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One Mission, One Goal: Veterans Health

About NCIRE

We are a scientific community of clinicians and researchers and we partner with the University of California, San Francisco (UCSF) and the San Francisco VA Health Care System (SFVAHCS) to bring the power of modern medicine to the health of our nation’s Veterans.

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Research News

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NCIRE is proud to announce the following exciting new developments for research conducted by NCIRE-supported Principal Investigators Drs. Michael Shlipak and Michelle Estrella:

UCSF/SFVAHCS research collaboration reveals lack of albuminuria testing and describes treatment approaches in the real-world setting for patients with type 2 diabetes and chronic kidney disease

University of California, San Francisco (UCSF), Kidney Health Research Collaborative (KHRC), and San Francisco VA Health Care System (SFVAHCS) has released 2 real-world evidence studies that are focused on helping appropriate patients with chronic kidney disease (CKD) access more timely treatment.

 

More than 1 in 7 American adults (14%) are estimated to have CKD, with diabetes and high blood pressure being the most common causes of CKD in American adults.(1) Many of these patients are unaware of their disease because there are typically no or few symptoms in the early stages of the disease and, historically, there is under-detection of CKD due to lack of testing. Treatment for CKD depends on the stage of disease and, while there is no cure, treatment can help slow its progression and lower the burden of associated heart disease complications.(2)

 

We are pleased to report the findings from the first 2 collaborative studies with UCSF and SFVAHCS.

 

  • Prescription Patterns of Cardiovascular- and Kidney-Protective Therapies Among Patients with Type 2 Diabetes and Chronic Kidney Disease was undertaken to assess the prevalence and correlations of prescriptions for 2 drugs that protect against CKD progression and heart disease events, sodium-glucose cotransporter 2 inhibitors (SGLT2is) and/or glucagon-like peptide 1 receptor agonists (GLP1-RAs) in individuals with T2D with and without CKD. This was a cross-sectional analysis of SGLT2i and GLP1-RA prescriptions from 1 January 2019 to 31 December 2020 in the Veterans Health Administration (VHA) System. This study, which was published in Diabetes Care, demonstrated that patients with the greatest risk of cardiovascular disease (CVD) and kidney failure (ie, with severe albuminuria, elevated 10-year risk of atherosclerotic CVD, and 5-year risk of end-stage kidney disease >5%) were less likely to receive SGLT2is or GLP1-RAs.(3)

 

  • Estimated Prevalence and Testing for Albuminuria in US Adults at Risk for Chronic Kidney Disease aimed to estimate the extent of albuminuria under-detection from lack of testing and evaluate its association with provision of common CKD treatments in patients with hypertension or diabetes. Using data from the 2007 to 2018 National Health and Nutrition Examination Surveys (NHANES), a model was created to predict abnormal albuminuria levels based on multiple predictor variables; this model was then applied to a 5% random sample of the Optum de-identified electronic health record dataset from 1 January 2017 to 31 December 2018 to predict the likelihood of abnormal albuminuria in untested patients in the clinical dataset. The results of these analyses, recently published in JAMA Network Open, estimate that two-thirds of patients with albuminuria were undetected due to lack of testing and that albuminuria testing was associated with greater likelihood of receiving CKD treatments.4 With improved identification of albuminuria, there would be a substantial opportunity to optimize care delivery for reducing kidney disease progression and cardiovascular complications.(4)

 

Drs. Estrella and Shlipak commitment to these research efforts, “We’re excited to continue these collaborative partnerships as it strongly aligns with the KHRC’s longstanding research dedication to optimize the prevention, early detection, and treatment of kidney disease and its associated cardiovascular complications. We believe that such academic-industry partnerships have the potential to close the gap between scientific discoveries and clinical care delivery, and additionally to accelerate research focused on early stages of kidney disease, which traditionally has lagged behind research into advanced stages of CKD.”

 

For more information, please contact Michelle.Estrella@ucsf.edu or Michael.Shlipak@ucsf.edu.

 

About UCSF and SFVAHCS’s Commitment in Kidney Disease

The University of California, San Francisco (UCSF) is one of the top hospitals in Northern California and the nation for kidney care.(5) The Kidney Health Research Collaborative (KHRC), based at UCSF and the San Francisco Veterans Affairs Health Care System (SFVAHCS), encompasses a group of leading scientists from multiple disciplines working to improve kidney health worldwide.(6) A non-profit research institute, the Northern California Institute for Research and Education (NCIRE) is a critical partner for the KHRC, as NCIRE provides outstanding administrative support for these awards from Bayer to KHRC. NCIRE promotes and supports the research of investigators who have joint faculty appointments at both UCSF and SFVAHCS, such as Drs. Estrella and Shlipak. San Francisco VA Health Care System (SFVAHCS) is a comprehensive network that provides health services to Veterans through the San Francisco VA Medical Center (SFVAMC) and nine community-based outpatient clinics in Santa Rosa, Oakland, Eureka, Ukiah, Clearlake, San Bruno and downtown San Francisco.

Funding for this research was provided by Bayer Healthcare Pharmaceuticals.

References

  1. Centers for Disease Control and Prevention. Chronic kidney disease in the United States, 2023. May 30, 2023. Accessed July 24, 2023. https://www.cdc.gov/kidneydisease/publications-resources/CKD-national-facts.html

  2. National Health Service. Chronic kidney disease – treatment. March 23, 2023. Accessed July 24, 2023. https://www.nhs.uk/conditions/kidney-disease/treatment/

  3. Lamprea-Montealegre JA, Madden E, Tummalapalli SL, et al. Prescription patterns of cardiovascular- and kidney-protective therapies among patients with type 2 diabetes and chronic kidney disease. Diabetes Care. 2022;45:2900-2906.

  4. Chu CD, Xia F, Yuxian D, et al. Estimated prevalence and testing for albuminuria in US adults at risk for chronic kidney disease. JAMA Network Open. 2023;6(7):e2326230. doi:10.1001/jamanetworkopen.2023.26230

  5. UCSF. Kidney disease (nephrology). Accessed July 31, 2023. https://www.ucsfhealth.org/list-of-clinics/kidney-disease-nephrology

  6. UCSF. Kidney Health Research Collaborative. Accessed July 31, 2023. https://khrc.ucsf.edu/

 

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Geriatrics Team Publications Explore Aging Research Challenges, and Nursing Home Needs for Older Dementia patients

Lead by University of California San Francisco (UCSF) Principal Investigator Dr. James Deardorff, several NCIRE-supported Investigators recently co-published two articles exploring research challenges in the geriatrics field and predicting the level of nursing home care needs for older adults with dementia.

Published in the Journal of the American Geriatrics Society, the article “Around the EQUATOR with Clin-STAR: Prediction modeling opportunities and challenges in aging research” highlights methodologic challenges that aging-focused researchers will encounter when designing and reporting studies involving prediction models for older adults and provides guidance for addressing these challenges.

NCIRE-supported Investigators Drs. Alexander Smith, John Boscardin, and Sei Lee joined Dr. Deardorff in suggesting that clinical prediction models are becoming increasingly popular and are often applied to populations involving older adults. Proper design and reporting of these studies are critical to ensure that they are developed and validated in a manner that does not misinform individuals or worsen healthcare inequities.

Read the article here: https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18704

In another article co-published by Dr. Deardorff and NCIRE-supported Investigators Drs. Deborah Barnes, John Boscardin, Kenneth Covinsky, Sei Lee, and Alexander Smith, the research team addressed the question: can need for nursing home level of care (NHLOC) in community-dwelling older adults with dementia be accurately predicted?

Titled “Development and External Validation of Models to Predict Need for Nursing Home Level of Care in Community-Dwelling Older Adults With Dementia”, the prognostic study showed that relatively simple models using self-reported or proxy responses can predict need for NHLOC among older adults with probable dementia with moderate discrimination and excellent calibration. Given that most individuals with dementia ultimately need NHLOC, model estimates may help frame conversations between patients and families/caregivers regarding care planning.

The study was published by the Journal of the American Medical Association (JAMA) Network-JAMA Internal Medicine, and may be read here:

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2812543

 

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The Middle-Out Approach to reconceptualizing, assessing, and analyzing traumatic stress reactions

NCIRE-supported Researchers, Drs. Shira Maguen and Sabra Inslicht co-published a paper with University of California, San Francisco and San Francisco VA Health Care System Principal Investigator Dr. Shane Adams that posits the importance of implementing the Middle-Out Approach to reconceptualizing, assessing, and analyzing traumatic stress reactions.

Published in the International Society for Traumatic Stress Studies’ Journal of Traumatic Stress by Shane Adams et al., the paper introduces the Middle-Out Approach as a new integrative methodological framework for advancing the study and treatment of traumatic stress reactions to be increasingly representative of more individuals and contexts. This approach is differentiated from other practices by the assessments and data used as well as their application and analysis.

The Middle-Out Approach aims to uncover unique theory- and data-driven phenotypes characterizing traumatic stress reactions that may have been previously obstructed by historical practices and restrictions of bottom-up, top-down, and variable centered-only designs and statistical approaches. This approach can help identify and explicate intra- and interindividual differences in traumatic stress reactions that can lead to increased empirical and diagnostic representations of unique experiences within diverse communities that meaningfully impact treatments.

 

Within the article, the research team provides a conceptual roadmap for integrating existing methods into new or existing studies to facilitate clear clinical applications and increased patient-centered care to address persisting research and clinical issues.

 

Sabra Inslicht, PhD, is a Staff Psychologist with the Mental Health Service with the San Francisco VA Health Care System (SFVAHCS), and Adjunct Professor of Psychiatry at the University of California, San Francisco (UCSF). Dr. Inslicht’s research focuses on identifying neurobiological mechanisms that underlie post-traumatic stress disorder (PTSD), fear conditioning models of PTSD, putative biomarkers that may explain sex differences in PTSD, and pharmacological and psychological interventions to ameliorate stress responding and insomnia.

Shira Maguen, PhD is the Mental Health Director of the Post-9/11 Integrated Care Clinic and Staff Psychologist on the Posttraumatic Stress Disorder Clinical Team (PCT) at the SFVAHCS, and Vice Chair of SFVAHCS and Professor in the Department of Psychiatry and Behavioral Sciences, UCSF School of Medicine. Dr. Maguen was appointed to and served on the Creating Options for Veterans' Expedited Recovery (COVER) Commission. She is also the San Francisco site co-lead for the VA Women’s Practice Based Research Network (PBRN) and Director of the SFVAHCS PTSD MIRECC Postdoctoral Research Fellowship.

 

Read More: https://onlinelibrary.wiley.com/doi/10.1002/jts.23005  

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Dr. Ovbiagele Appointed to Fellowship by the International Science Council

NCIRE-supported Principal Investigator and Board Member, Dr. Bruce Ovbiagele is one of more than 100 Fellows appointed by the International Science Council (ISC) to help advance its vision of science as a global public good.

The Fellowship is the highest honor that can be conferred on an individual by the ISC.  Together with the 123 individuals that were appointed in 2022, the new ISC Fellows will support the Council in its mission at a critical moment for science and sustainability for science as we enter the United Nation’s International Decade of Sciences for Sustainable Development (IDSSD) in 2024.

The new Fellows include eminent social and natural scientists, engineers and thought leaders who have made impactful contributions to science and society.  They hail from different countries and regions, disciplines, sectors and career stages.

Please join NCIRE in congratulating Dr. Ovbiagele on his fellowship appointment.

 

Bruce Ovbiagele, MD, MSc, MAS, MBA, MLS, is a vascular neurologist, clinical epidemiologist, and health equity scholar, with a focus on reducing the burden of stroke. He is Professor of Neurology and Associate Dean at UCSF, as well as Chief of Staff at SFVAHCS, and serves a Statuary Director on the NCIRE Board.

The International Science Council (ISC) is an international non-government organization created in 2018 as the result of a merger between the International Council for Science (ICSU) and the International Social Science Council (ISSC). The ISC works at the global level to catalyze and convene scientific expertise, advice and influence on issues of major concern to both science and society.

 

Learn more:

https://council.science/wp-content/uploads/2023/12/2023-ISC-Fellows.pdf

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Dr. Michael Weiner Among More Than 30 UCSF Scientists Honored By Clarivate

 

NCIRE-supported Principal Investigator, Dr. Michael Weiner is among more than 30 University of California, San Francisco scientist noted as “the most influential individuals in their respective fields” according to the most recent analysis of research citations by the science and intellectual property company, Clarivate.

 

Researchers were chosen according to authorship of highly-cited journal articles – those that ranked in the top 1% by citations for their field(s) and publication year over the past decade. This citation-based list was then refined by expert judgment at Clarivate to produce a final slate representing the top 0.1% of all scientists.

 

Please join NCIRE in congratulating Dr. Weiner on this recognition.

 

Michael Weiner, MD is a Professor, Radiology with the UCSF School of Medicine, and Principal Investigator of ADNI, a longitudinal study aimed at validating biomarkers for Alzheimer’s. He also launched BrainHealthRegistry.org, aimed at accelerating treatment development for brain diseases.

 

Read More: https://www.ucsf.edu/news/2023/12/426756/over-30-ucsf-scientists-honored-highest-impact-their-fields

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Congratulations to Drs. Alexander Smith and Sei Lee for their new NIH Award!    

Congratulations to NCIRE-supported researchers Drs. Alexander Smith and Sei Lee for receiving a NIH Award to support their research project titled “Prognostic Indices for Hospitalized Older Adults with and without Alzheimer’s Disease and Related Dementias.”

 

Funded by the National Institutes of Health (NIH), National Institute on Aging Lee and Smith will lead a 4 hospital consortium (University of California, San Francisco, Cleveland Clinic, Johns Hopkins and Beth Israel Deaconess) to use electronic health record data to identify hospitalized patients most appropriate for hospice and palliative care.

 

“Patients nearing the end of life requires different types of care” Lee said. “Our goal is to use clinical data that is already available in the Electronic Health Records (EHR) to identify patients at high risk for 6-month mortality to help clinicians identify which patients may be most appropriate for hospice care.”

 

Similarly, the research team will also use EHR data to identify patients at high risk for 2-year mortality to help clinicians identify patients who may benefit from a palliative care consultation or medication changes.

 

Previous studies leading up to this project focused on predicting time to outcomes.  For example, the research team’s last NIH grant focused on time to death and need for NH level of care for older adults with dementia.

 

“In addition, we’ve conducted studies using VA EHR data to predict time to death to help target colorectal cancer screening,” Lee said.

 

As for future plans for their current project, Drs. Lee and Smith are excited to be leading a consortium of 4 hospitals and their EHR systems.

 

“Our goal is to continue this consortium for future studies using EHR data from all 4 systems,” See said.

 

Alexander Smith, MD, MS, MPH is a Staff Physician with the San Francisco  Veterans Affairs Health Care System, and Associate Professor of Medicine at UCSF. He co-developed ePrognosis, an online guide for older patients seeking to determine if they should be screened for cancer. He has been a NCIRE-supported Principal Investigator since 2008.

Sei Lee, MD, MAS is Professor of Medicine with UCSF Geriatrics, and is Staff Physician, Sr Physician Scholar with the San Francisco VA Quality Scholars Fellowship. He has been a NCIRE-supported Principal Investigator since 2007.  

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Drs. Deborah Barnes and Rebecca Sudore published article in Sage Journals         

NCIRE-supported researchers Drs. Deborah Barnes and Rebecca Sudore co-published an article in Global Advances in Integrative Medicine and Health entitled, "Adaptation of an In-Person Mind-Body Movement Program for People with Cognitive Impairment or Dementia and Care Partners for Online Delivery: Feasibility, Satisfaction and Participant-Reported Outcomes".

Studies have shown that regular exercise is beneficial to those with neurodegenerative diseases such as Alzheimer’s and dementia. Therefore, it is vital that those with dementia can access and maintain an exercise regimen to help improve quality of life and stave off loss of independence and cognitive decline.

In 2013 and 2015, Barnes, working with NCIRE-supported researcher and Board Member Dr. Kristine Yaffe co-wrote studies that launched the pilot clinical trial, Preventing Loss of Independence through Exercise (PLIÉ), an in-person group mind-body movement program for people across the spectrum of cognitive decline and care partners (CPs). The novel, integrative exercise program showed promise for improving physical function, cognitive function, quality of life and caregiver burden in individuals with mild-to-moderate dementia.

Subsequent studies in 2020 and 2021, co-published by Barnes, Yaffe, and fellow NCIRE-supported researchers Drs. John Boscardin, Gary Abrams, and Linda Chao, further cemented findings that exercise specifically tailored to patients aged 55+ years with cognitive decline do cognitive activity, interoceptive self-regulation, well-being, and reduced feelings of social isolation.

In their current study, first published in Sage Journals, Barnes and Sudore wants to expand access to the beneficial program by way of developing and refining an online version called Moving Together and tested feasibility and satisfaction with an online delivery.

While technology navigation for older adults, did prove a challenge, it did not outweigh the overall benefits of the online version of the program; with participants reporting high satisfaction and positive outcomes across multiple domains. To overcome the tech challenge, the study reported that providing individual technology support is critical for the success of livestreamed, online interventions for dementia.

 

Deborah Barnes, PhD, MPH is a Professor at UCSF in the Department of Psychiatry and a Mental Health Research Investigator at the San Francisco Veterans Affairs Health Care System. Her research focuses on developing and evaluating strategies to maintain cognitive function and prevent or delay dementia onset in late life. Dr. Barnes also works on developing dementia risk prediction models that can be used to estimate the impact of risk factor reduction and to target prevention strategies toward those who are at greatest risk.

 

Rebecca Sudore, MD is a Staff Physician, Geriatrics Service with the San Francisco Veterans Affairs Health Care System, and Professor of Medicine at UCSF.

 

Read more: https://journals.sagepub.com/doi/10.1177/27536130231202989

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Congratulations to Dr. Theresa Allison for her new NIH Award!

Congratulations to NCIRE-supported researcher Dr. Theresa Allison for receiving a NIH Award to support her research project titled “The impact of music on well-being after diagnosis with Alzheimer's disease or its related dementias”!

The project focuses on using music as a focal point to prospectively examine changes to a patient’s experience with dementia over time. It is believed that music’s role in supporting a sense of personal identity and social music activities translates to supporting dementia caregiving relationships, as well as a patient’s individual identity.

“This project is built on the belief that a new dementia diagnosis does not have to be terrible for either the people diagnosed or their family and close friends,” Allison said.  “A new dementia diagnosis, adequately supported, can offer opportunities to figure out what is most important to us, to heal and support our relationships, and to find support in the community around us.”

But in order to do that, researchers need to understand how the diagnosis affects people and what sources of support help reinforce their personal identity, their social relationships and their place in the community, she explained.

Allison’s musical approach to dementia treatment is informed by her unique research background. She is a music anthropologist (ethnomusicologist) as well as a geriatric physician, with a Master of Music and a PhD in musicology as well as an MD.

As a geriatric physician and music anthropologist, Allison studies the role of music in daily life for older adults. This includes the impact of music on social well-being for older adults living in nursing home, the cognitive and social effects of singing in choirs, and the impact of everyday music activities for older adults living with dementia.

Currently, Allison’s research team is in the final months of a small, two-year longitudinal, observational study examining music in daily life in dementia caregiving relationships. For that study, researchers go into participants' homes to interview people living with dementia and their care partners and engage in usual music activities during those visits.

“We are learning about the different ways in which music and other favorite activities are used to support individual well-being and dementia caregiving relationships,” she said.

When asked of her future plans for the project, Allison said the study is designed to produce basic social science (observational) findings that can be used in two ways.

“First, it should produce the key information needed to the develop music-based research interventions that will have long-term impact on identity and social well-being as dementia progresses,” she said. “Second, these findings will be distributed to community-based organizations that provide dementia-related services so that they can develop innovative new services to support the abilities and identities of people living with dementia.”

NCIRE wishes Dr. Allison and her team the best of luck with their research endeavors!

 

Theresa Allison, MD, PhD is a Professor of Medicine and Family & Community Medicine with the University of California, San Francisco’s Division of Geriatrics, and a Staff Physician in Geriatrics with the Palliative and Extended Care Service Line at the San Francisco Veterans Affairs Health Care System.

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Dr. Bruce Ovbiagele, 2023-2024 recipient of the W. Lester Henry Award for Diversity, Equity and Inclusion

Congratulations to Dr. Bruce Ovbiagele for being the 2023-2024 recipient of the W. Lester Henry Award for Diversity, Equity, and Inclusion!

This award is one of 23 awards bestowed by the American College of Physicians (ACP) for 2023-2024. Recipients of the W. Lester Henry Award are recognized for advancing diversity in medicine or research and/or access to care for diverse populations.

The ACP also bestowed 58 Masterships.

Bruce Ovbiagele, MD, MSc, MAS, MBA, MLS, is a vascular neurologist, clinical epidemiologist, and health equity scholar, with a focus on reducing the burden of stroke. He is Professor of Neurology and Associate Dean at UCSF, as well as Chief of Staff at SFVAHCS, and serves a Statuary Director on the NCIRE Board.

 

The American College of Physicians (ACP) is a diverse community of internal medicine specialists and subspecialists united by a commitment to excellence. Internal medicine physicians apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. With 161,000 members in countries across the globe, ACP is the largest medical-specialty society in the world. ACP and its physician members lead the profession in education, standard-setting, and the sharing of knowledge to advance the science and practice of internal medicine.

Learn more: https://www.acponline.org/about-acp/awards-masterships-and-competitions/acp-announces-2023-24-recipients-of-masterships-and-national-awards

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Dr. Dolores Shoback honored with Outstanding Scholarly Physician Award from the Endocrine Society

Please join NCIRE in celebrating Dr. Shoback and her prestigious achievement!

On August 14, the Endocrine Society announced the 14 leading endocrinologists as winners of its prestigious 2024 Laureate Awards, the top honors in the field.

Among those awarded was NCIRE-supported Principal Investigator Dolores Shoback, MD, who received the Outstanding Scholarly Physician Award, recognizing her outstanding contributions to the practice of clinical endocrinology in academic settings.

Dr. Shoback cares for patients who have endocrine disorders such as metabolic bone disease, parathyroid disorders and osteoporosis at the San Francisco Veteran Affairs Health Medical Center and the University of California San Francisco (UCSF). She is also the Associate Program Director of UCSF's physician training program in diabetes, endocrinology and metabolism.

Dr. Shoback’s research interests include metabolic bone disease, the calcium-sensing receptor and parathyroid hormone. She is a basic and clinical investigator who has made contributions to our understanding of metabolic bone diseases. She has been an effective educator of physicians and patients for three decades.

Since becoming an Endocrine Society member in 1987, Dr. Shoback has held several service positions, including Secretary-Treasurer of its Board of Directors and Chair of the Finance and Audit Committee. She has been the Co-Chair of The Journal of Clinical Endocrinology & Metabolism Working Group, a member of the Editor-in-Chief Search Committee for Endocrinology and a member of the Osteoporosis Clinical Practice Guideline Writing Committee.

Established in 1944, the Society’s Laureate Awards recognize the highest achievements in the endocrinology field, including groundbreaking research and innovations in clinical care. The Endocrine Society will present the awards to the winners at ENDO 2024 in Boston June 1 – 4.

With its beginnings in 1917, the Endocrine Society is a global community of physicians and scientists dedicated to accelerating scientific breakthroughs and improving patient health and well-being.

Read More: https://endocrinenews.endocrine.org/meet-the-2024-endocrine-society-laureates/

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Dr. Bruce Ovbiagele honored with the inaugural American Academy of Neurology Health Care Equity Research Award and Lectureship

Please join NCIRE in celebrating our supported Principal Investigator and Board Member Dr. Bruce Ovbiagele who has received the inaugural American Academy of Neurology Health Care Equity Research Award and Lectureship!

Dr. Ovbiagele was honored with the award during the Health Care Equity Symposium, which took place as part of the Main Events at the American Academy of Neurology Annual Meeting in Boston, on April 24, 2023. He presented the lecture “Racial Disparities in Stroke: Metrics, Specifics, and Psycho-Socioeconomics’.

According to the American Academy of Neurology’s website, the award recognizes a neurologist or neuroscientist who has demonstrated their commitment to health equity and addressing health disparities through their clinical research, service, or leadership role.

Dr. Ovbiagele has been a member of the American Academy of Neurology since 1998 and serves as a Director on its Board.

 

Congratulations Dr. Ovbiagele for this inaugural achievement!

 

Bruce Ovbiagele, MD, MSc, MAS, MBA, MLS, is a vascular neurologist, clinical epidemiologist, and health equity scholar, with a focus on reducing the burden of stroke. He is Professor of Neurology and Associate Dean at UCSF, as well as Chief of Staff at SFVAHCS, and serves a Statuary Director on the NCIRE Board.

 

Read More: https://www.linkedin.com/feed/update/urn:li:activity:7081857581337493504/?updateEntityUrn=urn%3Ali%3Afs_feedUpdate%3A%28V2%2Curn%3Ali%3Aactivity%3A7081857581337493504%29

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Incorporating Prognosis into Clinical Decision-Making for Older Adults with Diabetes 

When it comes to diabetes, a patient’s prognosis of life expectancy and/or co-morbidities contribute to making sure treatments are not worse than the disease.

NCIRE-supported clinician-researcher Dr. Kenneth Covinsky co-wrote an editorial published in the Journal of General Internal Medicine that speaks to the vital role prognosis plays in guiding discussions between clinicians, patients, families, and caregivers around clinical decisions, such as diabetic care.

 

Quoted from the article: “Considerations around remaining life expectancy (LE) are particularly important in caring for older persons with diabetes. For example, the benefit of strict glycemic control in preventing vascular complications of type 2 diabetes is generally seen after several years. For older adults with diabetes and limited LE, intensive diabetes treatment using glucose-lowering medications exposes them to short-term harms and burdens with a potentially low likelihood of them surviving long enough to benefit from long-term glycemic control. One notable immediate harm is hypoglycemia, particularly with insulin and sulfonylureas, which can result in emergency department visits, hospitalizations, and cognitive decline.”

Kenneth E. Covinsky, MD, MPH is a clinician-researcher in the UCSF Division of Geriatrics. His research seeks to understand the factors that lead to disability in older persons and to improve the quality of life of those with older age disability and their caregivers. He holds the Edmund G. Brown, Sr. Distinguished Professorship in Geriatrics and is Principal Investigator of the UCSF Older Americans Independence Center.

Read more: https://link.springer.com/article/10.1007/s11606-023-08326-w

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Dr. Michael Steinman contributed to Verywell Health article “Is It Time to Review the Medications You Take?”  

NCIRE-supported Principal Investigator Dr. Michael Steinman contributed to the August 2, 2023 Verywell Health article “Is It Time to Review the Medications You Take?”, advocating for deprescribing excessive medication in older populations.

“A review of all the drugs you take—including over-the-counter products and supplements—can help your doctor determine the ones you need, the ones you don’t, best doses and also whether there are new and better drugs that might be good choices for you,” Steinman said.

Some examples of reasons to assess medication intake: patient was prescribed a short-term drug yet received no instructions of when to stop; patient was prescribed medication that may interact with an existing prescription of which a provider has no knowledge; patient’s medical condition may be resolved, and medication is no longer needed.

Such steps can help mitigate the adverse effects of over-prescribing and could very well save your life.

Learn More: https://www.verywellhealth.com/is-it-time-to-review-the-medications-you-take-7568542

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Disparities in advance care planning among older US immigrants 

While racial disparities in Advanced Care Planning (ACP) are known, NCIRE-supported researchers Drs. Rebecca Sudore and Alexander Smith sought to discover what disparities may be experienced by United States immigrants.

Their findings are featured in the co-authored study “Disparities in advance care planning among older US immigrants”, published in the Journal of the American Geriatrics Society.

The research team used data from the 2016 Health and Retirement Study, and defined ACP engagement as self-reported end-of-life discussions, designation of a power of attorney, documented living will, or “any” of the three behaviors. Immigration status was determined by respondent-reported birth outside the United States. Time in the United States was calculated by subtracting the year of arrival in the U.S. from the 2016 survey year.

Sudore, Smith, and their colleagues found that compared to US-born older adults, ACP engagement was lower for U.S. immigrants, particularly for those that recently immigrated. The group advocates future studies to explore ACP needs in the geriatric immigrant population and ways to address disparities in care.

 

Rebecca Sudore, MD is a Staff Physician, Geriatrics Service with the SF VA Health Care System, and Professor of Medicine at UCSF.

Alexander Smith, MD, MS, MPH is a Staff Physician with the SF VA Health Care System, and Associate Professor of Medicine at UCSF. He co-developed ePrognosis, an online guide for older patients seeking to determine if they should be screened for cancer.

 

Read More: https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18498

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Dementia Risk and Disadvantaged Neighborhoods 

In a recent co-authored study, NCIRE Supported scientist and Board Member Dr. Kristine Yaffe and her colleagues sought to answer the question: “Is there a difference in dementia incidence among Veterans Health Administration enrollees by neighborhood disadvantage as assessed by the Area Deprivation Index?”

Published in the Journal of the American Medical Association’s JAMA Neurology, the cohort study used a random sample of more than 1.6 million Veterans Health Administration (VHA) patients aged 55 years or older, who received care from the VHA between October 1999 and September 2021. Eligible participants also had to have had at least one visit and no diagnosis of prevalent Alzheimer disease and related dementias (ADRD) in the two years prior to their inclusion in the study and at least one follow-up visit.

To date, it is the largest study of its kind that combined health, demographic, and geographic data to paint a more complete and representative picture of dementia risk factors among older adults in relation to their socioeconomic environment.

The findings of the studies suggest that one’s socioeconomic environment does have a significant impact on one’s health; and that those living in socioeconomically disadvantaged neighborhoods are at higher risk of developing late-life cognitive impairment, resulting in increased risk for ADRD.

 

Dr. Yaffe discussed the findings of her co-authored study as part of JAMA Neurology's podcast series JN Learning. You may listen to it here: https://edhub.ama-assn.org/jn-learning/audio-player/18800154

To read the study article in full visit the JAMA Neurology site here: https://jamanetwork.com/journals/jamaneurology/fullarticle/2806622

The University of California San Francisco’s Weill Institute for Neurosciences also provides a brilliant write-up of the study here: https://psychiatry.ucsf.edu/news/study-finds-possible-link-between-disadvantaged-neighborhoods-and-dementia-risk

 

Kristen Yaffe, MD is Director of NeuroPsychiatry and Director of the Memory Evaluation Clinic at SFVAHCS. She is also the Scola Endowed Chair and Vice Chair, Professor of Psychiatry, Neurology, and Epidemiology, and Director of the Center for Population Brain Health at UCSF, and NCIRE Board Member.

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