operational effectiveness,” said UHC President and Chief Executive Officer Irene M. Thompson.

UHC examined data provided by member hospitals through its comparative clinical, operational, and core measures data bases and reviewed additional source data from the publicly reported Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Other hospitals recognized this year in addition to UH Case Medical Center:

• Methodist Hospital—A Clarian Health Partner, Indianapolis
• Rush University Medical Center, Chicago
• University Medical Center, Tucson
• The University of Kansas Hospital Authority, Kansas City

“As an organization, UHC is committed to improving members’ performance. Through this study, we are able to determine what structures and practices are associated with excellent performance across an AMC,” said Mark Keroack, M.D., M.P.H., Chief Medical Officer and Vice President of the UHC Clinical Practice Advancement Center. Dr. Keroack, with others at UHC, developed the study approach and has conducted several organizational development workshops for UHC members across the country.

He is the lead author of “Organizational Factors Associated With High Performance in Quality and Safety in Academic Medical Centers,” published in the December 2007 issue of Academic Medicine. The critical success factors first identified in that study are a shared sense of purpose throughout the organization, leadership style, an accountability system, a focus on results, and a collaborative culture.

Donald Hricik discusses new hypertension study published in the Journal of American Medical Association

Half of Americans are in control of their blood pressure. But the number of new cases has gone up according to a new study out published in the Journal of American Medical Association which finds that one out of every three people had their hypertension under control 20 years ago compared to 50% of patients now. However, the number of people diagnosed with the condition has continued to go up.

Dr. Donald Hricik of CWRUmedicine Division of Nephrology and Hypertension at University Hospitals Case Medical Center is interviewed for the story. Watch the video.