Insulin-producing cells derived from patient’s skin cells.

NEW YORK, NY (June 17, 2013) – A team from the New York Stem Cell Foundation (NYSCF) Research Institute and the Naomi Berrie Diabetes Center of Columbia University has generated patient-specific beta cells, or insulin-producing cells, that accurately reflect the features of maturity-onset diabetes of the young (MODY).

The researchers used skin cells of MODY patients to produce induced pluripotent stem (iPS) cells, from which they then made beta cells. Transplanted into a mouse, the stem cell-derived beta cells secreted insulin in a manner similar to that of the beta cells of MODY patients. Repair of the gene mutation restored insulin secretion to levels seen in cells obtained from healthy subjects. The findings were reported today in the Journal of Clinical Investigation.

Previous studies have demonstrated the ability of human embryonic stem cells and iPS cells to become beta cells that secrete insulin in response to glucose or other molecules. But the question remained as to whether stem cell-derived beta cells could accurately model genetic forms of diabetes and be used to develop and test potential therapies.

“We focused on MODY, a form of diabetes that affects approximately one in 10,000 people. While patients and other models have yielded important clinical insights into this disease, we were particularly interested in its molecular aspects—how specific genes can affect responses to glucose by the beta cell,” said co-senior author Dieter Egli, PhD, Senior Research Fellow at NYSCF, who was named a NYSCF–Robertson Stem Cell Investigator in 2012.

MODY is a genetically inherited form of diabetes. The most common form of MODY, type 2, results in a loss-of-function mutation in one copy of the gene that codes for the sugar-processing enzyme glucokinase (GCK). With type 2 MODY, higher glucose levels are required for GCK to metabolize glucose, leading to chronic, mildly elevated blood sugar levels and increased risk of vascular complications.

MODY patients are frequently misdiagnosed with type 1 or 2 diabetes. Proper diagnosis can not only change the patient’s course of treatment but affect family members, who were previously unaware that they, too, might have this genetic disorder.

NYSCF scientists took skin cells from two Berrie Center type 2 MODY patients and “reprogrammed”—or reverted—them to an embryonic-like state to become iPS cells. To examine the effect of the GCK genetic mutation, they also created two genetically manipulated iPS cell lines for comparison: one fully functional (two correct copies of the GCK gene) and one with complete loss of function (two faulty copies of the GCK gene). They then generated beta cell precursors from the fully functional and loss-of-function iPS cell lines and transplanted the cells for further maturation into immune-compromised mice.

“Our ability to create insulin-producing cells from skin cells, and then to manipulate the GCK gene in these cells using recently developed molecular methods, made it possible to definitively test several critical aspects of the utility of stem cells for the study of human disease,” said Haiqing Hua, PhD, lead author on the paper, a postdoctoral fellow in the Division of Molecular Genetics, Department of Pediatrics and Naomi Berrie Diabetes Center at Columbia University and the New York Stem Cell Foundation Research Institute.

When given a glucose tolerance test three months later, mice with MODY beta cells had decreased sensitivity to glucose but a normal response to other molecules that stimulate insulin secretion. This is the hallmark of MODY. Mice with two faulty copies of the GCK gene secreted no additional insulin in response to glucose. When the researchers repaired the GCK mutation using molecular techniques, cells with two restored copies of GCK responded normally to the glucose stress test. Unlike other reported techniques, the researchers’ approach efficiently repaired the GCK mutation without introducing any potentially harmful additional DNA.

“Generation of patient-derived beta cells with gene correction could ultimately prove to be a useful cell-replacement therapy by restoring patients’ ability to regulate their own glucose. This result is truly exciting,” said Susan L. Solomon, Chief Executive Officer of The New York Stem Cell Foundation.

The researchers also used an electron microscope to assess beta cells for insulin content by counting granules—packages that store insulin for release. Even though all beta cell types had a similar number of granules, complete loss of function of the GCK gene was associated with decreased beta-cell production.

“These studies provide a critical proof-of-principle that genetic characteristics of patient-specific insulin-producing cells can be recapitulated through use of stem cell techniques and advanced molecular biological manipulations. This opens up strategies for the development of new approaches to the understanding, treatment, and, ultimately, prevention of more common types of diabetes,” said co-senior author Rudolph Leibel, MD, Christopher Murphy Memorial Professor of Diabetes Research, Columbia University Medical Center, and Director, Division of Molecular Genetics, and Co-Director of the Naomi Berrie Diabetes Center.

The other authors are: Linshan Shang and Hector Martinez of the New York Stem Cell Foundation Research Institute; and Matthew Freeby, Mary Pat Gallagher, Thomas Ludwig, Liyong Deng, Ellen Greenberg, Charles LeDuc, Wendy K. Chung, and Robin Goland of the Division of Molecular Genetics, Department of Pediatrics, and Naomi Berrie Diabetes Center at Columbia University.

Funding for this study was provided by: The New York Stem Cell Foundation; the Russell Berrie Foundation; the Leona M. and Harry B. Helmsley Charitable Trust; the Hunter Eastman Scholar Award in Translational Diabetes Research; the James and Irene Hunter Charitable Fund; an ADA-Mentored Fellowship to H. Hua; and NIH Grants RO1 DK52431 and P30DK063608.

The authors report no financial or other conflict of interest.

About The New York Stem Cell Foundation

The New York Stem Cell Foundation (NYSCF) is an independent organization founded in 2005 to accelerate cures and better treatments for patients through stem cell research. NYSCF employs over 40 researchers at the NYSCF Research Institute, located in New York, and is an acknowledged world leader in stem cell research and in developing  pioneering stem cell technologies, including the NYSCF Global Stem Cell Array. Additionally, NYSCF supports another 60 researchers at other leading institutions worldwide through its Innovator Programs, including the NYSCF – Druckenmiller Fellowships and the NYSCF-Robertson Investigator Awards. NYSCF focuses on translational research in a model designed to overcome the barriers that slow discovery and replaces silos with collaboration.

NYSCF researchers have achieved four major discoveries in the field, including: the discovery of a clinical cure to prevent transmission of maternal mitochondrial diseases in December 2012; the derivation of the first-ever patient specific embryonic stem cell line (#1 Medical Breakthrough of 2011 by Time magazine); the discovery of a new way to reprogram stem cells; and the creation of the first disease model from induced pluripotent stem cells (also named the #1 Medical Breakthrough by Time magazine in 2008). More information is available at www.nyscf.org.

About the Naomi Berrie Diabetes Center

Upon its official opening in October 1998, the Naomi Berrie Diabetes Center at Columbia University Medical Center established a new standard of care for the 1.6 million people with diabetes in the New York area—combining world-class diabetes research and education programs with unprecedented family-oriented patient care. Founded with support from the Russell Berrie Foundation and other friends, and named in honor of the mother of the late Russell Berrie, founder of RUSS™ Toys, the center is today recognized as the most comprehensive diabetes research and treatment center in the tri-state region and has been designated a national “Diabetes Center of Excellence” —one of only three in the state of New York. Approximately one hundred and fifty clinicians and scientists, affiliated with the Center, conduct basic and clinical research related to the pathogenesis and treatment of all forms of diabetes and its complications. For more information, visit nbdiabetes.org.

Drs. Chung and Leibel are also members of the Columbia Stem Cell Initiative (www.ColumbiaStemCell.org), which brings together the many scientists and clinicians at Columbia focused on tapping the potential of stem cells for human health.

About Columbia University Medical Center

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.

- #### -

The post Researchers Demonstrate Use of Stem Cells to Analyze Diabetes Causes and Treatment appeared first on Columbia University Medical Center.

“This is the first paper to show that obesity is associated with hearing loss in adolescents,” said study first author Anil K. Lalwani, MD, professor and vice chair for research, Department of Otolaryngology/Head & Neck Surgery, Columbia University Medical Center.

The study found that obesity in adolescents is associated with sensorineural hearing loss across all frequencies (the frequency range that can be heard by humans); sensorineural hearing loss is caused by damage to the inner-ear hair cells. The highest rates were for low-frequency hearing loss—15.16 percent of obese adolescents compared with 7.89 percent of non-obese adolescents. People with low-frequency hearing loss cannot hear sounds in frequencies 2,000 Hz and below; they may still hear sounds in the higher frequencies (normal hearing range is from 20 Hz to 20,000 Hz). Often they can still understand human speech well, but may have difficulty hearing in groups or in noisy places.

“These results have several important public health implications,” said Dr. Lalwani, who is also an otolaryngologist at NewYork-Presbyterian Hospital/Columbia University Medical Center. “Because previous research found that 80 percent of adolescents with hearing loss were unaware of having hearing difficulty, adolescents with obesity should receive regular hearing screening so they can be treated appropriately to avoid cognitive and behavioral issues.”

Although the overall hearing loss among obese adolescents was relatively mild, the almost 2-fold increase in the odds of unilateral low-frequency hearing loss is particularly worrisome. It suggests early, and possibly ongoing, injury to the inner ear that could progress as the obese adolescent becomes an obese adult. Future research is needed on the adverse consequences of this early hearing loss on social development, academic performance, and behavioral and cognitive function.

“Furthermore, hearing loss should be added to the growing list of the negative health consequences of obesity that affect both children and adults—adding to the impetus to reduce obesity among people of all ages,” said Dr. Lalwani.

In the United States, nearly 17 percent of children are obese, defined as having a body mass index (BMI) of ≥95 percentile. (BMI in children is expressed as a percentile; adult BMI is expressed as a number based on weight and height.) Obesity and its associated morbidities have been identified as a risk factor for hearing loss in adults.

The study analyzed data from nearly 1,500 adolescents from the National Health and Nutrition Examination Survey—a large, nationally representative sample of adolescents between the ages of 12 and 19, conducted from 2005 to 2006 by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Participants were interviewed at home, taking into account family medical history, current medical conditions, medication use, household smokers, socioeconomic and demographic factors, and noise-exposure history.

Dr. Lalwani and his colleagues speculate that obesity may directly or indirectly lead to hearing loss. Although additional research is needed to determine the mechanisms involved, they theorize that obesity-induced inflammation may contribute to hearing loss. Low plasma levels of the anti-inflammatory protein adiponectin, which is secreted from adipose tissue, have been found in obese children, and low levels in obese adults have been associated with high-frequency hearing loss (which affects a person’s ability to understand speech). Obesity also may contribute indirectly to hearing loss as a result of its comorbidities, including type 2 diabetes, cardiovascular disease, and high cholesterol—all of which have been reported to be associated with loss of peripheral hearing (relating to the outer, middle, and inner ear).

The paper is titled, “Obesity is Associated with Sensorineural Hearing Loss in Adolescents.” The other authors (from the New York University Langone Medical Center) are Karin Katz, MD; Ying-Hua Liu, MD, PhD; Sarah Kim, BA; and Michael Weitzman, MD.

The authors declare no financial or other conflicts of interest.

####

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.

The post Obesity Associated with Hearing Loss in Adolescents appeared first on Columbia University Medical Center.

When Wendy Chung first started working with the ACLU to bring a case against Myriad Genetics, challenging its patents on two genes linked to breast cancer, many legal scholars said that the case would be an exercise in futility.

“I considered this my Don Quixote experience in life. That I would be going up against a windmill and there would be no opportunity to knock down patents,” says Chung, who is director of clinical genetics at Columbia University Medical Center.

But Chung persevered because of her patients. “Genetic testing is an important part of what I do to help people, but we were having difficulties getting access,” she says.

The tests her patients needed either were too costly—in the case of BRCA1 and BRCA2 tests from Myriad—or were unavailable when labs holding the patents stopped offering the tests. Chung approached the NIH and Congress with her concerns and then finally the ACLU, which suggested bringing a case against Myriad as one example of how gene patents were harming patients and patient care.

The case worked its way to the Supreme Court, and on June 13 the court issued a unanimous
(9–0) decision that natural genes cannot be patented. (Although the court let stand patents on human-made genes, including versions of human genes that omit extraneous pieces of DNA naturally found in human genes, Chung says that will have little effect on the majority of diagnostic gene tests.)

“I think the most immediate implication for women who need a breast cancer test is going to be that other laboratories will start offering the test, and potentially they will offer a test that includes a panel of 10 to 20 other genes, so women will get more valuable information,” Chung says.

“But the biggest implication of the decision, in my opinion, is that we are not going to be impeded in giving full information to our patients about all of their genes. We can now sequence a patient’s entire genome, but we had to put blinders on when it came to 20 percent of their genes. That’s huge in the way we’re advancing in genetic and genomic medicine.”

The post Supreme Court Rules Against Gene Patents appeared first on Columbia University Medical Center.

The proposed restrictions were approved by the New York City Board of Health. They are currently under appeal after being struck down by the New York State Supreme Court in March. Oral arguments began yesterday.

The new study looks at national data, but the researchers say the results are a strong validation of the obesity-prevention measure no matter where in the country it is implemented. “Our findings are clear: a law like this would address one of the fundamental causes of obesity—the growing portion size of sweetened drinks,” says lead author Y. Claire Wang, MD, ScD and assistant professor of Health Policy and Management at Columbia University’s Mailman School of Public Health. The study appears online in the American Journal of Clinical Nutrition.

Dr. Wang and co-author Seanna M. Vine, MPH, analyzed 19,147 dietary records from National Health and Nutrition Examination Surveys in the years 2007-2010 for the demographics related to the consumption of sugar-sweetened beverages, including sodas and other non-alcoholic drinks containing caloric sweeteners.

While 60.5% of Americans consumed sugary drinks on a daily basis, only 7.5% purchased them from a food establishment in portions larger than 16 ounces on a given day. The proportion was marginally higher in some groups: 8.6% of those who were overweight (compared to 6.4% of those who aren’t overweight), 13.6% of overweight teenagers, and 12.6% of overweight young adults aged 20 to 44. Americans with incomes less than 130% of the poverty line (eligible for the Supplemental Nutrition Assistance Program, SNAP, formerly food stamps) were found to consume large sugary drinks from food service establishments in equal proportion to those with higher incomes.

The results are surprising given that low-income Americans are more likely to consume sugary beverages in a given day than higher-income groups. The difference could be that fewer of these beverages are being purchased in restaurants. “Buying a large soda and drinking it at home costs less,” says Dr. Wang.

Until the legislation is enacted, it is impossible to know to what extent the consumption of sugary beverages will change. Under the proposed policy, consumers would be free to drink as much as they would like, and restaurants could offer free refills or discounts on multiple servings. Given these uncertainties, the researchers used a variety of scenarios to estimate how the policy would cut calories and consumption. A reasonable assumption, they say, would be that 80% of large soda drinkers downsize to a 16-ounce soda and 20% splurge on two 16-ounce sodas. In this case, adults would cut 63 calories daily; children and teenagers affected by the policy would cut 58 calories. Both would avoid three to four teaspoons of sugar.

These calorie reductions could go a long way toward reducing the number of excess calories taken in by American youth. Previous research by Dr. Wang found that a reduction of 64 calories per day is needed to reach the country’s Healthy People 2020 goal for reducing obesity.

The researchers also looked at where people consumed large sweetened drinks outside the home. Among food service establishments, 65% of the drinks were consumed in fast food restaurants, followed by 28% in restaurants with wait staff; 4% in a sports stadium, movie theater, or other entertainment venue; 2% from a street vendor; and 1% from a bar. These numbers would be slightly different in New York City, notes Dr. Wang, where there are more street vendors and full-service restaurants than the rest of the country.

The portion size cap might also have a spillover effect, influencing behaviors in the home, where most sugary drinks are consumed, says Dr. Wang, who co-leads a Dean’s Initiative at the Mailman School focused on advancing research on preventing obesity. “Changing social norms is difficult, but as portion sizes have grown, it’s useful to establish a new standard.”

When first introduced in 1955, a regular-size soda at McDonalds was 7 ounces. Today the chain offers 12-ounce drinks as the child size, 16-ounce drinks as small, 21-ounce drinks as medium, and 32-ounce drinks as large. In 1999-2004, an average U.S. teen consumed 301 calories in sugar-sweetened beverages, which is 13% of their total daily calories. To burn this off, they would need to walk more than 5 miles.

“This is an important study. It provides critical foundational evidence that the proposed efforts to restrict marketing of large sodas in New York City and elsewhere can have a substantial impact on population health,” says Sandro Galea, MD, DrPH, chairman of the department of Epidemiology at the Mailman School and a member of the New York City Board of Health.

This article originally appeared on the Mailman School of Public Health website.

The post NYC-Style Cap on Soda Size Would Target the Overweight, Not the Poor appeared first on Columbia University Medical Center.

While at Maryland, Dr. Stohler led a curriculum update, oversaw Maryland’s expansion to become the largest public dental school in the U.S., obtained the volunteer commitment of more than 200 practicing dentists to teach real-world dentistry, fostered faculty entrepreneurship, re-engineered the school’s business operation, and expanded the school’s global presence. Dr. Stohler also led the construction of new, fu lly digital academic and clinical facilities on the university’s downtown Baltimore campus, as well as a smaller facility in Perryville, Maryland, which is digitally managed from the downtown campus. He also administered the introduction of dental services to the Health Center on Maryland’s College Park campus.

“The College of Dental Medicine, with its combination of research opportunities, clinical initiatives, international character, and interdisciplinary academic programs, is poised to continue making important contributions to the local, national, and global communities it serves,” said President Bollinger. “I have known and admired Christian since our time together in Ann Arbor, and I’m looking forward to seeing the leadership he will provide as Dean.”

“Dr. Stohler has demonstrated a remarkable ability to promote all the missions of a great dental college,” said Dr. Goldman. “We are confident that he will build upon our legacy of leadership in academic dentistry, which began here at Columbia nearly a century ago.”

“I am delighted to join Columbia University,” said Dr. Stohler. “The bold leadership at the College of Dental Medicine, including a president I know from my time at Michigan; the pervasive and unwavering commitment to excellence and innovation; and the impressive esprit de corps among the faculty, which includes world-class clinicians—all of this makes Columbia a dream opportunity for me.”

Before joining the University of Maryland in 2003, Dr. Stohler spent more than 20 years at the University of Michigan in Ann Arbor, where he was professor at the School of Dentistry, research scientist at the Center for Human Growth and Development, director of research at the School of Dentistry, and professor and chair of the Department of Biologic and Materials Sciences. He also received the university’s Distinguished Service Award.

Dr. Stohler has helped lead National Institutes of Health (NIH)-funded work into the genetics, endocrinology, and neurobiology of the human response to pain—particularly in patients with TMJD, a chronic and painful jaw joint disorder that affects from 5–12 percent of the population. He was a member of the team that was the first to show that thinking that a placebo will relieve pain is enough to prompt the brain to release endorphins, the body’s own painkillers, and that this corresponds with a reduction in how much pain a person experiences. Dr. Stohler’s more than 120 articles and book chapters have been cited more than 5,400 times.

Dr. Stohler received his DMD from the University of Bern in Switzerland, where he also earned his DrMedDent in hematology, as well as certificates in oral surgery and prosthodontics. He holds an honorary doctoral degree of philosophy from Nippon Dental University in Tokyo.

He is a recipient of the Jerome M. & Dorothy Schweitzer Research Award from the Greater New York Academy of Prosthodontics and the Horace Wells Merit Award from the Connecticut State Dental Association. The National Dental Association; the Orthodontic Education and Research Foundation; and the Pierre Fauchard Academy, the international dental honor society, have honored him as well. He has chaired the Board of Scientific Counselors at the National Institute of Dental and Craniofacial Research and is a fellow of the American College of Dentistry and of the International College of Dentistry.

Dr. Stohler succeeds Ira B. Lamster, DDS, MMSc, who stepped down in 2012 after a decade leading the College of Dental Medicine, during which time the school established many new research, clinical, and educational programs. Ronnie Myers, DDS, vice dean for administrative affairs for the College of Dental Medicine, continued this expansion while serving as interim dean during the search.

Founded in 1916, the Columbia University College of Dental Medicine was one of the first dental schools in the United States. It is a national leader in dental education, patient care, community service, and research. The college also has played a leadership role in national health care policy issues. Faculty have advocated for expanded oral health care for both children and the elderly and developed novel programs to expand care locally and in developing countries. The college’s research program is at the vanguard of oral health advances. Current projects include research on the use of stem cells for craniofacial reconstruction and on the relationship between oral health and systemic diseases.

The mission of the College of Dental Medicine is to train general dentists, dental specialists, and dental assistants in a setting that emphasizes comprehensive dental care delivery and stimulates professional growth; to inspire, support, and promote faculty, pre- and postdoctoral student, and hospital resident participation in research to advance the professional knowledge base; and to provide comprehensive dental care for the underserved community of Northern Manhattan.

####

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.

The post Christian Stohler Named Dean of Columbia University’s College of Dental Medicine appeared first on Columbia University Medical Center.

OCD consists of obsessions, which are recurrent intrusive thoughts, and compulsions, which are repetitive behaviors that patients perform to reduce the severe anxiety associated with the obsessions. The disorder affects 2–3 percent of people worldwide and is an important cause of illness-related disability, according to the World Health Organization.

Using a new technology in a mouse model, the researchers found that repeated stimulation of specific circuits linking the brain’s cortex and striatum produces progressive repetitive behavior. By targeting this region, it may be possible to stop abnormal circuit changes before they become pathological behaviors in people at risk for obsessive-compulsive disorder (OCD). The study, which was led by Susanne Ahmari, MD, PhD, assistant professor of clinical psychiatry at Columbia Psychiatry and the New York State Psychiatric Institute, was published in the June 7 issue of Science.

While the obsessions and compulsions that are the hallmarks of OCD are thought to be centered in the cortex, which controls thoughts, and the striatum, which controls movements, little is known about how abnormalities in these brain regions lead to compulsive behaviors in patients.

To simulate the increased activity that takes place in the brains of OCD patients, Dr. Ahmari and her colleagues used a new technology called optogenetics, in which light-activated ion channels are expressed in subsets of neurons in mice, and neural circuits are then selectively activated using light delivered through fiberoptic probes.

“What we found was really surprising,” said Dr. Ahmari. “That activation of cortico-striatal circuits did not lead directly to repetitive behaviors in the mice. But if we repeatedly stimulated for multiple days in a row for only five minutes a day, we saw a progressive development of repetitive behaviors—in this case, repetitive grooming behavior—that persisted up to two weeks after the stimulation was stopped.”

She added, “And not only that, when we treated the mice with fluoxetine, one of the most common medications used for OCD, their behavior went back to normal.” The current study, as well as others currently being performed by Dr. Ahmari and her team, may ultimately provide clues for new treatment targets in terms of both novel drug development and direct stimulation techniques, including deep brain stimulation (DBS).

The study was supported by grants from NIMH (K08MH087718; K24 MH091555), the Louis V. Gerstner, Jr. Scholars Program, the Irving Institute for Clinical and Translational Research, the Gray Matters Foundation, the Leon Levy Foundation, and a NARSAD Young Investigator Award.

The authors declare no financial or other conflicts of interest.

###

Columbia University Department of Psychiatry & NYS Psychiatric Institute

Columbia Psychiatry is ranked among the best departments and psychiatric research facilities in the nation and has contributed greatly to the understanding and treatment of psychiatric disorders. It is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, and childhood psychiatric disorders. Visit http://columbiapsychiatry.org/ for more information.

Columbia University Medical Center

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visitcumc.columbia.edu or columbiadoctors.org.

The post Mice Give New Clues to Origins of OCD appeared first on Columbia University Medical Center.

Ravi P. Kiran, MBBS, MS, FRCS (Eng), FRCS (Glas), FACS, Msc EBM (Oxford), appointed chief of the Division of Colorectal Surgery

NEW YORK — Dr. Ravi P. Kiran has been named chief and program director of the Division of Colorectal Surgery at NewYork-Presbyterian/Columbia University Medical Center, effective June 1, 2013. Dr. Kiran, a renowned surgeon-scientist with expertise in inflammatory bowel disease, colorectal cancer, and other complicated colorectal conditions, joins NewYork-Presbyterian/Columbia from the Cleveland Clinic, where he was staff surgeon and head of the research section in the Department of Colorectal Surgery and director of its Rupert B. Turnbull Jr. School of Enterostomal Therapy.

Dr. Kiran brings a wealth of experience in laparoscopic and open colorectal surgery, anorectal procedures, and reoperative abdominal and pelvic surgery. He is one of only a few highly skilled surgeons nationwide to perform continent ileostomy reservoir procedures and other complex operations to avoid a permanent ostomy after rectal or colon resection. “Access to these options is invaluable to patients who may have had complications after prior surgeries, extensive cancers, fistulas, and other challenging conditions,” said Dr. Craig Smith, chair of the Department of Surgery and the Valentine Mott Professor of Surgery and Johnson and Johnson Distinguished Professor at Columbia University College of Physicians and Surgeons and surgeon-in-chief at NewYork-Presbyterian/Columbia. “We are pleased that our program now offers these advanced options to patients in the New York metropolitan area and beyond.”

As a researcher, Dr. Kiran has specific interests in surgical outcomes and quality and in evidence-based strategies for inflammatory bowel disease and other conditions. With a joint appointment at Columbia University College of Physicians and Surgeons and at Columbia’s Mailman School of Public Health, Dr. Kiran will facilitate research collaborations in epidemiology between the Department of Surgery and the Mailman School.

Dr. Kiran received his medical degree from and completed surgical training at Osmania Medical College in Hyderabad, India, and received advanced training in colorectal surgery in the United Kingdom. He completed his general surgery residency at Yale-Saint Mary’s Hospital and Bronx-Lebanon Hospital Center and fellowship training in colorectal surgery at the Cleveland Clinic. He is board certified in surgery and in colon and rectal surgery from the American College of Surgeons (FACS) and the American Society of Colon and Rectal Surgeons (FASCRS) and is a fellow of the Royal Colleges of Surgeons of England and Glasgow.

The author of more than 200 peer-reviewed publications, Dr. Kiran is also an editor and reviewer for numerous prominent journals and textbooks. As a student and physician, he has earned several distinctions, including the National Merit Scholarship and Gold Medals during his medical education and surgical training in India, Resident Researcher of the Year during surgical residency, Teacher of the Year in Colorectal Surgery at Cleveland Clinic in 2011, and the ASCRS Travelling Fellow Award in 2012, and was voted to the list of Best Doctors in Cleveland.

####

NewYork-Presbyterian Hospital, based in New York City, is the nation’s largest not-for-profit, non-sectarian hospital, with 2,409 beds. The Hospital has nearly 2 million inpatient and outpatient visits in a year, including 12,758 deliveries and 215,946 visits to its emergency departments. NewYork-Presbyterian’s 6,144 affiliated physicians and 20,154 staff provide state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children’s Hospital, NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian Hospital/Westchester Division. One of the most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. The Hospital has academic affiliations with two of the nation’s leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. For more information, visit www.nyp.org.

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.

The post Dr. Ravi Kiran Appointed Chief of Colorectal Surgery appeared first on Columbia University Medical Center.

A new study of gastric bypass surgery co-authored by physicians at Columbia University Medical Center has found that 49 percent of patients who have the surgery have their diabetes under control one year after surgery, compared with just 19 percent of patients who are put on an intensive medical management and lifestyle intervention program.

The findings were published June 5 in the Journal of the American Medical Association by a team of researchers from the University of Minnesota, Columbia, National Taiwan University Hospital, Mount Sinai Medical Center, Min-Sheng General Hospital in Taiwan, and the Mayo Clinic.

Gastric bypass surgery was designed to help people lose weight, but in the past decade physicians have noticed that the surgery can also improve diabetes control and, in some patients, remove the need for diabetes medications. With typical medical management, only 10 percent of type 2 diabetes patients in the United States can meet treatment targets established by the American Diabetes Association (ADA).

RELATED STORY: Does Metabolic Surgery “Cure” Diabetes?

“Right now there are millions of people with diabetes; it is one of the leading causes of heart disease, kidney failure, and blindness. It’s very difficult to prevent these problems, so the question of bariatric surgery is coming up more and more frequently. We don’t know if we should offer surgery or medical management,” says co-author Judith Korner, MD, PhD, associate professor of medicine and director of the Weight Control Center at Columbia University Medical Center.

Though observational studies that have followed surgical patients over time suggest that 40 to 80 percent of patients are helped by bariatric surgery, randomized control trials are considered the “gold standard” of evidence.

The study by Korner and her colleagues is among the first randomized clinical trials with diabetes patients to compare the two treatments. In the trial, 60 patients with diabetes and a Body Mass Index (BMI) between 30 and 40 underwent gastric bypass. Another 60 patients followed an intensive medical management protocol that included weekly support from dietitians and medications.

After one year, the researchers measured the ADA’s three treatment targets: glucose control (HbA1c under 7 percent), low LDL cholesterol (under 100 mg/dL), and a systolic blood pressure less than 130 mm Hg. Close to half of the gastric bypass patients met the three targets, compared with 19 percent of the medical management group.

Bariatric surgery is currently offered only to diabetes patients with a BMI of 35 or above, but based on the study’s findings, says Korner, that criterion may need to be re-evaluated.

“In our study patients with lower BMIs did as well as patients with higher BMIs; that really puts into question the criteria we have for who gets the surgery and who doesn’t,” she says. “Perhaps other health criteria should be applied, rather than high BMI, which is somewhat arbitrary.”

But first, larger randomized studies should be performed and more long-term data collected.

“The big question now is, how long will the improvements last,” Korner says. “If they last only two years, we have to ask whether it’s worth having the surgery. But if it lasts 10 to 15 years—as we see in some of the observational studies—it’s worth considering.”

An editorial published in JAMA with the study also says that more safety data is needed.

Bariatric surgery does result in substantial weight loss with excellent diabetes control but is offset by initial high cost and risks of surgical complications. The optimal approach for treatment of obesity and diabetes remains unknown. The answer will only come from more well-designed, randomized trials such as that performed by Ikramuddin et al that provide definitive answers.

For more information on the study, see the press release issued by JAMA or watch a video with the corresponding author, Sayeed Ikramuddin, MD, professor of surgery at the University of Minnesota.

http://newsroom.cumc.columbia.edu/wp-admin/post.php?post=18772&action=edit

The post Gastric Bypass Surgery Beats Medical Treatment at Managing Diabetes appeared first on Columbia University Medical Center.

Who: Nomita Sonty, PhD

Associate Clinical Professor of Medical Psychology
Administrative Director, Center for Pain Management, Department of Anesthesiology

What: Reduced patient wait times by up to 95 percent

How: Scheduling shifts and text messages to stay on time

As the administrative director of the Pain Management Center, Dr. Nomita Sonty had a problem—a hardworking physician with an overflowing schedule and a waiting room full of loyal but frustrated patients. Data from the patient-satisfaction survey company Press Ganey showed that the physician’s patients didn’t like waiting two hours; and his staff was frustrated because he wasn’t willing to give them much latitude in scheduling.

It was up to Dr. Sonty to break the bad news. “Time has become so precious for everyone, especially people who are working, that there’s a sense among patients that some physicians ‘value their own time but don’t value mine.’” That notion, Dr. Sonty says, is one that doctors cannot afford to perpetuate.

When this doctor, who thought a full schedule equaled a good schedule, saw the negative comments, Dr. Sonty says, she was able to persuade him that “by organizing his schedule differently, things would work better.” By reviewing the data, digging into the process, and getting buy-in from the physician, she was able to help him make needed improvements.

First they tried scheduling consult visits with shorter follow-up visits between them, but the doctor ran late when he lost track of time. “Interrupt me!” the doctor said. But finding an unobtrusive way to do so became a challenge. His staff tried a range of ways to get his attention, but all were deemed too intrusive.

Finally, when they tried texting the doctor, they met with success. “I am doing a time study from the time patients walk up to the front desk to the time they enter the exam room,” and this process has drastically reduced patient wait times, down from highs of one to two hours to five to 10 minutes, Dr. Sonty says.

If the doctor was running behind on a 45-minute consult, the team was instructed to send the doctor a text message. The doctor would excuse himself, meet with the waiting follow-up patient, and then resume his consult.

“I learned from the Access and Patient Satisfaction Committee to manage patient expectations by making sure they are informed when physicians are running late.” So far, it’s worked really well, with no patients choosing to reschedule a visit as a result, she says.

Dr. Sonty says there have been no patient complaints at all as a result of these changes. And, she adds, she’s noticed a small upswing in positive comments about wait times in recent Press Ganey reports.

The post Practice Tip: Taking the Pain Out of Waiting appeared first on Columbia University Medical Center.

Key to the academy’s success is the recognition that many staff already know how to do their jobs well. It is about sharing best practices and finding common solutions, not dictating them. “Managers and staff come to training with lots of knowledge and experience. My job is to help them share it,” says Aaron Vieira, ColumbiaDoctors training and development specialist.

The COMPASS Learning Academy provides a range of training to communicate and amplify key skills and share best practices for staff and managers who interact with patients. The ongoing program reinforces standards that make ColumbiaDoctors a destination for coordinated patient care, superior service, and improved patient satisfaction.

“Through the Learning Academy, we aim to ensure that our practice managers and staff have the right knowledge and tools to provide ‘wow’ service to our patients,” says Katherine Dauer, ColumbiaDoctors’ director of patient access.

Satisfied patients, she adds, will come back, tell friends about their great experiences, be engaged in their care, and have better clinical outcomes. “This will contribute positively to our financial bottom line, but more important, it is the right thing to do for our patients.”

In surveys from the first quarter of 2013, 92 percent of respondents said that the COMPASS Learning Academy training sessions were either “very good” or “excellent,” and 99 percent said that they would recommend the training to their colleagues.

Individuals reported that they immediately started using skills they learned to defuse tense situations and improve patient interactions.

Dagmaris Lopez-Reyes and Mary O’Connor of the Department of Obstetrics and Gynecology say they see the benefit of their Compass coursework in improved interactions with patients.

“I learned there are other ways to handle difficult challenges,” says Jennifer Valenzuela, Practice Manager/Medicine for CUMC’s Division of Digestive and Liver Disease, who participated in five of the trainings. During a recent training, attendees discussing professional communication skills were asked by Vieira how they had used skills discussed in earlier courses to improve patients’ experience of their visit.

“I go out of my way to make sure each patient feels like the only person in the office,” said Mary O’Connor, a physician aide in the Department of Obstetrics and Gynecology. “We are all a reflection of each other. We need to work as a team so patients walk away with a good memory of their time at ColumbiaDoctors.”

An Ob/Gyn colleague, medical secretary Dagmaris Lopez-Reyes, said follow through was very important with those patients she speaks with on the phone. “I remember to ask them if they need anything else at the end of the conversation, and it’s most important to follow up if they say they need a call made.”

Lopez-Reyes added that using the skills she’d learned in class had had a clear effect on her performance and interaction at work. “Being aware of my emotions helps me regulate everything from my body language to my tone of voice.”

Have you completed your Learning Academy classwork? Register now for an upcoming class or review the schedule here.

The post COMPASS Learning Academy: Finding the Way to Best Practices appeared first on Columbia University Medical Center.