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Dr. Kristine Yaffe co-authors studies that assess the risk of dementia in older adults with multiple sclerosis and related disorders; the health of the brain and midlife

May 8, 2024

In the co-authored study “Risk of dementia in older veterans with multiple sclerosis” published in the medical journal Multiple Sclerosis and Related Disorders, NCIRE-supported Investigator and NCIRE Board Member Dr. Kristine Yaffe and her fellow investigators found that among older veterans with multiple sclerosis (MS), risk of dementia diagnosis was higher compared to matched controls even after controlling for comorbidities. The risk difference was highest in northern regions and in younger patients. Clinicians caring for older MS patients should be aware of this risk and offer screening and treatment accordingly.

The study used data from a random sample of U.S. Veterans aged ≥ 55 years followed at Veterans Affairs Health Care Systems nationwide from 1999 to 2019.

In an additional study, “Trajectories in depressive symptoms and midlife brain health”, co-authored and published in the journal Translational Psychiatry, Dr. Yaffe and her colleagues investigated how depressive symptoms may either be a risk factor or prodromal to dementia in middle-aged adults. Investigating such an association in midlife may help clarify the role of depression in cognitive aging. The study aimed to identify trajectories in depressive symptoms in early to mid-life and related cognitive and brain outcomes in midlife.

The study included 3,944 Black and White participants (ages 26−45 years at baseline) from the Coronary Artery Risk Development in Young Adults (CARDIA) study with 20 years of follow-up.

Kristine Yaffe, MD is the 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, Director of the Center for Population Brain Health at UCSF, and NCIRE Board Member. She is an internationally recognized expert in the epidemiology of dementia and cognitive aging and the foremost leader in identifying modifiable risk factors for dementia. Her research, currently supported by over a dozen NIH, Department of Defense, VA, and foundation grants, bridges the fields of neurology, psychiatry, and epidemiology.

 

Read more:

  1. “Risk of dementia in older veterans with multiple sclerosis”. Multiple Sclerosis and Related Disorders, Volume 82 https://doi.org/10.1016/j.msard.2023.105372

  2. “Trajectories in depressive symptoms and midlife brain health”. Translational Psychiatry, Volume 14  https://doi.org/10.1038/s41398-024-02883-2

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Moral Injury Awareness and Prevention in Healthcare Organizations: A Blueprint Informed by the COVID-19 Pandemic

May 7, 2024

NCIRE-supported investigators Drs. Natalie Purcell, Shira Maguen, and Karen Seal co-authored the recent publication “Moral Injury Awareness and Prevention in Healthcare Organizations: A Blueprint Informed by the COVID-19 Pandemic”.

The publication is a result of the NCIRE CDC project titled “Moral Injury Among Healthcare Workers on the Frontlines of the COVID-19 Crisis.” (1 R21OH012201-01-00); and serves as a public-facing document with guidance for healthcare leaders and managers on preventing moral injury in the workplace. 

Moral injury is lasting psychological and spiritual distress that stems from violating one’s values or feeling betrayed by a trusted institution or authority. It is often associated with posttraumatic stress (PTSD), depression, anxiety, substance use, functional impairments, and suicide risk.

Healthcare workers whose jobs put them in high-stakes life-or-death situations, and who may experience intense and prolonged work stress, may be especially vulnerable to moral injury.

The research team surveyed 2,004 healthcare workers at VA inpatient units, emergency rooms, and community living centers during the COVID-19 pandemic with 39% reporting morally distressing experiences that could lead to moral injury.

The most common type of moral injury was betrayal-based moral injury: 30% of surveyed workers felt betrayed by healthcare leaders, coworkers, or others. Among the workers who reported potential moral injury, 79% reported burnout and 60% screened positive for posttraumatic stress (PTSD).

 

The guidance outlines five protective factors that could help prevent moral injury:

 

  1. Community support: Distressing events are not faced alone, and responsibility is meaningfully shared.

  2. Processing & debriefing: There is time and opportunity to process and discuss distressing events; there are breaks that allow for reflection and recovery.

  3. Learning & making change: It is possible to make meaningful changes to the situation or environment and to address the factors that caused moral distress.

  4. Leadership presence & communication: Leaders/managers are present and visible on the frontlines. Frontline workers feel heard and appreciated by leaders.

  5. Shared risks and burdens: There is an effort to share major risks and burdens, and to meaningfully acknowledge workers who must carry more than their share.

 

The guide was published by the Healthforce Center at the University of California San Francisco (UCSF).

 

Natalie Purcell, PhD, MPA is a sociologist who specializes in the study of violence, trauma, and pain across healthcare contexts. Her work uses mixed methods drawn from the social sciences and the humanities, as well as program-evaluation and implementation-science techniques.

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 San Francisco VA Health Care System (SFVAHCS), and Vice Chair of SFVAHCS and Professor in the Department of Psychiatry and Behavioral Sciences, UCSF School of Medicine.

Karen Seal, MD is a primary care internist and Chief of the Integrative Health Service for the SFVAHCS, and a Professor of Medicine and Psychiatry in Residence at UCSF. She directs the Integrated Care Clinic for Iraq and Afghanistan Veterans, the Integrated Pain Team Clinic and the roll-out of Complimentary and Integrative Health (CIH) services for veterans and VA staff.

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Bruce Ovbiagele, M.D., is a recipient of a national award from the American College of Physicians

April 26, 2024

NCIRE-supported Principal Investigator and Board Member Dr. Bruce Ovbiagele received the W. Lester Henry Award for Diversity, Equity, and Inclusion from the American College of Physicians (ACP) at its annual scientific conference, Internal Medicine Meeting 2024, on April 18th in Boston.

The W. Lester Henry Award for Diversity, Equity and Inclusion is given to an ACP member with outstanding accomplishments in advancing diversity, equity, and inclusion in the health care workforce, and/or improving health equity for people with historically marginalized group identities. The award was established in 2008.

 

Dr. Ovbiagele is the is Professor of Neurology and Associate Dean at the University of California, San Francisco, as well as Chief of Staff at the San Francisco Veterans Affairs Health Care System. In his Chief of Staff role, Dr. Ovbiagele serves as a statutory member of the NCIRE Board of Directors. Before his current position, he was Chair of the Department of Neurology at the Medical University of South Carolina for six years before moving to San Francisco. In his career thus far, he has led several National Institutes of Health–sponsored programs, which have helped to narrow local and global stroke disparities, as well as facilitated a strong pipeline of capable underrepresented-in-medicine researchers (>110), many of whom have become award-winning independently funded researchers. Dr. Ovbiagele has submitted content about his discoveries from his research activities to over 620 peer-reviewed publications and has edited five books.

His research work has been recognized with the highest scientific research awards of the American Academy of Neurology, American Brain Foundation, American Stroke Association, and American Heart Association. His health equity and community service efforts have been recognized with prominent awards from the American Neurological Association and World Stroke Organization. He served as Chair of the International Stroke Conference (the preeminent global stroke science meeting) for two years and is currently editor-in-chief of the Journal of the American Heart Association. Dr. Ovbiagele is an elected member of the National Academy of Medicine, Association of American Physicians, and the American Clinical and Climatological Association.

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HIV, HIV-specific Factors and Myocardial Disease in Women

March 10, 2024

In an effort to close the gap in research between men and women with HIV, NCIRE-supported Principal Investigators Drs. Phyllis Tien and Jorge Kizer recently co-authored the study “HIV, HIV-specific Factors and Myocardial Disease in Women”.

 

People with HIV (PWH) have an increased risk of cardiovascular disease. Cardiac magnetic resonance (CMR) has documented higher myocardial fibrosis, inflammation, and steatosis in PWH. However, studies have mostly relied on healthy volunteers as comparators and focused on men.

 

In their study, Drs. Tien and Kizer and their colleagues investigated the associations of HIV and HIV-specific factors with CMR phenotypes in female participants enrolled in the Women's Interagency HIV Study's New York and San Francisco sites. Primary phenotypes included myocardial native (n) T1 (fibro-inflammation), extracellular volume fraction (ECV, fibrosis) and triglyceride content (steatosis). Associations were evaluated with multivariable linear regression, and results pooled or meta-analyzed across centers.

 

Phyllis Tien, MD is a clinical translational researcher who investigates chronic viral infections, specifically HIV and HCV, and their metabolic and inflammatory consequences on long term organ injury (e.g. liver, bone and vascular injury). As part of this work, she also studies novel non-invasive techniques to estimate steatosis and fibrosis using magnetic resonance (MR) imaging and ultrasound-based transient elastography as well as novel CT and MR imaging methods to measure bone and vascular injury.

Jorge Kizer, MD, MSc is the Chief of the Division of Cardiology for the San Francisco VA Health Care System. His research program seeks to advance the understanding of risk factors for heart disease and stroke in order to improve prevention, risk stratification, and treatment of these disorders. These investigations leverage molecular epidemiology and cardiovascular imaging to identify biochemical markers and endophenotypes involved in the initiation, development, and progression of cardiovascular diseases.

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Addressing disparities in the global epidemiology of stroke

March 6, 2024

Stroke, the second leading cause of death and the third leading cause of disability worldwide, has seen numbers of those impacted by the disease decrease significantly; yet not everyone can revel in this medical achievement.

Co-authoring a recent article in Nature Reviews Neurology titled “Addressing disparities in the global epidemiology of stroke”, NCIRE-supported Principal Investigator and Board Member Dr. Bruce Ovbiagele highlights the rapid uptick in the burden of stroke in low- and middle-income countries (LMICs). The article sites that epidemiological, socioeconomic, and demographic shifts are the culprit for this desperate disparity, with increases to the incidence of stroke and other non-communicable diseases.

While high-income countries (HICs) have boasted lower incidents of stroke than their LMIC counterparts, there is still disparities in stroke epidemiology along racial, ethnic, socioeconomic, and geographical lines.

 

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.

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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

February 23, 2024

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.

 

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

January 24, 2024

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

January 23, 2024

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.

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Dr. Ovbiagele Appointed to Fellowship by the International Science Council

December 21, 2023

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.

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

December 20, 2023

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.

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

December 1, 2023

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

November 30, 2023

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.

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

November 8, 2023

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

August 24, 2023

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.

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

August 21, 2023

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.

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

August 18, 2023

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.​

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

August 17, 2023

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.

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Disparities in advance care planning among older US immigrants

August 15, 2023

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.

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Dementia Risk and Disadvantaged Neighborhoods 

August 14, 2023

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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Dr. Amy Byers and Research Team receive two new grants from the National Institute of Health’s National Institute on Aging

July 19, 2023

Please join NCIRE in congratulating our supported investigator Dr. Amy Byers and her Research Team for receiving two R01 grants from the National Institute of Aging, a division of the National Institute of Health!

NCIRE-supported researcher Dr. Salomeh Keyhani will join Dr. Byers as co-Principal Investigator (PI) for a study supported by grant NIA R01 AG076819, titled “Long-term Neuropsychiatric Sequelae of SARS-CoV-2 Infection in Late Life”. Dr. Lisa Barry from the University of Connecticut, will be the co-PI on the study supported by grant NIA R01 AG082157, titled “Alzheimer’s Disease and Related Dementias in the Most Incarcerated Generation: An Understudied Population with Health Disparities”.

Congratulations on your achievements!

Amy Byers, PhD, MPH is a Research Career Scientist at the San Francisco VA Health Center System (SFVAHCS), and Professor of Psychiatry & Behavioral Sciences and Medicine (Division of Geriatrics) at the University of California San Francisco (UCSF). She leads an independent program and oversees the Byers Lab.

Salomeh Keyhani, MD, MPH is primary care provider and UCSF investigator based at the SFVAHCS. Her research program includes the examination of the quality of care in the US health system and health care policy research. Her quality of care research to date has focused on examining the underuse and overuse of medical procedures, and her policy research to date has largely focused on areas important to health care reform and factors that may contribute to inefficiency and the use of inappropriate care in the US health care system.

Read More:

https://geriatrics.ucsf.edu/people/amy-byers

https://tobacco.ucsf.edu/people/salomeh-keyhani-md

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Research Team's abstract wins Merit Award at the 2023 American Society of Clinical Oncology Annual Meeting

July 18, 2023

NCIRE-supported Investigators Drs. W. John Boscardin, Alexander Smith and Louise Walter were part of a research team that submitted a Geriatric Oncology abstract entitled, "Associations of frailty with overall survival (OS) and functional decline among older adults with non-small-cell lung cancer (NSCLC) receiving chemotherapy, immunotherapy, and/or targeted therapy". The abstract was accepted to the American Society of Clinical Oncology (ASCO) annual meeting as a poster presentation and received a merit award. The annual meeting took place June 2- 6, 2023 in Chicago, Illinois.

The abstract poster was lead and presented by Howard Lee, MD, 2022 University of California San Francisco (UCSF) Hematology and Medical Oncology Fellow.

 

W. John Boscardin, PhD is a biostatistician with a joint appointment as Professor of Medicine and Epidemiology & Biostatistics at UCSF. His primary roles with the Department of Medicine are as Director of the Statistical Laboratory in the University of California San Francisco (UCSF) Division of Geriatrics, Co-leader (with Dr. Michael Steinman) of the UCSF Pepper Center Data and Analysis Core, and Co-leader (with Dr. Amy Kelley of the Icahn School of Medicine at Mt. Sinai) of the Analytics Core for the UCSF/Mount Sinai DEVELOP AD Research Program Project.

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.

Louise Walter, MD is a NCIRE Board Member and Professor of Medicine and Chief of the Division of Geriatrics at SFVAHCS and UCSF.  Dr. Walter is a practicing Geriatrician in the SFVAHCS Geriatrics Clinic, as well as a clinician-researcher who is an international leader in evaluating the real-world risks and benefits of cancer screening in older patients.

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Changes in Lung Volumes with Spirometric Disease Progression in COPD

July 17, 2023

Abnormal lung volumes representing air trapping identify the subset of smokers with preserved spirometry who develop spirometric COPD and adverse outcomes. However, how lung volumes evolve in early COPD as airflow obstruction develops remains unclear.

To establish how lung volumes change with development of spirometric COPD, NCIRE-supported Investigator Dr. Mehrdad Arjomandi and a team of researchers examined lung volumes from the pulmonary function data (seated posture) available in the U.S. Department of Veterans Affairs electronic health records (n=71,356) and lung volumes measured by computed tomography (supine posture) available from COPDGene (n=7,969) and SPIROMICS (n=2,552) cohorts, and studied their cross-sectional distributions and longitudinal changes across airflow obstruction spectrum. Patients with preserved ratio impaired spirometry (PRISm) were excluded from the analysis.

The team found that when it came to COPD, total lung capacity and vital capacity have biphasic distributions, change in nonlinear fashions as obstruction worsens, and could differentiate those GOLD-0 patients at risk for more rapid spirometric disease progression.

Mehrdad Arjomandi, MD is Professor of Medicine at UCSF and Director of the UCSF Human Exposure Laboratory at San Francisco General Hospital. He is also an Assistant Professor in residence, and Director of Environmental Medicine Clinic at the San Francisco VA Health Care System.

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The Fourth International Symposium on the Calcium Sensing Receptor (CaSR)

July 14, 2023

NCIRE was honored to support the Fourth International Symposium on the Calcium Sensing Receptor (CaSR), in conjunction with the Endocrine Society this past June.

The premier conference ran through June 13th – 14th in Chicago, Illinois and was co-chaired by NCIRE-supported researchers Drs. Wenhan Chang and Dolores Shoback.

The event boasted a vibrant international community of investigators and trainees working in the field, including structural biologists who give important insights into the structure and function relationship of the CaSR. “Those insights tell us why human beings born with just single mutations in this receptor can have lifelong high or low blood calcium levels,” said Shoback. “More importantly they provide critical information for future designs of more effective medications for treating CaSR-related human genetic disorders that were discovered more than a decade ago but remain difficult to treat.”

Another promising discovery highlighted at the symposium is a treatment for a rare human disease that will change the lives of children and adults in families with autosomal dominant hypocalcemia.  Phase 3 trials are beginning, and this will be an option for them likely in a few years. “These [pharmaceutical] drugs that have been on the shelf without a use before now are being tested in clinical trials to treat people with mutations in their CaSRs that cause hypocalcemia (low blood calcium levels) and low PTH (parathyroid hormone) levels.  And the data are looking very promising,” Shoback said.

Researchers also found that CaSR is not just a one-trick pony but plays vital roles in many other organ systems. The symposium highlighted ongoing efforts in re-purposing drugs that are being used to treat classic mineral disorders for treatments of other prevalent disorders.

“Although the CaSR emerged from work on calcium metabolism, we are now seeing that the CaSR may be modulated to treat the diseases asthma and childhood diarrhea, and they seem to work in preliminary clinical trials and/or studies of animal models,” Shoback said.

A previous UCSF MD/PhD trainee of Dr. Wenhan Chang, Christian Santa Maria, also reported at the symposium on the robust synergistic actions of positive CaSR modulator in promoting bone formation in animal models of osteoporosis, when it is co-injected with Teriparatide, a clinical drug being used to treat osteoporosis, but limited in its dose due to its significant hypercalcemia side-effects. Chang and Santa Maria found that co-injecting CaSR modulator can also effectively prevent the hypercalcemia induced by the Teriparatide.

 

“If these actions are corroborated in an ongoing VA-supported clinical trial led by Dr. Shoback, we will soon have a second-generation drug regimen which will be safer and more effective to treat this prevalent skeletal disease,” Chang said. 

 

Through his work with NCIRE-supported Researcher Dr. Chia-ling Tu, Chang found the CaSR in neurons may have a key role to play in the development of Alzheimer's Disease, since the CaSR can be modulated by amyloid proteins. 

A research group in UK reported that the CaSR is not just a barometer detecting the blood levels of Calcium, the closely inter-related ion phosphate is also able to switch the receptor on and off.

“This is highly significant as scientists have spent decades in searching the elusive ‘phosphate sensor(s)’ which critically mediate(s) phosphate metabolism in physiology and in diseases,” Chang said. “Whether the CaSR is a bona fide ‘phosphate sensor’ in those conditions requires further investigations.”

And it all started as a hunch.

Dr. Edward Brown, one of the world’s leading biomedical scientists, discovered the CaSR and cloned its cDNA. The process was based on hard work, a well-supported "hunch" that it would be a G-protein coupled receptor based on careful pharmacologic studies done by several groups and following the leads from the field of ion channels.

For his renowned achievements and contributions to the field, Brown was honored with a Lifetime Achievement Award by the entire 4th International Symposium Community at the event.

When nominated (and awarded) in 2019 for the Endocrine Society’s highest honor, the Fred Conrad Koch Lifetime Achievement Award, his colleague Dr. P. Reed Larsen had this to say about Dr. Brown: “His brilliant career exemplifies what all investigators aspire to, but rarely achieve. The elegance of his logic and the innovative approaches he applied in his quest to delineate calcium-induced parathyroid cell signaling, clone the calcium-sensing receptor (CaSR) cDNA, and translate this basic science into a fundamental understanding of human diseases and new diagnostic and therapeutic applications, are virtually unprecedented in a single investigator’s career.”

 

Wenhan Chang, PhD is a Research Biologist with the San Francisco VA Health Center System (SFVAHCS) and serves as Director for the SFVAHCS Bone Imaging Core. He is also a Professor of Medicine at UCSF.

Dolores Shoback, MD is a Staff Physician with Medical Services with the SFVAHCS and teaches as a Professor of Medicine at UCSF.

Chia-Ling Tu, PhD is a Research Endocrinologist with the Endocrine Unit at the SFVAHCS and Department of Medicine at UCSF.

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Telehealth delivery of group-format cognitive rehabilitation to older veterans with TBI: a mixed-methods pilot study

July 14, 2023

Traumatic brain injury (TBI) is common among Veterans and may interact with aging, increasing risk for negative cognitive, emotional, and functional outcomes. However, no accessible (i.e., in-home) group interventions for TBI targeted to older adults exist.

To address this gap in care, NCIRE-supported Investigators Drs. Gary Abrams, Raquel Gardner, Deborah Barnes, and NCIRE Board Member Dr. Kristine Yaffe, with a team of researchers, sought to adapt Goal Oriented Attentional Self-Regulation (GOALS) for delivery to older Veterans via in-home video telehealth (IVT) and evaluate feasibility and participant-rated acceptability of the telehealth GOALS intervention (TeleGOALS).

GOALS is a manualized, group cognitive rehabilitation training that improves executive function and emotional regulation among Veterans with TBI and healthy older adults.

 

The group tested the feasibility of the training amongst a group of six Veterans aged 69 years or older. From that several key themes emerged: (a) the importance of telehealth logistics, (b) facilitators' roles in prioritizing interpersonal connection, and (c) telehealth's capability to create opportunities for community reintegration.

Kristen Yaffe, MD is Director of NeuroPsychiatry and Director of the Memory Evaluation Clinic at the San Francisco VA Health Care System (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 the University of California San Francisco (UCSF), and NCIRE Board Member.

Gary Abrams, MD, FAAN is Professor of Neurology at the Weill Institute for Neuroscience in the Neurorvascular Division at UCSF.

Raquel Gardner, MD is a Staff Physician at the SFVAHCS; a Behavioral Neurologist with the Memory Evaluation Clinic, and the Memory and Aging Center and Weill Institute for Neurosciences, and Assistant Professor at UCSF.

Deborah Barnes, PhD is a Research Health Science Specialist with Mental Health Service at the SFVAHCS.

 

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Renuka Nayak speaks to connection between our gut and rheumatologic conditions: web series and seminar

July 13, 2023

NCIRE-supported Rheumatologist and Physician-Scientist Dr. Renuka Nayak had the opportunity to share her expertise on rheumatologic conditions for the Arthritis Foundation Patient Education Webinar Series in May. Her presentation, titled “The Gut Microbiome and Diet in Rheumatic Disease”, described the relationship between a person’s diet, their gut microbiota, and rheumatoid arthritis.

Dr. Nayak was also invited to speak about her research on the “Gut, Brain and Lupus” panel at the Lupus LA’s 2023 Global Symposium: The Future of Lupus in March. On this panel Dr. Nayak spoke to the surprising aspect of gut health—while our gut microbes may help us digest food and support our immune system, they may also inadvertently digest the very drugs meant to treat Lupus symptoms before they can make a beneficial impact.

“This has been a key focus of my research,” Nayak said. “This might be why some of my patients do not respond to these drugs. These drugs act on microbes too, and these microbes influence our immune system.”

 

Follow these links to learn more:

The Gut Microbiome and Diet in Rheumatic Disease (YouTube) -- https://www.youtube.com/watch?v=em12akdUIEY

Gut, Brain and Lupus (LinkedIn) -- https://www.linkedin.com/posts/lupus-la_lupus-las-global-symposium-panel-gut-brain-activity-7048308002734436352-iZ91/?utm_source=share&utm_medium=member_desktop

 

Congratulations are also in order for Dr. Nayak’s recent R03 grant award through the University of California San Francisco (UCSF) for her project “Microbial metabolites impacting the response to methotrexate in rheumatoid arthritis”. Project Summary describes the following: Rheumatoid arthritis (RA) is a debilitating autoimmune disease affecting over one million Americans, and while first-line therapy with methotrexate (MTX) works for many, in most patients, it is not enough. Our recent studies indicate that the gut microbiome plays important roles in RA treatment and that MTX acts on the microbiota to reduce inflammation. Understanding how MTX acts on the microbes to affect key metabolites may enable the development of new microbially targeted therapies to improve treatment response to MTX.

 

Renuka Nayak, MD, PhD is an Assistant Professor of Medicine/Rheumatology at UCSF and is co-appointed at the San Francisco VA Health Care System, where her research focuses on advancing the care and treatment of patients with rheumatologic conditions such as rheumatoid arthritis, lupus, psoriatic arthritis, and other autoimmune diseases.

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NCIRE-supported researchers shine at the 2023 American Geriatrics Society Annual Scientific Meeting

July 13, 2023

NCIRE-supported investigators excelled at the 2023 Annual Scientific Meeting of the American Geriatrics Society (AGS) held on May 4 – 6, 2023 in Long Beach, California.

Drs. W. John Boscardin and Michael Steinman presented work with their fellow colleagues on gabapentin and opioid prescribing in older adults at the meeting.

According to the Food and Drug Administration, gabapentin is an anticonvulsant indicated as adjunctive therapy in the treatment of partial seizures with and without secondary generalization in patients over 12 years of age with epilepsy. It has also been used to relieve postherpetic neuralgia after shingles and symptoms of moderate-to-severe restless legs syndrome.

In their presentation, Boscardin and Steinman showed that prescribing for gabapentin varied by racial and ethnic groups; however, the absolute variation found may not be clinically significant. Variation in opioid prescribing by race and ethnicity continues to persist.

Joined by NCIRE Board Member Dr. Kristine Yaffe, Boscardin and Steinman and their cohorts’ poster "High-risk medication use among community-dwelling older adults with dementia living alone" won Best in Category for the Health Services Research Presidential Poster session at the AGS Annual Meeting. The abstract poster was lead and presented by Dr. Matthew E. Growdon, Assistant Professor of Medicine at University of California San Francisco (UCSF).

Please join us in congratulating Drs. Boscardin, Steinman, and Yaffe on their success at the 2023 AGS Annual Meeting!

 

W. John Boscardin, PhD is a biostatistician with a joint appointment as Professor of Medicine and Epidemiology & Biostatistics at UCSF. His primary roles with the Department of Medicine are as Director of the Statistical Laboratory in the UCSF Division of Geriatrics, Co-leader (with Dr. Michael Steinman) of the UCSF Pepper Center Data and Analysis Core, and Co-leader (with Dr. Amy Kelley of the Icahn School of Medicine at Mt. Sinai) of the Analytics Core for the UCSF/Mount Sinai DEVELOP AD Research Program Project.

 

Michael Steinman, MD is a Staff Physician, Geriatrics, Palliative and Extended Care Service Line with the San Francisco VA Health Care System (SFVAHCS), and a Professor of Medicine at UCSF. He is also the co-director of the US Deprescribing Research Network, founded in 2019 with a grant from the National Institute on Aging to support and coordinate research into deprescribing. He also co-chairs the Beers Criteria guideline panel.

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.

 

The AGS Annual Scientific Meeting is the premier educational event in geriatrics, providing the latest information on clinical care, research on aging, and innovative models of care delivery. Held annually, the AGS Annual Scientific Meeting addresses the educational needs of geriatrics professionals from all disciplines. Physicians, nurse practitioners, nurses, pharmacists, physician assistants, social workers, long-term care and managed care providers, health care administrators, and others can update their knowledge and skills through state-of-the-art educational sessions, including invited symposia, workshops, and meet-the-expert sessions. Sessions also cover emerging clinical issues and current research in geriatrics, education, health policy, and delivery of geriatric health care.

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American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults

July 11, 2023

NCIRE-supported Principal Investigator Dr. Michael Steinman has long advocated against over prescribing medication to older adults 65 years and older. His admonitions have been widely shared in published articles and podcasts over the years,  as recently as the April 26th Economist article “Too many people take too many pills” and the June 1st session of the Society for Post-Acute and Long-Term Care (AMDA) podcast. Now his pharmacological expertise is featured in the 2023 Beers Criteria Guideline of Potentially Inappropriate Medications in Older Adults (AGS Beers Criteria) in the Journal of the American Geriatrics Society.

AGS Beers Criteria is widely used by clinicians, educators, researchers, healthcare administrators, and regulators. The intention of these guidelines is to: (1) reduce older exposure to potentially inappropriate medications (PIMs) by improving medication selection; (2) educate clinicians and patients; and (3) serve as a tool for evaluating the quality of care, cost, and patterns of drug use in older adults.

 

Michael Steinman, MD is a Staff Physician in Medical Service with the San Francisco VA Health Care System,[RR1]  and a Professor of Medicine at University of California San Francisco. He is also the co-director of the US Deprescribing Research Network, founded in 2019 with a grant from the National Institute on Aging to support and coordinate research into deprescribing. He also co-chairs the Beers Criteria guideline panel.

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Bronchodilator Responsiveness in Tobacco-Exposed People With or Without COPD

July 10, 2023

Dr. Mehrdad Arjomandi and his research colleagues posed the question: Is consistent Bronchodilator responsiveness (BDR) over time (always present) differentially associated with obstructive lung disease features relative to inconsistent (sometimes present) or never (never present) BDR in tobacco-exposed people with or without COPD?

BDR in obstructive lung disease varies over time and may be associated with distinct clinical features.

The research team retrospectively analyzed data from 2,269 tobacco-exposed participants in the Subpopulations and Intermediate Outcome Measures in COPD Study with or without COPD. They used various BDR definitions: change of ≥ 200 mL and ≥ 12% in forced expiratory volume in 1 second BDR (FEV1-BDR), change in forced vital capacity BDR (FVC-BDR), and change in FEV1, FVC or both American Thoracic Society-defined BDR (ATS-BDR).

They discovered that both consistent and inconsistent ATS-BDR were associated with asthma history and greater small airways disease (%parametric response mapping functional small airways disease) relative to never ATS-BDR in participants with GOLD stage 0 disease and the entire cohort.

 

Demonstration of BDR, even once, describes an obstructive lung disease phenotype with a history of asthma and greater small airways disease. Consistent demonstration of BDR indicated a high risk of lung function decline over time in the entire cohort and was associated with higher risk of progression to COPD in patients with GOLD stage 0 disease (visually evident emphysema).

Mehrdad Arjomandi, MD is Professor of Medicine at UCSF and Director of the UCSF Human Exposure Laboratory at San Francisco General Hospital. He is also an Assistant Professor in residence, and Director of Environmental Medicine Clinic at the San Francisco VA Health Care System.

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Using behavioral theory to adapt advance care planning for homeless-experienced older adults in permanent supportive housing

July 6, 2023

Older adults experiencing chronic homelessness (i.e., prolonged homelessness and a disabling condition) have low rates of advance care planning (ACP) despite high rates of morbidity and mortality. Rehousing of homeless-experienced individuals into permanent supportive housing (PSH) may present an opportunity to introduce ACP; but this is unknown.

 

Therefore, NCIRE-supported Investigator Dr. Rebecca Sudore and her cohorts explored staff and resident perceptions of conducting ACP in PSH.

The research team conducted semi-structured interviews with PSH staff and tenants in San Francisco using the capability (C), opportunity (O), motivation (M), behavior (COM-B) framework within the Behavior Change Wheel model and the Theoretical Domains Framework (TDF) to inform interviews, categorize themes, and guide qualitative thematic analysis.

They identified behavioral determinants related to ACP for formerly chronically homeless older adults in PSH. Future interventions should include using easy-to-use ACP materials and developing resources to educate PSH residents, train staff, and model ACP in groups or one-on-one sessions.

 

The results of the study were published in the Journal of the American Geriatric Society.

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

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Association of Frailty With Risk of Suicide Attempt in a National Cohort of US Veterans Aged 65 Years or Older

June 30, 2023

Is frailty a factor associated with risk for suicide attempts?

This is the question NCIRE-supported Researchers Drs. Kenneth E. Covinsky, W. John Boscardin, and Amy Byers sought to answer in a recent study published in the Journal of the American Medical Association.

The cohort study of nearly 3 million US veterans aged 65 years or older, the investigators found that risk of suicide attempt was higher in patients with all levels of frailty (prefrailty and mild, moderate, and severe frailty) compared with those without frailty. Risk of lethal suicide attempt was associated with lower levels of frailty.

The findings suggest that additional suicide prevention efforts should be directed toward patients with frailty complications associated with risk for suicide attempts and lethality.

 

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.

W. John Boscardin, Ph.D. is a biostatistician with a joint appointment as Professor of Medicine and Epidemiology & Biostatistics. His primary roles with the Department of Medicine are as Director of the Statistical Laboratory in the UCSF Division of Geriatrics, Co-leader (with Mike Steinman) of the UCSF Pepper Center Data and Analysis Core, and Co-leader (with Amy Kelley) of the Analytics Core for the UCSF/Mount Sinai DEVELOP AD Research Program Project.

 

Amy Byers, PhD, MPH is a Research Career Scientist at the SFVAHCS, and Professor of Psychiatry & Behavioral Sciences and Medicine (Division of Geriatrics) at UCSF. She leads an independent program and oversees the Byers Lab. The Byers Lab focuses on determining the incidence, prevalence, risk factors, and outcomes of late-life mental health disorders and behaviors, with a focus on late-life suicide and neuropsychiatric disorders using large, epidemiologic, and administrative datasets that include national probability samples, VA data, Centers for Medicare and Medicaid Services data, and national suicide attempt and death data.

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