1
|
Wade SA, Ali I, Milstone AM, Clever SL, Xiao S, Koontz DW, Hansoti B. Medical education during the COVID-19 pandemic: a reflection on the JHUSOM experience. BMC Med Educ 2024; 24:335. [PMID: 38528473 PMCID: PMC10964593 DOI: 10.1186/s12909-024-05266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND We sought to understand the relative risk of COVID-19 infection and identify risk factors for infection to identify targets for mitigation among medical students. METHODS An observational cohort study of Johns Hopkins School of Medicine students was conducted from June 2020 to July 2021. Blood samples were collected and tested at three visits to assess for antibodies against SARS-CoV-2. Additionally, a questionnaire was administered at each visit to collect demographic information and assess potential social and behavioral risk factors. RESULTS 264 students enrolled in the study, and 38 participants completed all study requirements by study end. Roughly 6% of the first- and second-year classes had a reported positive COVID-19 test compared to 5% of third- and fourth-year students. By visit 3, 92% of medical students had detectable antibodies against COVID-19 compared to 4% during the study enrollment period. From study enrollment to visit 3, there was a 10-fold increase in the percentage of students reporting attending large social gatherings and dining in restaurants. CONCLUSIONS Overall, few COVID-19 cases were found among medical students, even those on clinical rotations. As the study progressed, students reported engaging in higher-risk social behaviors in conjunction with increasing vaccination rates among students.
Collapse
Affiliation(s)
- Sydney A Wade
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Iman Ali
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron M Milstone
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah L Clever
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shaoming Xiao
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Danielle Winner Koontz
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of International Health, Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
2
|
Tackett S, Eller L, Scharff S, Balhara KS, Stouffer KM, Suchanek M, Clever SL, Yenawine P, Wolffe S, Chisolm MS. Transformative experiences at art museums to support flourishing in medicine. Med Educ Online 2023; 28:2202914. [PMID: 37074677 PMCID: PMC10120547 DOI: 10.1080/10872981.2023.2202914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/13/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE We implemented and evaluated a hybrid 4-week arts-based elective for clinical medical students to support flourishing. MATERIALS AND METHODS Five students participated in early 2022. Twelve sessions occurred in-person at art museums and other cultural centers, and five occurred online. Sessions incorporated varied arts-based learning activities, including Visual Thinking Strategies, a jazz seminar, and a mask-making workshop. We evaluated the course via weekly reflective essays, interviews 6 weeks after the course, and pre-post surveys that included four scales with clinical relevance: capacity for wonder (CfW), tolerance for ambiguity (TFA), interpersonal reactivity index, and openness to diversity. RESULTS Qualitatively, the course helped learners: 1) reconnect with individual characteristics and interests that had been neglected during medical education; 2) better appreciate others' perspectives; 3) develop identities as physicians; and 4) engage in quiet reflection, renewing their sense of purpose. Quantitatively, pre-post mean totals increased for the CfW (32.0 [SD 6.8] vs 44.0 [SD 5.7], p=.006) and TFA scales (16.4 [SD 5.2] vs 24.2 [SD 6.9], p=.033). CONCLUSIONS This elective facilitated learners' connecting with themselves, others, and their profession with improvement in clinically-relevant measures. This provides further evidence that arts-based education can foster professional identity formation and be transformative for students.
Collapse
Affiliation(s)
- Sean Tackett
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center and Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren Eller
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Samuel Scharff
- Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kamna S. Balhara
- Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Melissa Suchanek
- Clinical Research Associate, Department of Oncology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sarah L. Clever
- Department of Medicine and Assistant Dean for Student Affairs, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Suzy Wolffe
- manager of tour experience, Baltimore, MD, USA
| | - Margaret S. Chisolm
- Psychiatry and Behavioral Sciences, and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
3
|
Wade SA, Ali I, Milstone AM, Clever SL, Xiao S, Koontz DW, Hansoti B. Medical Education during the COVID-19 Pandemic: A Reflection on the JHUSOM Experience. Res Sq 2023:rs.3.rs-3328706. [PMID: 37841861 PMCID: PMC10571620 DOI: 10.21203/rs.3.rs-3328706/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background We sought to understand the relative risk of COVID-19 infection and identify risk factors for infection to identify targets for mitigation among medical students. Methods An observational cohort study of Johns Hopkins School of Medicine students was conducted from June 2020 to July 2021. Blood samples were collected and tested at three visits to assess for the presence of antibodies against SARS-CoV-2. Additionally, a questionnaire was administered at each visit to collect demographic information and assess potential social and behavioral risk factors. Results 264 students enrolled in the study, and 38 participants completed all study requirements by study end. Roughly 6% of the first- and second-year classes had a reported positive COVID-19 test compared to 5% of third- and fourth-year students. By visit 3, 92% of medical students had detectable antibodies against COVID-19 compared to 4% during the study enrollment period. From study enrollment to visit 3, there was a 10-fold increase in the percentage of students reporting attending large social gatherings and dining in restaurants. Conclusions Overall, few COVID-19 cases were found among medical students, even those on clinical rotations. As the study progressed, students reported engaging in higher-risk social behaviors in conjunction with increasing vaccination rates among students.
Collapse
Affiliation(s)
| | - Iman Ali
- Johns Hopkins University School of Medicine
| | | | | | | | | | | |
Collapse
|
4
|
Linz MO, Jun AS, Clever SL, Lawson SM, Sanyal A, Scott AW. Evaluation of Medical Students' Perception of an Ophthalmology Career. Ophthalmology 2018; 125:461-462. [DOI: 10.1016/j.ophtha.2017.10.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/13/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022] Open
|
5
|
Hall JA, Ship AN, Ruben MA, Curtin EM, Roter DL, Clever SL, Smith CC, Pounds K. Clinically relevant correlates of accurate perception of patients' thoughts and feelings. Health Commun 2014; 30:423-429. [PMID: 24949868 DOI: 10.1080/10410236.2013.865507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The goal was to explore the clinical relevance of accurate understanding of patients' thoughts and feelings. Between 2010 and 2012, four groups of participants (nursing students, medical students, internal medicine residents, and undergraduate students) took a test of accuracy in understanding the thoughts and feelings of patients who were videorecorded during their actual medical visits and who afterward reviewed their video to identify their thoughts and feelings as they occurred (Test of Accurate Perception of Patients' Affect, or TAPPA). Participants' accuracy scores were then correlated with participants' attitudes toward patient-centered care, clinical course background, recall of clinical conversation, evaluations of clinical performance made by preceptors, evaluations of interpersonal skill made by standardized patients in clinical encounters, and independent coding of behavior in a clinical encounter. Accuracy in understanding patients' thoughts and feelings was significantly correlated with nursing students' clinical course experience, clinicians' favorable attitudes to psychosocial discussion, standardized patients' evaluations of medical students' interpersonal skill, independent coding of medical students' patient-centered behavior while taking a social history, and undergraduates' more accurate recall of what an actor-physician said on video. Accuracy in perceiving patients' thoughts and feelings can be objectively measured and is a skill relevant to clinical performance.
Collapse
Affiliation(s)
- Judith A Hall
- a Department of Psychology , Northeastern University
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Hall JA, Ship AN, Ruben MA, Curtin EM, Roter DL, Clever SL, Smith CC, Pounds K. The Test of Accurate Perception of Patients' Affect (TAPPA): an ecologically valid tool for assessing interpersonal perception accuracy in clinicians. Patient Educ Couns 2014; 94:218-223. [PMID: 24184040 DOI: 10.1016/j.pec.2013.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 09/27/2013] [Accepted: 10/05/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE A clinician's ability to infer patients' thoughts and feelings is a critical component of high quality care. The goal of this article is to present a new test to measure this ability in clinicians, called the Test of Accurate Perception of Patients' Affect (TAPPA). METHODS Audiovisual clips were taken from patients' actual medical visits. The patients reviewed the videotape after the visit to identify their thoughts and feelings during the visit. This information was used to extract short audiovisual clips for which the correct answer was the patient's report of the thought or feeling associated with that clip. The TAPPA contains 48 audiovisual clips, each responded to in a multiple choice format. RESULTS The TAPPA showed good psychometric properties (optimal mean and good variance, adequate internal consistency, and strong re-test reliability) and convergent validity with other tests of emotion recognition. In addition, the test showed predicted better performance by female than male participants. CONCLUSION The TAPPA promises to be a valuable tool for research and education on provider-patient relationships and quality of care. PRACTICE IMPLICATIONS A tool for testing clinicians' understanding of patients' thoughts and feelings may contribute to better quality of care and to improved selection and training.
Collapse
Affiliation(s)
- Judith A Hall
- Department of Psychology, Northeastern University, Boston, USA.
| | - Amy N Ship
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Mollie A Ruben
- Department of Psychology, Northeastern University, Boston, USA
| | | | - Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Sarah L Clever
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - C Christopher Smith
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Karen Pounds
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, USA
| |
Collapse
|
7
|
Clever SL, Dudas RA, Solomon BS, Yeh HC, Levine D, Bertram A, Goldstein M, Shilkofski N, Cofrancesco J. Medical student and faculty perceptions of volunteer outpatients versus simulated patients in communication skills training. Acad Med 2011; 86:1437-1442. [PMID: 21952062 DOI: 10.1097/acm.0b013e3182305bc0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To determine whether medical students and faculty perceive differences in the effectiveness of interactions with real patients versus simulated patients (SPs) in communication skills training. METHOD In 2008, the authors recruited volunteer outpatients (VOs) from the Johns Hopkins University School of Medicine internal medicine practice to participate in communication skills training for all first-year medical students. VOs and SPs were assigned to clinic rooms in the simulation center. Each group of five students and its preceptor rotated through randomly assigned rooms on two of four session days; on both days, each student interviewed one patient for 15 minutes, focusing on past medical and family history or social history. Patients used their own histories, not scripts; students were not blinded to patient type. Students and faculty then rated aspects of the interview experience. Generalized linear latent and mixed-models analysis was used to compare ratings of communication skills training with VOs versus SPs. RESULTS All 121 first-year students participated in 242 interviews, resulting in 237 usable questionnaires (98%). They rated their experiences with VOs significantly higher than those with SPs on comfort, friendliness, amount of learning, opportunity to build relationships, and overall meeting of communication skills training needs. The 24 faculty preceptors' ratings of the 242 interactions did not differ significantly between VOs and SPs. CONCLUSIONS Use of VOs was well received by students and faculty for teaching communication skills. Expanding and further studying VOs' participation will allow greater understanding of their potential role in communication skills training of preclinical medical students.
Collapse
Affiliation(s)
- Sarah L Clever
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Clever SL, Jin L, Levinson W, Meltzer DO. Does doctor-patient communication affect patient satisfaction with hospital care? Results of an analysis with a novel instrumental variable. Health Serv Res 2008; 43:1505-19. [PMID: 18459954 DOI: 10.1111/j.1475-6773.2008.00849.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine the relationship between physicians' communication behaviors and patients' overall satisfaction with hospital care using a novel instrumental variable to address possible confounding of this association by patient attributes. DATA SOURCES/STUDY SETTING Administrative records and postdischarge survey data were obtained from patients discharged from the General Medicine service at an urban tertiary-care academic hospital between July 1, 1997 and June 30, 2000. Administrative data included comorbidities, demographic data, and payer status. In the discharge survey, patients rated their attending physician on four communication behaviors, other aspects of their hospital stay, and their overall hospital care. STUDY DESIGN The primary outcome was patients' ratings of their overall satisfaction with hospital care, and the primary independent variable was patients' ratings of their physicians' communication behaviors. To remove possible confounding of the association between patient ratings of physician communication and overall satisfaction by other patient-specific attributes, we created an instrumental variable (IV) in a two-stage linear regression. The IV was the mean of the communication ratings given to each physician by the other patients cared for by that physician. PRINCIPLE FINDINGS/CONCLUSIONS: Three thousand one hundred and twenty-three patients were included in the analysis. In the ordinary least squares regression, there was a significant positive relationship between overall satisfaction and overall ratings of attendings' communication behaviors, with an increase in overall satisfaction of 0.58 points on a 5-point scale for each 1-point increase in overall attendings' communication behaviors, p<.001. This relationship was maintained but attenuated in the IV regression, with a coefficient of 0.40, p=.046. Although we find that the relationship between patient communication ratings and overall patient satisfaction may be confounded by patient-level factors, we nevertheless continue to find evidence of a statistically significant and sizable relationship between physicians' communication behaviors and overall patient satisfaction after controlling for such factors.
Collapse
Affiliation(s)
- Sarah L Clever
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, 601 N Caroline St., Suite 7143, Baltimore, MD 21287, USA
| | | | | | | |
Collapse
|
9
|
Clever SL, Ford DE, Rubenstein LV, Rost KM, Meredith LS, Sherbourne CD, Wang NY, Arbelaez JJ, Cooper LA. Primary care patients' involvement in decision-making is associated with improvement in depression. Med Care 2006; 44:398-405. [PMID: 16641657 DOI: 10.1097/01.mlr.0000208117.15531.da] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression is undertreated in primary care settings. Little research investigates the impact of patient involvement in decisions on guideline-concordant treatment and depression outcomes. OBJECTIVE The objective of this study was to determine whether patient involvement in decision-making is associated with guideline-concordant care and improvement in depression symptoms. DESIGN Prospective cohort study. SETTING Multisite, nationwide randomized clinical trial of quality improvement strategies for depression in primary care. SUBJECTS Primary care patients with current symptoms and probable depressive disorder. MEASUREMENTS Patients rated their involvement in decision-making (IDM) about their care on a 5-point scale from poor to excellent 6 months after entry into the study. Depressive symptoms were measured every 6 months for 2 years using a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. We examined probabilities (Pr) of receipt of guideline-concordant care and resolution of depression across IDM groups using multivariate logistic regression models controlling for patient and provider factors. RESULTS For each 1-point increase in IDM ratings, the probability of patients' report of receiving guideline-concordant care increased 4% to 5% (adjusted Pr 0.31 vs. 0.50 for the lowest and highest IDM ratings, respectively, P < 0.001). Similarly, for each 1-point increase in IDM ratings, the probability of depression resolution increased 2% to 3% (adjusted Pr 0.10 vs. 0.19 for the lowest and highest IDM ratings respectively, P = 0.004). CONCLUSIONS Depressed patients with higher ratings of involvement in medical decisions have a higher probability of receiving guideline-concordant care and improving their symptoms over an 18-month period. Interventions to increase patient involvement in decision-making may be an important means of improving care for and outcomes of depression.
Collapse
Affiliation(s)
- Sarah L Clever
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
BACKGROUND Medical students are rarely taught how to integrate communication and clinical reasoning. Not understanding the relation between these skills may lead students to undervalue the connection between psychosocial and biomedical aspects of patient care. OBJECTIVE To improve medical students' communication and clinical reasoning and their appreciation of how these skills interrelate in medical practice. DESIGN In 2003, we conducted a randomized trial of a curricular intervention at Johns Hopkins University School of Medicine. In a 6-week course, participants learned communication and clinical reasoning skills in an integrative fashion using small group exercises with role-play, reflection and feedback through a structured iterative reflective process. PARTICIPANTS Second-year medical students. MEASUREMENTS All students interviewed standardized patients who evaluated their communication skills in establishing rapport, data gathering and patient education/counseling on a 5-point scale (1=poor; 5=excellent). We assessed clinical reasoning through the number of correct problems listed and differential diagnoses generated and the Diagnostic Thinking Inventory. Students rated the importance of learning these skills in an integrated fashion. RESULTS Standardized patients rated curricular students more favorably in establishing rapport (4.1 vs 3.9; P=.05). Curricular participants listed more psychosocial history items on their problem lists (65% of curricular students listing > or =1 item vs 44% of controls; P=.008). Groups did not differ significantly in other communication or clinical reasoning measures. Ninety-five percent of participants rated the integration of these skills as important. CONCLUSIONS Intervention students performed better in certain communication and clinical reasoning skills. These students recognized the importance of biomedical and psychosocial issues in patient care. Educators may wish to teach the integration of these skills early in medical training.
Collapse
Affiliation(s)
- Donna M Windish
- Department of Internal Medicine, Yale Primary Care Residency Program, New Haven, CT, USA.
| | | | | | | | | |
Collapse
|
11
|
Clever SL, Novack DH, Cohen DG, Levinson W. Evaluating surgeons' informed decision making skills: pilot test using a videoconferenced standardised patient. Med Educ 2003; 37:1094-1099. [PMID: 14984115 DOI: 10.1046/j.1365-2923.2003.01713.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Standardised patients (SPs) are effective in evaluating communication skills, but not every training site may have the resources to develop and maintain SP programmes. OBJECTIVES To test whether videoconferencing technology (VT) could enable an interaction between an SP and an orthopaedic surgeon that would allow the SP to accurately evaluate the surgeon's informed decision making (IDM) skills. We also assessed whether this sort of interaction was acceptable to orthopaedic surgeons as a means of learning IDM skills. METHODS We trained an SP to represent a 75-year-old woman considering hip replacement surgery. Orthopaedic surgeons in Chicago individually consulted with the SP in Philadelphia; each participant could see and hear the other on large television screens. The SP evaluated the surgeons' advice using a 23-item checklist of IDM elements, and gave each surgeon verbal and written feedback on his IDM skills. The surgeons then gave their evaluations of the exercise. RESULTS Twenty-two surgeons completed the project. The SP was > or = 80% accurate in classifying 20 of the 23 IDM skills when compared to a clinician rater. Although 12 (55%) of the orthopaedic surgeons felt that some aspects of the technology were distracting, most were pleased with it, and 19 of 22 (86%) would recommend the videoconferenced SP interaction to their colleagues as a means of learning IDM skills. CONCLUSIONS These results suggest that VT allows accurate evaluation of IDM skills in a format that is acceptable to orthopaedic surgeons. Videoconferencing technology may be useful in long-distance SP communication assessment for a variety of learners.
Collapse
Affiliation(s)
- Sarah L Clever
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
| | | | | | | |
Collapse
|
12
|
|
13
|
Abstract
Ethics education aims to train physicians to identify and resolve ethical issues. To address ethical concerns, physicians may need to confront each other. We surveyed medical students to determine if their comfort challenging members of their ward teams about ethical issues varies by specialty and what attributes of students and their teams contributed to that comfort. Compared to other specialties, students felt significantly less comfortable challenging team members about ethical issues on surgery and obstetrics/gynecology. We suggest that ethics education must address the atmosphere on ward teams and give students skills to help them speak out despite their discomfort.
Collapse
Affiliation(s)
- S L Clever
- Department of Medicine, Division of General Internal Medicine, University of Chicago, Chicago, IL 60637, USA.
| | | | | | | |
Collapse
|
14
|
Redlich CA, Blaner WS, Van Bennekum AM, Chung JS, Clever SL, Holm CT, Cullen MR. Effect of supplementation with beta-carotene and vitamin A on lung nutrient levels. Cancer Epidemiol Biomarkers Prev 1998; 7:211-4. [PMID: 9521435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Carotene and Retinol Efficacy Trial (CARET), a randomized, placebo-controlled lung cancer chemoprevention trial of 30 mg of beta-carotene and 25,000 IU of retinyl palmitate, was prematurely terminated when a 46% excess lung cancer mortality was found in subjects on the active arm. Before the CARET intervention ended, 21 men were recruited to participate in a 6-month biomarker study using the same intervention as CARET that determined the effect of this supplementation on lung nutrient levels. Plasma and bronchoalveolar lavage (BAL) cell nutrient levels were measured before and after the intervention. The group in the active arm (n = 10) had plasma carotene level increases of over 10-fold, with a small increase in plasma retinol levels BAL cell levels of beta-carotene in the active group also increased 10-fold, from 4.5 to 46.3 pmol/10(6) cells (P = 0.0008), with no change in BAL cell retinol levels. Surgically obtained lung tissue from three CARET subjects in the active arm showed elevated carotene lung tissue levels but no increase in lung retinol levels compared to a group of surgical controls. Combined with our previous work showing a strong correlation between BAL and lung tissue nutrient levels, these findings suggest that supplementation with beta-carotene and vitamin A results in increased lung tissue as well as BAL cell levels of beta-carotene, with little change in lung retinol.
Collapse
Affiliation(s)
- C A Redlich
- Yale University School of Medicine, New Haven, Connecticut 06510, USA.
| | | | | | | | | | | | | |
Collapse
|
15
|
Redlich CA, Grauer JN, Van Bennekum AM, Clever SL, Ponn RB, Blaner WS. Characterization of carotenoid, vitamin A, and alpha-tocopheral levels in human lung tissue and pulmonary macrophages. Am J Respir Crit Care Med 1996; 154:1436-43. [PMID: 8912761 DOI: 10.1164/ajrccm.154.5.8912761] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Increasing evidence suggests that beta-carotene, retinol (vitamin A), and alpha-tocopheral (vitamin E) may have important protective effects in the lung. However, surprisingly little is known about their storage and metabolism in human lung. Levels of beta-carotene, retinol, and alpha-tocopherol in human lung tissues and bronchoalveolar lavage (BAL) cells were determined with reverse-phase high-pressure liquid chromatography (HPLC). Fresh lung tissue, serum, and dietary questionnaires were obtained from 21 patients undergoing open lung surgery, and BAL cells from 12 of these patients. Dietary and serum levels of carotenoids, beta-carotene, retinol, and alpha-tocopherol were consistent with previously reported values. Lung tissue levels of total carotenoids, beta-carotene, retinol, and alpha-tocopherol were respectively 0.34 +/- 0.36 microg/g, 0.13 +/- 0.27 microg/g, 0.15 +/- 0.06 microg/g, and 9.60 +/- 4.86 microg/g tissue. Levels of these nutrients were also measured in BAL cells to establish potential markers for their lung tissue levels. Correlations between serum, BAL-cell, tissue, and dietary levels of the nutrients were determined. Lung tissue levels of total carotenoids, beta-carotene, and alpha-tocopherol, but not retinol, correlated well with their serum levels. Lung tissue levels of retinol and alpha-tocopherol correlated with their BAL-cell levels. These studies demonstrate quantifiable levels of retinol, alpha-tocopherol, and total carotenoids or beta-carotene in human lung tissue and BAL cells, and show that serum and/or BAL-cell levels of these nutrients can potentially be used to predict their lung tissue levels.
Collapse
Affiliation(s)
- C A Redlich
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | | |
Collapse
|