Richard H Moseley

Concordia University–Ann Arbor, Ann Arbor, Michigan, United States

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Publications (17)426.76 Total impact

  • New England Journal of Medicine 08/2014; 371(6):560-4. DOI:10.1056/NEJMcps1202137 · 54.42 Impact Factor
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    ABSTRACT: Although hospitalists may improve efficiency and quality of inpatient care, their effect on healthcare-worker communication and education has been less well-studied. To test various approaches to improving healthcare-worker communication and learner education within the context of a newly designed academic hospital medicine program. Before-and-after design with concurrent control group. A Midwestern Veterans Affairs medical center. Multimodal systems redesign of 1 of 4 medical teams (Gold team) that included clinical modifications (change in rounding structure, with inclusion of nurses, a Clinical Care Coordinator, and a pharmacist) and educational interventions (providing explicit expectations of learners and providing a reading list for both learners and attending physicians). Number of admissions, length of stay, readmissions, house officer and medical student ratings of attendings' teaching, medical student internal medicine National Board of Medical Examiners Subject Examination ("shelf" exam) scores, and clinical staff surveys. Length of stay was reduced by about 0.3 days on all teams after the initiative began (P = 0.004), with no significant differences between Gold and non-Gold teams. The majority of physicians (83%) and nurses (68%) felt that including nurses during rounds improved healthcare-worker communication; significantly more nurses were satisfied with communication with the Gold team than with the other teams (71% vs 53%; P = 0.02). Gold attendings generally received higher teaching scores compared with non-Gold attendings, and third-year medical students on the Gold team scored significantly higher on the shelf exam compared with non-Gold team students (84 vs 82; P = 0.006). Academic hospitalists working within a systems redesign intervention were able to improve healthcare-worker communication and enhance learner education without increasing patient length of stay or readmission rates. Journal of Hospital Medicine 2013;. © 2013 Society of Hospital Medicine.
    Journal of Hospital Medicine 11/2013; DOI:10.1002/jhm.2105 · 2.08 Impact Factor
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    ABSTRACT: A 55-year-old man presented with sinus congestion, headaches, chills, mild nausea, fatigue, and a "foggy" sensation that had lasted approximately 1 week. He reported darker urine than usual and had noticed that his eyes were turning yellow.
    New England Journal of Medicine 10/2012; 367(14):1342-7. DOI:10.1056/NEJMcps1011784 · 54.42 Impact Factor
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    ABSTRACT: Diets high in trans fats are associated with an increased risk of cardiovascular disease and components of the metabolic syndrome. The influence of these toxic fatty acids on the development of nonalcoholic fatty liver disease has not been significantly examined. Therefore, we sought to compare the effect of a murine diet high in trans fat to a standard high-fat diet that is devoid of trans fats but high in saturated fats. Male AKR/J mice were fed a calorically identical trans fat diet or standard high-fat diet for 10 days, 4 wk, and 8 wk. Serum alanine aminotransferase (ALT), lipid, insulin, and leptin levels were determined and the quantitative insulin-sensitivity check index (QUICKI) was calculated as a measure of insulin resistance. Additionally, hepatic triglyceride content and gene expression of several proinflammatory genes were assessed. By 8 wk, trans fat-fed mice exhibited higher ALT values than standard high-fat-fed mice (126 +/- 16 vs. 71 +/- 7 U/l, P < 0.02) despite similar hepatic triglyceride content at each time point. Trans fat-fed mice also had increased insulin resistance compared with high-fat-fed mice at 4 and 8 wk with significantly higher insulin levels and lower QUICKI values. Additionally, hepatic interleukin-1beta (IL-1beta) gene expression was 3.6-fold higher at 4 wk (P < 0.05) and 5-fold higher at 8 wk (P < 0.05) in trans fat-fed mice compared with standard high-fat-fed mice. Trans fat feeding results in higher ALT values, increased insulin resistance, and elevated IL-1beta levels compared with standard high-fat feeding.
    AJP Gastrointestinal and Liver Physiology 06/2009; 297(2):G378-84. DOI:10.1152/ajpgi.90543.2008 · 3.74 Impact Factor
  • New England Journal of Medicine 03/2009; 360(6):616-21. DOI:10.1056/NEJMcps0805187 · 54.42 Impact Factor
  • Clinton L Greenstone, Sanjay Saint, Richard H Moseley
    New England Journal of Medicine 07/2007; 356(23):2407-11. DOI:10.1056/NEJMcps062271 · 54.42 Impact Factor
  • Kris L Snow, Richard H Moseley
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    ABSTRACT: The thiazolidinedione derivatives, troglitazone, rosiglitazone, and pioglitazone, are novel insulin-sensitizing drugs that are useful in the treatment of type 2 diabetes. However, hepatotoxicity associated with troglitazone led to its withdrawal from the market in March 2000. In view of case reports of hepatotoxicity from rosiglitazone and pioglitazone, it is unclear whether thiazolidinediones as a class are associated with hepatotoxicity. Although the mechanism of troglitazone-associated hepatotoxicity has not been elucidated, troglitazone and its major metabolite, troglitazone sulfate, competitively inhibit adenosine triphosphate (ATP)-dependent taurocholate transport in isolated rat canalicular liver plasma membrane vesicles mediated by the canalicular bile salt export pump (Bsep). These results suggest that cholestasis may be a factor in troglitazone-associated hepatotoxicity. To determine whether this effect is 1) limited to canalicular bile acid transport and 2) is specific to troglitazone, the effect of troglitazone, rosiglitazone, and ciglitazone on bile acid transport was examined in rat basolateral (blLPM) and canalicular (cLPM) liver plasma membrane vesicles. In cLPM vesicles, troglitazone, rosiglitazone, and ciglitazone (100 microM) all significantly inhibited ATP-dependent taurocholate transport. In blLPM vesicles, these three thiazolidinediones also significantly inhibited Na(+)-dependent taurocholate transport. Inhibition of bile acid transport was concentration dependent and competitive in both cLPM and blLPM vesicles. In conclusion, these findings are consistent with a class effect by thiazolidinediones on hepatic bile acid transport. If hepatotoxicity is associated with this effect, then hepatotoxicity is not limited to troglitazone. Alternatively, if hepatotoxicity is limited to troglitazone, other mechanisms are responsible for its reported hepatotoxicity.
    Life Sciences 02/2007; 80(8):732-40. DOI:10.1016/j.lfs.2006.11.001 · 2.30 Impact Factor
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    ABSTRACT: 2002 marked the first time that the rate of hospital spending in the United States out-paced the overall health care spending rate of growth since 1991. As hospital spending continues to grow and as reimbursement for hospital expenses has moved towards the prospective payment system, there is still increasing pressure to reduce costs. Hospitals have a major incentive to decrease resource utilization, including hospital length of stay. We evaluated whether physician profiling affects physician satisfaction and hospital length of stay, and assessed physicians' views concerning hospital cost containment and the quality of care they provide. To determine if physician profiling affects hospital length of stay and/or physician satisfaction, we used quasi-experimental with before-versus-after and intervention-versus-control comparisons of length of stay data collected at an intervention and six control hospitals. Intervention hospital physicians were informed their length of stay would be compared to their peers and were given a questionnaire assessing their experience. Nearly half of attending pre-profiled physicians felt negative about the possibility of being profiled, while less than one-third of profiled physicians reported feeling negative about having been profiled. Nearly all physicians greatly enjoyed their ward month. Length of stay at the profiled site decreased by an additional 1/3 of a day in the profiling year, compared to the non-profiled sites (p < 0.001). A relatively non-instrusive profiling intervention modestly reduced length of stay without adversely affecting physician satisfaction.
    BMC Health Services Research 04/2006; 6:45. DOI:10.1186/1472-6963-6-45 · 1.66 Impact Factor
  • New England Journal of Medicine 03/2006; 354(5):509-14. · 54.42 Impact Factor
  • Amy Schmitt, Daniel J. Gilden, Sanjay Saint, Richard H. Moseley
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    ABSTRACT: We describe a 52-year-old man with type 2 diabetes mellitus who developed cholestatic hepatitis in association with rosiglitazone use. Liver biopsy findings included dilated canaliculi, inspissated bile, intrahepatocellular bile pigment deposits, and enlarged xanthomatous Kupffer cells. The form of liver injury reported in this case differs markedly from those reported previously for rosiglitazone.
    Journal of Clinical Gastroenterology 09/2005; 39(7):638-40. DOI:10.1097/01.mcg.0000170768.59696.16 · 3.19 Impact Factor
  • New England Journal of Medicine 03/2005; 352(5):489-94. DOI:10.1056/NEJMcps041569 · 54.42 Impact Factor
  • Richard H Moseley
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    ABSTRACT: Sepsis-associated cholestasis should always be considered as part of the differential diagnosis of jaundice in the hospitalized or critically ill patient. The development of a disproportionate elevation of serum bilirubin in comparison with serum alkaline phosphatase and serum aminotransferases should be considered an early warning sign of an underlying infection, even in the absence of fever,leukocytosis, or other signs or symptoms. Prompt recognition and appropriate medical and surgical intervention may reduce morbidity and mortality.
    Clinics in Liver Disease 03/2004; 8(1):83-94. DOI:10.1016/S1089-3261(03)00134-X · 2.70 Impact Factor
  • New England Journal of Medicine 12/2003; 349(19):1848-53. DOI:10.1056/NEJMcps031315 · 54.42 Impact Factor
  • Archives of internal medicine 11/2003; 163(21):2650-2651. DOI:10.1001/archinte.163.21.2650 · 13.25 Impact Factor
  • Richard H Moseley
    Current Opinion in Gastroenterology 06/2003; 19(3):181-4. DOI:10.1097/00001574-200305000-00001 · 3.66 Impact Factor
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    ABSTRACT: The incidence of acute liver failure or serious liver injury in diabetic patients is needed to evaluate the safety of hypoglycemic drug therapy. We conducted a retrospective cohort study of 5 health maintenance organizations. Study patients were 171,264 health plan members 19 years or older when they received oral hypoglycemic drugs or insulin between April 1, 1997, and June 30, 1999. We searched for hospital discharge diagnoses and procedures potentially indicative of acute liver injury and reviewed the full-text medical records. Acute liver failure was defined as acute liver disease and (1) hepatic encephalopathy, (2) prothrombin time prolongation greater than 3 seconds or international normalized ratio greater than 1.5, and (3) a total bilirubin level greater than 3.0 mg/dL (>51 micro mol/L). Acute liver injury was diagnosed in individuals who did not meet 1 or more of the criteria for acute liver failure but had alanine transaminase or aspartate transaminase levels greater than 500 U/L. We identified 35 cases of acute liver failure or injury not clearly attributable to a known cause other than use of hypoglycemic agents. The age- and sex-standardized incidence per 1000 person-years was 0.15 for insulin users, 0.08 for sulfonylurea users, 0.12 for metformin users, and 0.10 for troglitazone users. The incidence was higher (on the order of 0.3 per 1000) during the first 6 months of exposure to all hypoglycemic agents. Acute liver failure or injury not clearly attributable to other known causes occurred on the order of 1 per 10,000 person-years among diabetic patients treated with oral hypoglycemic drugs or insulin.
    Archives of Internal Medicine 03/2003; 163(6):728-34. DOI:10.1001/archinte.163.6.728 · 13.25 Impact Factor

Publication Stats

191 Citations
426.76 Total Impact Points


  • 2007–2013
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2012
    • University of Michigan
      • Department of Internal Medicine
      Ann Arbor, MI, United States
  • 2006
    • Good Samaritan Hospital
      Cincinnati, Ohio, United States
  • 2005
    • University of Utah
      • Department of Internal Medicine
      Salt Lake City, UT, United States