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Andrew Shuman and Christian Vercler are both contributors to the January issue of the American Medical Association's Journal of Ethics. Drs. Shuman and Vercler both provide commentaries related to challenging ethical cases.


The link to the issue can be found here.

Funded by: NIH

Funding Years: 2016-2021

 

There is a fundamental gap in understanding how Mild Cognitive Impairment (MCI) influences treatment and Decision Making for serious illnesses, like Cardiovascular disease (CVD), in older patients. Poor understanding of Clinical Decision Making is a critical barrier to the design of interventions to improve the quality and outcomes of CVD care of in older patients with MCI. The long-term goal of this research is to develop, test, and disseminate interventions aimed to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans with MCI. The objective of this application is to determine the extent to which people with MCI are receiving sub-standard care for the two most common CVD events, Acute myocardial infarction (AMI) and acute ischemic stroke, increasing the chance of mortality and morbidity in a population with otherwise good quality of life, and to determine how MCI influences patient preferences and physician recommendations for treatment. AMI and acute ischemic stroke are excellent models of serious, acute illnesses with a wide range of effective therapies for acute management, Rehabilitation, and secondary prevention. Our central hypothesis is that older Adults with MCI are undertreated for CVD because patients and physicians overestimate their risk of dementia and underestimate their risk of CVD. This hypothesis has been formulated on the basis of preliminary data from the applicants' pilot research. The rationale for the proposed research is that understanding how patient preferences and physician recommendations contribute to underuse of CVD treatments in patients with MCI has the potential to translate into targeted interventions aimed to improve the quality and outcomes of care, resulting in new and innovative approaches to the treatment of CVD and other serious, acute illnesses in Adults with MCI. Guided by strong preliminary data, this hypothesis will be tested by pursuing two specific aims: 1) Compare AMI and stroke treatments between MCI patients and cognitively normal patients and explore differences in Clinical outcomes associated with treatment differences; and 2) Determine the influence of MCI on patient and surrogate preferences and physician recommendations for AMI and stroke treatment. Under the first aim, a health services research approach- shown to be feasible in the applicants' hands-will be used to quantify the extent and outcomes of treatment differences for AMI and acute ischemic stroke in older patients with MCI. Under the second aim, a multi-center, mixed-methods approach and a national physician survey, which also has been proven as feasible in the applicants' hands, will be used to determine the influence of MCI on patient preferences and physician recommendations for AMI and stroke treatment. This research proposal is innovative because it represents a new and substantially different way of addressing the important public health problem of enhancing the health of older Adults by determining the extent and causes of underuse of effective CVD treatments in those with MCI. The proposed research is significant because it is expected to vertically advance and expand understanding of how MCI influences treatment and Decision Making for AMI and ischemic stroke in older patients. Ultimately, such knowledge has the potential to inform the development of targeted interventions that will help to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans.

PI: Deborah Levine

CO(s): Darin Zahuranec, MD & Ken Lenga, MD. PhD.

Thu, December 20, 2007

A CBSSM study found that colostomy patients who felt that their condition was irreversible reported better quality of life than those who hoped that they would be cured. For a summary, see this press release and video. The researchers are Dylan M. Smith, PhD; Peter A. Ubel, MD; Aleksandra Jankovic, MS (all at the University of Michigan); and George Loewenstein, PhD, (of Carnegie Mellon University). Health Psychology will publish the article in mid-November 2009.

Press coverage of this research has been extensive. Peter Bregman reported on the study in the July 2009 Business Week Online, applying the concepts to help people manage their stressful and unpredictable lives. Read his full article here. Preliminary data from this study were cited in the 7th Annual “Year in Ideas” issue of the New York Times Magazine in December 2007. Read recent international media coverage:
US News and World Report Health Day
Voice of America Radio
Daily Mail UK
Reuters India

Funded by Health and Human Services, Department of-National Institutes of Health

Funding Years: 2014 - 2016.

Mexican Americans (MAs) suffer more from stroke than non-Hispanic whites (NHWs). Ischemic stroke is more common in MAs and their neurologic, functional and cognitive outcomes after stroke are worse than in NHWs. The reasons for the disparity in post-stroke outcome are unclear. Pre-stroke function and initial stroke severity are similar between the two groups as are ischemic stroke sub-types. One potential explanation for the worse post-stroke neurologic, functional and cognitive outcome in MAs compared with NHWs is allocation and effectiveness of post-stroke rehabilitation. There is remarkably little data demonstrating whether rehabilitation is dosed differently for MAs compared with NHWs, and still less information about whether, for a given dose of rehabilitative services following stroke, there is differential benefit by ethnicity. The current application will utilize the existing population-based Brain Attack Surveillance in Corpus Christi (BASIC, NSR0138916) project's infrastructure and strong community relations to develop and pilot a method to collect the necessary data to determine the role of rehabilitation in ethnic disparities in post-stroke outcomes. Previous studies have suggested that looking at overall time spent in rehabilitation does not predict post-stroke outcome. However, specific components of physical, occupational and speech therapy, a practice-based approach, has been shown to be associated with stroke outcomes, and these associations have been shown to vary by race. However, this practice-based approach has not been implemented in a population-based manner across the range of settings where stroke patients receive rehabilitation services, and no study has used this approach in an ethnically diverse population. Therefore, our plan is to build on previous work by developing and utilizing a practice-based design in our population-based stroke study. Specifically, we will 1) continue to build the needed relationships with rehabilitation service providers in the community;2) work with local rehabilitation therapists to refine data collection instruments as part of the practice-based design;3) pilot test data collection of specific rehabilitation components of post-stroke rehabilitation across all rehabilitation settings;and 4) analyze this data to determine the feasibility of this approach for a larger study and to provide preliminary data on differences in access and effectiveness by ethnicity. In total, our infrastructure development, refinement of tools to measure specific therapy modalities and pilot testing will position us perfectly to submit an R01 application to identify ethnic differences in access to rehabilitation and specific rehabilitation services associated with improved functional outcome in MAs and NHWs.

PI(s): Lynda Lisabeth, Lewis Morgenstern

Michael Poulin,PhD, has joined the faculty at the University at Buffalo, State University of New York (SUNY) as an AssistantProfessor of Psychology. Dr. Poulin was a post-doctoral fellow at CBSSM for twoyears, under the mentorship of StephanieBrown, PhD.  During this time he was anactive member of the CBSSM research community and a delightful colleague. Dr. Poulin's research focuses on the effects of stress on health and well-being, especiallythe ways people cope with stressful events. He examines how people's beliefsabout the world, including religious beliefs and beliefs about thetrustworthiness of others, influence adjustment to stress.  

Brian Zikmund-Fisher, PhD, a CBSSM investigator and Director of the CBSSM Internet Survey lab, is the principal investigator on an Investigator Initiated Research award from the Foundation for Informed Medical Decision Making that began in October 2008.  The grant, entitled "Learning by Doing: Improving Risk Communication Through Active Processing of Interactive Pictographs," will fund the development and testing of of Flash-based interactive risk graphics that research participants or patients can use to visually demonstrate how likely they believe some event is to occur. Dr. Zikmund-Fisher hopes that people who create risk graphics themselves will have a better intuitive understanding of risk than people who just view static images. Co-investigators on the award include Angela Fagerlin, Peter A. Ubel, and Amanda Dillard.

CBSSM Seminar: Aaron Scherer, PhD

Wed, February 03, 2016, 3:00pm to 4:00pm
Location: 
NCRC, Building 16, Room 266C

Aaron Scherer, PhD


CBSSM Postdoctoral Fellow

The Language of Medicine

Is the way we talk about health and medicine simply expressive or does the language we use actually change how we perceive and respond to health risks and medical interventions? Aaron Scherer will discuss a number of studies that explore how metaphors, labels, and explanations may shape our health-related perceptions and behavior.

The study "Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014", co-authored by Ray De Vries, was featured in JOTWELL: The Journal of Things We Like (Lots). JOTWELL is an online publication that highlights the best recent scholarship relevant to the law. You can view the article here.

The novelty of risk and vaccination intentions (May-12)

It's 2009.  Early in the year, a 9-year-old girl from California became the first person with a confirmed case of H1N1 ("swine") influenza in the United States.  Shortly thereafter, the U.S. declared a public health emergency and the World Health Organization declared a phase 6 pandemic (the highest level possible).  By September 2009 a vaccination was developed and was available within a month.

You've been following the news about the H1N1 influenza as developments have unfolded throughout the year, and you feel some concern.  You have been wondering about the risk of coming down with the H1N1 flu yourself and have been thinking about whether you should be vaccinated. 

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