Published February 3, 2017
UB faculty members are increasingly being asked to contribute their expertise to the formulation of national and international clinical practice guidelines, which in turn benefits their trainees and patients.
Such evidence-based guidelines are used to inform health care decisions and lead to higher quality health care that is safer, more accessible, equitable and affordable.
Faculty invited to serve on panels that recommend clinical guidelines are leaders in their field, says Timothy F. Murphy, MD, SUNY Distinguished Professor of medicine and senior associate dean for clinical and translational research.
“They earned this distinction through clinical expertise in treating patients and also have participated in or directed the clinical research that the panels use to design the guidelines,” he says.
“UB faculty who are invited to serve on panels that publish clinical guidelines are being recognized as experts in their fields.”
Anne B. Curtis, MD, was a key contributor to new guidelines that incorporate the latest research on the best way to treat patients with atrial fibrillation.
One of the world’s leading clinical cardiac electrophysiologists and an expert in cardiac arrhythmias, Curtis has been involved in clinical research in atrial fibrillation for years. She has held many leadership positions in professional societies, such as the Heart Rhythm Society (she is a past president), the American College of Cardiology and the American Heart Association.
“The national guidelines on atrial fibrillation provide advice on the kinds of treatments that patients with atrial fibrillation should receive,” says Curtis, SUNY Distinguished Professor, Charles and Mary Bauer Professor and chair of medicine.
“It is important for clinicians to know which treatments are mandatory, which may or may not be advisable based on the patient’s condition and the characteristics of the arrhythmia in that particular patient, and which treatments are of no value or even potentially harmful.”
Curtis says the experts on the clinical guidelines writing committees weigh the strength of the evidence from clinical trials in developing these recommendations, evaluating both the quality of the clinical studies and how definitive the findings are.
The Infectious Diseases Society of America (IDSA) selected Brahm H. Segal, MD, professor of medicine in the Division of Infectious Diseases, to contribute to clinical practice guidelines for the diagnosis and management of aspergillosis.
“Invasive aspergillosis is an unusual infection that principally affects patients with a significantly impaired immune system,” he says. “The IDSA guidelines review data in the medical literature and provide evidence-based guidelines to physicians.”
In 2016, Gil I. Wolfe, MD, professor and Irvin and Rosemary Smith Chair of neurology, was co-chair of an expert panel that published the first international treatment recommendations for patients with myasthenia gravis (MG).
A leading authority on neuromuscular disorders, with a special focus on MG, Wolfe was an obvious choice as he was chair of the MG Foundation of America Medical/Scientific Advisory Board when the idea of assembling an international consensus panel and developing the recommendations was first conceived.
“This is the first international consensus statement on treatment in myasthenia gravis, a worldwide disease that impacts around one of every 8,000 to 10,000 people” he says.
“It aggregates the expertise of MG experts from around the world to provide a resource for neurologists and other practitioners who may not have as large a clinical experience, providing them a guide to optimally manage their patients with MG.
“It also provided definitions for certain concepts, such as what comprises a favorable outcome from therapy,” Wolfe adds. “This can be useful in research paradigms.”
Having a number of UB faculty contributing to national and international clinical practice guidelines stands the school’s training programs in good stead.
“When a training program’s faculty are serving on expert panels, it means that our medical students, residents and fellows are being trained by leaders in the field,” Murphy says.
“Trainees at other institutions read the guidelines, while our trainees are taught directly by the experts who designed the guidelines,” he says. “This enhances the quality of training substantially.”
Residents and fellows want to train with faculty who are on the leading edge of their field, Curtis notes.
“It assures them that they will be getting the most up-to-date training,” she says. “Being selected to be on a guideline-writing committee is clear evidence of such prominence.”
In the case of the myasthenia gravis guidelines, Wolfe says they provide trainees with a framework to understanding how neuromuscular medicine experts approach the treatment of MG patients.
“Instead of reading a whole host of literature, they can start by looking at such guidelines, which are typically heavily referenced, and go from there,” he says.
The guidelines also provide clinicians within the UBMD Physicians’ Group a framework for when they discuss treatment options with their patients.
“I have even provided patients copies of the published paper,” Wolfe says.
Luther K. Robinson, MD, a recently retired professor of pediatrics, has dedicated his career to studying and preventing fetal alcohol syndrome (FAS).
He was an inaugural member of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (FASD), and a longstanding member of the transdisciplinary Fetal Alcohol Syndrome Epidemiology Research (FASER) program funded primarily by the National Institute on Alcohol Abuse and Addiction (NIAAA), and he helped develop effective prenatal interventions and treatment approaches.
“Our first publication on operationalizing diagnostic criteria appeared in 2005 and reflected the results of more than 10 years of national and international research on fetal alcohol syndrome,” he says.
Robinson was again involved in the 2016 publication that updated those clinical guidelines for diagnosing FASD.
“This newer publication is a continuation of that work, building on data from thousands of subjects and control patients in our studies that have been funded through the NIAAA,” Robinson says.
“In addition to the known physical characteristics of FAS, the paper references an updated, Likert scale lip-philtrum guide that can be used without specific postdoctoral training in dysmorphology or clinical genetics.”
Robinson says he has long been an advocate of general pediatricians being on the “front line” of diagnosing FAS because there are not enough specialists to diagnose it.
“As advocates for children, the general pediatric readership now has updated tools for the diagnosis and ongoing care of affected children and their caregivers,” he says.
Curtis agrees that work on clinical practice guidelines assures patients they can be confident they are being taken care of according to the latest information available.
“In fact, clinicians on guideline-writing committees know what the recommendations will be well before they are published,” she says. “While we are not permitted to divulge the content of the guidelines before they are published, we can certainly practice according to what we know will be the latest recommendations.”
Faculty expertise produces a domino effect with far-reaching consequences for the greater good, Murphy notes.
“A faculty member who is a leader in the field has wide-ranging influence on the quality of care in a teaching health care system,” he says. “An expert influences their colleagues through lectures, teaching rounds, performing consults and daily interactions during patient care.
“Residents and students who are taught by experts then have an influence on other attending physicians and physicians in practice,” Murphy adds. “Ultimately, patients benefit through receiving care that represents best practices.”
Murphy says there are other benefits as well, noting clinical research and excellent health care go hand in hand.
Benefits for patients who participate in clinical trials include improved outcomes and more cost-efficient health care, he says
“In addition, surveys show that patients who participate in clinical research are more satisfied with their health care,” Murphy says. “The reason for these benefits is not entirely clear but likely results from regular contact with health care professionals related to the follow-up visits of the clinical trials.”