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Funded by National Institutes of Health

Funding Years: 2014-2016

Nearly half of patients undergoing coronary artery bypass grafting (CABG) nationwide are exposed to red blood cell (RBC) products. While large volumes (3+ units) of transfusions may be delivered to a given patient to preserve life in cases of acute blood loss, evidence suggests that even small amounts (1-2 units) of RBCs often transfused to address poor oxygen delivery are associated with a 16% increase in a patient's risk of mortality and a 27% increase in morbidity, even after case mix adjustment. It is vitally important to allocate RBC products appropriately, given both that cardiac surgery utilizes between 20-25% of the total national blood supply, and the Red Cross reports that 32 of their 36 regions had less than a day's supply available to meet hospital needs. In short, it is important to improve our understanding of how and in what context decisions are made regarding 1-2 units of RBCs, given its association with morbidity, mortality and resource utilization. Growing evidence suggests that some transfusions may be discretionary. In the state of Michigan, nearly 40% of CABG patients are exposed to 1-2 units of RBCs, although the absolute rate varies 32% across institutions. Center-specific variation in transfusion practices is likely attributed to thelack of consensus regarding the indications, setting and hematocrit trigger for transfusions. Given this uncertainty, transfusion rates may be the consequence of differences in organizational (e.g. protocols, types of decision-makers, lack of performance feedback regarding transfusion practice) and provider (e.g. knowledge, beliefs concerning the benefit/harm of transfusions, and inclination to transfuse) factors. Interventions to reduce the rate of unnecessary transfusions first require identifying the set of determinants (at the organizational or provider level) that mot fully explain the observed variation in RBC utilization across regional medical centers. We will use the prospective data and infrastructure of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC), a consortium of all 33 cardiac surgical programs in Michigan, to: (1) Develop, pilot, and implement surveys to hospitals and clinical providers within the state of Michigan to describe determinants of 1-2 units of RBC transfusions during cardiac surgery, and (2) Identify the primary organizational and provider characteristics contributing to variability in transfusions. Results from this study will set the sage for a behavioral modification study aimed at reducing the rate of RBC transfusions in the setting of cardiac surgery.

PI(s): Richard Prager, Donald Likosky

Co-I(s): Darin Zahuranec, Min Zhang, Marc Zimmerman, Milo Engoren

Research Ethics

Research Ethics Service

The Research Ethics Service, led by Kayte Spector-Bagdady, JD, MBioethics and Raymond De Vries, PhD within the Center for Bioethics and Social Sciences in Medicine, aims to enable a culture of normative, empirical, and educational inquiry to serve as the ethical backbone of research at Michigan Medicine. Its three areas of focus include:


1. Education: providing instruction on Research Ethics and Responsible Conduct of Research;
2. Consultation: offering a consulting service for colleagues with questions about the ethical conduct of research; 
3. Research: using a variety of methods to study issues in Research Ethics.


Research Ethics and Responsible Conduct of Research Education

Coursework and independent projects into research ethics and the responsible conduct of research may be available upon request. Current courses include the Responsible Conduct of Research for K Awardees (RCR4K) Implementation Package offered through the Michigan Institute for Clinical & Health Research (MICHR) and Legal Rules and Ethical Issues for Clinical Research (HMP 540) through the Clinical Research Design and Statistic Analysis Masters Program at the UM School of Public Health.


Research Ethics Consultation Service

Personalized Research Ethics Consultation may be available during normal business hours for investigators across Michigan Medicine designing or conducting their own research protocols. For further information or to request a consultation please contact kaytesb@med.umich.edu.


Mixed Methods Research into Human Subjects Research Ethics

The Program in Research Ethics also supports a vibrant mixed-methods empirical program for research on human subjects research ethics.

Bioethics Grand Rounds -Reshma Jagsi, MD, DPhil

Wed, October 25, 2017, 12:00pm
Location: 
UH Ford Auditorium

Reshma Jagsi, MD, DPhil

Title – "Ethical Issues Related to Fundraising from Grateful Patients"

Abstract: Health care institutions are becoming increasingly deliberate about philanthropic fundraising given the need to sustain their missions in the face of decreases in governmental research funds and lowering reimbursement for clinical care.  Donations from grateful patients constitute 20% of all philanthropic contributions to academic medical centers, totaling nearly $1 billion a year in recent years.  Institutions frequently employ development professionals to facilitate philanthropy. The development literature describes various approaches for identifying patients capable of contributing, cultivating potential donors, and engaging physicians in the solicitation of grateful patients, emphasizing that patients themselves may also benefit from exercising altruism in this way.  However, little evidence exists to guide the ethical practice of grateful patient fundraising, and concerns exist regarding privacy and confidentiality, patient vulnerability, and physicians' conflicts of obligations in this context.  Therefore, we will discuss how the process of philanthropic development should be structured in order to demonstrate respect for all persons involved, including patients who donate, those who might consider donation, those who do not wish to donate, and those who cannot afford to do so.

Lunch is provided. Please note: Lunch is first come, first served.

 

Raymond De Vries, PhD

Associate Director

Raymond De Vries PhD is Associate Director at the Center for Bioethics and Social Sciences in Medicine at the University of Michigan and is a Professor in the Department of Learning Health Sciences and the Department of Obstetrics and Gynecology. He is also visiting professor at CAPHRI School for Public Health and Primary Care, University of Maastricht, the Netherlands.

Last Name: 
De Vries

Kayte Spector-Bagdady, JD, MBioethics

Faculty

Kayte Spector-Bagdady is an Assistant Professor in the Department of Obstetrics and Gynecology at the University of Michigan Medical School and is also the Chief of the Research Ethics Service in the Center for Bioethics and Social Sciences in Medicine (CBSSM). At UM she also serves as Chair of the Research Ethics Committee, a clinical ethicist through CBSSM’s Clinical Ethics Service, and a member of IRB Council. She is on the Board of Directors for the American Society for Bioethics & Humanities.

Last Name: 
Spector-Bagdady

Conference on Bioethics: First Do No Harm: Avoiding Overdiagnosis and Overtreatment in Medicine

Sat, November 11, 2017, 8:45am
Location: 
Sheraton Ann Arbor Hotel | 3200 Boardwalk Street | Ann Arbor, MI

Registration available here.
 
8:45 am
Welcome, Opening Remarks, and Presentation of Certification of Appreciation Award to Blue Cross Blue Shield of Michigan Foundation
Lauren B. Smith, MD, Chair, MSMS Committee on Bioethics; Department of Pathology, University of Michigan
Audrey J. Harvey, CEO, Blue Cross Blue Shield of Michigan Foundation; and,
Shauna Ryder-Diggs, MD, Blue Cross Blue Shield of Michigan Foundation
 
9:00 - 10:00 am
7 Assumptions that Drive Too Much Medical Care
H. Gilbert Welch, MD, MPH, Professor of Medicine, Community & Family Medicine, The Dartmouth Institute, The Geisel School of Medicine at Dartmouth, Adjunct Professor, Business Administration, Tuck School
of Business and Adjunct Professor, Public Policy, Dartmouth College
 
10:00 - 11:00 am
Responding to those who Hope for a Miracle
Devan Stahl, PhD, Assistant Professor, Center for Ethics & Humanities in the Life Sciences, Department of Pediatrics & Human Development, Michigan State University
 
11:15 am - 12:15 pm
Whose Decision is it Anyway? Code Status and the Unilateral DNAR
Adam Marks, MD, Associate Director of the Adult Palliative and Supportive Care Clinic, East Ann Arbor Health and Geriatrics Center, Adult Palliative Care Medical Director, Arbor Hospice
 
1:15 - 2:15 pm
Capacity for Preferences: An Overlooked Factor in Ethical Dilemmas with Incapacitated Patients
Jason A. Wasserman, PhD, Associate Professor, Biomedical Science, Faculty Advisor on Professionalism, Oakland University William Beaumont School of Medicine; and,
Mark C. Navin, PhD, Associate Professor of Philosophy, Oakland University William Beaumont School of Medicine
 
2:15 - 3:15 pm
Over-treatment/Over-diagnosis of Genetic Testing
Michele Gornick, PhD, MA, Department of Internal Medicine, University of Michigan Medical School
 
3:30 - 4:30 pm
Case Studies
 
4:30 pm
Closing Remarks
Lauren B. Smith, MD, University of Michigan

2015 Bishop Lecture featuring Lawrence O. Gostin, J.D., LL.D. (Hon.)

Tue, March 17, 2015, 11:00am
Location: 
Founders Room, Alumni Center, 200 Fletcher St., Ann Arbor, MI

Bishop Lecture in Bioethics: "Law, Ethics, and Public Health in the Vaccination Debates: Politics of the Measles Outbreak" (Keynote Address for the 2015 CBSSM Research Colloquium)

Abstract: The measles outbreak of early 2015 is symptomatic of a larger societal problem–the growing number of parents who decide against vaccinating their children. This failure is causing the resurgence of childhood diseases once eliminated from the United States.
falseThis presentation explores the legal and ethical landscape of vaccine exemptions. While all states require childhood vaccinations, they differ significantly in the types of religious and/or philosophical exemptions permitted, the rigor of the application process, and available review mechanisms. States with relaxed exemption policies disproportionately experience more outbreaks of vaccine-preventable disease.

Vaccine exemptions are an illustration of the “tragedy of the commons,” in which parents choose not to vaccinate their children, relying on the fact that other parents will vaccinate their children, thus providing community immunity. However, the net result of many individual decisions not to vaccinate is the collapse of herd immunity and thus an upsurge in preventable disease and death.
The failure to vaccinate puts others at risk, thus violating an important ethical principle. However, punishing individual parents could entrench political opposition to vaccine policy. The most ethical and effective solution is for state legislatures to tighten vaccination laws, making it more difficult to obtain non-medical exemptions.

Lawrence O. Gostin, J.D., LL.D. (Hon.) is University Professor, Georgetown University’s highest academic rank conferred by the University President. Prof. Gostin directs the O’Neill Institute for National and Global Health Law and is the Founding O’Neill Chair in Global Health Law. He is Professor of Medicine at Georgetown University, Professor of Public Health at the Johns Hopkins University, and Director of the Center for Law & the Public’s Health at Johns Hopkins and Georgetown Universities. Prof. Gostin is also the Director of the World Health Organization Collaborating Center on Public Health Law & Human Rights.

  • Click here for the video recording of the 2015 Bishop Lecture.

Funded by the Agency for Healthcare Research and Quality

Funding Years: 2015-2019

The theme of the University of Michigan Patient Safety Learning Laboratory ("M-Safety Lab") is to improve the delivery of inpatient care by cross-linking investigators from diverse disciplines - including engineering, medicine, nursing, architecture and design and computer science - who share a common interest in patient safety. Our overarching goal is to implement novel methods to enhance cognition and communication among care providers in order to reduce hospital-acquired complications. The M-Safety Lab will include a robust infrastructure that will support two projects, each of which has the potential to transform the delivery of inpatient care. Both projects - Project 1 will develop a new monitoring system for hospitalized patients and Project 2 will address the common, but understudied area of diagnostic and therapeutic error - will be based on two major interrelated themes: Preventing hospital-acquired complications and improving medical decision-making through enhanced cognition and communication. We have assembled an extremely broad and productive group of investigators from a large number of synergistic disciplines. The Laboratory-Wide Aim is to establish a cohesive M-Safety Lab comprised of multidisciplinary, collaborating teams of investigators supported by a robust infrastructure including an Innovation, Development, Evaluation and Administration (IDEA) Core that will help oversee the development and successful completion of both projects from problem analysis to evaluation, and will provide methodological, technical, and administrative support for the M-Safety Lab.

PI(s): Sanjay Saint

Co-I(s): Amy Ellen Cohn, Frank Jacob Seagull, Jan Stegemann, Jennifer Meddings, Laurence McMahon, Mary Rogers, Michael Greene, Milisa Manojlovich, Rachael Schmedlen, Richard Lewis, Robert Adams, Sarah Krein, Satinder Baveja, Scott Flanders, Timothy Hofer, Vineet Chopra

2011 CBSSM Research Colloquium

Fri, May 20, 2011 (All day)

The second annual Bioethics Research Colloquium was held Friday, May 20, 2011, at the Alumni Center.  The Colloquium was jointly sponsored by the Center for Bioethics and Social Sciences in Medicine and the Center for Ethics in Public Life. 

The majority of the colloquium was devoted to presentations of research in or about bioethics conducted by University of Michigan faculty, fellows and students.  Presentations focused on theoretical, empirical, and critical approaches to understanding and resolving ethical issues in health care and the life sciences.

Presenters:

  • Apurba Chakrabarti, Department of Cellular, Molecular, and Developmental Biology: A bureaucratic framework of IRBs: Understanding how cultural forces influence the contemporary IRB bureaucracy.
  • Nathaniel Adam Tobias Coleman, Department of Philosophy: Online sexual racism and the prevalence of HIV among black MSM. 
  • Susan Dorr Goold, MD, MHSA, MA, Department of Internal Medicine: Market failures, moral failures, and health reform (keynote).
  • Henry Greenspan, PhD, Residential College, LSA: Temptation and trespass in the pharmaceutical industry: Incentivizing ethical self-regulation. 
  • Lisa H. Harris, MD, Department of Obstetrics and Gynecology: Obstetrician-gynecologists' objections to and willingness to help patients obtain abortion in various clinical scenarios: A national survey. 
  • Aisha T. Langford, MPH, Comprehensive Cancer Center: The misdiagnosis of the minority problem in cancer clinical trials: Is our focus on medical mistrust causing harm? 
  • Naomi Laventhal, MD, Department of Pediatrics and Communicable Diseases: Innovative therapies in the newborn intensive care unit: The ethics of off-label use of therapeutic hypothermia.
  • Erika Manu, MD, Department of Internal Medicine: Resident attitudes and experience with palliative care in patients with advanced dementia.
  • Karen M. Meagher, Department of Philosophy (MSU): Considering virtue: Public health and clinical ethics.
  • Andrew Shuman, MD, Department of Otolaryngology: The right not to hear: The ethics of parental refusal of hearing rehabilitation.
  • Lauren Smith, MD, Department of Pathology: Pathology review of outside material: When does it help and when can it hurt? 

2014 CBSSM Research Colloquium and Bishop Lecture (Myra Christopher)

Thu, May 15, 2014 (All day)
Location: 
Vandenberg Meeting Hall (2nd floor), The Michigan League, 911 N. University, Ann Arbor, MI

2014 CBSSM Colloquium and Bishop Lecture featuring Myra Christopher

The Center for Bioethics and Social Sciences in Medicine (CBSSM) Research Colloquium was held Thursday, May 15, 2014 at the Vandenberg Meeting Hall (2nd floor), The Michigan League, 911 N. University Ave, Ann Arbor, MI 48109.
 

The CBSSM Research Colloquium featured the Bishop Lecture in Bioethics as the keynote address.  Myra Christopher presented the Bishop Lecture with a talk entitled: "The Moral Imperative to Transform the Way Pain is Perceived, Judged and Treated." Myra Christopher holds the Kathleen M. Foley Chair in Pain and Palliative Care at the Center for Practical Bioethics.

The 2014 Research Colloquium presenters:

  • Andrew G. Shuman, MD, Assistant Professor, Department of Otolaryngology, University of Michigan: "When Not to Operate: The Dilemma of Surgical Unresectability"
  • Phoebe Danziger, MD, University of Michigan Medical School: "Beliefs, Biases, and Ethical Dilemmas in the Perinatal Counseling and Treatment of Severe Kidney Anomalies"
  • Kathryn L. Moseley, MD, MPH, Assistant Professor, Pediatrics and Communicable Diseases, University of Michigan: "Electronic Medical Records: Challenges for Clinical Ethics Consultation"
  • Helen Morgan, MD,  Department of Obstetrics and Gynecology, University of Michigan: "Academic Integrity in the Pre-Health Undergraduate Experience"
  • Tanner Caverly, MD, MPH, Health Services Research Fellow, Ann Arbor VA Medical Center and Clinical Lecturer, University of Michigan: "How Transparent are Cancer Screening & Prevention Guidelines about the Benefits and Harms of What They Recommend?"
  • Susan D. Goold, MD, MHSA, MA , Professor of Internal Medicine and Health Management and Policy, School of Public Health, University of Michigan: "Controlling Health Costs: Physician Responses to Patient Expectations for Medical Care"
 

 

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