Sep 1 2010

Eluding Lupus

U-M researchers aim to conquer short-term and long-term effects

The problem

Lupus is a chronic autoimmune disease that affects an estimated 500,000 to 1.5 million Americans, most of them women of child-bearing age. Symptoms range from rash, arthritis, hair loss and chest pain to more severe problems like kidney and neurologic disease. “There is a price that people pay for early menopause,” he says. Women who go through menopause before age 40 have increased mortality, cancer, cardiovascular and neurologic diseases, and osteoporosis, and are up to six times more likely to suffer from depression. This, in addition to not being able to have children.

Additionally, Health System researchers have found that lupus patients suffer rapid and severe damage to blood vessels, which causes a markedly higher incidence of heart disease.  So, even if lupus symptoms are controlled for 20 years, patients still have a 5- to 50-fold increased risk of heart disease.

The concept

The use of Cytoxan, a drug that is highly toxic to a woman’s ovaries, resulted in infertility in 20 to 50 percent of women who were treated with the drug.  An early step to reduce toxicity was to introduce sequential therapy — using the toxic drug just long enough to induce a remission and then switching to a safer drug. Read the rest of this entry »

Sep 1 2010

Paying it Forward

One gastroenterologist uses expertise and research to propel minorities in academia

As a child, Juanita Merchant, M.D., Ph.D., wanted to be a math teacher and consequently “came alive” while working in an organic chemistry lab as an undergraduate at Stanford University. There, two women senior research scientists became her role models; one of them was unable to receive admission into the faculty for reasons unrelated to her professional experience.

“She said to me, ‘As a minority and as a woman, you need to get an M.D. and Ph.D. if you want to succeed in academia,’ says Merchant, who subsequently obtained both degrees from Yale University. She now holds the H. Marvin Pollard professorship in Gastrointestinal Sciences at the Medical School.

Now, Merchant is fulfilling her childhood desire by teaching medical students in the departments of Internal Medicine; Molecular and Integrative Physiology; and Developmental Biology, as well as the Center for Organogenesis and gastroenterology fellows. She also mentors many undergraduates, graduate students, postdoctoral fellows and junior faculty in her laboratory. Read the rest of this entry »

Sep 1 2010

Medical Admissions Stream Team

Improving the Patient Journey

Getting “the right patient in the right bed at the right time” may seem like a given. But in the Health System, where 80 percent of unscheduled admissions arrive through the Emergency Department, it’s not as easy as it sounds.

A Medical Admissions Stream Team is working to ensure patients have a smooth journey through the Health System. The Michigan Quality System is taking a systematic approach to major patient journeys — starting with adult medical admissions —by bringing together teams to address issues that arise as patients move through our complex health system.

“We’re now looking across entire value streams (the flow of patients from unit to unit) to be sure we are delivering ‘end-to-end’ value to our patients,” says Jeffrey S. Desmond, M.D., clinical assistant professor of Emergency Medicine and service chief for adult emergency medicine.

Desmond represents the ED on a Medical Admissions Stream Team (MAST) convened by Margaret Calarco, Ph.D., senior associate director of patient care and chief of Nursing Services. The team also includes representatives of the Medical Observation Unit, the Admissions and Bed Coordination Center, and inpatient medicine services. When looking across the entire adult medical patient journey, the team first chose to tackle the timely placement of patients in the right service and unit because of the potential to impact quality, safety and efficiency of care. Read the rest of this entry »