Alternate lab test shows comparable accuracy, non-biased results.

In a study supported by the National Institutes of Health, researchers propose changing a key measure in kidney disease diagnosis and treatment to eliminate the use of race as a variable, providing a non-biased kidney function test that does not compromise accuracy. The study suggests use of a blood lab test called cystatin C, which does not vary by a person’s race, to replace the current lab test called creatinine, which does. The findings come from a detailed analysis of data from the Chronic Renal Insufficiency Cohort (CRIC) Study, a nationwide longstanding study funded by NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The results are published in the New England Journal of Medicine(link is external).

Health care providers use estimated glomerular filtration rate, or eGFR, calculations as a primary diagnostic tool to learn how well a person’s kidneys function and to classify the severity of their disease, from mild loss of kidney function to end-stage kidney disease. The eGFR helps determine prognosis and treatment, such as when hemodialysis or a transplant may be needed.

Since 1999, race has been a variable used in estimating GFR. Current eGFR calculations also use a person’s age, sex, and serum creatinine levels. Serum creatinine, which the kidneys filter out, is a waste product from the normal metabolism of muscle cells in one’s body. Studies have shown that Black Americans, on average, can have higher levels of serum creatinine in their blood, independent of kidney function. To account for this difference, eGFR calculations include a person’s self-reported race to give more valid results.

“Using race as a testing factor risks kidney disease misdiagnosis. There is great variance within the genetic ancestry of people who identify as ‘Black’ which means we cannot reliably view ‘Black’ people as being from a single ancestral group,” said Afshin Parsa, M.D., NIDDK program director for CRIC. “Misdiagnosis could lead to a person receiving incorrect drug dosing, or delays in receiving dialysis or a kidney transplant. Current eGFR calculations could be exacerbating racial inequities in a disease that disproportionately affects Black people, so this study set out to identify factors that wouldn’t rely on including a person’s race to calculate eGFR.”

CRIC researchers found that even when adjusting for a wide range of factors, using serum creatinine to calculate eGFR without using a race term can lead to systematic bias and race-related misclassification of kidney disease status in people tested.

Yet, unlike serum creatinine, most biomarkers – substances that can help identify disease or stages of a disorder – aren’t affected by race or ancestry. By analyzing data from CRIC participants, the researchers found that using cystatin C – which is not affected by race or ancestry – as a race-independent replacement biomarker for serum creatinine provided accurate and non-biased results.

“We hope this study’s results will build momentum toward widespread adoption of cystatin C for the purposes of estimating GFR. The alternative eGFR test requires no special equipment, can be standardized, and the more it’s adopted, the less it would cost,” said Chi-yuan Hsu, M.D., professor and chief of nephrology at University of California, San Francisco, and lead author of the study.

CRIC is one of the largest and longest-running studies looking at the causes, frequency, and consequences of chronic kidney disease, or CKD, in the United States. Nearly all CRIC’s participants are people with mild to severe loss of kidney function. Since Black people are at higher risk for CKD than other groups, approximately half of CRIC participants are Black. This analysis used more than 1,200 CRIC participants’ data, including measures of body mass and muscle mass, genetic ancestry data, and self-identified race.

“An accurate eGFR formula that does not rely on self-reported race is a huge leap forward for all people with, and at risk for, chronic kidney disease,” said NIDDK Director Griffin P. Rodgers, M.D. “NIDDK is committed to addressing health disparities, and we hope this study’s finding leads to positive changes in how CKD is identified and treated—helping address the risk of systemic bias and error in diagnosing and treating a disease that already disproportionately affects Black people.”

CRIC received funding through NIDDK grants DK060990, DK060984, DK061022, DK061021, DK061028, DK060980, DK060963, and DK060902.

About the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): The NIDDK, a component of the National Institutes of Health (NIH), conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe, and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see www.niddk.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.



Better outcomes are inherent only if correct medications are dispensed, researchers say

September 23 2021 – Many prescriptions are sent to the pharmacy via electronic health record systems; however, correct routing of discontinued medications continues to be a problem, which increases the risk for medication safety events. In an abstract presented at the American College of Cardiology Quality Summit Virtual, taking place Sept. 29 – Oct. 1, 2021, Intermountain Healthcare examined several methods to alert community pharmacy staff about canceled medications, potentially avoiding almost 200 safety events over two months.

“Currently there is no ideal way to notify a pharmacy that a clinician has discontinued medication for a patient, often leading to a discontinued medication or incorrect dose to be refilled and causing confusion for the patient,” said Jeffrey A. Goss, FNP-c, MSN, APP Director of Heart Failure for Intermountain Healthcare in Murray, Utah, and one of the study authors. “Patients are at risk for taking a medication that is no longer indicated or at the wrong dose, which has important medication safety indications.”

The study was designed to determine why pharmacy communication on canceled medications was not occurring and identify the best way to communicate those changes from the patient encounter to the pharmacy. According to the researchers, Intermountain Healthcare had a number of safety events occur involving discontinued medications being taken along with new medications, resulting in hospitalization.

Initially, the team at Intermountain Healthcare tried temporary fixes, including clinical staff (registered nurses or pharmacists) personally calling the pharmacy to alert them of medication changes and requesting the medication be removed from the patient’s profile. Clinicians were also asked to document medication changes in the “comments” box of a prescription being sent electronically to alert pharmacy staff about medication changes. This includes documenting information such as, “this prescription replaces…,” but not all pharmacies see this information and it was not a reliable method of communication.

Over the course of 60 days, 16 advanced practice providers at the Intermountain Medical Center Advanced Heart Failure/Transplant team turned on the CancelRX functionality in their electronic medical record system. CancelRX is a function that notifies the pharmacy of a discontinued medication as it would a new prescription. The functionality was initially turned off due to a high number of associated error messages to clinicians. It is also dependent on the pharmacy also having this functionality turned on to receive the messages.

During the CancelRX trial, the Intermountain Medical Center Advanced Heart Failure/Transplant team tracked a totally of 558 discontinued medications. The team received 359 error messages and made 148 phone calls to pharmacies. In total, 196 potential safety events were avoided using both phone calls and CancelRX during the 60-day trial. The five pharmacies or chains where error messages were received by the trial team included Intermountain Pharmacies (210), Smiths (117), Walgreens (38), Costco (25) and CVS (23).

“Effective communication between the clinician and the pharmacy is paramount to ensuring patients only received medications they require. In addition to the safety implications, this will also reduce the likelihood of a patient purchasing a discontinued prescription, resulting in cost savings for patients and insurance payers,” said Steven Metz, PharmD, BCPS, Advanced Clinical Ambulatory Care Pharmacist, Intermountain Healthcare in Murray, Utah, and one of the study authors.

According to the researchers, better outcomes are inherent if the correct medications are being dispensed to patients based on clinician recommendations. They recommend health systems review how their electronic medical record system interface with their local pharmacies to ensure one less area of potential error in patient care.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.



The following statement is attributable to:
Gerald E. Harmon, M.D.
President, American Medical Association on September 23 2021

“We commend the Advisory Committee on Immunization Practices (ACIP) for their thoughtful deliberations and recommendations supporting a booster dose of the Pfizer-BioNTech COVID-19 vaccine, at least six months after the primary series, in individuals 65 years of age and older, long-term care facility residents, and in persons aged 50 – 64 with underlying medical conditions. The ACIP also recommended a booster dose based on individual risk-benefit analysis for those aged 18 – 49 with underlying medical conditions.

“The latest data shows a decline in vaccine effectiveness against SARS-CoV-2 infection in individuals 65 years of age and older, particularly during the Delta wave. The good news is data also shows that a booster dose of the Pfizer-BioNTech COVID-19 vaccine, given six months after the primary series, increases the immune response in this population. Today’s recommendation will help provide those individuals for whom the benefits of boosters outweigh the risks with further protection against COVID-19 cases, hospitalizations and deaths.

“The scientific evidence is clear that the vaccines against COVID-19 are safe and remain effective in preventing hospitalization and severe disease. With hospitalization rates 10 to 22 times higher in the unvaccinated compared to the vaccinated, our top priority should remain reaching those individuals who remain unvaccinated against COVID-19. We continue to strongly urge everyone who has not yet been vaccinated against COVID-19 and is eligible, including pregnant people, to get vaccinated as soon as possible to protect themselves and their loved ones from severe complications, hospitalization, and death.

“Following the deliberations of the Vaccines and Related Biological Products Advisory Committee and the action taken by the U.S. Food and Drug Administration yesterday to authorize Pfizer-BioNTech COVID-19 vaccine boosters, ACIP’s recommendation will allow physicians and other vaccine providers to offer a booster dose of the Pfizer vaccine to those patients who need it.

“The ACIP did not recommend booster doses for adults at risk of occupational or environmental exposure, such as health care personnel, teachers, and other essential workers. We await further reviews of the evidence on booster doses in this population, which we believe could help preserve our nation’s health care capacity so we can continue providing care to our patients. We also acknowledge that those who received the Moderna and Johnson & Johnson COVID-19 vaccines are awaiting guidance on booster doses.

“Anyone with questions about the vaccines should speak with their physician and review trusted resources, including getvaccineanswers.org. We will continue to support measures to ensure widespread vaccination among our communities and other evidence-based public health measures, such as physical distancing and wearing face masks, to help protect those not yet eligible for vaccination.”



Board also approves increase in Memorial’s minimum wage to $15/hour

September 23 2021 – South Florida, like other areas of the country, has experienced serious surges brought on by the COVID-19 pandemic, creating a high demand for healthcare services and challenges across hospitals. Medical teams cared for a high level of COVID-19 cases coupled with steady patient volumes in other clinical areas, such as cardiac and cancer.

Memorial Healthcare System has been on the forefront of the pandemic, managing up to 738 COVID-19 positive patients at the peak of the latest surge, while also investing $16 million in personal protection supplies, and supplementing its front line with close to 1,000 contract nurses to address the constant needs brought on by the pandemic this past year.

Such level of response had significant impact on Memorial’s finances, yet the Board of Commissioners for the South Broward Hospital District, which oversees all actions for Memorial, voted Wednesday to still move forward with the adoption of the lowest millage rate ever recorded for the district. This latest millage reduction to 0.1144 marks the 11th year in a row that the Board has voted to lower the overall millage rate, resulting in the lowest rate in the history of the South Broward Hospital District. Commissioners supported their decision based on Memorial’s strong financial position and having the ability to provide that reduction to residents in south Broward County. 

What does the lowest millage rate represent?

The 0.1144 millage rate represents a 4.59 percent decrease from last year’s rate of 0.1199. The resulting gross tax revenues are estimated to reach $7.7 million. After accounting for early payment discounts and a certain percentage of uncollectible taxes, the anticipated tax payments this year of $7.6 million will provide the District enough revenue to cover its governmental obligations, which include paying Broward County’s Medicaid Match program and community redevelopment agencies in several municipalities in south Broward County, as well as tax collector commissions and property appraiser fees.

The newly adopted millage rate will leave no net tax revenue to fund uncompensated care, the District will use operating income to cover all uncompensated care costs for the entire Memorial Healthcare System, including its six hospitals and its eight Memorial Primary Care clinics. In fiscal year 2022 uncompensated care is projected to exceed $967 million.

Memorial’s Minimum Wage Increase

On a separate and unanimous vote, the Board of Commissioners also approved an increase in the Memorial Minimum Wage, from $13 an hour to $15 an hour – an investment of over $8 million in Memorial’s workforce. This is the second minimum wage increase in the last six months.

This historic reduction of this millage rate coupled with the increase in minimum wage also comes at a time when Memorial Healthcare System continues to offer a comprehensive array of services, such as cardiac and stroke care, Level 1 trauma services, maternity, kidney transplant and many others. Memorial’s quality and safety has been recognized nationally by Leapfrog Group, a national nonprofit organization that collects and transparently reports hospital performance. Memorial Cardiac and Vascular Institute continues to receive outstanding ratings from the Society of Thoracic Surgeons, placing Memorial in the top 1% of U.S. cardiovascular centers for 2017. Memorial also remains one of only a handful of public hospitals in the nation to achieve AA, Aa3 financial ratings by Standard and Poor’s and Moody’s, respectively.  

About Memorial Healthcare System

Memorial Healthcare System is one of the largest public healthcare systems in the country and is a national leader in quality care and patient satisfaction. Its facilities include Memorial Regional Hospital, Memorial Regional Hospital South, Joe DiMaggio Children’s Hospital, Memorial Hospital West, Memorial Hospital Miramar, Memorial Hospital Pembroke and Memorial Manor nursing home. The system received the following recognitions: Modern Healthcare magazine’s “Best Place to Work in Healthcare,” Florida Trend’s “Florida’s Best Companies to Work For,” and Becker’s Hospital Review’s “150 Great Places to Work in Healthcare.” For more information, visit mhs.net.



September 23 2021 – Visitors to Joe DiMaggio Children’s Hospital often comment that it doesn’t feel like a traditional hospital. That’s due, in large part, to its power-of-play philosophy, an all-encompassing effort to make ‘Joe D.’ a warm and welcoming place for children and families.

Now, thanks to the generosity of the Finker-Frenkel Family Foundation, positive experiences for patients will be taken to a new level, literally, as part of the four-story expansion of the hospital. The future eighth floor, currently under construction, will feature the nation’s newest Garth Brooks Teammates for Kids Child Life Zone with therapeutic play, relaxation and interactive areas for children in the hospital. The space will become the 14th Child Life Zone that Teammates for Kids has created through partnerships with some of the country’s leading children’s hospitals. 

“On behalf of our board, we want to say thanks to the Finker-Frenkel Family Foundation for their support of the Child Life Zone at Joe DiMaggio Children’s Hospital. Along with the amazing Child Life staff, their support will allow kids to do what they do best, BE KIDS!,” said Jason Grahame, president of Teammates for Kids.

The significant contribution made by the Finker-Frenkel Family Foundation is part of “Catch the Love,” the capital campaign that will underwrite a substantial part of the estimated $170 million cost to expand the children’s hospital from four floors to eight. Joe DiMaggio Children’s Hospital Foundation has already raised more than $40 million in the fundraising effort.   

“One of our foundation’s major areas of focus has always been promoting the health and welfare of children around the world,” said Raul Cabrera, a spokesperson for the Finker-Frenkel Family Foundation. “Joe DiMaggio Children’s Hospital has long been a safe and welcoming space for kids and families going through some of the hardest times of their lives. Words cannot express how proud I am to be supporting this incredible organization as it expands to help more children.”

In addition to the Child Life Zone, the expanded Joe DiMaggio Children’s Hospital will add new state-of-the-art patient rooms, cardiac hybrid operating rooms, additional surgical and interventional radiology suites, new intensive care and cardiac intensive care units, and an intraoperative MRI. The project is expected to be completed in the fall of 2022.

Joe DiMaggio Children’s Hospital is one of the nation’s leading pediatric hospitals, offering a comprehensive scope of healthcare services and programs in a caring, compassionate setting designed specifically for children. A level one trauma center, it combines advanced technology, the expertise of board-certified specialists, and a patient and family-centered approach to heal the body, mind, and spirit of those it touches.

The hospital’s nonprofit foundation focuses on philanthropy to positively impact patients, families, and underwrite programs, facilities, and equipment that support the pediatric facility’s mission. 

To learn more about Joe DiMaggio Children’s Hospital, visit jdch.com and connect with @jdchospital on Facebook, Twitter, YouTube, and Instagram.