University Times

Sim training cuts med errors

Compared to conventional lecture-style education, simulation-based learning reduces the number of medication errors, according to a University study published online in the Journal of Intensive Care Medicine.

The majority of serious mistakes that occur in hospitals are due to medication administration errors, which can be fatal, noted principal investigator Amy L. Seybert, a faculty member in the School of Pharmacy’s Department of Pharmacy and Therapeutics.

“Patients in intensive care units are at increased risk for these errors because of the number of medications they receive, as well as the complexity of the ICU environment,” she said.

The study was conducted in adult coronary critical care (CCU) and medical intensive care (MICU) units at UPMC Presbyterian.

A dozen nurses in each unit were observed administering and documenting each patient’s medications. After the initial observation, the nurses took part in an educational session that was either simulation-based or a lecture. Both sessions equally focused on the errors that were identified during the initial observation period.

The nurses who were assigned to the simulation-based session worked with a human-appearing simulator from the Peter M. Winter Institute for Simulation, Education and Research (WISER) to correct errors and practice proper medication administration techniques. When errors occurred, the simulator responded with physiological changes, including shifts in blood pressure, heart rate and verbal response.

The group that attended the lecture reviewed medication administration techniques and consequences related to common errors. This session was presented in a traditional in-service setting.

Participants were given multiple-choice quizzes along with a five-question subjective evaluation before and after the sessions. The nurses also were observed administering medication twice more: one-four weeks after the educational session and again eight-12 weeks after the session.

“After the educational sessions and the first observation period, our research found that the medication administration error rate significantly decreased to 4 percent for the CCU nurses who participated in the simulation-based training and slightly increased to 22.7 percent for the MICU nurses who participated in the lecture-style sessions,” Seybert said. After the second observation period, the medication error rate for the CCU nurses rose to 6.2 percent while the error rate for the MICU nurses increased to 36.7 percent. The two groups showed no significant difference in quiz scores.

Pitt co-authors included Pamela L. Smithburger and Sandra L. Kane-Gill of UPMC and the School of Pharmacy, Lawrence R. Kobulinsky of WISER and Joseph T. Samosky of the Simulation and Medical Technology Research and Development Center.

ARRA funds Pitt research

More than $1.5 million in National Institutes of Health research grants funded by the American Recovery and Reinvestment Act was awarded in May to Pitt investigators.

Receiving grants were:

• John W. Mellors of medicine, $486,282 for “Rational Design of NRTI for Drug-resistant HIV-1”;

• Laura J. Niedernhofer of microbiology and molecular genetics, $18,665 for “The Contribution of DNA Interstrand Crosslinks to Aging”;

• Constance Chu of orthopaedic surgery, $21,271 for “Chondrogenesis in Situ;”

• David Lewis of psychiatry, $460,440 for “Inhibition, Oscillations and Information Processing in Schizophrenia”;

• Lewis Falo of dermatology, $245,890 for “Immunization Strategies for Autologous HIV Immunotherapy,” and

• Hannah Rabinowich of pathology, $311,712 for “Cross-regulation of Apoptosis and Autophagy as a Molecular Basis for Reversal of Tumor TRAIL Resistance.”

Through May, University investigators have been awarded more than $166 million in ARRA research funds.

Few PA Medicaid kids get dental care

A significant number of children in Pennsylvania covered by Medicaid did not receive basic dental health services that could help prevent serious medical problems, according to a report published online by the Pennsylvania Medicaid Policy Center (PMPC) at Pitt’s Graduate School of Public Health (GSPH). The report found that the majority of children on Medical Assistance are enrolled in managed care, but only 42.8 percent of these children had an annual dental visit in 2009.

The report authors stated that one main obstacle is a shortage of dentists who will accept Medical Assistance, possibly due to reimbursement rates that are low compared to other Medicaid programs nationally and are set at about 53.2 percent of regular dental service fees.

Medical Assistance covered more than 1 million, or 35.5 percent, of all children in Pennsylvania in 2009. In 2008, Medical Assistance spent about $124.9 million on dental services, or $109 per enrolled child.

“Only 26 percent of practicing dentists in Pennsylvania were reimbursed by Medical Assistance in 2009,” said Judith R. Lave, PMPC director and GSPH faculty member in health economics. “Medical Assistance may need to re-examine reimbursement practices to ensure services are being appropriately covered. This could help encourage more dentists to participate in the program and improve access to care for low-income children.”

PMPC senior policy analyst Monica R. Costlow co-authored the report.

The report is available at www.pamedicaid.pitt.edu/documents/Dental_rp_10_8_.pdf.

Medicare spending varies by region

Widespread geographic variations exist in drug spending among Medicare beneficiaries, with some regions spending twice as much as others, according to a GSPH study published in the Online First issue of the New England Journal of Medicine.

The study also found that higher spending on drugs was not balanced by lower spending on other medical services such as hospitalizations.

Lead author GSPH health economics faculty member Yuting Zhang and researchers from the Harvard School of Public Health calculated and mapped drug and non-drug medical spending in 2007 among 306 hospital-referral regions. They controlled for geographic differences in health care prices, population demographics, insurance status and overall health.

The authors found that drug spending accounted for more than 20 percent of total medical spending, but varied substantially. The highest region for drug spending under Medicare was Manhattan, N.Y. ($2,973 annually per beneficiary) and the lowest was Hudson, Fla. ($1,854 annually). Non-drug medical spending also varied widely and was twice as high in the highest-spending regions compared to the lowest.

Variations in drug spending were found to be associated only slightly with variations in non-drug medical spending.

“Spending more on drugs didn’t clearly result in less spending on other medical services,” said  Zhang. “Although there was a weak correlation between the two types of spending, high spending in one area was not offset by low spending in the other. This [information] gives us valuable insight into the use of health care resources and may help guide public policy related to health care reform.”

The study was funded by Pitt and National Institute of Mental Health and the Agency for Healthcare Research and Quality.

UPCI researcher gets ASCO award

Shannon Puhalla, a faculty member in the Department of Medicine and breast oncologist with the Magee-Womens cancer program of UPMC Cancer Centers, was among 14 physicians nationwide to receive a 2010 Career Development Award from the American Society of Clinical Oncology (ASCO). The award provides $200,000 over three years for physicians in their first-third year of practice to establish independent clinical research programs.

Puhalla will use the award to fund a study investigating the combination of hormone therapy with a drug currently under development that may target breast cancer stem cells. According to Puhalla, some research demonstrates that hormone therapy treatment may cause certain types of breast cancer cells to spread. Her study will seek to discover whether a drug designed to inhibit the interaction between the cancer cells and the hormone therapy could treat certain patients successfully.

“Ideally, this treatment eventually could allow certain patients to avoid mastectomy or possibly even chemotherapy,” said Puhalla.

Energy-saving computer research funded

The National Science Foundation’s Division of Computer and Network Systems has awarded a continuing grant of $1.9 million to computer science faculty member Bruce Childers to study energy efficient data centers.

The project uses multiple technologies to construct a high-capacity, energy-efficient memory system for virtualized computer servers with a new storage class memory architecture that incorporates multiple memory technologies.

Co-PIs are Daniel Mosse, Youtao Zhang and Sangyeun Cho of computer science and Jun Yang of the Department of Electrical and Computer Engineering.

Pharmacy awards announced

The School of Pharmacy recently announced the following research grants and awards:

• The Center for Education and Drug Abuse Research (CEDAR) received a five-year, $10 million NIH grant to continue investigating the cause of substance use disorders. Through this grant, faculty will continue to follow nearly 800 families to learn more about the genetic, behavioral and environmental factors that contribute to such disorders.

Senior CEDAR collaborators are director Ralph Tarter, scientific director Michael Vanyukov, psychiatry and pharmacology faculty member Duncan Clark, psychiatry faculty member Jack Cornelius, statistics core director Levent Kirisci, and pharmaceutical sciences faculty members Ada Mezzich, Galina Kirillova and Maureen Reynolds.

• Kirisci also received a five-year, $677,090 NIH grant for his work to quantify and track risk factors for substance use disorders in youth and young adults. His work focuses on the development of the transmissible liability index, a system that helps to determine a child’s genetic risk for addiction.

• Pharmaceutical sciences faculty member Dexi Liu received a four-year, $1.7 million NIH grant for his research to develop gene therapy for treatment of hemophilia.

• Pharmaceutical sciences faculty member Wen Xie received a five-year $1.6 million NIH grant for his research to determine whether the aryl hydrocarbon receptor protein is a therapeutic target for fatty liver disease.

• Pharmaceutical sciences faculty member Xiang-Qun (Sean) Xie received a five-year, $1.6 million NIH grant to investigate the molecular mechanisms of human G-protein coupled cannabinoid CB2 receptor activation and immune signal transduction to facilitate structure-based design for novel CB2-target therapeutic drugs without psychotropic side effects.

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The University Times Research Notes column reports on funding awarded to Pitt researchers as well as findings arising from University research.

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