UPMC Physician Resources

Older Adults with Depression and Mild Cognitive Impairment are More Vulnerable to Accelerated Brain Aging, Pitt Study Says

PITTSBURGH, Aug. 7, 2014 – People who develop depression and mild cognitive impairment (MCI) after age 65 are more likely to have biological and brain imaging markers that reflect a greater vulnerability for accelerated brain aging, according to a study conducted by researchers at the University of Pittsburgh School of Medicine. The findings were published online in Molecular Psychiatry.

Older adults with major depression have double the risk of developing dementia in the future compared with those who have never had the mood disorder, said senior investigator Meryl A. Butters, Ph.D., associate professor of psychiatry, Pitt School of Medicine. But there’s no clear explanation for why a treatable mood disorder like depression leads to increased risk for dementia, a progressive brain disease. Until now, most studies have examined only one or two biomarkers to get at this question.

“Our study represents a significant advance because it provides a more comprehensive and integrated view of the neurobiological changes related to mild cognitive impairment in late-life,” she said. “Better understanding of the neurobiology of cognitive impairment in depression can provide new targets for developing more specific treatments, not only for its prevention and treatment, but also for its down-stream negative outcomes, including the development of dementia and related disorders.”

The team collected blood samples from 80 older adults in remission after being treated for major depression, 36 of whom had MCI and 44 with normal cognitive function. Their blood was tested for 242 proteins involved in biologic pathways associated with cancer, cardiovascular diseases, and metabolic disorders as well as psychiatric and neurodegenerative disorders. The researchers also performed PET and MRI brain scans on the participants to look for indicators of cerebrovascular disease, brain atrophy or shrinkage, and beta-amyloid, which is the protein that makes up the brain plaques associated with Alzheimer’s disease.

The MCI group was more likely to have differences in the biologic activity of 24 proteins that are involved in the regulation of immune and inflammatory pathways, intracellular signaling, cell survival, and protein and lipid balance.

Brain scans revealed a greater propensity for cerebrovascular disease – for example, small strokes – in the MCI group, but there was no difference in the amount of beta-amyloid deposition.

“If you take these results altogether, they suggest that people with depression and cognitive impairment may be more vulnerable to accelerated brain aging, which in turn puts them at risk for developing dementia,” Dr. Butters said. “Ultimately, if we can understand what happens in the brain when people are depressed and suffer cognitive impairment, we can then develop strategies to slow or perhaps stop the impairment from progressing to dementia.”

Next steps include assessing the protein panel in older people with normal cognitive function who have not experienced depression.

Co-authors of the study include Etienne Sibille, Ph.D., Ying Ding, Ph.D., George Tseng, Ph.D., Howard Aizenstein, M.D., Ph.D., Frances Lotrich, M.D., Ph.D., James T. Becker, Ph.D., Oscar L. Lopez, M.D., Michael T. Lotze, M.D., William E. Klunk, M.D., Ph.D., and Charles F. Reynolds, M.D., all of the University of Pittsburgh; and the first author is Breno S. Diniz, M.D., Ph.D., now of the Federal University of Minas Gerais, Brazil.

The project was funded by National Institutes of Health grants MH080240, MH90333 (ACISR for Late Life Depression Prevention and Treatment), AG05133 (Alzheimer Disease Research Center), MH09456; CA047904-22S1, CA160417, CA181450; the John A. Hartford Foundation Center of Excellence in Geriatric Psychiatry; and the Brazilian Intramural Research Program.

Screening and Drug Therapy Predicted to Make Hepatitis C a Rare Disease

PITTSBURGH, Aug. 4, 2014 – Newly implemented screening guidelines and improved, highly effective drug therapies could make hepatitis C a rare disease in the United States by 2036, according to the results of a predictive model developed at the University of Pittsburgh Graduate School of Public Health.

The results of the analysis, funded by the National Institutes of Health (NIH) and performed with the University of Texas MD Anderson Cancer Center, are published in the Aug. 5 issue of the Annals of Internal Medicine.

A “rare” disease is one that affects at most one in every 1,500 people. Approximately one in every 100 people in the U.S. currently has chronic hepatitis C, a viral infection that compromises liver function.

“Making hepatitis C a rare disease would be a tremendous, life-saving accomplishment,” said lead author Mina Kabiri, M.S., a doctoral student in Pitt Public Health’s Department of Health Policy and Management. “However, to do this, we will need improved access to care and increased treatment capacity, primarily in the form of primary care physicians who can manage the care of infected people identified through increased screening.”

In the U.S., hepatitis C is the leading cause of chronic liver disease and the leading reason for liver transplantation. At 15,100 deaths annually, hepatitis C surpassed the annual number of deaths from HIV in 2007. The economic burden associated with chronic infection is estimated at $6.5 billion a year.

“This is, indeed, a very interesting time for hepatitis C patients and providers,” said senior author Jagpreet Chhatwal, Ph.D., now of the University of Texas MD Anderson Cancer Center, who performed most of the research while at Pitt Public Health. “Several changes have happened in the last two years, including screening policy updates and availability of highly effective therapies.”

In 2012, the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommended that anyone born between 1945 and 1965 — encompassing about 81 percent of chronically infected people — receive a one-time screening for hepatitis C. Hepatitis C often is asymptomatic, meaning that infected people do not know they have it until it is detected through a blood screening.

In early 2014, hepatitis C drug regimens that could be taken orally were introduced to the market, allowing primary care physicians and infectious disease specialists to take on the role of treating hepatitis C patients. The drugs have been shown to be highly effective in making the virus almost undetectable in the blood of patients previously found positive for hepatitis C.

The research team created a highly detailed computer model of the natural history and progression of hepatitis C, both with and without treatment. The model predicts the number of hepatitis C infections in the U.S. at any given time from 2001 to 2050, under multiple potential scenarios describing future treatment, while taking into consideration infection status awareness, stage of disease, treatment history and continued drug development, based on data from the National Health and Nutrition Examination Survey (NHANES) and published clinical studies.

To validate the prediction, the researchers ran the model for the years 2003 to 2010 and predicted 2.7 million cases of hepatitis C, which equaled the actual number of cases reported by NHANES.

The research team then considered what would happen if the guidelines were increased to include a one-time universal screening for hepatitis C among all U.S. citizens, not just baby boomers.

“In that scenario, nearly 1 million cases of hepatitis C would be identified in the next 10 years,” said Ms. Kabiri. “And that translates into making hepatitis C a rare disease by 2026, a decade earlier than we’d predicted with the current screening guidelines.”

The researchers note that such a measure would bring increased costs. The oral therapy regimen costs as much as $1,000 per day.

The model estimated that universal screening coupled with the new drug therapies would reduce liver-related deaths by 161,500 and liver transplants by 13,900 from 2014 to 2050.

“Though impactful, the new screening guidelines do not identity the large number of hepatitis C patients who would progress to advanced disease stages without treatment and could die,” said Dr. Chhatwal. “More aggressive screening recommendations are essential in further reducing the burden, preventing liver-related deaths and eventually eradicating hepatitis C.”

Future research will be needed to determine how the reduction in deaths and transplants offsets the increased costs of screening and drug therapy.

Additional researchers on this study are Alison B. Jazwinski, M.D.; Mark S. Roberts, M.D.; and Andrew J. Schaefer, Ph.D., all of Pitt.

This study was supported by the National Center for Advancing Translational Sciences of the NIH under award number KL2TR000146.

Community Pharmacist Intervention Boosts Drug Adherence, Reduces Health Care Costs, Pitt Study Says

PITTSBURGH, Aug. 4, 2014 – Community pharmacists can dramatically help their patients stick to their prescription regimens, according to a new study led by researchers at the University of Pittsburgh School of Pharmacy. The findings, reported today in Health Affairs, suggest also that greater adherence to medications can lead to a reduction in emergency room visits and hospital admissions, thereby lowering health care costs for a variety of chronic conditions including diabetes and asthma.

About 70 percent of all Medicare patients get their prescriptions filled at neighborhood drug stores, but pharmacists can do more for patients than just prepare medications, said lead investigator Janice Pringle, Ph.D., associate professor and director of the Program Evaluation and Research Unit (PERU) at Pitt’s School of Pharmacy. She noted their training, knowledge and community accessibility perhaps makes them the ideal health professionals to help people learn how and why to take their medications.

“This untapped resource could be harnessed and used to improve public health and reduce overall health care costs,” Dr. Pringle noted. “If people took their medications as prescribed, diabetes would not evolve and worsen, blood pressure would normalize, cholesterol would be reduced dramatically, and the risk for severe health problems, such as heart attack or stroke, would be reduced. Patients would live longer and probably enjoy a higher quality of life.”

For the study, dubbed the Pennsylvania Project, 283 community pharmacists were trained at short workshops by PERU staff to ask customers a few quick questions about medication adherence using established survey tools. They also were taught to have a brief dialog with patients whose screening scores indicated they were at risk of not taking their medications as prescribed by their doctors. The conversation might include questions and reassurances about side effects or to request that the patient talk to the pharmacist after taking the medication for a little while to report how they were feeling.

During 2011, 29,042 people had prescriptions filled at 107 Rite Aid pharmacies that implemented the screening and brief intervention approach (SBI) and 30,454 people who went to 111 “control” pharmacies that didn’t use SBI.

The research team then reviewed insurance claims data to evaluate medication adherence with a measure called “Proportion of Days Covered” or PDC. A PDC of 80 percent, meaning the medication was taken for at least 80 percent of expected period, is considered to be the minimal medication dose needed to achieve the desired clinical outcome. PDC80 values were calculated for both the intervention year and for 2010, the year prior to SBI implementation.

For the five classes of common medications the researchers reviewed, PDC80 rates increased in the SBI group during the intervention compared to the control group, ranging from 3.1 percent for beta blockers to treat high blood pressure to 4.8 percent for oral diabetes drugs. About 75 percent of the net improvement was due to patients who were at high risk for poor medication adherence achieving the PDC80 benchmark after the intervention. Health care costs dropped by $341 annually per person for SBI patients taking oral diabetes drugs and by $241 for SBI patients taking statins to lower cholesterol.

“The cost savings demonstrated by the Pennsylvania Project should draw the attention of many payers to the value of leveraging pharmacists in the community where their members live to improve health and wellness and reduce overall health care costs,” said study co-author Jesse McCullough, Pharm.D., director of field clinical services at Rite Aid Corp. “This is another area where the value of the pharmacist to the health care system is demonstrated.”

“High quality medical care is a ‘team sport’ involving physicians and other providers, nurses, care managers, health plans and well trained pharmacists,” said Michael Madden, M.D., vice president and chief medical officer at Gateway Health Plan, which provided pharmacy claims data for the study. “Improving medication adherence rates improves quality, public health and saves money, and this study demonstrates the value pharmacists can add.”

“The Pennsylvania Project demonstrated that realizing untapped clinical performance value from a network of pharmacies is as much about the ability of a health plan to foster a supportive environment as it is about the ability of a pharmacy to execute an improvement effort,” said study co-author Mark Conklin, Pharm.D., vice president at Pharmacy Quality Solutions. “The relationship between the two entities, based on shared objectives and continuous learning, is the key ingredient.”

Each SBI pharmacy also received monthly PDC-measure feedback reports through CECity’s cloud-based performance management platform that allowed pharmacists to gauge their performance relative to peers and helped them identify their population of patients at risk for non-adherence.

“The Pennsylvania Project is a perfect example of how a continuous learning health system model can be developed and scaled to improve quality and decrease the cost of patient care,” said study co-author Annette Boyer, R.Ph., vice president of business development at CECity.

Arnie Aldridge, Ph.D., of RTI International, also was a co-author of the study.

The project was funded by Pharmacy Quality Alliance.

Ann E. Thompson, M.D., to Become Next Vice Dean of the University of Pittsburgh School of Medicine

PITTSBURGH, Aug. 1, 2014 – Associate Dean for Faculty Affairs Ann E. Thompson, M.D., will become vice dean of the University of Pittsburgh School of Medicine on Oct. 1.

In this role, Dr. Thompson will serve as a senior deputy to Arthur S. Levine, M.D., Pitt’s senior vice chancellor for the health sciences and John and Gertrude Petersen Dean of the School of Medicine, in the management and advancement of the medical school.

“Dr. Thompson’s many achievements include building and maintaining successful clinical and academic programs with exceptional records for fellowship training and research productivity,” Dr. Levine said. “She has held leadership roles as a medical school administrator and in her clinical field of critical care medicine, and has consistently advocated for the recruitment and promotion of outstanding women at Pitt and in academic medicine as a whole.”

Dr. Thompson is professor and vice chair (professional development) of the Department of Critical Care Medicine and medical director for clinical resource management at Children’s Hospital of Pittsburgh of UPMC. She served as chief of pediatric critical care from 1981 to 2009 and was interim chair of the Department of Critical Care Medicine from 2006 to 2008. She is a past president of the Society of Critical Care Medicine — only the second woman to hold that position — and she is a senior editor of Pediatric Critical Care Medicine.

“I look forward to this new challenge and the chance to contribute to the continued growth and success of our premier medical school,” Dr. Thompson said. “Living up to the standards set by my predecessor, Dr. Steven Kanter, will be a major challenge, but the faculty, students and staff here are truly exceptional, and I am confident we will continue along the same world-class trajectory he helped so much to establish.”

Dr. Thompson received her bachelor of arts in biology from the University of Chicago in 1969 and her medical degree from Boston’s Tufts University School of Medicine in 1974. After completing her pediatric residency training at the Tufts New England Medical Center and Children’s Hospital of Philadelphia (CHOP), she trained in anesthesiology at the Hospital of the University of Pennsylvania and did a fellowship in pediatric critical care and research at CHOP, which is where she held her first faculty position. In 2003, she received a master’s degree in health care policy and management from Carnegie Mellon University.

Dr. Thompson succeeds Steven L. Kanter, M.D., who will become dean of the medical school at the University of Missouri-Kansas City on Oct. 1.

“During his 12-year tenure as vice dean, Dr. Kanter has become an international expert in medical education and curriculum innovation, and has created a culture of collaborative learning and support for our medical students and faculty alike,” Dr. Levine said. “While we will miss him greatly, we are delighted that he has earned this wonderful opportunity to implement his well-honed leadership skills, experience and creativity as the dean of a medical school.”

Surgical, Other Advances Made at UPMC Improve Graft Survival of Intestinal, Multi-Visceral Transplant Patients

SAN FRANCISCO, July 30, 2014 – Innovations in surgical techniques, drugs and immunosuppression have improved survival after intestinal and multi-visceral transplants, according to a retrospective analysis of more than 500 surgeries done at UPMC over nearly 25 years.

The study was led by Goutham Kumar, M.D., a transplant surgery fellow at UPMC’s Thomas E. Starzl Transplantation Institute. Dr. Kumar was recognized for his work with the Young Investigator Award by the 2014 World Transplant Congress and presented his findings at the group’s July 26 to 31 meeting in San Francisco.

“UPMC has led the way in the development of new surgical techniques and important research involving transplantation, and our analysis shows that our innovations have made a real difference to patients,” Dr. Kumar said.

The researchers examined 541 intestinal and multi-visceral transplants done at UPMC from 1990 to 2013. The total consisted of 228 pediatric transplants and 313 adult transplants; 252 were intestine-only transplants, 157 were liver-intestine, 89 were full multi-visceral, and 43 were modified multi-visceral. A majority of the pediatric patients suffered from gastroschisis, followed by volvulus and necrotizing entercolitis. The adult patients needed transplants because of thrombosis, Crohn’s disease or some kind of obstruction.

Researchers analyzed several outcomes and found that pre-conditioning with certain immunosuppressants, the time the graft is outside of the body, certain blood types and a disparity in the gender of donor and recipient were among the factors predicting graft survival.

Co-authors on the study are George Mazariegos, M.D., Guillerme Costa, M.D., Gaurav Gupta, M.D., Dolly Martin, Geoff Bond, M.D., Kyle Soltys, M.D., Rakesh Sindhi, M.D., Abhinav Humar, M.D., and Hiroshi Sogawa, M.D., all of either the Thomas E. Starzl Transplantation Institute, Children’s Hospital of Pittsburgh of UPMC or UPMC.

In addition to Dr. Kumar, six other UPMC and University of Pittsburgh Schools of the Health Sciences researchers were recognized this year with Young Investigator Awards by the World Transplant Congress. They and their presentations are:

Aravind Cherukuri, M.D., Ph.D.
“Transitional B Cell (TrB) T1/T2 Ratio is a Marker for Graft Dysfunction in Human Kidney Transplant Recipients (KTRs)”

Vinayak Rohan, M.D.
“Outcomes of Liver Transplantation for Unresectable Liver Malignancy in Children”

Qing Ding, Ph.D.
“TIM-1 Signaling is Required for Maintenance and Induction of Regulatory B Cells Through Apoptotic Cell Binding or TIM-1 Ligation”

Kanishka Mohib, Ph.D.
“TIM-4 Expression by C Cells Identifies an Inflammatory B Effector 1 Subset that Promotes Allograft Rejection and Inhibits Tumor Metastases”

Dalia Raich-Regue, Ph.D.
“Myeloid Dendritic Cell-Specific mTORC2 Deficiency Enhances Alloreactive Th1 and Th17 Cell Responses and Skin Graft Rejection”

Tripti Singh, M.D.
“B Cell Depletion of Naïve Recipients Enhances Graft Reactive T Cell Responses”

Naturally Occurring Antibodies May be Treatment for BK Nephropathy in Kidney Transplant Patients

SAN FRANCISCO, July 30, 2014 – A viral infection known as BK that commonly causes kidney transplant dysfunction in patients taking high doses of immunosuppressants may be treated with naturally occurring antibodies that already are widely available, according to UPMC-led research that was presented this week at the World Transplant Congress in San Francisco.

The BK virus infects most healthy children in the U.S., but the infection is usually asymptomatic and readily cleared by the immune system. However, following natural infection, latent virus persists in the kidneys for an indefinite time because antibodies in the plasma and circulating T-cells remain at levels that are high enough to prevent virus reactivation.

“However, if the immune system is suppressed — for example by kidney transplant medications designed to prevent rejection of the organ — viral infection flares up and damages the kidney. This causes a condition called BK virus nephropathy,” said Parmjeet Randhawa, M.D., a UPMC pathologist and professor of transplant pathology at the University of Pittsburgh, who led the research. “Currently, there are no anti-viral drugs or vaccines specifically designed for BK nephropathy, and none is likely to be licensed for at least the next 10 years.”

Dr. Randhawa and his team found that anti-BK antibodies are present at very high levels in immunoglobulin preparations currently being used to treat other viral infections, as well as immunologic disorders such as antibody mediated rejection of transplanted organs. These antibodies interact with a BK virus surface protein called VP-1 and effectively neutralize the virus. Such neutralized viruses can no longer infect human cells.

“By artificially constructing viruses varying in the composition of the proteins on their surface, we have shown that this neutralizing action is effective against all six common BK virus strains circulating in human populations,” Dr. Randhawa said. “These findings open the way to conduct clinical trials for preventing and treating BK nephropathy in kidney transplant patients.”

As the proposed immunoglobulin preparations are natural products derived from healthy human subjects, associated side effects are expected to be minimal, Dr. Randhawa said.

Collaborators on the study were Diana Pastrana, Ph.D., and Christopher Buck, Ph.D., both of the National Cancer Institute; Gang Zeng, M.D., of the University of Pittsburgh Department of Pathology; Mel Berger, Ph.D., of CSL Behring, in King of Prussia, Pa.; and Sundaram Hariharan, M.D., and Ron Shapiro, M.D., both of UPMC.

Dementia Patients More Likely to Get Implanted Pacemakers, Says Pitt Study

PITTSBURGH, July 28, 2014 – People with dementia are more likely to get implanted pacemakers for heart rhythm irregularities, such as atrial fibrillation, than people who don’t have cognitive difficulties, according to researchers at the University of Pittsburgh School of Medicine. In a research letter published online today in JAMA Internal Medicine, the researchers noted the finding runs counter to expectations that less aggressive interventions are the norm for patients with the incurable and disabling illness.

To look at the relationships between cognitive status and implantation of a pacemaker, lead investigator Nicole Fowler, Ph.D., a health services researcher formerly at the Pitt School of Medicine, and her team examined data from 33 Alzheimer Disease Centers (ADCs) entered between September 2005 and December 2011 into the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set.

Data from more than 16,000 people who had a baseline and at least one follow-up visit at an ADC were reviewed. At baseline, 48.5 percent of participants had no cognitive impairment, 21.3 percent had a mild cognitive impairment (MCI), and 32.9 percent had dementia.

The researchers found that participants with cognitive impairment were significantly older and more likely to be male, have ischemic heart disease, and a history of stroke. Rates of atrial fibrillation and congestive heart failure were similar among the groups.

The likelihood of getting a pacemaker, a device that regulates the heart beat, was lowest for those who had no cognitive difficulties and highest for dementia patients.

“Participants who had dementia before assessment for a new pacemaker were 1.6 times more likely to receive a pacemaker compared to participants without cognitive impairment, even after clinical factors were taken into account,” said Dr. Fowler, now at Indiana University. “This was a bit surprising because aggressive interventions might not be appropriate for this population, whose lives are limited by a severely disabling disease. Future research should explore how doctors, patients and families come to make the decision to get a pacemaker.”

There was no difference among the groups in the rates of implantation of cardioverter defibrillators, which deliver a small shock to get the heart to start beating again if it suddenly stops.

Co-authors of the paper include Jie Li, M.S., Charity G. Moore, Ph.D., Samir Saba, M.D., Oscar L. Lopez, M.D., and Amber E. Barnato, M.D., M.P.H., M.S., all of the University of Pittsburgh, and Kim G. Johnson, M.D., of Duke University Medical Center.

The project was funded by the Agency for Healthcare Research and Quality and National Institutes of Health, National Institute on Aging grant AG05133. The NACC database is funded by National Institutes of Health, National Institute on Aging grant AG016976.

Children’s Brain Care Institute Expert Receives Grant for Mitochondrial Disease Research

PITTSBURGH, July 28, 2014 — The United Mitochondrial Disease Foundation (UMDF) recently awarded nearly $500,000 in grants to researchers investigating potential treatments for mitochondrial disease. The research grant awards were presented at the UMDF’s annual symposium, Mitochondrial Medicine 2014: Pittsburgh.

Michael Bell, MD, of the Brain Care Institute (BCI) at Children’s Hospital of Pittsburgh of UPMC, received a grant of $25,000 for his project, “Improving CNS delivery of brain antioxidants after acute metabolic decompensation in mitochondrial disease,” which will investigate a combination of two FDA-approved drugs for their effectiveness in treating children and young adults with Leigh’s Syndrome. This work has the potential to improve brain function in patients with a mitochondrial disease for which there are currently no proven treatments. Dr. Bell is working on this project with Amy Goldstein, MD, of the Division of Child Neurology, and Bob Clark, MD, and Hülya Bayir, MD, from the Department of Pediatric Critical Care Medicine, who all are part of the Brain Care Institute.

Dr. Bell is also director of Pediatric Neurocritical Care and the Pediatric Neurotrauma Center at Children’s. He is associate director of Pediatric Neurointensive Care and Perinatal Brain Injury at the Safar Center for Resuscitation Research at the University of Pittsburgh, and associate professor of Critical Care Medicine and Neurological Surgery at the University of Pittsburgh School of Medicine.

The UMDF is the largest, non-governmental contributor of grants focused on mitochondrial disease research. Since 1996, the UMDF has funded more than $13 million dollars in research projects.

UPMC Clinicians Win Beckwith Institute Grants to Engage Patients, Improve Care

PITTSBURGH, July 25, 2014 –To experiment with changes big and small that might better engage patients and improve health care, The Beckwith Institute recently awarded 11 new grants to UPMC clinicians and other staff.

The wide-ranging projects include an effort to develop a shared decision-making tool for family members of patients in intensive care units (ICUs) and the creation of an interactive, Web-based “thermometer” to monitor the mood and energy of adolescents with bipolar disorder.

Supported by UPMC Chairman G. Nicholas Beckwith and his wife, Dotty, with matching funds from UPMC, the Beckwith Institute annually provides grants to improve clinical outcomes by empowering both clinicians and patients to explore innovative ways of transforming health care.

“Through the inspiring leadership and generous financial assistance of Nick and Dotty Beckwith, we are able to empower clinicians and other staff to experiment with new methods for transforming care delivery,” said Tami Minnier, UPMC chief quality officer. “At the heart of every project chosen for this program is an emphasis on engaging and educating patients and families so that they can play a meaningful role in the health care decisions that affect them.”

The grants are administered through two complementary efforts: The Frontline Innovation Program, which focuses on improving the patient bedside experience, and the Clinical Transformation Program, which supports comprehensive redesign of processes to put the involvement of the patient and their loved ones at the core.

The projects awarded 2014-2015 grants include:

  • a novel “mood and energy” tracking application for patients with pediatric bipolar disorder
  • a mobile application that allows patients to track and navigate the complex organ transplant process
  • a Web-based communication and decision support tool to improve the quality of shared decision-making in the ICU and to prepare family members for the role of surrogate decision maker
  • use of personal health monitoring devices for elderly patients with heart disease to promote patient engagement and prevent complications
  • an effort to assess patients for readmission risk and to ensure appropriate outreach after hospital discharge
  • resources to engage pediatric patients in diabetes care
  • standardization of sexual assault care at UPMC facilities
  • an asthma education program for children that includes a nurse hotline and online patient portal
  • a decision-making tool to help patients with chronic obstructive pulmonary disease make informed treatment decisions
  • development of a protocol that can be used to safely identify and discharge blunt trauma patients who have sustained no significant injury
  • a multidisciplinary effort to reduce unnecessary hospital readmissions for patients with complex health needs

UPMC-Developed Test Increases Odds of Correct Surgery for Thyroid Cancer Patients

PITTSBURGH, July 24, 2014 – The routine use of a molecular testing panel developed at UPMC greatly increases the likelihood of performing the correct initial surgery for patients with thyroid nodules and cancer, report researchers from the University of Pittsburgh Cancer Institute (UPCI), partner with UPMC CancerCenter.

The test, available at the UPMC/UPCI Multidisciplinary Thyroid Center and other diagnostic testing agencies, improved the chances of patients getting the correct initial surgery by 30 percent, according to the study published this month in the Annals of Surgery.

“Before this test, about one in five potential thyroid cancer cases couldn’t be diagnosed without an operation to remove a portion of the thyroid,” said lead author Linwah Yip, M.D., assistant professor of surgery in Pitt’s School of Medicine and UPMC surgical oncologist.  Previously, “if the portion removed during the first surgery came back positive for cancer, a second surgery was needed to remove the rest of the thyroid. The molecular testing panel now bypasses that initial surgery, allowing us to go right to fully removing the cancer with one initial surgery. This reduces risk and stress to the patient, as well as recovery time and costs.”

Cancer in the thyroid, which is located in the “Adam’s apple” area of the neck, is now the fifth most common cancer diagnosed in women.  Thyroid cancer is one of the few cancers that continues to increase in incidence, although the five-year survival rate is 97 percent.

Previously, the most accurate form of testing for thyroid cancer was a fine-needle aspiration biopsy, where a doctor guides a thin needle to the thyroid and removes a small tissue sample for testing. However, in 20 percent of these biopsies, cancer cannot be ruled out. A lobectomy, which is a surgical operation to remove half of the thyroid, is then needed to diagnose or rule-out thyroid cancer. In the case of a postoperative cancer diagnosis, a second surgery is required to remove the rest of the thyroid.

Researchers have identified certain gene mutations that are indicative of an increased likelihood of thyroid cancer, and the molecular testing panel developed at UPMC can be run using the sample collected through the initial, minimally invasive biopsy, rather than a lobectomy. When the panel shows these mutations, a total thyroidectomy is advised.

Dr. Yip and her colleagues followed 671 UPMC patients with suspicious thyroid nodes who received biopsies. Approximately half the biopsy samples were run through the panel, and the other half were not. Patients whose tissue samples were not tested with the panel had a 2.5-fold higher statistically significant likelihood of having an initial lobectomy and then requiring a second operation.

“We’re currently refining the panel by adding tests for more genetic mutations, thereby making it even more accurate,” said co-author Yuri Nikiforov, M.D., Ph.D., professor in the Department of Pathology at Pitt and director of thyroid molecular diagnostics at the UPMC/UPCI Multidisciplinary Thyroid Center. “Thyroid cancer is usually very curable, and we are getting closer to quickly and efficiently identifying and treating all cases of thyroid cancer.”

In 2009, the American Thyroid Association (ATA) revised its guidelines to add that doctors may consider the use of molecular markers when the initial biopsy is inconclusive.

“The ATA is currently revising those guidelines to take into account the latest research, including our findings,” said senior author Sally Carty, M.D., Pitt professor of surgery, co-director of the UPMC/UPCI Multidisciplinary Thyroid Center and recent president of the American Association of Endocrine Surgeons. “The molecular testing panel holds promise for streamlining and eliminating unnecessary surgery not just here but nationwide.”

A previous study led by Dr. Yip showed the panel to be cost-saving when used to help in the diagnosis of thyroid cancer.

Each year, approximately half of the 25,000 patients assessed at UPMC’s Multidisciplinary Thyroid Center are found to have thyroid conditions, and more than 900 thyroid operations are performed by the center’s surgeons. The center aims to provide patients with one-stop evaluation from thyroid experts in a variety of fields, including surgery and endocrinology.

Additional researchers on this study are Laura I. Wharry, M.D., Michaele J. Armstrong, Ph.D., Ari Silbermann, B.S., Kelly L. McCoy, M.D., and Michael T. Stang, M.D., all of the Pitt Department of Surgery; Nobuyuki P. Ohori, M.D., and Marina N. Nikiforov, M.D., all of the Pitt Department of Pathology; Shane O. LeBeau, M.D., Christopher Coyne, M.D., and Steven P. Hodak, M.D., all of the Pitt Department of Endocrinology; Julie E. Bauman, M.D., of the PItt Department of Hematology/Oncology; Jonas T. Johnson, M.D., of the Pitt Department of Otolaryngology; and Mitch E. Tublin, M.D., of the Pitt Department of Radiology.

This study was funded by a grant from UPMC.

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