Carol A. Mancuso MD is a general internist and clinical epidemiologist with specific interests in patient-centered clinical research and medical education. As a clinical researcher, Dr. Mancuso focuses on treatment expectations and outcomes in patients with musculoskeletal conditions, and self-management and quality of life in patients with asthma. Dr. Mancuso is actively involved in training physicians to be clinical researchers through her roles as an NIH-sponsored clinical mentor and the Co-Director of the Masters Degree Program in Clinical Epidemiology and Health Services Research at the Weill Cornell Graduate School of Medical Sciences.
In collaboration with orthopedic surgeons at the Hospital for Special Surgery, Dr. Mancuso conducted a series of studies to ascertain patientsí expectations of orthopedic surgery. This work led to the development of validated surveys to measure patientsí expectations of hip, knee, and shoulder surgery which have become gold standards used in national and international outcomes studies. Among patients with other musculoskeletal conditions, specifically rheumatoid arthritis and systemic lupus erythematosus, Dr. Mancuso studied major psychosocial adverse consequences of disease such as job loss, fatigue, and physical inactivity. Dr. Mancuso also conducted a trajectory of work assessing self-management, depressive symptoms, and quality of life in primary care and emergency department patients with asthma. Dr. Mancuso continues to actively conduct research in these areas with support from NIH and Foundation grants.
Dr. Mancuso is also dedicated to training future clinical researchers. She is the Co-Director of the Masters Degree Program in Clinical Epidemiology and Health Services Research at Cornell focusing on teaching physicians to conduct investigator-initiated studies in actual clinical settings. In addition, Dr. Mancuso is the Co-Director of a T32 training grant in Clinical Epidemiology and Health Services Research supported by the Agency for Healthcare Research and Quality, and is a member of the faculty of two T32 training grants in Rheumatology and Musculoskeletal Research supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. As a recipient of a clinical mentorship award from the National Heart Lung and Blood Institute, Dr. Mancuso continues to expand her role as a teacher and mentor to physicians and students throughout the Hospital for Special Surgery and the Cornell Medical Center.
Mancuso CA, Jout J, Salvati EA, Sculco TP. Fulfillment of patientsí expectations of total hip arthroplasty. J Bone Joint Surg Am 2009;91:2073-2078.
Mancuso CA, Graziano S, Briskie LM, Peterson MGE, Pellicci PM, Salvati EA, Sculco TP. Randomized trials to modify patientsí expectations of hip and knee arthroplasty. Clin Ortho Relat Res 2008;466:424-431
Mancuso CA, Sculco TP, Salvati EA. Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty 2003;18:872-878.
Mancuso CA, Altchek DW, Craig EV, Jones EC, Robbins L, Warren RF, Williams-Russo P. Patientsí expectations of shoulder surgery. J Shoulder Elbow Surg 2002;11:541-549.
Mancuso CA, Sculco TP, Wickiewicz TL, Jones EC, Robbins L, Warren RF, Williams-Russo P. Patientsí expectations of knee surgery. J Bone Joint Surg 2001;83-A:1005-1012.
Mancuso CA, Sayles W, Allegrante JP. Randomized trial of self-management education in asthma patients and effects of depressive symptoms. Ann Allergy Asthma Immunol 2010;105:12-19.
Mancuso CA, Sayles W, Allegrante JP. Development and testing of an asthma self-management questionnaire. Ann Allergy Asthma Immunol 2009;102:294-302.
Mancuso CA, Rincon M, Sayles W, Paget SA. Comparison of energy expenditure from lifestyle physical activities between patients with rheumatoid arthritis and healthy controls. Arthritis Care Res 2007;57:672-678.
Carol A. Mancuso MD is a general internist and clinical epidemiologist whose research interests focus on quality of life outcomes in chronic diseases and patientsí experiences with the health care system. Her areas of particular interest are elective orthopedic surgery, adverse lifestyle outcomes caused by rheumatoid arthritis and systemic lupus erythematosus, and self-management and quality of life in asthma patients. In addition, Dr. Mancuso is an NIH-sponsored educator to train physicians to become independent researchers.
Patientsí Expectations and Satisfaction with Outcomes of Orthopedic Surgery
Dr. Mancuso conducted a series of studies to ascertain patientsí expectations and satisfaction with hip, knee, and shoulder surgery. She found that in addition to improvement in pain and function, major expectations included regaining independence and restoring psychological well-being. These studies resulted in the development and validation of patient-derived surveys that have become gold standards for measuring expectations in clinical practice and research. Dr. Mancuso used these surveys in a study supported by the Arthritis Foundation to assess fulfillment of expectations of total hip arthroplasty, and in two randomized controlled trials supported by the National Institute on Aging to test the effectiveness of educational interventions to modify expectations of total hip and total knee arthroplasty. Future work will include development of expectations surveys for patients undergoing spine surgery, and assessment of change in expectations during staged bilateral arthroplasty and revision arthroplasty.
Adverse Psychosocial Outcomes in Patients with Connective Tissue Diseases
Most studies of employment in patients with rheumatoid arthritis (RA) focus on job loss; less is known about workplace experiences in patients who continue to work. To study these experiences, Dr. Mancuso conducted a longitudinal study comparing the incidence of negative workplace events between employed patients with RA and healthy controls. Compared to controls, negative events were associated primarily with more fatigue and more social stress in RA patients. In addition, RA patients were more likely not to meet national goals for daily physical activity and to become progressively more inactive over time. In a parallel study supported by the Mary Kirkland Center for Lupus Research, patients with systemic lupus erythematosus (SLE) also were more likely not to meet national activity goals. Future work will include measurement of exercise capacity and development of an intervention to increase lifestyle physical activity in SLE patients.
Improving Quality of Life and Clinical Outcomes in Primary Care and Emergency Department Patients with Asthma
As a Robert Wood Johnson Generalist Physician Faculty Scholar, Dr. Mancuso conducted a longitudinal study to identify patient-centered predictors of functional decline and resource utilization in asthma patients. The results showed that more depressive symptoms, less self-efficacy and unrealistic expectations predicted worse outcomes. This work became the foundation for the development of a patient self-management program aimed at increasing asthma knowledge, self-efficacy, and asthma-related social support. The program was tested with primary care patients in a randomized controlled trial supported by a K-23 award from the National Heart Lung and Blood Institute, and determined that the intervention was particularly affective in patients with more depressive symptoms.
During these studies, Dr. Mancuso found that many asthma patients limit physical activity and avoid exercise because they are concerned about exacerbating their respiratory symptoms. Lack of exercise, however, predisposes not only to direct adverse cardiovascular events, but also to obesity, depressive symptoms, and decreased pulmonary reserve, all of which can lead to adverse asthma outcomes. In order to increase physical activity, Dr. Mancuso conducted a randomized controlled trial to study the effectiveness of a novel psychosocial intervention to foster healthy lifestyle activities in primary care asthma patients. Supported by the National Heart Lung and Blood Institute, the trial resulted in clinically important increases in weekly physical activity, and was particularly effective in patients with more depressive symptoms.
Patients who present to urban emergency departments (ED) for asthma often do not have good self-management skills and do not have established sources of primary care. To address the educational needs of asthma ED patients, Dr. Mancuso conducted a randomized controlled trial supported by the National Heart Lung and Blood Institute aimed at fostering self-management in patients presenting for asthma to the ED at two inner city hospitals. Patients received interventions that addressed asthma knowledge, self-efficacy, and social support, and provided feedback regarding respiratory function. Quality of life and repeat ED visits improved in both groups, with particular benefit in younger patients.
A recurring theme throughout this trajectory of work has been the impact of depressive symptoms on asthma outcomes. This covariate will be assessed in detail in future work supported by the National Heart Lung and Blood Institute which will characterize the spectrum and manifestations of depressive symptoms in asthma patients.
Medical Education in Research
Dr. Mancuso is actively involved in training future clinical researchers through her roles as the Co-Director of the Masters Degree Program in Clinical Epidemiology and Health Services Research at the Weill Cornell Graduate School of Medical Sciences, the Co-Director of a T32 training grant in Clinical Epidemiology and Health Services Research supported by the Agency for Healthcare Research and Quality, and two T32 training grants in Rheumatology and Musculoskeletal Research supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. In addition, through a clinical mentorship award from the National Heart Blood and Lung Institute, Dr. Mancuso trains physicians to become independent investigators. Dr. Mancuso is a member of the Orthopedic Clinical Review Panel at the Hospital for Special Surgery which guides orthopedic surgeons in clinical research projects. She also is a sponsor for the Weill Cornell Medical College Travelers Research Fellowship Program, which offers minority college students opportunities to participate in medical research.
Dr. Mancuso is a Fellow of the American College of Physicians and is a member of the Society for General Internal Medicine, the American Thoracic Society, and the Society for Clinical Epidemiology and Health Services Research. Dr. Mancuso also is the clinical epidemiologist of an external Data and Safety Monitoring Board at the Mount Sinai School of Medicine for a randomized controlled trial assessing an herbal therapy for asthma supported by the National Center for Complementary and Alternative Medicine.