Publications by authors named "Jennifer Leiser"

13 Publications

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Increasing URiM Family Medicine Residents at University of Utah Health.

PRiMER 2021 26;5:42. Epub 2021 Oct 26.

Office for Health Equity and Inclusion, University of Utah, Salt Lake City, UT.

Introduction: The Department of Family and Preventive Medicine is home for the University of Utah's Family Medicine Residency program. Although Utah's diversity is steadily increasing, the race/ethnic diversity of the program's family medicine residency does not reflect the state's general population.

Methods: From 2017 to 2021, the residency instituted several adjustments to recruitment processes, including modification of an existing screening system to better highlight resiliency in overcoming challenging life experiences; promotion of commitment to diversity during interview days; incorporation of increased participation from diverse faculty and residents on interview days; and addition of outreach from the Office of Health, Equity, Diversity, and Inclusion. Underrepresented in medicine (URiM) applicants were the first to be offered interviews in an identical screening score cohort, and were ranked highest in rank lists in cohorts with identical final rank scores.

Results: Over the past five match cycles, Latinx residents have increased from zero to six, and underrepresented Asian residents from zero to two. In the 2021 match cycle, five of 10 incoming residents (50%) are URiM. Overall, URiM residents are now 30%, and residents of color 36%, of a total of 30 residents across all 3 training years. We found that eight URiM interviews were needed for every one URiM match.

Conclusion: Intentional resident recruitment initiatives can transform racial/ethnic diversity in a family medicine residency program in a short amount of time.
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http://dx.doi.org/10.22454/PRiMER.2021.279738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8612583PMC
October 2021

Understanding the Prevalence of Prediabetes and Diabetes in Patients With Cancer in Clinical Practice: A Real-World Cohort Study.

J Natl Compr Canc Netw 2021 Mar 10;19(6):709-718. Epub 2021 Mar 10.

2Huntsman Cancer Institute, and.

Background: This study aimed to understand the prevalence of prediabetes (preDM) and diabetes mellitus (DM) in patients with cancer overall and by tumor site, cancer treatment, and time point in the cancer continuum.

Methods: This cohort study was conducted at Huntsman Cancer Institute at the University of Utah. Patients with a first primary invasive cancer enrolled in the Total Cancer Care protocol between July 2016 and July 2018 were eligible. Prevalence of preDM and DM was based on ICD code, laboratory tests for hemoglobin A1c, fasting plasma glucose, nonfasting blood glucose, or insulin prescription.

Results: The final cohort comprised 3,512 patients with cancer, with a mean age of 57.8 years at cancer diagnosis. Of all patients, 49.1% (n=1,724) were female. At cancer diagnosis, the prevalence of preDM and DM was 6.0% (95% CI, 5.3%-6.8%) and 12.2% (95% CI, 11.2%-13.3%), respectively. One year after diagnosis the prevalence was 16.6% (95% CI, 15.4%-17.9%) and 25.0% (95% CI, 23.6%-26.4%), respectively. At the end of the observation period, the prevalence of preDM and DM was 21.2% (95% CI, 19.9%-22.6%) and 32.6% (95% CI, 31.1%-34.2%), respectively. Patients with myeloma (39.2%; 95% CI, 32.6%-46.2%) had the highest prevalence of preDM, and those with pancreatic cancer had the highest prevalence of DM (65.1%; 95% CI, 57.0%-72.3%). Patients who underwent chemotherapy, radiotherapy, or immunotherapy had a higher prevalence of preDM and DM compared with those who did not undergo these therapies.

Conclusions: Every second patient with cancer experiences preDM or DM. It is essential to foster interprofessional collaboration and to develop evidence-based practice guidelines. A better understanding of the impact of cancer treatment on the development of preDM and DM remains critical.
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http://dx.doi.org/10.6004/jnccn.2020.7653DOI Listing
March 2021

Which detoxification regimens are effective for alcohol withdrawal syndrome?

J Fam Pract 2021 03;70(2):E16-E17

Family Physicians Inquiries Network.

BENZODIAZEPINES REMAIN THE FIRST-LINE REGIMEN FOR ALCOHOL WITHDRAWAL SYNDROME (AWS) AND ARE THE ONLY CLASS MORE EFFECTIVE THAN PLACEBO FOR REDUCING SEIZURE (STRENGTH OF RECOMMENDATION [SOR]: B, BASED ON 3 MEDIUM-QUALITY RANDOMIZED CONTROLLED TRIALS [RCTS]). ANTICONVULSANTS ARE NO MORE EFFECTIVE THAN PLACEBO AT REDUCING SEIZURES (SOR: B, BASED ON 10 MODERATE-QUALITY RCTS). GABAPENTIN REDUCES WITHDRAWAL SYMPTOMS AND IS LESS SEDATING THAN BENZODIAZEPINES (SOR: B, BASED ON 1 MEDIUM-QUALITY RCT). CARBAMAZEPINE ALSO REDUCES WITHDRAWAL SYMPTOMS (SOR: B, BASED ON 3 RCTS). EVIDENCE OF BENZODIAZEPINE SUPERIORITY TO OTHER DRUGS WITH RESPECT TO SAFETY IS LACKING (SOR: A, BASED ON A META-ANALYSIS).
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http://dx.doi.org/10.12788/jfp.0157DOI Listing
March 2021

A Longitudinal Curriculum for Quality Improvement, Leadership Experience, and Scholarship in a Family Medicine Residency Program.

Fam Med 2020 09;52(8):570-575

Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT.

Background And Objectives: The Accreditation Council for Graduate Medical Education (ACGME) requires all residents be trained in quality improvement (QI), and that they produce scholarly projects. While not an ACGME requirement, residents need leadership skills to apply QI knowledge. We developed the Skills-based Experiential Embedded Quality Improvement (SEE-QI) curriculum to integrate training in QI, leadership, and scholarship.

Methods: The University of Utah Family Medicine Residency Program began using the novel curriculum in 2012. The aim of the curriculum is to tie didactic teaching in quality improvement, leadership, and scholarship with skills application on multidisciplinary QI teams. Coaching for resident leaders is provided by faculty. Third-year resident leaders prepare academic presentations. Results of the ACGME Practice-Based Learning and Improvement (PBLI) 3 scores and number of scholarship presentations are described as a measure of efficacy.

Results: Two cohorts of residents completed the curriculum and all competency assessments. The average initial and final competency scores for competency PBLI-3 showed improvement and the average final competency for each cohort was above the proficient level. The residency requirements for QI scholarship did not change with introduction of the curriculum, but the amount of optional curricular QI scholarship and independent QI scholarship increased.

Conclusions: The SEE-QI curriculum resulted in a high level of resident QI competency, opportunity for leadership training, and an increase in scholarship. We studied the results of this curriculum at one institution. Efforts to tie QI, leadership, and scholarship training should be evaluated at other programs.
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http://dx.doi.org/10.22454/FamMed.2020.679626DOI Listing
September 2020

Outcomes Associated with Pharmacist-Led Diabetes Collaborative Drug Therapy Management in a Medicaid Population.

J Pharm Health Serv Res 2017 Mar 19;8(1):59-62. Epub 2016 Dec 19.

Department of Pharmacotherapy, University of Utah, 30 S. 2000 E., Salt Lake City, UT 84112, 801 587 7728,

Objectives: Pharmacist-led diabetes collaborative drug therapy management (CDTM) has been shown to improve outcomes. Whether such programs are effective specifically in Medicaid patients, who face barriers to access and self-management, has not been well characterized. This pilot study explores glycemic control, utilization and costs associated with pharmacist-led CDTM in a small population of Medicaid patients with type 2 diabetes mellitus (T2DM).

Methods: A pre-post, historical cohort study was conducted of patients with T2DM and Medicaid coverage who received pharmacist-led CDTM in community-based primary clinics between 2008-2012. Outcomes included change in HbA1c, healthcare costs and utilization.

Results: This study included 79 Medicaid patients with T2DM who received pharmacist-led CDTM. A subset of 46 patients with Medicaid coverage through an affiliated Medicaid Plan, Healthy U, was identified for additional analysis. At 6-months follow-up, HbA1c was a mean (SD) of 2.0% (2.0) lower than the baseline of 10.3% (1.7). Primary care clinic encounters increased by a mean (median) of 3.4 (2) visits. Per patient health system charges increased by a mean (median) of $4,392 ($620) and the amount paid by Medicaid in the Healthy U subset was $822 ($68) higher in the follow-up period.

Conclusion: A pharmacist-led diabetes CDTM intervention was associated with improved glycemic control in Medicaid patients, which corresponded with a higher number of primary care visits and observed costs. These findings are consistent with studies not limited to Medicaid, suggesting that CDTM can be effective in type 2 diabetes patients with Medicaid coverage.
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http://dx.doi.org/10.1111/jphs.12162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473652PMC
March 2017

Measuring body mass index according to protocol: how are height and weight obtained?

J Healthc Qual 2011 May-Jun;33(3):28-36. Epub 2010 Nov 11.

Division of Public Health, University of Utah School of Medicine, USA.

Previous investigation at our resident-teaching, family medicine clinics determined that >80% of adult patients have body mass index (BMI) recorded in the electronic medical record. The quality of this measure, however, is not known. The objective of this study was to determine the accuracy of documented BMI. We used an observational study design to determine the means by which clinic staff obtain height and weight values from patients. We found that staff only obtained 35.4% of these measurements according to protocol. The major reason for noncompliance with protocol was that shoes were not removed for the measurements. Our investigation indicated that providers, quality improvement teams, and researchers should not assume the accuracy of the recorded BMI. Future investigation is warranted to improve the quality of these measurements in the outpatient setting.
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http://dx.doi.org/10.1111/j.1945-1474.2010.00115.xDOI Listing
June 2012

Primary care issues in patients with mental illness.

Am Fam Physician 2008 Aug;78(3):355-62

Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.

Family physicians commonly care for patients with serious mental illness. Patients with psychotic and bipolar disorders have more comorbid medical conditions and higher mortality rates than patients without serious mental illness. Many medications prescribed for serious mental illness have significant metabolic and cardiovascular adverse effects. Patients treated with second-generation antipsychotics should receive preventive counseling and treatment for obesity, hyperglycemia, diabetes, and hyperlipidemia. First- and second-generation antipsychotics have been associated with QT prolongation. Many common medications can interact with antipsychotics, increasing the risk of cardiac arrhythmias and sudden death. Drug interactions can also lead to increased adverse effects, increased or decreased drug levels, toxicity, or treatment failure. Physicians should carefully consider the risks and benefits of second-generation antipsychotic medications, and patient care should be coordinated between primary care physicians and mental health professionals to prevent serious adverse effects.
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August 2008

Cerebral palsy: physical activity and sport.

Curr Sports Med Rep 2006 Dec;5(6):319-22

Shriners Hospitals for Children Intermountain, Fairfax Road at Virginia Street, Salt Lake City, UT 84103, USA.

Physical activity and fitness are well recognized as essential to the health of able-bodied people, both young and old. The exact role of athletics and fitness in the lives of people with cerebral palsy is less well defined. In this review we examine the benefits of physical activity and athletics for people of all ages with cerebral palsy. Precautions for safe exercise prescription are discussed. The primary care practitioner will be able to recommend appropriate activities or refer patients to appropriate sources for further evaluation.
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http://dx.doi.org/10.1007/s11932-006-0060-xDOI Listing
December 2006

Management of the difficult patient.

Am Fam Physician 2005 Nov;72(10):2063-8

The University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.

All physicians must care for some patients who are perceived as difficult because of behavioral or emotional aspects that affect their care. Difficulties may be traced to patient, physician, or health care system factors. Patient factors include psychiatric disorders, personality disorders, and subclinical behavior traits. Physician factors include overwork, poor communication skills, low level of experience, and discomfort with uncertainty. Health care system factors include productivity pressures, changes in health care financing, fragmentation of visits, and the availability of outside information sources that challenge the physician's authority. Patients should be assessed carefully for untreated psychopathology. Physicians should seek professional care or support from peers. Specific communication techniques and greater patient involvement in the process of care may enhance the relationship.
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November 2005

Caspase inhibition attenuates contractile dysfunction following cardioplegic arrest and rewarming in the setting of left ventricular failure.

J Cardiovasc Pharmacol 2004 Dec;44(6):645-50

Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.

Hyperkalemic cardioplegic arrest (HCA) and rewarming evokes postoperative myocyte contractile dysfunction, a phenomenon of particular importance in settings of preexisting left ventricular (LV) failure. Caspases are intracellular proteolytic enzymes recently demonstrated to degrade myocardial contractile proteins. This study tested the hypothesis that myocyte contractile dysfunction induced by HCA could be ameliorated with caspase inhibition in the setting of compromised myocardial function. LV myocytes were isolated from control pigs (n = 9, 30 kg) or pigs with LV failure induced by rapid pacing (n = 6, 240 bpm for 21 days) and were randomized to the following: (1) normothermia (2003 myocytes), incubation in cell culture medium for 2 hours at 37 degrees C; (2) HCA only (506 myocytes), incubation for 2 hours in hypothermic HCA solution (4 degrees C, 24 mEq K); or (3) HCA + z-VAD, incubation in hypothermic HCA solution supplemented with 10 microM of the caspase inhibitor z-VAD (z-Val-Ala-Asp-fluoromethyl-ketone, 415 myocytes). Inotropic responsiveness was examined using beta-adrenergic stimulation (25 nM isoproterenol). Ambient normothermic myocyte shortening velocity (microm/s) was reduced with LV failure compared with control values (54 +/- 2 versus 75 +/- 2, respectively, P < 0.05). Following HCA, shortening velocity decreased in the LV failure and control groups (27 +/- 5 and 45 +/- 3, P < 0.05). Institution of z-VAD increased myocyte shortening velocity following HCA in both the LV failure and control groups (49 +/- 5 and 65 +/- 5, P < 0.05). Moreover, HCA supplementation with z-VAD increased beta-adrenergic responsiveness in both groups compared with HCA-only values. This study provides proof of concept that caspase activity contributes to myocyte contractile dysfunction following simulated HCA. Pharmacologic caspase inhibition may hold particular relevance in the execution of cardiac surgical procedures requiring HCA in the context of preexisting LV failure.
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http://dx.doi.org/10.1097/00005344-200412000-00004DOI Listing
December 2004

Myocyte contractility with caspase inhibition and simulated hyperkalemic cardioplegic arrest.

Ann Thorac Surg 2004 May;77(5):1684-9; discussion 1689-90

Division of Cardiothoracic Surgery Research, Medical University of South Carolina, Charleston, South Carolina 29425, USA.

Background: Exposure of left ventricular (LV) myocytes to simulated hyperkalemic cardioplegic arrest (HCA) has been demonstrated to perturb ionic homeostasis and adversely affect myocyte contractility on rewarming. Altered ionic homeostasis can cause cytosolic activation of the caspases. While caspases participate in apoptosis, these proteases can degrade myocyte contractile proteins, and thereby alter myocyte contractility. Accordingly, this study tested the hypothesis that caspase inhibition during HCA would attenuate the degree of myocyte contractile dysfunction upon rewarming, independent of a loss in myocyte viability.

Methods: Porcine (n = 8) LV myocytes were isolated and assigned to the following treatment groups: normothermic control: incubation in cell culture media for 2 hours at 37 degrees C; HCA only: incubation for 2 hours in hypothermic HCA solution (4 degrees C, 24 mEq K(+)); or incubation in hypothermic HCA solution supplemented with 10 microM of the caspase inhibitor, z-VAD (z-Val-Ala-Asp-fluoromethyl-ketone, HCA+zVAD). Myocyte viability, assayed as a function of mitochondrial function, was determined to be similar in the normothermic and both HCA groups.

Results: The HCA caused a significant reduction in myocyte shortening velocity compared with normothermic control values (41 +/- 6 versus 86 +/- 8 microm/s, p < 0.05). The HCA+zVAD group had significantly improved myocyte shortening velocity compared with the HCA only group (63 +/- 7 microm/s, p < 0.05).

Conclusions: Independent of changes in viability, caspase inhibition attenuated myocyte contractile dysfunction after HCA and rewarming. Thus, caspase activation during HCA contributes, at least in part, to impaired myocyte contractility with rewarming. Supplementation of HCA with caspase inhibitors may provide a means to preserve myocyte contractile function after cardioplegic arrest.
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http://dx.doi.org/10.1016/j.athoracsur.2003.10.054DOI Listing
May 2004

Myocardial remodeling after discrete radiofrequency injury: effects of tissue inhibitor of matrix metalloproteinase-1 gene deletion.

Am J Physiol Heart Circ Physiol 2004 Apr 20;286(4):H1242-7. Epub 2003 Nov 20.

Division of Cardiothoracic Surgery, University of South Carolina, Charleston, SC 29425, USA.

Discrete myocardial lesions created through the delivery of radiofrequency (RF) energy can expand; however, the mechanisms have not been established. Matrix metalloproteinases (MMPs) play an important role in myocardial remodeling, and MMP activity can be regulated by the tissue inhibitors of the metalloproteinases (TIMPs). This study examined the role of TIMP-1 in postinjury myocardial remodeling. Lesions were created on the left ventricular (LV) epicardium of wild-type (WT, 8-12 wk, 129SVE) and age-matched TIMP-1 gene-deficient (timp-1(-/-)) mice through the delivery of RF current (80 degrees C, 30 s). Heart mass, LV scar volumes, and collagen content were measured at 1 h and 3, 7, and 28 days postinjury (n = 10 each). Age-matched, nonablated mice were used as reference controls (n = 5). Heart mass indexed to tibial length increased in WT and timp-1(-/-) mice but was greater in the timp-1(-/-) mice by 7 days. Scar volumes increased in a time-dependent manner in both groups but were higher in the timp-1(-/-) mice than the WT mice at 7 days (1.48 +/- 0.09 vs. 1.20 +/- 0.11 mm(3).mg(-1).mm, P < 0.05) and remained higher at 28 days. In the remote myocardium, wall thickness was greater and relative collagen content was lower in the timp-1(-/-) mice at 28 days postinjury. Discrete myocardial RF lesions expand in a time-dependent manner associated with myocyte hypertrophy remote to the scar. Moreover, postinjury myocardial remodeling was more extensive with TIMP-1 gene deletion. Thus TIMP-1 either directly or through modulation of MMP activity may regulate myocardial remodeling following infliction of a discrete injury.
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http://dx.doi.org/10.1152/ajpheart.00437.2003DOI Listing
April 2004

Changing family physicians' visit structuring behavior: a pilot study.

Fam Med 2003 Nov-Dec;35(10):726-9

Department of Family and Preventive Medicine, University of Utah, Salt Lake City 84132, USA.

Objective: This study assessed the degree to which family physicians elicit patients' agendas and negotiate the agenda of the medical visit, related this behavior to late-arising patient concerns and satisfaction with the visit, and assessed the degree to which visit-structuring behavior can be modified by a brief workshop.

Methods: We reviewed 65 audiotaped clinic visits conducted by three experienced family physicians before (36 visits) and after (29 visits) a workshop on structuring outpatient visits. We also collected patient and physician satisfaction ratings through post-visit questionnaires.

Results: Patient concerns were explicitly elicited in 64% of pre-workshop visits and 90% of post-workshop visits. Significant increases occurred in agenda setting (14% of pre-workshop visits, 52% of post-workshop visits), agenda negotiating (0% of pre-workshop visits, 38% of post-workshop visits), and physician satisfaction with visits.

Conclusions: A brief continuing medical education intervention improved family physicians' visit structuring.
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May 2004
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