Henry Ford Hospital Research Articles

Building Bridges: Increasing Access to Care and Continuation of Medication for Opioid Use Disorder Through Community Partnerships

The opioid epidemic continues to pose a formidable challenge to public health, necessitating innovative approaches to enhance access to care and support continuity of treatment for individuals with opioid use disorder (OUD). Opioid overdose-related deaths in Detroit have increased over four-fold from 1999 to 2019, yet the rate of medication for opioid use disorder (MOUD) prescriptions in Detroit has been half the rate compared to Michigan as a whole. Limited access to care remains a major factor in continued opioid use, which is driven in part by an individual’s insurance coverage. As the largest payer of substance use disorder services in the United States, Medicaid plays a central role in efforts to address the opioid epidemic. Over half of the Detroit population is either enrolled in Medicaid or uninsured. Henry Ford Hospital (HFH) continues to treat hospitalized patients with OUD. Post-discharge follow-up appointments for continuation of MOUD have been shown to increase rates of prolonged abstinence, reduce rates of readmission, and decrease mortality rates. Despite HFH’s significant community impact, there have been limitations on which insurance carriers are accepted at our institution when patients try to establish outpatient primary care or specialty addiction medicine services for MOUD. This insurance-driven barrier has consequently limited our ability to provide best practices in supporting patients with OUD. To address this disparity, we aimed to investigate the impact of leveraging our partnership with Community Health and Social Services (CHASS) Clinic, a local Federally Qualified Health Center network, as an opportunity for underinsured and non-insured patients with OUD to have increased access to post-discharge follow-up appointments with qualified providers for continuation of MOUD. In collaboration with the HFH Addiction Medicine Consult team, HFH Primary Care Physicians, and CHASS MOUD providers, we designed a multifaceted intervention to improve the continuum of care for patients with OUD. We established a post-discharge referral pathway between HFH and CHASS, enhancing communication channels to facilitate care coordination. If a patient was admitted to HFH with a diagnosis of OUD and received an Addiction Medicine consult, the primary team was advised to arrange a post-discharge follow-up appointment for MOUD. The location of the appointment was determined by the patient’s insurance. Patients already established with HFH, or with commercial insurance, were scheduled with HFH providers for MOUD. Patients with Medicaid or no insurance were scheduled with CHASS MOUD providers. In the six months prior to implementation, only 3 of 60 (5%) of patients with a diagnosis of OUD that received an Addiction Medicine consult were scheduled to have a post-discharge follow-up for MOUD. In three months after implementation, 8 of 32 (25%) patients received post-discharge follow-up for MOUD. By utilizing the partnership between HFH and CHASS, our intervention was associated with a five-fold higher rate of follow-up appointments for continuation of MOUD. These findings underscore the effectiveness of community partnerships in addressing barriers to care and enhancing treatment for individuals with OUD.

Abstract 14356: Higher Burdon of Premature Ventricular Complexes is Not Uncommon in Stable Well Treated Heart Failure Patients and Relate to Poorer Outcomes

Introduction: While premature ventricular contractions (PVCs) are generally considered benign, recent evidence suggests that even the contractions preceding PVCs are inefficient so that even a moderate burden of PVCs may be associated with loss of contractile efficiency and increased risk of events. It is however unclear what proportion of stable heart failure (HF) patients have a moderate to high burden of PVCs, despite being well-treated. Aim: The aim of this study was to assess the proportion of HF patients that have more than 5% PVCs and whether this higher number is related to worse outcomes. Methods: We retrospectively analyzed electronic medical records from 676 adult patients with either an ejection fraction < 40% or NTproBNP more than 600 pg/ml at the Amsterdam UMC (AMC) who received Holter monitoring between 2014 and 2022. In a second independent cohort from a heart failure registry at Henry Ford Hospital (HFH) in Detroit, Michigan, we retrospectively reviewed all participants with ejection fraction < 40% that had a Holter monitor at any point (n=180). Results: The median baseline age of the Amsterdam UMC patients was 62 and 40% were female. The HFH cohort had a median age of 64 years and 50% were female. Results are summarized in the table. During the follow-up period, significantly more patients died in the group with more than 5% PVCs (p < 0.05 in the Amsterdam UMC cohort). Conclusions: We show in two independent cohorts that around 8-10% of HF patients have a significant burden of PVCs (i.e. >5% of all heartbeats), despite adequate use of beta-blocker therapy. This proportion of PVCs is associated with an increased risk of death over one year. This suggests that in HFrEF patients, PVCs burden more than 5% of heartbeats may not be as harmless as often thought.

Clinical experience with regadenoson SPECT myocardial perfusion imaging: insights into patient characteristics, safety, and impact of results on clinical management.

The Henry Ford Hospital (HFH) regadenoson (REG) registry includes patients with a variety of comorbidities allowing for the evaluation of outcomes in a large, unselected population. Using a database of electronic medical records and nuclear cardiology reports, patients aged > 18years who underwent REG-facilitated single-photon emission computed tomography (SPECT) testing at HFH between January 2009 and August 2012 were identified. The primary objective was to describe the clinical and demographic characteristics of patients who had undergone REG only vs REG WALK (REG + low-level exercise) SPECT. A total of 2104 patients were included in the analysis (mean age 65.3years; 50% women; 51% African American, 43% Caucasian). For the REG only (n = 1318) and REG WALK (n = 786) cohorts, SPECT was abnormal in 37% of patients (REG only, 39%; REG WALK, 34%; P < 0.01). No differences in diagnostic modalities or interventions in 90days after SPECT were observed. Immediate safety analysis showed no deaths 48h after REG SPECT testing. Although they guide invasive therapy, abnormal scans do not automatically lead to invasive testing. This demonstrates the focus on initial medical management, which reflects the existing evidence of initial goal-directed medical management of stable coronary disease.

669. Rapid Molecular Testing of Sputum for Identification of Pulmonary Tuberculosis: Impact on Duration of Respiratory Isolation

BackgroundCurrent guidelines recommend molecular testing directly on sputum of patients with suspected pulmonary tuberculosis (TB) to facilitate discontinuation of airborne infection isolation (AII). Henry Ford Hospital (HFH), a tertiary care center in Detroit, MI serves a population at high-risk for TB. Molecular testing of sputum using GeneXpert/MTB RIF (Xpert; Cepheid) (GXTB) was implemented at HFH on March 2019. Providers were permitted to remove patients from AII using 3 negative acid-fast bacillus smears (AFB) or 2 negative GXTB results. We evaluated the impact of GXTB on duration of AII over a 2-year period: Pre-implementation (January 2018 to February 2019) and post-implementation (March 2019 to February 2020).MethodsRetrospective data was abstracted for all patients placed in AII during the study period. Demographic data, TB risk factors, duration of AII, length of hospital stay (LOS), accuracy and turn-around-times (TAT) of AFB and GXTB were compared in the pre- and post-implementation periods. Categorical variables were studied using chi-square testing, and continuous variables were studied using T-test or Mann Whitney U test as appropriate.ResultsDuring the study period, 269 patients with suspected TB were placed in AII: 137 pre-implementation and 132 post-implementation. Clinical characteristics and TB risk factors were generally comparable in both groups (Table 1). Abnormal chest X-ray was more frequent in patients in the post-implementation phase. All cases of culture positive TB were detected by AFB and GXTB. TAT of AFB results before and after implementation were similar and ranged from 20-24 hours (Table 2). In the post-implementation period, TAT of GXTB compared to AFB was 6.35 vs 21.28 hours (p < 0.0001). Duration of AII was shortened by almost 24 hours (70.2 vs 93.7 hours, p=0.031) (Table 3). Time from first sample collection to final results of all samples was 19.2 vs 52.6 hours, p< 0.0001. There was no difference in total LOS pre and post-implementation.Table 1. Clinical Characteristics of Patients with Suspected Pulmonary Tuberculosis Table 2. Turnaround times (TAT) of AFB and GeneXpert/MTB (Xpert) RIF before and after implementation Table 3. Duration of Airborne Isolation, Total Turn-Around Times, and Hospital Length of Stay in the Pre- and Post-implementation Period ConclusionImplementation of rapid direct molecular testing reduced the duration of respiratory isolation for patients with suspected pulmonary TB. Further provider education regarding the reliability of GXTB in excluding TB may be necessary to reduce overall hospital LOS.Disclosures All Authors: No reported disclosures

56. Could Maturation Effect Contribute to In-hospital Mortality Improvement During COVID-19 Pandemic?

BackgroundThe surge of COVID-19 cases overwhelms hospital systems necessitating rapid learning of the disease process and management. During the course of a novel pandemic, multiple interventions are rapidly implemented to improve patient outcomes. When evaluating efficacy of individual interventions, one should account for the simultaneous improvements in knowledge and experience of healthcare providers (HCP), known as the maturation effect. We hypothesized that multiple processes rapidly implemented, along with the maturation effect would result in improved survival of COVID-19 patients hospitalized over the course of the pandemic.MethodsThis retrospective study was done at Henry Ford Hospital (HFH), a 900-bed tertiary care facility in Detroit, Michigan. The first COVID-19 patient was hospitalized on March 10, 2020 followed by a rapid surge of cases. We evaluated the trends of in-hospital case fatality rate of COVID-19 PCR positive patients through April 28, 2020. Time-points of sequential implementation of key measures for the management of COVID-19 patients were recorded.ResultsA total of 1023 COVID-19 patients were hospitalized during the study period with 165 deaths (16 %). Case fatality rate during week one was 42% and down trended over time (Figure 1). Key measures were sequentially implemented over the course of the study period as shown in Figure 1. These included development and implementation of in-house PCR testing, dedicated infectious diseases COVID-19 rounding teams, treatment guidelines and algorithms, and early steroid use in hypoxic patients. Figure 2 demonstrates that despite the surge of COVID-19 admissions, mortality continued to improve over time.Figure 1. Trend line of all-cause in-house morality over time Figure 2. Mortality by admission date over time ConclusionMaturation effect takes into consideration that regardless of individual interventions, HCP improve their knowledge of the disease process and treatment over time leading to better outcomes. Our study shows the possibility of the maturation effect leading to improved survival in hospitalized COVID-19 patients. The maturation effect should be accounted for when evaluating the effect of specific interventions for COVID-19.DisclosuresMarcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)

Comparison of Roche TaqMan v.2.0, Abbott RealTime and Modified Abbott Residual Viremia Assays in Testing of Routine Samples for Viremia Monitoring in HIV Care

BackgroundRoutine HIV RNA clinical monitoring frequently reports virermia (VL) as detectable, quantifiable <50 or blips >50 c/mL. To assess whether the results represent true increases or just assay variability, we designed comparisons of the Roche COBAS AmpliPrep / COBAS TaqMan HIV-1 Test version 2.0 (TM) and the Abbott RealTime HIV-1 assay (RT) to a residual viremia (RV) assay with a limit of detection of 3 c/mL, the Modified Abbott Residual Viremia assay (MARV).MethodsHIV suppressed patients on stable therapy presenting for routine visits at the HIV clinic in Henry Ford Hospital (HFH) were prospectively enrolled. Blood samples and questionnaires were obtained at each visit. Paired plasma samples were processed and analyzed per manufacturer instructions; HFH clinical laboratory processed the samples using the TM assay and the McKinnon Research Laboratory performed the FDA approved RT assay and RV testing using the MARV assay. Parametric and non-parametric analyses were conducted as indicated.Results124 HIV patients are reported with a mean age of 51, mostly male (84%) and African American (64%). Mean CD4 cell counts were 661 cells/mm3. TM assay results for 196 plasma samples were not detectable (ND) 119 (61%), detectable (DT) 61 (31%) and quantifiable viremia (QV) >20 c/mL 16 (8%). 5 patients had QV over 50 c/mL. 60 tested patients (49.5%) had at least one sample either DT or QV. TM results were not correlated to CD4 cell counts, antiretrovirals, medical conditions or reported adherence (avg. 97%). 174 RT and 187 MARV paired tests were ND on 142 (81%) / 121 (65%), DT on 34 (17%) RT, and quantifiable in 0% / 34 (33%) of the samples respectively. Higher VL detection by the TM was shown compared with the RT (P = 0.005) and MARV (P < 0.001) assays. Mean QV by the MARV was 5.0 vs.. 55 c/mL on the TM assay (P < 0.001). VL for all assays trends correlated when compared for ND, DT and >20 copies/mL (P < 0.001). Bland-Altman plots show higher VL detected by TM as compared with MARV (P < 0.001) and good correlation between RT and MARV assays (P = 0.6).ConclusionHIV viremia is more frequently reported by TM assay as compared with the RT assay and was significantly higher than VL detected by the MARV assay. Over detection of VL by the TM assay may impact clinical decision making and increase cost of care.Disclosures J. Mckinnon, Abbott Molecular: Speaker’s Bureau, Grant recipient, Research grant and Speaker honorarium D. Lucic, Abbott Molecular: Employee, Salary

388 Implementation of an Emergency Department Syphilis and HIV Point-of-Care Screening Process During an Outbreak of Syphilis in Detroit, MI in Collaboration With the Infectious Disease Department and the Centers for Disease Control and Prevention

The number of primary and secondary syphilis cases in Detroit, Michigan increased from 73 in 2010 to 199 to 2013. Cases were predominantly in young African American men with who have sex with men and with had a high rate of HIV co-infection. The infectious disease (ID) department at Henry Ford Hospital (HFH), in collaboration with the Centers for Disease Control and Prevention (CDC) determined the emergency department (ED) would be the optimal setting to implement a screening program. Young men in Detroit are typically non-health care seeking; however, EDs are venues they do frequent when they access the health care system. We hypothesized that the implementation of an ED screening model would detect an increased number of syphilis and HIV cases than were seen with standard care. Point-of-care (POC) testing would allow presumptive treatment of active syphilis cases in the emergency department, whereas traditional testing would not typically result and allow for care within a typical ED visit time frame. Syphilis and HIV screening was offered to men aged 18-34 years seen in the HFH ED with an Emergency Severity Index (ESI) of 2-5. Dedicated, non-ED staff employed 2 rapid finger-stick POC tests: the Alere Determine HIV-1/2 Ag/ab Combo test (Determine) and the Syphilis Heath Check (SHC) treponemal tests. Participants also underwent venipuncture for standard lab-based testing for HIV and syphilis. Screening took place from 7:30am to 5pm, Monday through Friday. Patients were first approached by screeners, typically before the initial clinician contact and were offered screening. Confirmatory lab-based testing using the Biorad 4th generation HIV test, RPR, and TPPA tests were drawn in conjunction with ED nursing staff during their routine bloodwork. ED clinicians were notified of positive SHC POC testing and patients were treated presumptively in the ED. From 6/10/2015 to 3/11/2016, 871 patients were enrolled. Active syphilis (RPR + TPPA +) was identified in 6 (0.7%) participants, and newly diagnosed HIV in 7 (0.8%). There was one case of syphilis-HIV coinfection, and the combined prevalence was 1.4%. Three patients were treated in the ED for syphilis based on their POC testing results without treatment complications. The implementation of an ED syphilis and HIV POC screening program is a feasible method to detect new cases of disease. The screening process can be incorporated into ED patient flow and provide clinicians with immediate test results to determine the need for treatment. POC HIV and syphilis testing are particularly important to ED providers, who may not otherwise receive important test results for their patients before they leave the emergency department.

Optimization of Patient-Specific Inhaler Regimens: A Pharmacy-Pulmonology Collaborative Pilot Program in the Ambulatory Care Setting

SESSION TITLE: Educator Breakout session SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 24, 2016 at 01:30 PM - 02:30 PM PURPOSE: Inhaler technique is an important component of optimal control of asthma and COPD. Evidence suggests that 50-90% of patients use their inhalers improperly and that detailed training alone is insufficient for maintaining correct inhaler technique with each device. Currently, there are no objective assessments or treatment guidelines to direct clinicians in selecting the optimal inhaler delivery device. The purpose of this pilot study is to evaluate the effects of the addition of a pulmonary clinic pharmacist to assess inhaler technique and to optimize inhaler regimens using a Vitalograph Aerosol Inhalation MonitorTM (VAIM). METHODS: This prospective, observational cohort study enrolled patients seen in the outpatient pulmonary clinic at Henry Ford Hospital (HFH) from October 2015 to March 2016. Patients were included if they had a diagnosis of COPD or asthma, spoke English, and were 18 years of age or older. Patients were excluded if they presented for imaging results review, had a tracheostomy, or had a diagnosis of interstitial lung disease, sarcoidosis, or lung cancer. A pharmacist provided inhaler regimen recommendations to physicians based on objective VAIM assessments to help develop an individualized therapy plan. If the recommendations were accepted, the pharmacist then reviewed any inhaler changes with the patient. Follow-up phone calls were made at one and four weeks after the initial visit. The primary endpoint was asthma or COPD control as defined by changes in asthma control test (ACT) or COPD assessment test (CAT) scores, patient-reported symptoms, and weekly rescue inhaler use. Secondary endpoints included changes in patient adherence as measured by the Morisky Medication Adherence Scale (MMAS4) and to describe the utility of the VAIM in objectively assessing inhaler technique. RESULTS: A total of 53 patients with COPD and/or asthma were screened; 44 patients met inclusion criteria. The majority of patients were female (59%) with a diagnosis of COPD and a median age of 60 years. Eighty-one percent of patients were interacting with a clinical pharmacist in the pulmonary clinic for the first time. While 72% of patients were on appropriate therapy per GINA and GOLD clinical guidelines, 27 (61%) patients received a recommendation to change inhaler devices based on VAIM assessments. Following pharmacist intervention and change in inhaler devices, rescue inhaler use decreased from 24.4 times per week at baseline to 10.6 times per week at week 4 (p=0.0019); CAT scores (n=19) improved from 24.4 at baseline to 20.2 at week 4 (p=0.0079); and ACT scores (n=12) improved from 12.3 at baseline to 16.6 at week 4 (p=0.04). The MMAS4 score improved from 0.8 to 0.4 at week 4 (p = 0.0217). CONCLUSIONS: A pharmacist-performed objective assessment of inhaler technique and subsequent pharmacologic recommendations added to a routine pulmonary clinic visit are not only feasible, but also may improve patient outcomes. CLINICAL IMPLICATIONS: Based on the success of this pilot program, the pulmonary clinic at HFH plans to implement this pharmacist intervention into the current practice model. DISCLOSURE: The following authors have nothing to disclose: Emily Blum, Krishna Thavarajah, Amber Lanae Smith No Product/Research Disclosure Information

Employment Status and Participation in Cardiac Rehabilitation: DOES ENCOURAGING EARLIER ENROLLMENT IMPROVE ATTENDANCE?

For patients hospitalized for a cardiac event, an earlier appointment to outpatient cardiac rehabilitation (CR) increases participation. However, it is unknown what effect hastening CR enrollment might have among employed patients planning to return to work (RTW). Using 2 complementary data sets from Henry Ford Hospital (HFH) and Mayo Clinic, we assessed when employed patients eligible for CR anticipated a RTW, the impact of an earlier appointment on CR enrollment, and the effect of employment status on the number of CR sessions attended. Patients at HFH attended CR at either 8 or 42 days (through randomization), whereas Mayo Clinic patients attended 10 days after hospital discharge per standard routines. Among 148 patients at HFH, 65 (44%) were employed and planned to RTW. Of these, 67% desired to RTW within 1 to 2 weeks, whereas 28% anticipated an RTW within 1 to 3 days. Home financial strain predicted nonparticipation in CR (P < .001) and was associated with an earlier planned RTW. Among 1030 patients at Mayo Clinic, 393 (38%) were employed. Employed (vs nonemployed) patients enrolled in CR 3.3 days sooner (P < .001), but attended 1.6 fewer CR sessions (P = .04). In employed patients from both health systems, an earlier (vs later) appointment to CR did not result in additional exercise sessions of CR. Employed patients plan to RTW quickly, in part because of home finances. They also enroll earlier into CR than nonemployed patients. Despite these findings, earlier appointments do not seem to favorably impact overall CR participation.

Frequency of estrogen receptor-negative breast cancer in women with African ancestry: Results from an international study

22015 Background: Lifetime breast cancer (BC) incidence is lower yet BC mortality is higher for African American (AA) compared to White American (WA) women. These paradoxical patterns have generated speculation regarding a possible genetic association between BC risk and African ancestry. Little is known about the BC burden of Africa. The African ancestry of AA populations can be traced to western sub- Saharan Africa as a consequence of the colonial-era slave trade. We therefore studied BC patterns in Ghana, since contemporary Ghanaian/African (Afr) and AA women are likely to have some shared ancestry. Methods: Creation of an international BC registry was approved by IRBs of University of Michigan, Henry Ford Hospital (HFH) and Komfe Anoyke Teaching Hospital in Kumasi, Ghana. Features of Ghanaian breast tumors (25 unselected cases) were compared to 435 AA and 812 WA tumors from Michigan by t-test and Chi-squared analyses. Results: AA cases were younger than WA cases (mean age 62.4 versus 60.8 yrs; p=0.05); precise ages were unknown for several of the Afr cases, but it is known that more than half of the Afr cases were younger than 45 yrs. Significant differences were observed for estrogen receptor (ER) expression and frequency of “triple negative” disease (tumors neg for ER, PR and HER2/neu expression) between the three populations (Table). Frequency of ER-neg and triple neg tumors was highest in the Afr cases, lowest in WA cases, and intermediate in AA cases. Results were unchanged when cases were matched on tumor grade. Conclusion: AA and Afr women have an elevated risk of endocrine-resistant and triple-negative breast cancer. The sequential increase in frequency of these aggressive subtypes observed for WA versus AA versus Afr women suggests a possible association with extent of African ancestry. Future international studies of breast cancer in women with African ancestry may improve insights regarding the pathogenesis of ER-negative disease. Frequency of ER-negative breast CA in White American, African American, and Ghanaian African Women Marker Expression White American African American Ghanaian African p-Value ER-negative 21.5% 35.2% 64% < 0.001 ER/PR/HER2-negative 14.4% 24.4% 56% < 0.001 No significant financial relationships to disclose.

193: Blood Pressure (BP) Control in Patients With Chronic Kidney Disease (CKD) in the Setting of a Nurse Practitioner (NP) Managed CKD Clinic Model

BLOOD PRESSURE (BP) CONTROL IN PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD) IN THE SETTING OF A NURSE PRACTITIONER (NP) MANAGED CKD CLINIC MODEL naima ogletree, schawana thaxton, jerry yee, sandeep soman. henry ford hospital, detroit, mi, usa. Limited data exists about the effectiveness of care delivered by a nurse practitioner managed chronic kidney disease (CKD) clinic on BP control. Mean BP varies from 131-157/80-91 even for patients enrolled in major clinical trials of patients with CKD involving BP analysis. Rates of achieving BP of less than the target of 130/80 for CKD patients vary from 17 to 22%. A single-centre historical prospective review of a cohort of patients who attended the CKD clinic at Henry Ford Health System between July 2005 and June 2007 was conducted. Care in this clinic is provided by NPs, who consult with physicians when needed. Data was available for 487 patients followed in the CKD clinic in the above period and analyzed over eight quarters in this time period. Mean number of visits with the nurse practitioner were 5.74± 4.9 (range 1-25). Of the 487 patients, there were 408 (83.8%) African Americans, 65 (13.3%) Caucasians, and 2.8% others. 50.3% (242) were females, and 49.7% (245) males. Mean age was 70.9 ± 13.1 yrs. At total of 2254 BP readings were available for analysis. For all the readings available, mean SBP was 135.41±20.4 mm Hg (range 78-218) and DBP was 68.8 ± 11.57 mm Hg (range 30-150). The mean of the average systolic and diastolic BP for each individual for this period was 136.06 ± 17.1 and 70.8± 10.7 mm Hg respectively. Mean number of BP medications was 2.88±1.32, and 68.5% patients were on at least one medication to suppress the renin angiotensin axis. Average BP was less than 125/75, 130/80, 140/80 and 140/90 mm Hg in 25.5%, 36.8%, 59.4% and 62.8% patients respectively. Results show BP targets achieved in this model of NP managed CKD clinic providing care to predominantly African American patients was comparable to results obtained in various tertiary clinics reported in the literature. Further analysis is required to see if this effect on BP control extends across other domains of CKD care in this CKD clinic model.

Historical perspective on the Department of Neurosurgery at the Henry Ford Hospital.

The Henry Ford Hospital (HFH) was founded in 1915 as a philanthropic gift from Henry Ford, the automobile magnate and inventor of the Model T. The hospital and its organizational structure represented a nonsectarian facility that would provide care for all members of society. The system was patterned after the newest and most modern medical centers at the time in Europe, Canada, and the United States, including the German Krankenhauser, the Johns Hopkins Hospital, the Mayo Clinic, and the Peter Bent Brigham Hospital in Boston. The HFH grew into the Henry Ford Health System in the 1970s to 1990s, with the acquisition of other hospitals, the development of a multiple-region-based clinic system through southeastern Michigan, and the development of comprehensive, vertically integrated health care systems. The Division of Neurosurgery at HFH was established by Albert Crawford in 1926. The tradition of training residents in neurosurgery began in 1946, and the residency training program was accredited by the American Board of Neurosurgery in 1954. In 1970, the Division of Neurosurgery of the Department of Surgery was combined with the Division of Neurology to create the joint Department of Neurology and Neurosurgery. A separate Department of Neurosurgery was established in 1981. Four individuals have served as chairmen of the Department of Neurosurgery at HFH, i.e., Albert Crawford (1926-1952), Robert Knighton (1952-1978), James Ausman (1978-1991), and Mark Rosenblum (1992 to the present). During the 1980s and 1990s, HFH evolved into the vertically integrated, regionally distributed Henry Ford Health System. Under the current direction of Dr. Rosenblum, the Department of Neurosurgery at HFH has grown to include 11 full-time neurosurgeons, 2 neuro-oncologists, and 3 investigators with Ph.D. degrees and has recently expanded into three additional hospitals in southeastern Michigan, paralleling the growth of the system. The faculty annually treats more than 2,000 cases in all neurosurgical subspecialties, ranging from neuro-oncological surgery, cranial base surgery, radiosurgery, cerebrovascular surgery, epilepsy surgery, treatment of movement disorders, pain and spasticity surgery, pediatric neurosurgery, and neurotrauma treatment to complex instrumentation of the spine. This article chronicles the history of the Henry Ford Health System and the Department of Neurosurgery, its research endeavors, and its residency training program.

Transesophageal echocardiography in critical care units: Henry ford hospital experience and review of the literature

Transthoracic echocardiography is of limited value in intensive care units primarily because of mechanical ventilators, surgical wounds, and the inability to position the patient to his left side. Imaging from the transesophageal window overcomes these problems, resulting in good-quality study in these patients subsets. We performed both transthoracic and transesophageal echocardiography with color-flow Doppler tests in 121 patients in various critical care units. The transesophageal ultrasound test was valuable in identifying patients with suspected left-sided native and prosthetic valve vegetations, prosthetic mitral but not aortic valve regurgitation, native mitral and aortic valve pathoogy, and aortic dissection and in determining cardiac etiology of systemic emboli, hypotension, hypoxia, and heart failure. Based on transesophageal echocardiographic findings, additional information was provided in 38 (32%) patients, resulting in appropriate surgery in 22 instances. In conclusion, transesophageal echocardiography is a useful tool in evaluating critically ill patients.

Common clonal origin of synchronous primary head and neck squamous cell carcinomas: Analysis by tumor karyotypes and fluorescence in situ hybridization

Two synchronously arising primary squamous cell carcinomas (SCC) originating from separate sites in the anterior floor of mouth (FOM) and the pyriform sinus (PS) were evaluated by karyotype and fluorescence in situ hybridization (FISH) to determine whether they were of common or independent ancestry. The primary tumors were designated Henry Ford Hospital (HFH)-SCC-8a (FOM) and HFHSCC-9a (PS), and the respective recurrent tumors after chemotherapy and radiation were designated -8b and -9b. HFH-SCC-8a and -8b were cultured and had closely related hypotetraploid karyotypes of monoclonal origin. Karyotypes could not be obtained from the second primary tumor HFH-SCC-9a or its recurrence -9b. However, we used karyotypes from HFH-SCC-8a and -8b as a guide to select FISH probes for the histological evaluation of genetic markers in tumor sections. Fluorescence in situ hybridization on metaphase chromosomes from the cell cultures was useful in modifying the tumor karyotypes. Fluorescence in situ hybridization identified a chromosome Y rearrangement that was not obvious from the HFH-SCC-8a and -8b karyotypes, and this Y rearrangement served as a unique clonal marker. Using two probes for the Y chromosome we showed that all four tumors shared the same Y rearrangement with loss of Yq (DYZ1) and retention of Ycen (DYZ3). Furthermore, FISH showed that all four tumors had the same aneuploidy patterns for chromosomes X, Y, 7, 9, 15, 16, and 17. From karyotypic and FISH analysis disomy for X and 9 centromere regions and the rearranged Y were all predicted and observed in the tumor tissue sections. Tetrasomy and trisomy for 7, 15, 16, and 17 were predicted from the karyotypes and this also was observed using FISH in all four tumors. These FISH aneuploidy patterns and the presence of a clonal Y marker in all four tumor samples indicate that the synchronous primaries and their recurrences were of monoclonal origin.

Ethnic distribution of intracranial aneurysms

The reported higher incidences of intracranial arterial aneurysms (IAA) in Africa and Asia raised the question of possible racial differences in aneurysm incidence. This prompted a retrospective study of the 244 cases of IAA seen at the Henry Ford Hospital (HFH) from 1979 to 1985. There were 171 whites and 73 blacks in the study group. The results showed a higher white to black case ratio (2.3:1) than the white to black hospital population ratio (1.14:1). If only bleeding aneurysms were considered, there were 81 whites and 52 blacks, with a white to black case ratio of 1.6:1, thus giving only a borderline racial difference. The peak age of aneurysm incidence was the fifth decade for blacks and the sixth decade for whites. The most common aneurysms sites were: [table: see text]

Measurement of vertebral area on spine X-rays in osteoporosis: Reliability of digitizing techniques

Much of the clinical research in osteoporosis is directed toward documenting a reduction in vertebral fracture rate, but there is considerable disagreement about defining and quantifying vertebral fractures. We have evaluated the technique of digitizing landmarks identified on lateral radiographs of thoracic and lumbar vertebrae and computing vertebral body area. Reduction in area indicates that fractures occurred. Radiographs from 10 patients with osteoporosis and vertebral fractures were obtained from each of two centers. Henry Ford Hospital (HFH) and Mayo Clinic (MC), and vertebral area for each individual in the complete set of 20 radiographs was calculated at each center. Measurements at the two centers differed by a multiplicative constant related to the method of recording landmarks on the radiographs that was estimated using 300 x-rays from HFH. After adjusting the MC areas for this multiplicative relationship, the average ratio of the HFH areas to the transformed MC areas of individual vertebrae (T4-L5) ranged from 0.98 to 1.06. The correlation between HFH and transformed MC areas for individual vertebrae averaged 0.85, with slopes between 0.87 and 1.00, intercept average -0.57. Within-patient rank correlation averaged 0.97. We conclude that radiographic digitization is a reliable and reproducible method of determining vertebral body dimensions that is suitable for evaluating radiographs obtained at different clinical sites and for comparison with normal data. This technique should prove useful for documenting the presence of a vertebral fracture that may not be readily apparent on visual inspection of radiographs and for monitoring serial changes in vertebral body dimensions in long-term epidemiologic and therapeutic studies.

Atrophie Blanche

International Journal of DermatologyVolume 21, Issue 1 p. 1-8 Atrophie Blanche Richard E. Stiefler M.D., Richard E. Stiefler M.D. From the Departments of Dermatology, Henry ford Hospital, Delroit. Michigan and Cleveland Clinic Foundation. Cleveland, OhioSearch for more papers by this authorWilma F. Bergfeed M.D., Corresponding Author Wilma F. Bergfeed M.D. From the Departments of Dermatology, Henry ford Hospital, Delroit. Michigan and Cleveland Clinic Foundation. Cleveland, OhioAddress for reprints: Wilma F. Bergfeld, M.D., Department of Dermatology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44106.Search for more papers by this author Richard E. Stiefler M.D., Richard E. Stiefler M.D. From the Departments of Dermatology, Henry ford Hospital, Delroit. Michigan and Cleveland Clinic Foundation. Cleveland, OhioSearch for more papers by this authorWilma F. Bergfeed M.D., Corresponding Author Wilma F. Bergfeed M.D. From the Departments of Dermatology, Henry ford Hospital, Delroit. Michigan and Cleveland Clinic Foundation. Cleveland, OhioAddress for reprints: Wilma F. Bergfeld, M.D., Department of Dermatology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44106.Search for more papers by this author First published: January 1982 https://doi.org/10.1111/j.1365-4362.1982.tb00474.xCitations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume21, Issue1January 1982Pages 1-8 RelatedInformation

ANNOUNCEMENT OF NEW APPOINTMENT—HENRY FORD HOSPITAL

Journal of the American Geriatrics SocietyVolume 15, Issue 4 p. 402-402 ANNOUNCEMENT OF NEW APPOINTMENT—HENRY FORD HOSPITAL First published: April 1967 https://doi.org/10.1111/j.1532-5415.1967.tb02815.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume15, Issue4April 1967Pages 402-402 RelatedInformation