UPMC Physician Resources

Genetic Test Helps Improve Outcomes in Heart Stent Patients

A genetic test recently implemented at UPMC Presbyterian can significantly reduce the risk of cardiovascular events by helping to identify more effective medication for some heart patients, according to the results of a large study conducted in part at the University of Pittsburgh and UPMC. The findings are being presented today at the American Heart Association’s Scientific Sessions in New Orleans.

The test identifies a genetic deficiency that affects the body’s ability to activate clopidogrel, a common anti-clotting drug given after a coronary artery stent is inserted. About 30 percent of all patients have the genetic deficiency, which can lead to decreased clopidogrel effectiveness and increased risk for adverse cardiovascular events, such as strokes, heart attacks and death.

In the current study from the National Institutes of Health’s Implementing Genomics in Practice (IGNITE) Network, researchers at the University of Pittsburgh School of Pharmacy and other sites throughout the country analyzed medical outcomes in 1,815 patients who had genetic testing at the time of their cardiac procedure. The testing allows physicians to pinpoint the best anti-clotting medication for each patient.

The study reported significant results: About 60 percent of patients with the genetic deficiency were given a different, more effective medication. Using the genetic data to guide changes in therapy reduced the percentage of deaths, heart attacks or strokes by nearly half compared with those who continued taking clopidogrel, the researchers found. Among those who had the genetic deficiency and continued taking clopidogrel, 8 percent experienced one of those complications.

“We saw significantly fewer adverse events among patients who were switched to an alternative drug,” said Larisa Cavallari, PharmD, director of the Center for Pharmacogenomics at the University of Florida College of Pharmacy who led the multi-institutional study.

Earlier this year, UPMC Presbyterian became one of the first medical centers in the country to make this test available for patients as part of the PreCISE-Rx (Pharmacogenomics-guided Care to Improve the Safety and Effectiveness of Medications) initiative. Approximately 10 percent of the study population was analyzed by the team at Pitt and UPMC, one of the affiliates in the IGNITE Network.

“This study is a major step forward as it shows applying pharmacogenomics to achieve a precision medicine approach in cardiac stent patients can provide significant benefits,” said Philip Empey, PharmD, PhD, assistant professor of pharmacy and therapeutics at the Pitt School of Pharmacy and leader of the Pitt team.

PreCISE-Rx is a leading initiative of the Institute for Precision Medicine (IPM), a joint effort by UPMC and Pitt to move biomedical research into personalized well-being and clinical care.

“The success of PreCISE-Rx demonstrates that the IPM is well-positioned to dramatically improve the standard of care through precision medicine by taking advantage of the world-class clinical and research expertise in Pittsburgh,” said Adrian Lee, PhD, professor of pharmacology and chemical biology at Pitt, and director of the Women’s Cancer Research Center, University of Pittsburgh Cancer Institute.

Other institutions that participated in the clopidogrel research were the University of North Carolina, the University of Maryland-Baltimore, the University of Alabama-Birmingham, Vanderbilt University Medical Center, the University of Illinois-Chicago, Indiana University-Indianapolis, Sanford Health, Duke University and the University of Pennsylvania.

International Team Decodes Cellular Death Signals

A multidisciplinary international team of scientists solved the mystery of a recently discovered type of controlled cell death, mapping the path to potential therapies for conditions ranging from radiation injury to cancer. The study, led in part by the University of Pittsburgh, is reported today in two papers in Nature Chemical Biology.

Ferroptosis is a way the body uses iron (which is “ferro” in Latin) to catalyze a reaction that safely destroys and recycles a malfunctioning or damaged cell. Until this study, scientists didn’t know how the body signaled – within the damaged cell and to other cells – that this well-regulated death needed to occur.

“Our team successfully decoded the signaling language that cells use to trigger ferroptosis,” said Valerian E. Kagan, PhD, DSc, professor in the Pitt Graduate School of Public Health’s Department of Environmental and Occupational Health, and lead author of one of the papers. “You can think of it like the scanners and radios that policemen use to find and arrest a criminal.

“The goal is to communicate enough information to neutralize the problem and remove the criminal, or damaged cell, but without creating such a commotion that you disrupt the society, which, in this example, would be other, well-functioning cells.”

Through two years of experiments bridging fields ranging from public health and critical care medicine to basic biology and chemistry, the team analyzed hundreds of molecular combinations generated in the ferroptotic process to discover that only four molecules actually signal for the cell to die. All four are phospholipids – naturally occurring molecules that make up cell membranes.

“Scientists have long known that these lipids were important for encasing the cell and giving it structure,” said Kagan. “What they didn’t know – what we’ve only learned in recent scientific history – is that they do so much more, including communicating and signaling messages like ‘danger’ inside the cell itself, to other cells and to the cellular community as a whole, so that organisms can function in a coordinated way.”

Kagan and Hülya Bayɪr, MD, professor in Pitt’s Department of Critical Care Medicine and senior author of one of the papers, had previously worked together to decode another type of more well-known cell death, called apoptosis. They then decided to pursue the more esoteric ferroptosis, which had first been discovered in 2012.

“Ferro means iron, and we live in Pittsburgh, the Iron City – it would be a shame for us not to understand this process,” said Kagan, whose team looked for therapeutic value as they decoded the signaling process.

Kagan and Bayɪr also study ways to protect people against radiation, such as what would be given off in a terrorist attack. The findings gave them reason to think that ferroptosis may underlie radiation induced cellular damage as well.

“More and more, we’re appreciating that the damage from acute radiation is happening to the lining of the intestine, and that damage triggers a cascade of health complications that lead to sepsis, a very deadly syndrome,” said Bayɪr. “We believe that the radiation is triggering ferroptosis in the cells that line the intestine. If we can stop that process and get the body to repair, rather than systematically destroy, those cells, we might save the victims of devastating dirty bomb attacks.”

Conversely, in cancer, the body is failing to destroy dysfunctional cancer cells, allowing tumors to grow unchecked. By understanding the ferroptotic pathway, the researchers hope to find medications that can prompt it to recognize and kill cancer cells.

The researchers have already partnered with several UPMC clinicians to explore ways to translate their scientific findings into therapies that could help patients.

Sebastian Doll, PhD, José Pedro Friedman Angeli, PhD, and Marcus Conrad, PhD, all of Helmholtz Zentrum München in Germany, are lead or senior authors on the accompanying Nature Chemical Biology publication. In addition to a multi-disciplinary team of Pitt leading investigators, including  Joel Greenberger, MD, Rama K. Mallampalli, MD, Claudette St Croix, PhD, Simon Watkins, PhD, and Ivet Bahar, PhD, and others at Helmholtz Zentrum München, additional co-authors are from the University of Heidelberg in Germany and Columbia University in New York.

This research is supported by National Institutes of Health grants P01HL114453, U19AI068021, NS076511, NS061817, P41GM103712 and ES020693; Deutsche Forschungsgemeinschaft grants CO 291/2-3 and CO 291/5-1; and the Human Frontier Science Program grant HFSP-RGP0013/2014.

Heart Failure Care Improving, but Hospitalizations on the Rise

Although hospitalizations have increased in recent years for patients with congestive heart failure, survival rates and length of stay have improved, according to new research from experts at the University of Pittsburgh School of Medicine and UPMC Heart and Vascular Institute. The results, published in the journal Clinical Cardiology and presented Sunday at the American Heart Association Scientific Sessions, were based on more than 15 million US hospital admissions between 1996 and 2009 due to congestive heart failure.

The prevalence of heart failure is increasing in the US due to its aging population and significant advancements in management of associated co-morbidities, such as ischemic heart disease, diabetes, stroke, peripheral vascular disease and hypertension. More than 5 million Americans are living with heart failure, and close to 500,000 patients are newly diagnosed each year.

Heart failure also is a common cause of hospital admissions, leading to significant costs for the nation’s health care system. A recent report from the American Heart Association estimated the annual direct and indirect costs associated with heart failure in the US at more than $30.7 billion. However, until this study, little was known about recent trends involving those admissions, including length of stay and in-hospital mortality.

“There has been significant progress in heart failure management over the past two decades, but more has to be done,” said Muhammad Bilal Munir, MD, clinical instructor of medicine in Pitt’s Division of General Internal Medicine and corresponding author of the study. “The number of hospitalizations has increased, identifying a need to implement heart failure quality measures stringently to reduce these admissions, therefore reducing heart failure-associated health care costs.”

The number of heart failure hospitalizations increased from 1,000,766 in 1996 to about 1,173,832 in 2009, according to study results. The mean length of stay fell from 6.07 days in 1996 to about 5.26 days in 2009, and inpatient mortality rates declined from 4.92 percent in 1996 to 3.41 percent in 2009.

Researchers say the findings likely reflect the changes in the management of heart failure across the country, which include numerous advances in care such as new drug therapies and sophisticated devices. Further efforts are needed to curb the cost of heart failure management, experts agreed, with a focus on reducing heart failure hospital admissions and readmissions, especially for patients with less severe symptoms who could be treated with aggressive outpatient management.

Additional study authors are Michael S. Sharbaugh, MPH; Floyd W. Thoma; Muhammad Umer Nisar, MD; Amir S. Kamran, MD; Andrew D. Althouse, PhD; and Samir Saba, MD, all from the UPMC Heart and Vascular Institute.

Western Psychiatric Institute and Clinic of UPMC Host 33rd Annual Pittsburgh Schizophrenia Conference

On November 18, 2016, join Western Psychiatric Institute and Clinic of UPMC and the University of Pittsburgh Department of Psychiatry for the nation’s longest running scientific meeting devoted to exploring the latest research findings related to schizophrenia and other psychotic disorders.

Held at the Sheraton Station Square, this year’s program features presentations on a wide range of topics including:

  • The relevance of animal models to the prevention and treatment of schizophrenia
  • New findings in the area of genetics 
  • The importance of early detection and intervention 
  • The role of spirituality in recovery from serious mental illness

The conference also welcomes Stephen Marder, MD, Professor of Psychiatry and Biobehavioral Sciences at the UCLA David Geffen School of Medicine, who will be presenting the Gerald E. Hogarty Excellence in Schizophrenia Research Memorial Lecture. Dr. Marder will present on the topic of “New Clinical Targets for Improving Functioning in Schizophrenia.”

Click here to register online and here to download the conference program.

For more information about the conference and how to register, please contact Nancy Mundy at mundynl@upmc.edu.

Click here for more resources and free online CME in psychiatry.

Children’s Hospital of Pittsburgh Experts At the 30th Annual North American Cystic Fibrosis Conference

PrintThe 30th annual North American Cystic Fibrosis Conference was held October 27-29 in Orlando. The event brought scientists, clinicians, and other healthcare professionals from around the world to share the latest ideas and advances in cystic fibrosis research, drug development, and patient care, and included posters and presentations from field-leading experts.

Several Children’s Hospital of Pittsburgh of UPMC faculty and staff presented at the conference on a number of topics including:

 

Poster: Identification of Novel Inhibitors of Ubiquitination That Improve Rescue of F508DELCFTR by VX-809

Goeckeler-Fried, Jennifer; Estabrooks, Samuel K; Chiang, Annette; Chung, Wook Joon; Ye, Zhaofeng; Denny, Rajiah Aldrin; Weissman, Allan M; Camacho, Carlos J; Sorscher, Eric J; Brodsky, Jeffrey L

Poster: Recognition of CFTR By BCL2 Associated Athnaogene 3 (BAG3): A Pathway meditating Autophagic CFTR Degradation

Mishra, Sanjay K ; Frizzell, Raymond A.

Poster: Ubiquitin-Specific Proteases 11(USP11)and 28(USP28)Regulate F508DELCFTRStability Via SUMOConjugation

Gong, Xiaoyan; DaPaula ,AnaCarina; Ahner, Annette; Frizzell, Raymond A

Poster/Workshop Presentation: Predicted Phosphorylation Site in SLC26A9 Modulates CFTR-Dependent Activity

Wang, Xiaohui; Larsen, Mads B; Frizzell, Raymond A.; Bertrand, Carol A.

Poster: Pseudomonas aeruginosa Benefits From Respiratory Viral Infection in Cystic Fibrosis

Jeffrey Melvin

Poster: Viral-Bacterial Interactions in the Paranasal Sinuses in Cystic Fibrosis

Jeffrey Melvin

Abstract: Dynamics of Staphylococcus aureus growth on airway epithelial cells

Megan R Kiedrowski

Presenting: Thursday, Oct. 27 – W06: INF/MIC: Pathogenesis of Airway Infection (speaking 10:20-10:30a)

Poster Session I (11:15a-1:45p), Friday, Oct. 28 – JIB: Junior investigators best abstract session: Basic Science (12:15-1:35p)

Poster: Dysregulation of Nutritional Immunity during Respiratory Viral Infection Promotes Pseudomonas aeruginosa Biofilm Growth

Matthew Hendricks

Poster: SIRT1 Mediates Resveratrol Inhibition of CFTR In Primary Bronchial Epithelium

Agnieszka Swiatecka-Urban, MD, FASN

Poster: TGF-β1 Upregulates Microrna- 145 To Block ∆F508-CFTR Rescue

Agnieszka Swiatecka-Urban, MD, FASN

Poster: Anti-biofilm activity and in vivo efficacy of an engineered peptide antibiotic”

Berthony Deslouches

Workshop III: CLIN: *Emerging Issues in CF Lung Transplantation

A. Faro, J. Pilewski

Poster: Infection and depressed mucociliary clearance in pediatric and adult CF patients

Corcoran TE, Locke LW, Myerburg MM, Weiner DJ, Pilewski JM

Poster: Nitrogen Back Diffusion During Multiple Breath Washout With 100% Oxygen

Weiner DJ, Pederson K, Nielson JG.

Poster: Lung Function Perception in Cystic Fibrosis

Forno E, Weiner DJ

Topical Therapy for Radiation-Induced Skin Damage Shows Promising Results

A team of University of Pittsburgh researchers has demonstrated that a newly developed topical therapy applied before or after radiation exposure prevents skin damage in both animal and human models.

The results, published online in the Journal of Investigative Dermatology, are expected to accelerate efforts that will lead to clinical studies and licensing of the technology, said Louis Falo, MD, chairman of the Department of Dermatology at the Pitt School of Medicine and corresponding author for the study.

The skin is the largest human organ and protects the body from physical, chemical and environmental exposures. Radiation-induced skin damage ranges from photo-aging and ultraviolet sun exposure to radiation dermatitis, a treatment-limiting condition caused by radiation therapy; and skin radiation syndrome, a frequently fatal consequence of exposures from nuclear accidents.

Dr. Falo teamed with Joel Greenberger, MD, professor and chair of the Department of Radiation Oncology, and Peter Wipf, PhD, Distinguished University Professor of Chemistry, in 2008. Drs. Greenberger and Wipf were exploring treatments to mitigate radiation poisoning caused by an accident at a nuclear power facility or from a so-called “dirty bomb” device. Together, they determined that the approaches being developed and investigated at Pitt could potentially benefit the approximately 1 million people annually in the U.S. who undergo radiation therapy to the skin for breast, head and neck, and other cancers.

“During the course of radiation therapy, patients can develop irritating and painful skin burns that can lead to dangerous infections and diminished quality of life,” Dr. Falo said. “Sometimes the burns are so severe that patients must stop their treatment regimen. Our results show that topical treatment with this therapeutic agent prevents skin damage at the source.”

Dr. Wipf’s lab developed the molecule that targets the formation of oxidative free radicals in the cell’s mitochondria, thereby preventing inflammation and cell death.

“This provides for potentially improved treatment options for patients undergoing radiation therapy with the prospect for more simplified treatment regimens and reduced concern about quality of life post-treatment,” he said. Dr. Wipf’s former student, Joshua Pierce, PhD, who now operates his own lab at North Carolina State University, is credited with synthesizing the molecule, named JP4-039.

Dr. Falo said he is optimistic about the therapy’s performance in clinical trials because the treatment appears to be effective in a model that uses human skin obtained from cosmetic procedures.

Looking beyond treating radiation therapy, he and his team are pursuing further studies of the molecule’s ability to reduce skin damage from sun exposure, including sunburns and the molecular changes that lead to skin cancer, as well as cosmetic applications to prevent skin changes caused by the oxidative stress that is associated with normal skin aging.

Additional authors on this study are Rhonda M. Brand, PhD, Michael W. Epperly, PhD, J. Mark Stottlemyer, BS, Xiang Gao, PhD, Erin M. Skoda, PhD, Song Li, MD, PhD, Saiful Huq, PhD, and Valerian E. Kagan, PhD, D.Sc, all of Pitt.

This research was funded by National Institute of General Medical Sciences grants P50 GM067082 and U19-A1068021, and National Institute of Allergy and Infectious Diseases grant 1RC1AI081284, and the Coulter Foundation.

UPMC Partners with Bon Secours to Open Advanced Radiation Treatment Center in Ireland

UPMC and Bon Secours Health System Ltd. today announced that they have formed a joint venture in Cork, Ireland, to own and operate one of the nation’s most advanced radiation therapy centers for the treatment of cancer patients. The new center will combine the expertise of Ireland’s largest independent health care provider with UPMC’s world-renowned model of cancer care that brings innovative and personalized treatments close to where patients live.

“This partnership builds upon the world-class medical and surgical oncology services that we already offer to patients in Cork,” said Bill Maher, chief executive officer of Bon Secours Health System. “With the help of UPMC, we will soon enhance our cancer services by providing access to leading-edge radiation technology and clinical protocols.”

The radiotherapy center will be built on the Bon Secours campus in Cork as part of a new, six-story expansion currently under construction. The joint venture, to be managed by UPMC and owned equally by both partners, will lease space from Bon Secours. Starting in 2019, it expects to treat patients with two advanced Varian TrueBeam Radiotherapy System linear accelerators, providing image-guided radiation therapy (IGRT) and intensity-modulated radiation therapy (IMRT). Used for a variety of cancers, these approaches are designed to improve patient outcomes while minimizing side effects.

“We’re excited to work with such a highly regarded clinical partner as Bon Secours to reach more patients in Ireland with world-class care close to home,” said Charles Bogosta, president of UPMC International and UPMC CancerCenter. “This new facility will share in the learning and best practices at the UPMC Whitfield Cancer Centre in Waterford, now celebrating 10 years of providing state-of-the-art radiotherapy and personalized care in Ireland.”

The center in Cork also will benefit from access to the entire UPMC CancerCenter network, comprising more than 40 sites in the US and around the world. As part of that powerful network, patients have access to cutting-edge treatments, protocols and technologies guided by the latest scientific evidence. UPMC CancerCenter partners with the University of Pittsburgh Cancer Institute, western Pennsylvania’s only National Cancer Institute-designated Comprehensive Cancer Center.

In 2006, UPMC CancerCenter opened its first international cancer center, UPMC Whitfield, based on UPMC’s “hub-and-spoke” model in which a wide range of oncology services are offered in local communities with support from UPMC’s academic and clinical hub at the Hillman Cancer Center in Pittsburgh. Based on its high quality standards and patient safety, UPMC Whitfield was accredited by the Joint Commission International in 2008. UPMC also operates a radiation center in Rome and works with partners in Kazakhstan, Lithuania, Colombia, Russia, Myanmar and other nations to improve cancer care worldwide.

“With Bon Secours, we look forward to continuing to grow the number of patients that we can help in Ireland,” said Mr. Bogosta. “This investment underscores UPMC’s commitment to improving cancer care in Ireland, while giving us access to knowledge and resources that will strengthen our medical and research mission in Pittsburgh and around the world.”

Completion of the agreement is contingent on the approval of the Competition and Consumer Protection Commission of Ireland.

UPMC Senior Services Honors Resnick as 2016 Grand Champion

UPMC Senior Services will honor Neil Resnick, MD, Thomas Detre Professor and chief of the Division of Geriatric Medicine and Gerontology as its 2016 Grand Champion for demonstrating exceptional leadership in improving the lives of seniors in western Pennsylvania and nationally. It is the highest honor awarded by UPMC Senior Services.

“Dr. Resnick’s research has fundamentally changed the clinical care of older patients around the world. Through innovation and collaboration, he’s created specialized centers to evaluate the most difficult problems, trained others to do the same, and has investigated geriatric conditions that had fallen through the cracks,” said Deborah Brodine, president of UPMC Community Provider Services. “UPMC Senior Services is exceptionally proud to recognize him for such exemplary work on behalf of the seniors in western Pennsylvania.”

The awards will be presented October 26 at the annual UPMC Senior Services “Celebrating Senior Champions” Dinner and Auction at the Omni William Penn hotel.

Dr. Resnick founded the Aging Institute of UPMC Senior Services at the University of Pittsburgh, which is now one of the country’s top-funded aging research programs. His research led to a discovery of a new cause of incontinence, a syndrome that leads to significant disability, and helped develop new approaches to its diagnosis and treatment. These approaches also led to federal guidelines that have since been adopted by many other countries.

Additionally, Dr. Resnick has made major research contributions to other geriatric conditions, including osteoporosis, falls and delirium. Lessons from his research also enabled him to develop geriatric modules for primary care providers and help national urological and gynecological organizations develop training programs in geriatrics.

“This award is such a wonderful testament to the importance of geriatric care, as well as to the research we need to offer still better care tomorrow,” said Dr. Resnick. “It’s been an incredible privilege to have been able to do both and it is a real honor to receive this award.”

The UPMC Senior Services also will honor Operation Safety Net as its 2016 Community Champion. James S. Withers, MD, founder and CEO of Pittsburgh Mercy’s Operation Safety Net, will accept the award on behalf of the organization. Operation Safety Net supports the homeless of Pittsburgh, a growing segment of which are seniors, by delivering health care, case management, housing follow up, and other vital health and human services.

Elaine H. Berkowitz, DMD, will receive the 2016 Caregiver Champion award. Dr. Berkowitz practices geriatric and special needs dentistry in private homes, nursing homes, personal care homes, rehabilitation hospitals and general hospitals, bringing essential oral care to the home-bound, including residents at UPMC Canterbury Place.

World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition 2016

PrintThe 5th World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition (WCPGHAN) was held October 5-8, 2016 in Montreal. This event showcased state of the art science and technology in the field of pediatric gastroenterology, hepatology, and nutrition, as well as presentations and keynote speeches from experts who are leaders in their field.

The conference encompassed nine themes including:

  • IBD
  • Celiac and other GI disorders
  • Neurogastroenterology and motility
  • Endoscopy
  • Hepatology
  • Pancreatology
  • Global health
  • Nutrition and intestinal rehabilitation
  • Transplantation

Several Children’s Hospital of Pittsburgh of UPMC faculty and staff spoke at the conference on a number topics including:

Immune Tolerance and Rejection
Pharmacology (pharmaco-genetics) and immunosuppression: Past, present and future
Patrick McKiernan, MD

Steatorrhea: What if it’s not Cystic Fibrosis
Mark Lowe, MD, PhD

Acute Liver Failure – Pathogenesis and Management
Rob Squires, MD and Anil Dhawan, MD

Pancreas
Mark Lowe, MD PhD

Pancreatitis

Inflammatory Responses/ Healing in Pancreatic Injury
Sohail Husain, MD

Poster Presentations

Sterile Cerebrosprinal Fluid Ascites: A Rare Complication After Ventriculoperitoneal Shunting
James Squires, MD, and  Kristen Critelli, MD (fellow)

Clinical Variability Following Partial External Biliary Diversion In Familial Intrahepatic Cholestasis 1 Deficiency
James Squires, MD,  Robert Squires, MD, and Amy Morris, RN, CCPC

Concussions are Treatable, More Research Needed, say Leading U.S. Experts in Published Paper

Concussions, often viewed by the public as dire and perplexing, can be effectively treated despite their complexity, according to experts from around the US in a Statement of Agreement available online and published in the December issue of the journal Neurosurgery.

In October, 2015, leading concussion clinicians and researchers gathered at UPMC in Pittsburgh for the “Targeted Evaluation and Active Management” (TEAM) symposium, an unprecedented meeting and white paper designed to propose and share nationally the participants’ agreement on the best practices, protocols and active therapies for treating concussions.

The conference discussions, led by chair Micky Collins, PhD, director of the UPMC Sports Medicine Concussion Program, along with co-directors Anthony Kontos, PhD, and David Okonkwo, MD, PhD, of UPMC and the University of Pittsburgh, resulted in the Statement of Agreement publication. The two-day meeting was fully funded by a grant from the NFL Foundation.

“This conference was remarkable because it brought together a diverse group of leading experts in cutting-edge research and clinical treatment to approach this injury in ways that will help move concussion treatment forward,” said Anthony Kontos, PhD, research director for the UPMC Concussion Program, associate professor in the University of Pittsburgh Department of Orthopaedic Surgery.

The US Center for Disease Control (CDC) estimates that as many as 4 million concussions occur each year in the US, and sport- and recreation-related concussions in particular have increasing incidence. Symptoms, which can be subtle and last days or weeks, include but are not limited to headache, confusion and nausea.

“There has been only limited evidence-based guidance, particularly for primary care providers, about the active treatment of concussion,” Dr. Collins said. “This makes it difficult for clinicians to determine how best to treat patients with this injury. Many are treating patients with concussion using a uniform, rest-based approach today much the same way they did a decade ago.”

Doctors typically advise patients to rest—both the brain and body—until symptoms abate, which might require accommodations at school or work. If the injury was sustained during sports, the patient is instructed not to return to play on the same day and to gradually increase aerobic, exertion-based activity while symptoms are carefully monitored.

But, as described at the symposium and in the published Statement of Agreement, research is beginning to show active rehabilitation can help people recover more quickly and safely than simply resting.

“More research in large, multicenter trials is needed to figure out what kinds of treatments are most effective for a set of symptoms and for individual patients,” Dr. Collins said. Most importantly, we believe concussions are treatable and patients can and do get better.”

A 2015 Harris Poll of more than 2,000 US adults found that 71 percent did not recognize that concussions are treatable. In the same report, 1 in 3 patients who had been diagnosed with a concussion reported receiving no prescribed treatment.

“The purpose of the UPMC symposium was to engage leading clinicians and scientists in a discussion of what we know about concussion and its treatment,” Dr. Okonkwo said. “We hope to build on this effort to share the best available information to improve public understanding and guide future research.”

The authors feel the Statement of Agreement is a step forward in the field and will lead to a collaborative era.

“Over the past decade, many of us individually have accumulated quite a bit of experience about which treatments work for specific symptoms and deficits caused by concussion. We are looking forward to working together to rigorously test these treatments,” said David Brody, MD, PhD, co-author and professor of neurology, Washington University School of Medicine in St Louis.

The Neurosurgery paper was co-written by 37 experts representing 32 clinical and academic institutions, including:

• Jon Almquist, ATC, VATL, ITAT, Fairfax Concussion Center
• Julian Bailes, MD, University Health System, University of Chicago Pritzker School of Medicine
• Mark Barisa, PhD, Baylor Institute for Rehabilitation
• Jeffrey Bazarian, MD, MPH, University of Rochester
• Joshua Bloom, MD, Carolina Sports Concussion Clinic
• David Brody, MD, PhD, Washington University St. Louis
• Robert Cantu, MD, Emerson Hospital, Boston University
• Javier Cardenas, MD, Barrow Neurological Institute
• Jay Clugston, MD, University of Florida
• Randy Cohen, DPT, ATC, University of Arizona
• Ruben Echemendia, PhD, Psychological and Neurobehavioral Associates
• R.J. Elbin, PhD, University of Arkansas Office for Sports Concussion Research
• Richard Ellenbogen, MD, University of Washington
• Janna Fonseca, ATC, Carolina Sports Concussion Clinic
• Gerry Gioia, PhD, Children’s National Health System
• Kevin Guskiewicz, PhD, ATC, University of North Carolina Chapel Hill
• Robert Heyer, MD, Carolinas Medical Center
• Gillian Hotz, PhD, University of Miami
• Grant L. Iverson, PhD, and Ross Zafonte, DO, Harvard Medical School
• Barry Jordan, MD, MPH, Burke Rehabilitation and Research
• Geoffrey Manley, MD, University of California San Francisco
• Joseph Maroon, MD, University of Pittsburgh
• Thomas McAllister, MD, and Daniel Thomas, MD, Indiana University
• Michael McCrea, PhD, Medical College of Wisconsin
• Anne Mucha, DPT, UPMC Centers for Rehabilitation Services
• Beth Pieroth, PhD, North Shore University Health System
• Ken Podell, PhD, Methodist Concussion Center at Houston Hospital
• Matt Pombo, MD, Emory University Healthcare
• Teena Shetty, MD, Hospital for Special Surgery, Weill Cornell Medical College
• Allen Sills, MD, and Gary Soloman, PhD, Vanderbilt University Sports Concussion Center
• Tamara C. Valovich-McLeod, PhD, ATC, FNATA, AT, Still University
• Tony Yates, MD, Pittsburgh Steelers

For more information on concussion research at UPMC, please visit rethinkconcussions.com.

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