UMKC researcher helped lead studies published in New England Journal of Medicine

UMKC School of Medicine researcher John Spertus, M.D., M.P.H., is part of two large NIH-funded clinical studies published in the New England Journal of Medicine, Monday, March 30. The studies indicate eliminating unnecessary revascularization treatments for cardiac patients could save the United States hundreds of millions of dollars annually.

Spertus serves as professor of medicine and Daniel J. Lauer, M.D., Endowed Chair in Metabolism and Vascular Disease Research at the School of Medicine, and Clinical Director of Outcomes Research at Saint Luke’s Hospital.

The studies looked specifically at coronary artery disease patients who had high-risk blockages with least 10 percent or more of the heart muscle being at risk. One focused on patients with preserved kidney function and the other targeted patients with end-stage kidney failure. That latter group has largely been excluded from almost all cardiovascular trials, despite having a high prevalence of coronary artery disease and death, Spertus said.

Both studies, conducted in unison, examined the most important outcomes for patients, clinical events (e.g. heart attacks, death) and patients’ symptoms, function and quality of life. Participants were randomized to undergo invasive angiography and revascularization with aggressive medical therapy or aggressive medical therapy alone. The goals of the medical treatment were cholesterol reduction, blood pressure control, aspirin and medications to treat chest pain.

The studies in patients with preserved kidney function showed that invasive medical procedures provided no reduction in clinical events, but did improve patients’ symptoms and quality of life, if they had chest pain within a month of entering the trial. These health status benefits were evident within three months and sustained out to four years.

“Importantly, this benefit was only observed in patients who had angina, chest pain, and not in asymptomatic patients,” Spertus said. “There is no indication for these procedures in patients whose symptoms are well-controlled with medications alone. If we avoided revascularization in asymptomatic patients, we could potentially save about $500 million to $750 million a year in the United States alone.”

Among patients with very severe kidney disease, there was no significant difference in clinical events or in patients’ symptoms and quality of life.

“While disappointing, this is a very ill patient population for whom an aggressive, invasive treatment strategy does not seem to offer much benefit,” Spertus said.

The NEJM is publishing four papers from these studies on March 30, one for each trial focusing on the clinical events and another for each trial focusing on the quality of life outcomes. Spertus was involved in writing all four and is the lead author on the two quality of life papers. He and his team designed, analyzed and led the health status, quality of life components of both trials.

Spertus is the author of the Seattle Angina Questionnaire (SAQ) that used in the studies. It is widely recognized throughout the world as the gold standard for quality of life measurement in cardiac medicine.

“Our group has led its use and analyses in multiple studies and quality improvement efforts,” Spertus said. “In light of these findings, the SAQ may start becoming a routine part of clinical care in cardiology.”

Research Study Can Help People Get Healthier

Enhanced Lifestyles for Metabolic Syndrome trial will test group vs. self-directed approaches

UMKC is looking for participants.

Metabolic syndrome is a bundle of risk factors caused by common lifestyle choices that can lead to serious conditions such as diabetes, stroke, heart disease and cancer. Currently, one-third of Americans have metabolic syndrome, up from one-fourth a decade ago.

Over the next two years, with funding from the William G. McGowan Charitable Fund, the Enhanced Lifestyles for Metabolic Syndrome (ELM) Trial, developed at Rush University Medical Center in Chicago, aims to enroll 600 people who are at high-risk chronic disease and are interested in managing this risk by optimizing their lifestyle. In addition to UMKC at Truman Medical Centers in Kansas City, the other sites are Rush in Chicago; University of Colorado Denver; Geisinger Health System in Wilkes-Barre and Scranton, Pennsylvania; and Rochester Institute of Technology in New York.

The Kansas City study site is overseen by a prestigious UMKC School of Medicine team of principal investigators: endocrinologist Betty Drees, M.D., dean emeritus of the school and Jannette Berkley-Patton, Ph.D., director of the Health Equity Institute; and Matthew Lindquist, D.O.

“Metabolic syndrome is a serious condition because it is so common, and it can silently increase risk of heart disease and stroke without early warning symptoms,” Drees said. “Research into how to stop it early and keep it controlled is very important in preventing heart disease in individuals and in the population as a whole.”

Starting in January, participants will engage in the program for six months, and then will be followed for an additional 18 months, to allow for an assessment of how well they have been able to sustain the good habits they developed and the health benefits they received.

“We know that making these small lifestyle changes can have a big impact on people who have health issues that indicate they may have metabolic syndrome. Plus, everyone who participates will receive a free Fitbit. Other lifestyle-change programs can cost upwards of $500, but ELM will be free to our participants, which is awesome.” – Jannette Berkley-Patton

photo of vegetables and free weights

The ELM program provides tools, methods and support for healthier eating, increased physical activity and stress management. Guidelines include making vegetables half of every lunch and dinner, exercising for at least 30 minutes on most days, and learning to be less reactive to stressors.

The Rush team has been studying a group-based version of ELM for nearly a decade. The group approach, which has been shown to be effective, requires participants to attend meetings. While those can be helpful, they’re time-consuming and may be inconvenient; from a public-health standpoint, groups are expensive and labor-intensive. So researchers want to know: Can we simplify this treatment? Can participants get the same or better health results under their own direction, with only minimal contact with the program?

“Metabolic syndrome is a serious condition because it is so common, and it can silently increase risk of heart disease and stroke without early warning symptoms. Research into how to stop it early and keep it controlled is very important in preventing heart disease in individuals and in the population as a whole.” – Betty Drees

For this study, a “self-directed” program will be compared to a group-based program, with the best lifestyle information available in clinical practice today provided in both..

Everyone in the self-directed arm will be assigned to a coordinator, and will receive a Fitbit activity tracker, access to the program’s website and monthly tip sheets for six months.

In the group-based program, participants will get most of those things, too. But instead of the tip sheet, group members will meet for an hour and a half weekly for three months, biweekly for an additional three months, and monthly for 18 months after that. They will also have access to the ELM website. They will learn, for example, to distinguish when they are eating because they are hungry from when they turn to food because it is available or they are bored or sad.

Participants in both arms of the program will report for three follow-up visits so their progress can be assessed. They will receive lab results and physical measures after each visit.

“We are hoping we can learn how self-guided and group support programs can help people eat healthier and move more,” Berkley-Patton said. “We know that making these small lifestyle changes can have a big impact on people who have health issues that indicate they may have metabolic syndrome. Plus, everyone who participates will receive a free Fitbit. Other lifestyle-change programs can cost upwards of $500, but ELM will be free to our participants, which is awesome.”

How to participate

Participants in the study must be ages 18 years or older, not have diabetes, speak English, be willing to commit to a healthy lifestyle and have at least three of metabolic syndrome’s five risk factors:

  • Central fat (waist circumference of 40 inches or more for men, 35 inches or more for women)
  • High blood pressure
  • High blood sugar
  • Low HDL cholesterol
  • Elevated triglycerides

A condition of enrollment is a willingness to participate in either arm of the trial. Participants will not get to choose. To participate in the Kansas City area, email ELMtrial@tmcmed.org or call Alex Lyon at (816) 404-4418.

A woman in an exercise class

Spertus involved in big stent study

A leading UMKC and Saint Luke’s Health System researcher, John Spertus, M.D., M.P.H., was heavily involved in important heart-procedure research that was published earlier this month and presented at the annual conference of the American Heart Association.

You can read an interview with Spertus about the research here.

A Washington Post story said the study, called ISCHEMIA, found that invasive procedures to unclog blocked arteries — in most cases, the insertion of a stent, a tiny mesh tube that props open a blood vessel after artery-clearing angioplasty — were no better at preventing heart attacks and death in patients with stable heart disease than were pills and improvements in diet and exercise. Overall, the study results suggest that invasive procedures, stents and bypass surgery, should be used more sparingly in patients with stable heart disease and the decision to use them should be less rushed, experts said.

Spertus is a UMKC professor of medicine and Daniel J. Lauer Endowed Chair in Metabolism and Vascular Disease Research. At Saint Luke’s Mid America Heart Institute, as clinical director of outcomes research, he developed technology that guides physicians and patients in medical-decision making by using models to measure and predict the risk factors of various procedures. Many experts cite two tools he created — the Seattle Angina Questionnaire and the Kansas City Cardiomyopathy Questionnaire — as the gold standards for measuring symptoms, function and quality of life in treating coronary artery disease and heart failure. Both have been translated into more than 95 languages.

A year ago he received the American Heart Association’s 2018 Distinguished Scientist Award. He previously received the association’s Lifetime Achievement Award in 2015 and the Council on Quality of Care and Outcomes Research Distinguished Achievement Award in 2013.

 

Health for all remains an elusive goal

From left: Rex Archer, Mary Anne Jackson, Eric Williams, D. Rashaan Gilmore and Bridget McCandless.

Community leaders discuss UMKC efforts to close gaps

Health equity is a broad concept that encompasses differences in disease and mortality rates, and in access to healthcare services, among different population groups. It also includes differences in social determinants of health, such as poverty, exposure to toxins and access to healthy food.

UMKC leadership quantifying and addressing these differences was the focal point of the UMKC Engagement Showcase, the university’s signature event celebrating Engagement Week – a special week of engaged leadership, partnership and learning hosted by UMKC and the UM System.

The event included a demonstration of the System’s new online Engagement Portal and a panel discussion on health equity led by the director of the new UMKC Health Equity Institute, Jannette Berkley-Patton, Ph.D., of the UMKC School of Medicine.

Engagement with community partners by the UM System and its four universities is hardly a new phenomenon. Curt Crespino, UMKC vice chancellor for external relations and constituent engagement, noted that UMKC history is rooted in an enduring city-campus partnership.

Marshall Stewart, chief engagement officer for the UM System, said what’s new is a more systematic and coordinated approach to engagement, including a transformation of the system’s Extension programs, designed to expand engagement beyond Extension’s original rural focus to forge engagement partnerships in every community and corner of the state.

“Urban and rural communities are facing very similar issues across Missouri. Our mission is to work together with all of our stakeholders to expand our impact by using our research to help transform lives,” said UMKC Chancellor Mauli Agrawal. “That spirit of connection to the city and engagement with our community was woven into the origin story of UMKC. And we are excited to take those efforts to the next level in collaboration with the efforts being led by the system.”

Following are excerpted highlights of the health equity panel.

Jannette Berkley-Patton, director, UMKC Health Equity Institute:

“We spend billions on healthcare but are still one of the unhealthiest countries in the world.” The burden of health disparities rests primarily on groups outside the mainstream, including people of color, rural communities, veterans and seniors. Large federal grants allow for the creation of effective programs, “but what happens when the grant ends? Everything goes away. We need to figure out how to take the Cadillacs we create with these million-dollar grants and turn them into Pintos.”

Rex Archer, director, Kansas City Health Department:

“We need to change the structural issues that create the (health equity) problem.” These include issues with disparities in housing, poverty, education, safety and more.

Mary Anne Jackson, interim dean, UMKC School of Medicine:

In 2014, the Kansas City area had to contend with a large outbreak of a serious respiratory illness among school-age children. Researchers were notified early enough to identify the virus responsible and contain the outbreak. “We were able to address this in time because of the strong connections we have with people in the community who brought it to our attention.”

Eric Williams, pastor, Calvary Temple Baptist Church:

Conducting funerals for victims of gang violence and AIDS led Williams to involvement in public health. “Conversations about HIV were happening, but it was all on the down-low. (Berkley-Patton) helped us to understand that some of the things we were already doing were working” to change behaviors.

Rashaan Gilmore, founder and director, BlaqOut:

BlaqOut surveyed gay African Americans about their health care priorities, and the top response was health care access. “It was because they didn’t feel welcomed by traditional providers. We asked them to recommend strategies to address that, and we developed interventions based on those results.”

Bridget McCandless, former president and CEO, Health Forward Foundation:

After 15 years working in a free health clinic, she changed her approach from providing care to impacting policy “because I saw that policy could be far more effective.” Citing a sampling of dramatic health disparities between local white and black populations, she said “there’s no excuse for us to have disparities like that.” Data analysis can empower highly effective strategies if we act on the findings. “We’re getting smart enough to figure this out. (Data-driven policy) can be the new germ theory; it can revolutionize the delivery and effectiveness of health care.”

Dr. Mark Nichols appointed interim chair of Biomedical and Health Informatics

School of Medicine Interim Dean Mary Anne Jackson, M.D., has appointed Mark Nichols, Ph.D., interim chair of the Department of Biomedical and Health Informatics effective August 1, 2018. In this role, he will work closely with faculty, staff and students to help position the department as a catalyst for innovation and creativity.

Dr. Nichols received his Ph.D. from Yale University in Molecular Biophysics & Biochemistry. He then undertook postdoctoral training in molecular biology at the German Cancer Research Center, and the European Molecular Biology Lab, both in Heidelberg.

In 1998, Dr. Nichols returned to the United States as an assistant professor of Pharmacology and Chemical Biology at the University of Pittsburgh, School of Medicine.

From 2010-2016, he served as a Scientist Administrator for Research Development in the Senior Vice Chancellor’s Office of Research at the University of Pittsburgh. In that capacity, he served all six health science schools at the University of Pittsburgh with the specific objective of assisting other investigators in their quest to obtain extramural research funding. His work resulted in 77 grants funded for more than $121 million.

In 2016, Dr. Nichols was recruited to UMKC as Associate Dean for Research at the School of Nursing and Health Studies and as Associate Research Professor in the Department of Biomedical and Health Informatics at the School of Medicine.

His expertise includes molecular mechanisms of drug and enzyme action, molecular biology, mutagenesis, cloning, signal transduction, genomic regulation, cell cycle, and steroid hormones, with peer-reviewed publications in 20 biomedical journals, an siRNA biotechnology patent, and funding from NIH (NIDDK, NCI), DOD CDRMP, and American Cancer Society.

School of Medicine announces new chair of Biomedical and Health Informatics

Shui Qing Ye, M.D., Ph.D.

School of Medicine Dean Steven Kanter, M.D., has announced the appointment of Shui Qing Ye, M.D., Ph.D. as chair of the Department of Biomedical and Health Informatics. The appointment will take effect January 1, 2018.

A professor of pediatrics at the School of Medicine, Ye will continue to occupy the William R. Brown / Missouri Endowed Chair in Medical Genetics and Molecular Medicine.

As department chair, he will work closely with faculty, staff, and students to help position the Department of Biomedical and Health Informatics as a catalyst of innovation and creativity. Ye is an expert in genomics and translational bioinformatics, which will help foster important collaborations with other units throughout the university and with School of Medicine clinical partners. He has a strong track record of using new-age tools to gather and explore Big Data, and of partnering with researchers locally and worldwide in an effort to pinpoint new diagnostic biomarkers and therapeutic targets for human diseases.

Ye is the author of two highly acclaimed books on bioinformatics and Big Data in addition to extensive research experience. He served previously as director of the Gene Expression Profiling Core at the Center of Translational Respiratory Medicine at Johns Hopkins University School of Medicine. Additionally, he served at the University of Chicago Pritzker School of Medicine as director of the Molecular Resource Core.

Ye earned his medical degree from Wuhan University School of Medicine at Wuhan City, Hubei Province, China. He completed a postdoctoral fellowship in lipid metabolism at the Oklahoma Medical Research Foundation in Oklahoma City, and received his Ph.D. in molecular mechanisms of disease from the University of Chicago Pritzker School of Medicine.

Biomedical research now a primary discipline of UMKC’s I-Ph.D. program

Jeremy Provance is one of four students in UMKC’s Interdisciplinary Ph.D. program with a primary emphasis on bioinformatics through the School of Medicine’s Department of Biomedical and Health Informatics.

Four graduate students in UMKC’s Interdisciplinary Ph.D. (I-Ph.D.) program have begun working toward their doctorate degree with a primary emphasis on bioinformatics through the School of Medicine’s Department of Biomedical and Health Informatics.

The four started their coursework this semester, becoming the first students to pursue a Ph.D. through the School of Medicine.

The I-Ph.D. program allows students to work across disciplines to develop an individualized academic plan requiring a primary discipline and at least one co-discipline. In collaboration with the university’s School of Graduate Studies, the medical school has offered bioinformatics as a co-discipline since the fall semester of 2014. Bioinformatics has two co-discipline students who are on track to complete their degrees next May; one with a primary discipline in molecular biology and biochemistry, and the other with a primary discipline in engineering.

The School of Medicine also offers a master’s degree in bioinformatics and a graduate certificate in clinical research through the Department of Biomedical and Health Informatics.

“I feel like our co-discipline program has been successful because we have had students from so many different primary disciplines,” said Mary Gerkovich, Ph.D., associate professor and coordinator for the I-Ph.D. discipline.

Through the bioinformatics emphasis, the students primarily focus on biomedical data and knowledge, with an emphasis on how to use that information in problem solving and decision making to develop the technology and processes that will shape future health care.

Gerkovich said the program helps students think about biomedical research in the context of interacting with people.

“We’re very excited with our initial group,” Gerkovich said. “We think they’re really strong students and it’s perfect that they all have different co-disciplines because it points out the intersection between what we’re doing and so many different units within the university.”

The students with primary disciplines in bioinformatics are studying co-disciplines in mathematics and statistics, cellular biology and biophysics, entrepreneurship, and computer sciences.

“In our little cohort of four students, we have a diverse mix of what they’ll be doing and the kind of research they’ll be working on,” Gerkovich said.

Jeremy Provance is a software analyst in the School of Medicine’s Center for Health Insights. He completed his master’s degree in bioinformatics last May and decided to continue in the I-Ph.D. program. He will be working largely in cardiovascular outcomes research with the Mid America Heart Institute at Saint Luke’s Hospital.

Provance said a number of factors made the program appealing. The quality of faculty and the research at UMKC were the major factors, as well as the interdisciplinary aspect of the program.

“It ensures that I’m going to interact with related but separate disciplines to really dig deep and draw connections between bioinformatics and, in my case, entrepreneurship and innovation,” Provance said. “Being at the medical school means I have access to a lot of health science faculty in addition to everyone on the Volker campus. Biomedical and health informatics itself is largely interdisciplinary, so it’s a big plus to know faculty with a lot of varying expertise, even outside the department.”

David Walsh, another I-Ph.D. student, worked at the Veterinary Diagnostic Lab at Kansas State University for three years before moving to Kansas City about a year ago and discovering the program at UMKC. With a bachelor’s degree in biotechnology, Walsh began learning more about the relationship between genomics and bioinformatics. Now, he hopes to incorporate his interest in computer programming with finding process improvements for tracking samples and controls, and checking results.

“Using the tools of informatics, it’s possible to develop the targeted treatments that we need, and I want to be involved in helping our species overcome disease,” said Walsh.

Gerkovich said the I-Ph.D. program benefits both the university and the community. While it helps provide graduate students to support faculty research endeavors throughout UMKC and the School of Medicine, it is also developing a community resource.

“Our department has really put an emphasis on trying to develop collaborations with area institutions,” Gerkovich said. “One of our goals is to do exactly that, develop collaborations with corporations such as Cerner and our affiliate hospitals so that we have students working with people in those organizations. We’re training students to have the skills to contribute to those types of environments.”

UMKC, TMC and Children’s Mercy Win $930K Grant from CDC

cdc550The University of Missouri-Kansas City, Truman Medical Centers (TMC) and Children’s Mercy have won a quality-improvement grant from the Centers for Disease Control and Prevention for diagnostic laboratory testing at TMC. The three-year grant, which will use Cerner Health Facts data, is funded up to $930,000.

“The methods developed through this project will demonstrate value of both local and national medical data warehouses to inform quality improvement initiatives related to laboratory medicine,” said Mark Hoffman, primary investigator on the grant. Hoffman is chief research information officer at Children’s Mercy and is a faculty member in biomedical and health informatics and pediatrics at the UMKC School of Medicine. Kamani Lankachandra, chair of pathology at UMKC and the director of the pathology lab at TMC, is a co-investigator.

Diagnostic laboratory testing results are used in 60 to 70 percent of all clinical decisions. While laboratories have strong procedures to manage process-quality concerns within the lab, they often do not have access to reliable information related to test ordering or the use of test results to inform patient treatment.

Electronic health record data is increasingly used to populate local data warehouses, including those implemented using the National Institutes of Health-funded “informatics for integrating biology and the bedside” application, often shortened to i2b2. Some electronic health record vendors, including Cerner, manage national data warehouses populated with de-identified data from contributors that have provided data rights. Electronic health record data merged with laboratory information system data can provide diagnostic laboratories with information needed to better understand quality gaps, especially those related to test ordering and patient treatment informed by laboratory results.

TMC and their primary academic partner, UMKC, have collaborated with Cerner to implement i2b2 as a de-identified analytical data warehouse reflecting local clinical processes at TMC. And through this collaboration, UMKC has received a full copy of the Cerner Health Facts national data warehouse; few academic research centers in the world have access to this vast amount of medical data.

The de-identified data in Health Facts represents more than 600 inpatient and outpatient facilities and health care decisions for more than 47 million unique patients. Significantly, Health Facts includes more than 3 billion diagnostic laboratory results and more than 350 million medication orders.

UMKC will use the combination of i2b2 and Health Facts to prioritize up to 10 laboratory- related quality gaps, informed by insights from the practice-based evidence in Health Facts. TMC’s i2b2 data will be utilized to evaluate baseline status for candidate quality improvement projects. The prioritization phase will use Health Facts to characterize the severity of the quality gaps at TMC.

This project will provide methods that will enable TMC to develop quality improvement initiatives that are prioritized and designed using these data sources.

Cheng appointed director of SOM’s Research, Statistical Consult Service

Cheng_An_Lin
An-Lin Cheng, Ph.D.

The School of Medicine has announced the appointment of An-Lin Cheng, Ph.D., as director of the Research and Statistical Consult Service in the Department of Biomedical and Health Informatics.

A tenured faculty member in the UMKC School of Nursing and Health Studies for the past 10 years, Cheng has also held a joint appointment at the School of Medicine in Biomedical and Health Informatics since 2011.

Her primary roles will be to lead the Research and Statistical Consult Service and collaborate with researchers on the UMKC Hospital Hill Campus. She will provide expertise and advice on proper research design and assistance to researchers in ethical and accepted methods of data analysis and interpretation.

Cheng has extensive experience handling large data sets and conducting secondary data analyses. Her primary research interests have involved the development of statistical methods for the design and analysis of data in clinical trial studies. She has collaborated with researchers from a wide range of disciplines including medicine, dentistry, nursing, biomedical engineering, environmental sciences, statistics and biostatistics.

Faculty, residents, fellows and students are invited to contact Cheng early in their research process to request support. Guidelines and an application for the Research and Statistical Consult Service can be found on the Department of Biomedical and Health Informatics website at https://med.umkc.edu/dbhi/consultation/.

Faculty appointments will enhance student research

The Dean’s Office has announced the appointments of three faculty members to key positions at the School of Medicine.

Lawrence Dall, M.D., professor of internal medicine and docent, and Michael Wacker, Ph.D., associate teaching professor of physiology, will each serve as assistant dean for student medical research. Mark Hoffman, Ph.D., associate professor of biomedical and health informatics and pediatrics, and director of the Center for Health Insights, will assume the additional role of assistant dean for educational innovation.

These individuals will work in their new roles to enhance the continued development of research and education opportunities at the School. Dr. Dall and Dr. Wacker will ensure that medical students who want to do research while in medical school have the best experience possible. They also will assist in the development of student research-related policies and a database of student research activity. Dr. Hoffman will work with faculty and students to explore innovative ideas in medical education, especially those that exploit new technology.

DallDr. Dall joined the School of Medicine faculty in 1982, serving as a docent through 1998, and rejoining the faculty as docent again in 2013. He also was physician group leader for IPC/Providence Medical Center, and was associate medical director for Midwest Hospital Specialists in Kansas City. At the School of Medicine, he has been chief of the section of infectious diseases, and served as chair of the Council of Docents.

Wacker_Michael 2015Dr. Wacker has been a faculty member in the Department of Basic Medical Science since 2007. He was selected as winner of the 2015 Elmer F. Pierson Good Teaching Award and consistently has received high marks from students for his teaching. Dr. Wacker has authored many peer-reviewed publications, received extramural grants in cardiovascular research, and has served as a mentor for many student research award winners. Prior to joining the School of Medicine, Dr. Wacker was an instructor and academic program coordinator for the NIH Postbaccalaureate Research Education Program in molecular biosciences at the University of Kansas.

Mark HoffmanDr. Hoffman joined the School of Medicine in 2013. He spent 16 years leading genomics, public health, and research initiatives at Cerner Corporation. He has 17 issued patents, was the principal investigator on a University of Missouri System interdisciplinary-intercampus grant, and has written peer-reviewed publications.