Category Archives: Internal Medicine

Internal Medicine

Expert panel that sparked mammogram controversy now says tests … – Los Angeles Times

A new look at the science of preventing breast cancer deaths promises to reshape when, and how many, mammograms American women will get again.

An influential panel intends to recommend that U.S. women begin mammograms to screen for breast cancer at 40 and continue getting them once every two years until age 75. Doing so is expected to reduce the number of breast cancer deaths by 19% compared with following the mammography regimen it previously endorsed.

The new slate of draft recommendations from the U.S. Preventive Services Task Force marks a major shift from the controversial advice it promulgated in 2009 and largely reiterated in 2016 that most women could safely wait until 50 to begin having their breasts scanned for signs of potential malignancies. The panel also said women at average risk could be screened every other year instead of annually.

In calling for fewer mammograms over a womans lifetime, the task force cited the frequency with which breast cancers were overdiagnosed, leading to invasive yet unnecessary treatment, as well as the harms that come from needless biopsies and other work-ups done in response to false-positive test results. It also recognized that mammograms expose women to radiation, which in some cases could wind up causing cancer in otherwise healthy women.

Those recommendations touched off a firestorm and were denounced by womens health advocates, who have long argued that early detection gives the best chance of survival.

What prompted the task force to change its mind and advise that screening mammograms begin at 40? The members said they were strongly influenced by the experiences of Black women, who tend to develop aggressive breast cancers earlier than white women do, and to die of them more often. According to one study, Black women are 39% more likely to die of breast cancer than the population of women as a whole.

Screening women of color for breast cancer earlier is just the first of many steps that must be taken to close persistent gaps along ethnic lines. For Black, Hispanic, Latina, Asian, Native American and Alaska Native women, timely follow-up and effective treatment for breast cancer will be needed as well, the experts warned.

Also driving the changes in the draft recommendations is a growing recognition of the risks faced by women with dense breasts, which make malignancies both more common and harder to detect on mammographic images.

Almost half of all women have dense breasts, and the task force members said they had little research to guide them on whether to recommend additional screening or other kinds of imaging, such as MRI or ultrasound.

New and more inclusive science about breast cancer in people younger than 50 has enabled us to expand our prior recommendation and encourage all women to get screened every other year starting at age 40, said Dr. Carol Mangione, chief of internal medicine at UCLA and the chair of the group that wrote the task forces proposed recommendation. The new guidelines will help save lives and prevent more women from dying due to breast cancer, she added.

Dr. Patricia Ganz, a breast cancer expert at UCLA who has served on many cancer-screening panels, said that there is little new evidence driving the task forces shift. But she called the groups focus on addressing racial inequities in breast cancer very, very important. And she said the every-other-year mammography schedule is in line with practices in Canada and Europe.

I do think this is a very good recommendation: It leaves doctors and their patients a lot of flexibility to decide how aggressive or relaxed their breast cancer screening should be, Ganz said. The fact that they recommend starting at 40 means these women will have an opportunity early to engage in a process of calculating their personal risks.

In doing so, women find they are subject to a range of breast-cancer screening recommendations.

The American Cancer Society suggests women begin annual mammograms at 45, then consider switching to biennial tests at 55. Women who would prefer to begin annual screening at 40 can do so, and they should continue getting mammograms as long as they expect to live at least 10 more years, the ACS adds.

The American College of Radiology and Society of Breast Imaging recommend annual mammography screening for all women ages 40 and older who are at average risk of breast cancer.

Neither group suggests that 75 should be a hard upper limit for screening mammograms. But the American College of Radiology has recommended that all women have a risk assessment for breast cancer by the age of 25, and discuss with their doctor whether earlier screening with mammography and/or MRI is needed.

Dr. Debra L. Monticciolo, a radiologist at Massachusetts General Hospital, was highly critical of the task forces decision to recommend mammograms every other year considering that Black women and Jewish women die from breast cancer prior to age 50 or even 40 more often than white women as a whole. Thats just going to exacerbate the racial disparities, she warned.

Their own evidence shows that the most lives are saved with yearly screening, said Monticciolo, who led the drafting of the American College of Radiology/Society of Breast Imaging recommendations. With annual screening of women 40-to-79, you get a 42% mortality reduction. Limit that to every other year, and it drops the mortality reduction to 30%. These are womens lives that would be saved. I dont know what their thinking is here.

The task force noted other consequences of shifting from the least-intensive to the most-intensive screening schedule, however. The number of mammograms a typical woman received tripled, as did the number of false positive readings. The rate of overdiagnosis more than doubled, from 8% of cases to 17%.

Dr. Otis Brawley, a Johns Hopkins oncologist and cancer epidemiologist, said that while it seems counterintuitive that screening less often could save more lives, its a possibility that cries out for rigorous testing.

Even many experts cant come to grips with how many cancers are caused by mammogram screening and how many deaths are diverted by that screening, said Brawley. People who carry genes that predispose them to some cancers may be particularly vulnerable to radiation-induced mutations, he said. But thats not a trade-off thats been explored with strong research, he added.

The task force made clear that its new recommendations were not undergirded with rock-solid confidence. That women should begin getting mammograms at 40 had its most solid research backing. But the task force assigned far lower confidence values to its every-other-year schedule of mammography, and to the idea that breast-cancer detection after 75 may not be lifesaving.

There is very limited research on this age population, the groups report acknowledged.

The draft recommendation will be open for public comment until June 5. Comments can be submitted on the task forces website.

Link:

Expert panel that sparked mammogram controversy now says tests ... - Los Angeles Times

Internal Medicine

Migrants line up at the border, awaiting the end of Title 42 – The Texas Tribune

Sign up for The Brief, The Texas Tribunes daily newsletter that keeps readers up to speed on the most essential Texas news.

EL PASO As the clock ticked down to the end of a policy used to expel migrants from the U.S. nearly 3 million times over the past three years, the lines formed again on a patch of American soil between the Rio Grande and the border wall.

Hundreds of migrants men, women and children stood in ragged lines, waiting near a gate in the wall for their turn to pass through. They were watched by Border Patrol agents and National Guard members in fatigues. For the moment, no one moved.

A group of four Venezuelan men with a boy and a Colombian couple with their 2-year-old son waded across the shallow river and were turned back by National Guard. The migrants said the soldiers told them the border was closed and they should go to another area 5 miles east where agents may let them pass.

The public health emergency order known as Title 42 which has been largely used as an immigration enforcement policy to quickly expel migrants, including asylum-seekers, trying to enter the U.S. ended late Thursday night.

In preparation, federal, state and border officials across the roughly 2,000-mile U.S.-Mexico border have implemented a series of policies to prepare for what they fear will be a chaotic crisis as thousands of migrants who have been forced to wait in Mexican border cities make a crucial decision: Follow the Biden administrations new rules and make an appointment to request asylum, or try their luck crossing the border en masse.

In South Texas, video footage from journalists on Wednesday showed hundreds of immigrants gathering on the banks of the Rio Grande near Brownsville. In neighboring Hidalgo County, County Judge Richard Cortez issued a seven-day disaster declaration on Thursday.

I have received credible information from officials with Customs and Border Protection that large groups of migrants are probing our international border in search of crossing points, he said. I have decided to declare this emergency as a first step in securing all available state and federal resources to ensure the health and safety of our residents.

El Paso, Laredo and Brownsville had previously declared states of emergency. On Wednesday, El Paso city officials converted two vacant middle schools into migrant shelters using federal money.

After Thursday, immigration agents will seek to deport migrants who attempt to enter the country without first having set up an appointment to enter the U.S. through a port of entry, using a government cellphone app known as CBP One. Migrants also have the option of applying for asylum at one of the new processing centers in Guatemala or Colombia, which will give successful applicants the option to legally enter Canada, Spain or the U.S.

"Starting tonight, people who arrive at the border without using a lawful pathway will be presumed ineligible for asylum, Homeland Security Secretary Alejandro Mayorkas said in a statement late Thursday. The border is not open. People who do not use available lawful pathways to enter the U.S. now face tougher consequences, including a minimum five-year ban on re-entry and potential criminal prosecution."

A couple of hours before Title 42 was set to end, a federal judge in Florida blocked the Biden administration from carrying out a key part of its plan: paroling migrants into the country without a formal notice to appear in court. The temporary restraining order came in response to a lawsuit by Floridas attorney general. Border officials used parole during the Trump administration and under previous administrations.

When the deadline came at 9:59 p.m. local time in El Paso, hundreds of migrants were still in line at the border wall gate, waiting for Border Patrol agents to apprehend them. Men stood in one line, women and children in another.

Whenever agents took a small group of them through the gate, the migrants applauded and cheered.

Earlier Thursday at a migrant camp in Ciudad Jurez, across the river from El Paso, Venezuelan migrant Richard Arcia, 23, said hell continue trying to use the app until he can get an asylum appointment. If hes successful, he said he plans to go to New Jersey, where he has family.

Arcia said hes spent the past two months in Jurez after leaving Peru, where he lived for five years after his home countrys economy began to collapse amid political instability. He worked for a brewery, distributing beer to businesses, until criminal organizations in Peru began extorting Venezuelan immigrants.

He would pay $54, or two days pay, each time. He said one of his friends was killed after refusing to pay.

Whats better, to live in Venezuela going hungry, or try to cross to find a better life? he said. I dont need the American government to give me anything. I have a support system [in New Jersey], and Ill get to work as soon as I can.

Another Venezuelan migrant, 32-year-old Jhonan Polo, arrived at the camp Wednesday with his brother, two nephews and two cousins. The family hopes to get to Boston, where they have a cousin who has lived there for two years.

The camp, outside of a detention center that caught fire in March, killing 40 migrants, has shrunk from an estimated 100 people on Monday to about 60 Thursday evening. Some at the camp said others have left, hoping to sneak into the U.S. or surrender to Border Patrol before Title 42 ends.

Polo said hell look for construction work in Jurez until he can get an appointment through the app.

We want to do it the legal way, God willing, he said. I dont think its a secret why we left, or the conditions of my country: bad economy and bad salaries.

Were relieved because were one step away from a better life, he added. We just want to get to work and provide a life to our family that we couldnt provide in Venezuela.

Thousands of migrants have crossed the border into El Paso in the days leading up to the change, many of them immediately surrendering to Border Patrol agents. Some have avoided detection and entered the country illegally, sleeping in the streets of the citys downtown as they try to find transportation to the nations interior.

Earlier this week, immigration agents handed out Spanish-language flyers to migrants asking those without permission to be in the U.S. to turn themselves in. On Tuesday, hundreds of migrants who had been camping outside of El Pasos Sacred Heart Church did so; agents gave them a notice to appear at a later date at immigration offices across the country.

Since March 2020, when the Trump administration invoked Title 42 for the first time, immigration agents have used it about 2.7 million times at the southern border amid a dramatic increase in migration: In fiscal year 2022, which ended in September, agents apprehended immigrants a record-breaking 2.3 million times at the southern border.

Apprehensions have hit 1.2 million on the southern border during the first six months of the current fiscal year.

On Tuesday, border agents apprehended more than 11,000 people who crossed the border illegally nearly double the number in a typical day, The New York Times reported. After Title 42 lifts, U.S. officials are expecting up to 13,000 migrants to cross the southern border every day.

Ruben Garcia, director of the network of migrant shelters called Annunciation House based in El Paso, said that as of Thursday afternoon, Border Patrol agents already had released 400 migrants to his organizations shelters a number he said is higher than normal but manageable.

But that could change after Title 42 ends, Garcia said.

Your guess is as good as mine, he said when asked what tomorrow could look like.

On Wednesday, Border Patrol chief Raul Ortiz told reporters in El Paso that he does not expect an increase in illegal crossings after Thursday night.

The increases that weve seen in the last five to six days, I think were really the surge, he said, according to news outlets. I think that what we see now is a continued effort by some to message incorrectly that once Title 42 goes away, its going to be a free-for-all along the border.

Among the latest changes in immigration policy, the Biden administration finalized a rule that went into effect Thursday that will deny asylum to migrants who passed through a third country where they could have sought asylum instead.

U.S. Customs and Border Protection acting Commissioner Troy Miller on Thursday said that Mexico will continue to accept 30,000 migrants monthly from Venezuela, Cuba, Haiti and Nicaragua if they try to enter the U.S. illegally and are deported.

Migrants who enter the United States unlawfully by crossing the southwest border, and not via a lawful pathway, will be returned to Mexico and may be transported away from Mexicos northern border to locations in southern Mexico, Miller said. As we have said many times, the border is not open to irregular migration.

Immigrant rights advocates have criticized the Biden administration for the third-country asylum policy, which is similar to what the Trump administration had proposed.

Michele Heisler, the medical director for Physicians for Human Rights and professor of internal medicine and public health at the University of Michigan, said she welcomes the end of Title 42, which she said had no public health benefit, but criticized the Biden administrations new asylum policy as cruel.

This new rule is likely to cause significant harm to a population that is already highly vulnerable due to the factors that made them seek protection in the first place, compounded by the conditions faced on their journey to the border, including extortion, kidnapping, rape and other forms of physical and psychological violence, she said.

Shortly before Title 42 ended Thursday night, a group of about 15 migrants crossed the river seeking to join the line at the border wall, but the National Guard refused to let them past the concertina wire between the river and the wall. They waited for about an hour until they gave up and walked away.

Sindy, 34, a Colombian migrant in the group who declined to give her last name, said she had been waiting all day on the U.S. bank of the river with a group of Venezuelan migrants. They decided to cross the river after spending two months in Jurez unsuccessfully trying to get an appointment through the app, she said.

All this sacrifice for nothing, she said.

Sindy said she left her two daughters back in Colombia with her mother and was robbed by criminals during the long journey north. She still hopes to get to Houston where her sister lives.

Rebuffed by the soldiers, she and the rest of her group left looking for a place to sleep for the night. They said they had no money.

Jayme Lozano Carver contributed to this story.

Disclosure: The New York Times has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribunes journalism. Find a complete list of them here.

Tickets are on sale now for the 2023 Texas Tribune Festival, happening in downtown Austin on Sept. 21-23. Get your TribFest tickets by May 31 and save big!

Go here to see the original:

Migrants line up at the border, awaiting the end of Title 42 - The Texas Tribune

Internal Medicine

ACP, Annals of Internal Medicine Host First Obesity Forum for … – American College of Physicians

Expert panel provides practical advice for managing overweight and obesity in clinical practice

PHILADELPHIA, March 14, 2023 On March 8, the American College of Physicians (ACP) andAnnals of Internal Medicinehosted the first virtual forum on the current clinical challenges related to managing overweight and obesity in clinical practice. During the forum, a panel of experts discussed three specific cases representing common clinical scenarios and answered audience questions about each of them. The panelists shared pragmatic clinical information and a replay of the full discussion is freely available to ACP members. The video and accompanying editorial from Christine Laine, MD, MPH, FACP, Senior Vice President of ACP and Editor-in-Chief of Annals of Internal Medicine and Christina Wee, MD, MPH, Senior Deputy Editor of Annals of Internal Medicine were published today in Annals of Internal Medicine.

Overweight and obesity now affects more than 40 percent of Americans and is associated with an increased risk for many common and serious illnesses, said Dr. Laine. Just as important, persons with obesity suffer from stigma, in large part because the condition has been erroneously viewed as a condition brought on by a persons own unhealthy behavior. In this forum, experts not only provide practical advice on management, but also help to dispel some of the misconceptions surrounding obesity that may contribute to unconscious bias among internal medicine physicians who are on the front lines treating these patients.

Dr. Wee, who is also an obesity researcher and Associate Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, served as moderator for the forum and introduced each of the panelists. These included:

After hearing the clinical vignettes, the panelists provided their recommendations for addressing the unique circumstances surrounding the patients overweight or obesity. The panelists made several important points, all of which are detailed in the forum editorial. Of note, they stressed that obesity is a complex medical condition resulting primarily from an interaction of genes and the environment. This distinction is crucial because physicians need to be able to discuss weight with patients without assigning blame or shame. It also goes a long way in explaining why modification of diet and exercise is difficult to achieve, notes Dr. Wee.

To solve a problem, one must be able to define it accurately. As such, the panelists discussed the importance of developing a better and more inclusive measure of overweight and obesity. Body mass index, or BMI, the current standard of body composition, is an imperfect measure that differs with ethnicity, sex, body frame, and muscle mass.

"In addition to better measures of obesity, we need better strategies for treatment," said Dr. Wee. "Studies show that diet and exercise alone are unlikely to result in long-term obesity benefit. The good news is that we now have effective pharmacological and surgical therapies that may need to be considered as part of a multi-component intervention for appropriate patients. Of course, shared decision-making is an important part of this approach."

The forum, Overweight and Obesity: Current Clinical Challenges, was the first forum of its kind hosted by ACP and Annals of Internal Medicine. Previous forums focused on the infectious diseases COVID-19 and MPox, and another forum focused on the physicians role in preventing firearm injury.

###

About the American College of PhysiciansTheAmerican College of Physiciansis the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 160,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter,FacebookandInstagram.

About Annals of Internal MedicineAnnals of Internal Medicineis the flagship journal of the American College of Physicians (ACP).Annalsis the most widely read and cited general internal medicine journal and one of the most influential peer-reviewed clinical journals in the world.Annals mission is to promote excellence in medicine, enable physicians and other health care professionals to be well-informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. New content is published every Tuesday atAnnals.org. Follow Annals on TwitterandInstagram@AnnalsofIM and onFacebook.

ACP Media Contact:Andrew Hachadorian, (215) 351-2514,AHachadorian@acponline.orgAnnals Media Contact:Angela Collom, (215) 351-2653, ACollom@acponline.org

See more here:

ACP, Annals of Internal Medicine Host First Obesity Forum for ... - American College of Physicians

Internal Medicine

Aiming to become chief resident? Here are 7 must-have attributes – American Medical Association

For physicians approaching the end of their graduate medical education, the role of chief resident can present an opportunity to gain leadership experience and potentially open doors for administrative and academic roles in medicine down the road.

For a study published in the journal Clinics in Dermatology, researchers examined how chief residents are selected across 51 dermatology programs. That data, combined with insight from a veteran residency program director, offer direction on the path that resident physicians can take if they have aims on becoming chief residents.

How chiefs are selected

The methods by which programs select chief residents can vary widely by institution and specialty. Looking at the study of chief selection in dermatology programs, about one-third of those programs awarded a chief designation to all senior residents. The other two-thirds used a combination of selection methods in the process.

The most common methods of residency selection were program-director selectionabout 25% of selection processesand a tally of faculty votes (roughly 20%).

The reasons why chief residents were selected also varied. According to this study in dermatology programs, the most important attributes, in descending order, were:

Brilliance alone is not enough

Deborah Spitz, MD, directs residency training in the Department of Psychiatry and Behavioral Neuroscience at University of Chicago Medicine. Her reasons for selecting chief residents largely aligned with those highlighted in the study.

The way [our selection] is set up is my assistant program director and I talk about which of [the] residents are most responsible and most mature, Dr. Spitz said. What we're looking for is people who have the trust of the residents and who have a sense of collaboration. If somebody were a really brilliant person but they didn't have the trust of the residents, that would be a big problemas a chief resident.

Dr. Spitz said the pool of candidates for a chief resident position in her program is usually four or five physicians, and two ultimately are given the chief designation. The dermatology study, likewise, had an average resident class size of 5.8.

Those numbers are considerably smaller than resident class sizes would be in a specialty such as internal medicine. In some instances, as is the case in the University of Chicagos internal medicine program, chief residents do an extra year of training while they are in that position. This is less common in smaller specialties.

In some fields being a chief, especially in fields where it's an extra year of residency, is quite an accolade, Dr. Spitz said. It's like winning a prize in a large program where there's a lot of competition to become chief. It speaks well for you, especially if you're going into academia.

The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, handling medical student-loan debt, and other essential tips about succeeding in graduate medical training.

Know the chief residents role

The role of chief resident is more administrative than it is clinical. The study of dermatology programs found that the most common responsibilities for chief residents were clinical scheduling, resident education planning and working as a liaison between residents and faculty.

The role of chief resident is a unique one, and Dr. Spitz highlighted that it might not always be pleasant.

If the residents are disgruntled, the chief resident is supposed to help fix it. That's not very easy, and it might be impossible. Those jobs ultimately belong to the training director, but the chief resident is sort of the first-line person that you go to.

Not everybody is cut out to be an administrator, Dr. Spitz added. Some people are cut out to be clinicians. We want everybody to have a little bit of a chief resident-type experience where they run a service and get a sense of what that's like, but some of them may ultimately decide not to do it. And thats totally fine. Not everybody should do it.

Read more:

Aiming to become chief resident? Here are 7 must-have attributes - American Medical Association

Internal Medicine

Simmons Cancer Center investigators receive nearly $15 million in … – UT Southwestern

DALLAS March 13, 2023 Ten scientists in the Harold C. Simmons Comprehensive Cancer Center at UTSouthwestern Medical Center have been awarded nearly $15 million in grants from the Cancer Prevention and Research Institute of Texas (CPRIT) to advance research on a wide range of cancer issues.

Our researchers continue to push the envelope on developing a better understanding of cancer and new ways to help cancer patients in Texas and beyond, efforts that are well recognized in this current round of CPRIT funding, said Carlos L. Arteaga, M.D., Director of the Simmons Cancer Center, Associate Dean of Oncology Programs at UTSouthwestern, and holder of The Lisa K. Simmons Distinguished Chair in Comprehensive Oncology.

Keith E. Argenbright, M.D., Professor of Family and Community Medicine, in the Simmons Cancer Center, and in the Peter ODonnell Jr. School of Public Health, was awarded $2,500,000 to expand a program that provides breast cancer screening and follow-up care for low-income, uninsured, or underinsured women in the North Texas area. This project is expected to fund at least 1,850 screening mammograms and 125 biopsies and aims to reduce disparities in breast cancer screening and detection, particularly those associated with race/ethnicity and socioeconomic status. Dr. Argenbright is a Distinguished Teaching Professor at UTSW.

David Gerber, M.D., Professor in the Department of Internal Medicine and in the ODonnell School of Public Health and holder of the David Bruton, Jr. Professorship in Clinical Cancer Research, was awarded $1,922,312 to expand existing lung cancer screening and tobacco cessation programs. The effort targets ZIP codes with the greatest lung cancer risk and most pronounced health disparities, particularly in southern Dallas. To accomplish this goal, nurse navigators at Parkland Health will provide education, logistical support, and psychosocial support to patients through telephone, video, and on-site interactions.

Rodney Infante, M.D., Ph.D., Assistant Professor of Internal Medicine, Division of Digestive and Liver Diseases, and in the Center for Human Nutrition, was awarded $1,050,000 to study changes in the tumor microenvironment that promote cancer cachexia, a wasting syndrome that causes significant fat and muscle loss. Leveraging better insight into these tumor-host interactions could lead to new therapeutics for this undertreated condition.

Mamta Jain, M.D., Professor of Internal Medicine, was awarded $2,499,616 to expand an existing program that works to prevent liver cancer by screening for, immunizing against, and treating the associated hepatitis B (HBV) and hepatitis C virus (HCV). Rather than focusing on the baby boomer generation for these interventions, the researchers are expanding the program to focus on adults ages 18 to 79 for HCV and ages 19 to 59 for HBV.

Ram S. Mani, Ph.D., Assistant Professor of Pathology and Urology, was awarded $1,049,641 to better understand how enhancers DNA switches that regulate the expression of genes drive prostate cancer. The findings could lead to new strategies to prevent or delay prostate cancer.

Samuel McBrayer, Ph.D., Assistant Professor of Pediatrics and in the Childrens Medical Center Research Institute at UTSouthwestern, was awarded $1,048,465 to develop drugs based on a chemical called 5J12 that has shown promise in fighting glioblastoma (GBM), the most common type of primary brain cancer in adults. 5J12, which blocks a protein involved in making cholesterol, has been shown to kill GBM cells growing in petri dishes and has been given safely to mice. This work will be done in close collaboration with the laboratories of Deepak Nijhawan, M.D., Ph.D., Associate Professor of Internal Medicine and Biochemistry, UTSouthwestern Presidential Scholar, and holder of the Joseph F. Sambrook, Ph.D. Distinguished Chair in Biomedical Science; and Jef De Brabander, Ph.D., Professor of Biochemistry and holder of the Julie and Louis Beecherl Jr. Chair in Medical Science.

Lance S. Terada, M.D., Professor of Internal Medicine, Chief of the Division of Pulmonary and Critical Care Medicine, and holder of the Dr. Carey G. King, Jr. and Dr. Henry M. Winans, Sr. Chair in Internal Medicine, was awarded $1,049,994 to study how healthy cells, known as endothelial cells, support cancerous tumors using autophagy. In that process, old, damaged, or abnormal cellular components are broken down and recycled for important cellular functions. The researchers plan to study whether inhibiting this process could lead to new ways to fight cancer.

Tao Wang, Ph.D., Assistant Professor in the ODonnell School of Public Health and in the Center for the Genetics of Host Defense, together with Junzhou Huang at UT Arlington and Alexandre Reuben at M.D. Anderson Cancer Center were awarded $1,199,997 to develop an artificial intelligence method that can predict binding between T-cell receptors and antigens on tumor cells. This knowledge could help facilitate the development of new, personalized immunotherapies for cancer patients.

Guanghua Xiao, Ph.D., Professor in the ODonnell School of Public Health and in the Lyda Hill Department of Bioinformatics and holder of the Mary Dees McDermott Hicks Chair in Medical Science, was awarded $1,303,815 to develop digital pathology and artificial intelligence tools to predict the prognosis of patients with rhabdomyosarcoma, the most common type of soft tissue sarcoma in children. Data from whole slide images, patient genetics, and clinical information could eventually be used collectively by this system to make more precise diagnoses and treatment decisions.

Zhenyu Zhong, Ph.D., Assistant Professor of Immunology, was awarded $1,049,997 to study the molecular underpinnings of liver inflammation that promote hepatocellular carcinoma, a type of liver cancer that has become the second-leading cause of cancer-related death worldwide. Results from this study could guide the future design of liver cancer therapies.

About UTSouthwestern Medical Center

UTSouthwestern, one of the nations premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institutions faculty has received six Nobel Prizes, and includes 24 members of the National Academy of Sciences, 18 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,900 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UTSouthwestern physicians provide care in more than 80 specialties to more than 100,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 4 million outpatient visits a year.

Original post:

Simmons Cancer Center investigators receive nearly $15 million in ... - UT Southwestern

Internal Medicine

Opinion: CT must codify the Aid in Dying bill. Here’s why. – The Connecticut Mirror

As a retired physician with 50 years of clinical and teaching experience in internal medicine, I wish to respond to an article in the Connecticut Mirror by Joseph Bentivegna MD, opposing an Aid in Dying Bill for the relief of terminally ill patients, recently approved by the Public Health Committee of the state legislature.

He makes a series of assertions, none of which is supported by evidence, about the mass mayhem which might follow the passage of this bill. He presents a scenario in which patients are smothered with pillows, doctors kill thousands, people are coerced by their relatives into ending their lives because they are chronically disabled, and he professes that it is impossible to know when someone is terminally ill.

I have to note that as an ophthalmologist who rarely if ever actually deals with end-of-life management, he is not really expected to have expertise in this issue. What he may not do however, is assume that if he is unable to recognize terminal illness, no one else can either.

In the U.S., we have actual peer-reviewed published evidence of the medical and social effects of such legislation. Aid in dying has been practiced in Oregon since 1997. Since its passage, about 1,500 terminally ill patients have availed themselves of this option to shorten their torment. NONE of the horror scenarios envisioned by Dr. Bentivegna has materialized.

It is now the law in 10 states and in Washington, D.C., again without social chaos or an increase in related murder. About one third of those obtaining a lethal dose of a drug to be self-administered at home have opted not to do so, but have been surveyed during their illness. Published studies show that they find solace in the knowledge that they can always end their suffering, should it become unbearable.

The average length of time between obtaining the drug and taking it is six weeks in those who ultimately use it. Thus their action is not rash or impulsive. Many are depressed, something not unusual in dying people. Even in some who might respond to treatment, the treatment will not alter the course of their end stage disease and might well take longer than they have left to live.

I do agree with Dr. Bentivegna that the interposition of a psychiatric evaluation into the process renders it cumbersome. In fact it was rescinded in Oregon without adverse effect.

No one whose religious or ethical stance prevents their participation in this program, either as physician or as patient, need do so. This legislation codifies an inherent human right to shape the last days of life with privacy and in dignity without any trace of harm to society, as evidenced by long term experience. It should become law in Connecticut.

Herbert Ross, MD FACP lives in Lyme.

View original post here:

Opinion: CT must codify the Aid in Dying bill. Here's why. - The Connecticut Mirror

Internal Medicine

This Early Long COVID Clinic Was Led by PM&R and Family and … – Patient Care Online

The long COVID clinic at the University of Washington (UW) in Seattle was established in the early days of recognition that post-acute sequelae of SARS-CoV-2 was a real phenomenon affecting large numbers of people and was not going to fade away.

The long COVID clinic initiative was driven by the UW department of rehabilitation medicine and began with foundational clinicians in rehabilitation, family, and internal medicine, according to Christopher McMullen, MD, CAQSM, assistant professor of rehabilitation medicine and sports and spine medicine at UW and a physiatrist in practice at a UW multispecialty outpatient clinic.

McMullen, along with his primary care colleague Nina Maisterra, MD, discuss the role of physical medicine and rehabilitation in care for long COVID patients and the very large role for primary care.

The rest is here:

This Early Long COVID Clinic Was Led by PM&R and Family and ... - Patient Care Online

Internal Medicine

Intercalation helps to develop doctors with a more holistic approach … – The BMJ

Intercalated degrees can sharpen medical students understanding of the world as well as their clinical acumen, say Reagan Lee and Oscar Han

Intercalation gives UK medical students the chance to take a year out of their medical programme to obtain another degree in a discipline of interest. These degrees can range from medicine adjacent subjects like anatomy or pharmacology to those outside the scope of the usual medical curriculum, such as a humanities subject. Intercalation is often considered a valuable experience by students, and until recently it could assist them in securing their desired foundation training posts. The rules have now changed, however, and students entering the UK foundation programme in 2023 are the first cohort to no longer be awarded points for having these additional degrees.1

If intercalation no longer counts towards applications, is it still worthwhile? Yes. Medicine is a lengthy and demanding career, which begins with five or six years of medical school. It can be difficult to remember that there is no rush to get through thismedicine is a marathon, not a sprint. Intercalation allows medical students to take a break from the rigours of clinical medicine, reducing stress and potentially preventing burnout.

One of the many reasons to intercalate is the opportunity to take some time away from medicine to appreciate other disciplines. Doing so will encourage students to approach medicine with a wider perspective when they return. After all, society does not revolve around medicine, but rather a complex mix of humanities, sciences, and the arts. Intercalating allows students to develop a more holistic set of ideas and approaches.

In non-collegiate UK universities, medics often form close knit cliques owing to the intense nature of the course. Intercalating allows medical students to expand their social circle to include those who study a range of subjects. In clinical practice, we can become desensitised to aspects of medicine that the public might find unpleasant. If we rarely interact with people outside our course, how can we truly understand what other people think about medicine and factor this into our practice so that we provide the best standard of care?

Intercalation provides lots of opportunities to learn skills that are transferable to clinical practice. Students can explore specific areas of medicine in detail, such as cutting edge cardiovascular treatments. Research oriented students might be able to familiarise themselves with the bench-to-bedside process, while also critically appraising research and interpreting statistics. Other students will focus on different areas. Students studying psychology, for example, might learn more about the emotional, social, and cognitive elements that shape patients behaviour and experiences, whereas those studying medical anthropology could obtain a greater understanding of different societal attitudes towards medicine, enabling them to practise in a culturally informed way. Overall, an intercalated degree can develop and sharpen our understanding of the world, as well as our clinical acumen.

Intercalating can also confer benefits outside of clinical practice. Work produced from the intercalated degree can develop into publications and conference presentations. Intercalation allows students to form a good professional network early on, paving the way for future career advancement.

Given the many advantages of intercalating, the removal of additional degrees as part of the education performance measure of UK foundation programme applications in 2020 caused controversy. It was later announced that, from 2023, undergraduate degrees, including intercalated degrees, would no longer count towards the application scoring matrix for internal medicine training.2 No alterations have yet been made to the point scoring system for the specialised foundation programme.3

Some have argued that these changes are for the betterone reason the UK Foundation Programme Office cited for their decision is that additional degrees are no longer helpful in differentiating between candidates.4 And with many candidates not able to afford these additional qualifications, there is a question of equity here.

The financial opportunity costs of starting work later, coupled with the anxiety of resuming your medical degree with a cohort of strangers, might make some students reluctant to intercalate. More financial support should be provided to widen access so that the benefits of intercalating are attainable for everyone.

Over the years, medicine has increasingly become a checklist exercise for medical students, as we tick boxes in our portfolios to progress. Many of us may have forgotten our initial drive to build up our skills and learn more about the world around us. Keeping in sight the idea of constant learning in a medical career, we should take up the opportunity to intercalate, which broadens our horizons and enables us to develop holistically not only as clinicians, but as people.

Competing interests: Both authors are medical students. They have no competing interests and are unpaid.

Provenance and peer review: Not commissioned; not externally peer reviewed.

The rest is here:

Intercalation helps to develop doctors with a more holistic approach ... - The BMJ

Internal Medicine

Loneliness, isolation down but still high among older adults | The … – The University Record

After three years of pandemic living, loneliness, isolation and lack of social contact have finally started to decline among older adults, a new University of Michigan poll shows.

But one in three people between ages 50 and 80 say they still sometimes or often experience these feelings, or sometimes go a week or longer without social contact with someone from outside their home. Thats down from about half of older adults in June 2020.

The percentages who currently feel lonely, isolated or lacking contact were much higher among older adults who say their physical or mental health is fair or poor, as well as those with a health problem or disability that limits their daily activities and those who are not working or unemployed.

Around half or more of the older adults in each of these groups currently experience these feelings. Thats a rate about twice as high as their peers who are in better health or dont have a disability or activity-limiting health issue.

The new findings from U-Ms National Poll on Healthy Aging, gathered in late January, add to previous data from polls taken in 2018 and during all three pandemic years using the same questions.

That allows the poll team to see that for older adults overall, these measures are nearly back to pre-pandemic levels, which were already high. The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine.

Three years into the COVID-19 pandemic, we see reason for hope, but also a real cause for concern, said Preeti Malani, the polls senior adviser and former director, and a Medical School infectious disease professor who is also trained in geriatrics. If anything, the pandemic has shown us just how important social interaction is for overall mental and physical health, and how much more attention we need to pay to this from a clinical, policy and personal perspective.

Poll director Jeffrey Kullgren said loneliness and isolation were high before the pandemic and it will take a concerted effort to bring these rates down further.

While we must always balance risk of infection with risk of isolation in older adults, we now know that a combination of vaccination, medication, testing, ventilation and masking can protect even the most vulnerable and allow them to engage socially, said Kullgren, associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System.

The poll team notes that chronic loneliness has been shown by researchers to be associated with adverse impacts on mental, cognitive and physical health, as well as general well-being and even longevity.

More about the findings:

In general, rates of all three measures plateaued in 2021 and 2022, down from June 2020 highs, before dropping in the January 2023 poll.

Mental health: Rates of feeling a lack of companionship were more than twice as high among those who say their mental health is fair or poor (73%) than among those who report better mental health (excellent, very good or good). Similarly, 77% of those in the fair/poor mental health group reported feeling isolated compared with 29% in the better mental health group, and 56% of those in the fair/poor mental health group reported infrequent social contact compared with 30% in the better mental health group.

Physical health: The differences were less stark but still large among those who reported fair or poor physical health compared with those in better physical health. Lack of companionship was experienced by 55% of the fair/poor group and 33% of the better group, isolation was experienced by 55% vs. 29% and lack of social contact was experienced by 56% vs. 29%.

Disability or health condition: 51% of those who have a disability or health condition that they say limits their activity also say they experience a lack of companionship, compared with 30% of those without such conditions. The percentages were similar for feelings of isolation.

Living alone: 47% of those who live alone report a lack of companionship, compared with 33% of those who live with others. There was a smaller but still measurable difference between the two groups in feelings of isolation.

Despite the modest improvement these results show, social isolation and loneliness are still an urgent concern for older adults, said Claire Casey, president of AARP Foundation. Research shows that social isolation affects health and well-being, and can lead to unemployment. Greater economic security for older adults demands that we address loneliness.

Originally posted here:

Loneliness, isolation down but still high among older adults | The ... - The University Record