More bang for the buck
Eyes have it
Research dollars at new high
Human touch still best
High-tech detectives
Ambassadors through health
Healthy children, healthy adults
Take the E out of exercise?



Moving Forward

 

 
More bang for the buck

Physicians, hospitals, and health plans are always looking for ways to enhance patient care. Now a team of high-powered researchers from Aetna US Healthcare has joined the Woodruff Health Sciences Center (WHSC) to help us find the best, most cost-effective treatments for patients.

The cornerstone of the new Emory Center on Health Outcomes and Quality is a group of 14 specialists in "outcomes research," the economic and epidemiologic study of how well health interventions work. The researchers are poised to collaborate extensively with clinicians and researchers across the WHSC on studies related to patient outcomes and quality improvement. In the past, the group has studied how managed care structures and intervention strategies affect patient outcomes in diabetes, asthma, arthritis, cardiovascular disease, and mental illness. Researchers have also studied physical activity, ethnic disparities in cancer screening, and the effects of health literacy on patient outcomes.

The new collaboration will include access to the extensive data resources of Aetna's US Quality Algorithms (USQA) group -- the performance and outcomes measurement subsidiary of the largest managed care organization in the nation. This will give Emory a major assist in its capability to do health services research, according to Kenneth Thorpe, director of the new Emory center and chair of the Rollins School of Public Health department of health policy and management, where the Emory center is housed. "This is an unusual opportunity for Emory by integrating academically trained researchers who had been working hands-on in the private sector, looking at issues of quality and outcomes," he says.

Based in Atlanta, the USQA Center for Health Care Research has collaborated with academic institutions such as Emory, government agencies such as the Centers for Disease Control and Prevention, and other health industry leaders for more than seven years. Aetna will continue to support and collaborate on relevant research at the Emory center for at least two years.

Last year, the USQA center was one of nine research consortia awarded a contract by the Agency for Healthcare Research and Quality to establish the Integrated Delivery System Research Network. This model of field-based research links top researchers in the nation with some of the country's largest health care systems.

In recognition of Aetna's contribution to establish the new Emory center, the WHSC will create a lecture series on health outcomes and quality research. The multischool, multidisciplinary center will also offer a long distance master of public health degree in outcomes research.


Eyes have it

The Emory Eye Center continues to be singled out as one of the top 10 ophthalmic programs in the nation. It's one of the top 10 NIH-funded ($6 million) eye research programs in the United States. And after polling ophthalmology department chairs and directors of residency programs across the nation, Ophthalmology Times ranks the Emory center among the best in these areas:
  • Overall program (8th)
  • Patient care (7th)
  • Residency (6th)

Additionally, U.S. News & World Report last July named Emory as one of the country's 10 best eye centers, the eighth year in a row that the news magazine has included Emory in its ophthalmology rankings.


Research dollars at new high



Research funding to the Woodruff Health Sciences Center increased by 14.3% this year, rising to $232.9 million or 94% of the university's total of $247.9 million. The center's research budget has increased by $100 million since 1995-1996, when it garnered $132.9 million or 90.9% of the university's total. Research funding to the university as a whole rose 57% during that time, placing Emory among the nation's fastest-growing research universities.

"This research growth has occurred despite tremendous economic pressures on academic health centers," says Michael Johns, executive vice president for health affairs, and despite severe research space limitations that will be eased temporarily by the Whitehead Biomedical Research Building, the Winship Cancer Institute Building, and other research construction and renovations finished or in progress. Other strong omens for future growth include the establishment this year of a clinical trials office, the addition of new core labs, and strong recruits in cancer, neuroscience, and other areas.

Here's a breakdown of funding:

  • School of Medicine: $167.3 million, a 13% increase. Ranked 23rd in the nation in NIH funding.
  • Yerkes Regional Primate Research Center: $36.2 million, a 31% increase.
  • The Rollins School of Public Health: $25.7 million, a 2% increase.
  • Nell Hodgson Woodruff School of Nursing: $3.3 million, more than double last year's funding.

Human touch still best


Humanism in medicine can be taught most effectively through interactions at the patientŐs bedside.

Despite widespread recognition that positive physician-patient interactions benefit the treatment of disease, medical students and residents still receive little effective training in the human dimensions of their craft, say expert teachers in a consensus report in the Journal of the American Medical Association.

Humanism in medicine can be taught most effectively not through formal coursework, but through interactions that occur directly at the patient's bedside, the article concludes.

Physicians at six academic medical centers, led by William Branch, professor of medicine at Emory, surveyed more than 50 faculty physicians nationwide who teach medical students and residents in a variety of educational settings. They looked at the extent to which humanism is a part of medical education and for barriers that may prevent physicians-in-training from receiving humanistic education.

The authors, who were part of an ad hoc group created by the American Academy on Physician and Patient in 1998, defined humanism as "the physician's attitudes and actions that demonstrate interest in and respect for the patient and that address the patient's concerns and values."

Through an institution's "hidden curriculum," medical trainees are socialized into the culture of medicine by integrating the institution's values and attitudes into their knowledge and skills of medical practice, the authors said. They recommended broad changes in attitudes within medical schools, including addressing the overall climate of medical education within institutions -- a climate that often has more of an impact on students than any formal lesson, they noted.

"It is not possible to teach the human side of medicine away from the patients themselves," Branch says. "The methods we suggest are useful even within the fast-paced setting of clinical rounds. The goal is to create a learning environment that treats the students and residents with respect, establishes an atmosphere of trust and collaboration, and addresses the human needs of learners, who also are under a great deal of stress."

Attending physicians may exert a powerful influence on the attitudes of their students and encourage positive, caring attitudes through the personal interest they show in patients, in the way they respond to crises, and by modeling effective listening skills. In bedside teaching, medical educators should discourage dehumanizing language, integrate the medical with psychosocial aspects of care, emphasize teamwork, and provide timely feedback, the authors suggest.

"We believe that physicians in training should be practicing and receiving feedback on their humanistic skills at the same time they are learning the technical, scientific skills of medical practice," Branch says.


High-tech detectives


Physicians will be able to detect cancerous tumors earlier and more precisely, thanks to breakthrough medical imaging technology that will soon arrive at Emory. Emory is one of only three sites in the United States to receive the new combination scanner to diagnose cancer. The scanner fuses positron emission tomography and computerized tomography information to help pinpoint and localize cancerous tumors faster and more accurately.

Created by GE Medical Systems, the scanner should arrive at Emory in several months, pending approval of a certificate of need by the state of Georgia.


Ambassadors through health



The new Lillian Carter Center for Inter-
national Nursing continues the nursing
school's mission to provide health care
for vulnerable people around the world.


 'In developing countries, nurses are the only providers of primary care. They are the only thing that stand between disaster and social stability.' --Desmond Tutu

They came from more than 60 countries, but the nursing leaders who arrived here in October did so with a common purpose: to help stem the critical shortage of nurses worldwide.

No matter what country, the nursing workforce issues each faces are similar: need for higher salaries, better working conditions, more learning opportunities, and ethical policies to curb the migration of nurses to nations where nursing is more attractive. Yet, no single solution exists. What works to recruit nursing students and keep nurses on the job in Scotland (where more than 35,000 nurses and midwives serve a population of 5.1 million) won't work in Ghana (which has a public health workforce of 29,000 and a population of 18.4 million).

One underlying message came through loud and clear: Because nurses are the backbone of health care, they must toot their horns more loudly to shape workforce policy and improve patient outcomes. They must make their ideas known to government leaders and translate their research findings into terms (financial and otherwise) that decision-makers understand.

The global nursing partnerships conference was the first major initiative of the Lillian Carter Center for International Nursing (LCCIN). The center was established last year by the Nell Hodgson Woodruff School of Nursing to address nursing workforce issues and provide education, research, and leadership development opportunities for nursing students and nurses in and outside the United States.

The gathering was a professional milestone for the nursing school and its dean, Marla Salmon, who was asked by the International Council of Nursing (ICN) to host a global forum in conjunction with international nursing work under way at Emory. Two years in the making, the conference provided an opportunity for the nursing school and the Woodruff Health Sciences Center to take the lead in addressing international nursing issues with input from ICN; the World Health Organization; the governments of the United Kingdom, Canada, and the United States; and The Carter Presidential Center, where much of the conference was held. In return, some 300 nursing and health leaders from Albania to Zimbabwe opted to attend the conference, even after terrorists attacked the United States in September.

Along with their newfound knowledge, the nurse leaders took away an armload of inspiration from former US President Jimmy Carter and South African Archbishop Desmond Tutu.

Carter happily joined their ranks when Salmon named him as the Lillian Carter Center's first honorary nurse fellow. "My mother, who I'm sure is in heaven, would be surprised and pleased that I'm a nurse," said Carter. He was there to dedicate the center named for Miss Lillian (pictured at left), who served as a community nurse and Peace Corps volunteer. Her famous son recalled growing up in Plains, Georgia, surrounded by respected nurses like his mother, who often was the only link between life and death for poor farming families struck by illness.

"They couldn't pay her, but she didn't care," said Carter. "I have never forgotten that lesson, and it made me appreciate nursing."

Tutu formed a special bond with nurses early in life as well. When tuberculosis landed him in the hospital as a teenager, he developed a crush on his nurse. The smitten teen grew up to receive a Nobel Peace Prize for his efforts to end apartheid in South Africa. The archbishop added another honor to his credit when the LCCIN recognized his efforts to enhance human health through humanitarianism.

Just as important, nursing leaders at the global partnerships conference were lauded for their service as ambassadors of peace through health. In Carter's view, politicians can learn a lot from nurses at the bedside.

"That is where love is shown in its purest form," he said. "I hope you return to your homes with a renewed commitment to let your voices be heard."

To read more about the Lillian Carter Center for International Nursing, see the autumn 2001 issue of Emory Nursing on the web at whsc.emory.edu/mzine_emory_nursing.cfm


Healthy children, healthy adults



Jane Fonda's generosity will fund the
Marion Howard Chair in Adolescent
Reproductive Health and a new center
that will develop and implement training
programs that will impact children and
youth. Pictured from left are Howard,
medical school Dean Thomas Lawley,
Fonda, and Michael Johns, executive
vice president for health affairs.

Sometimes it takes visionary citizens stepping forward to help faculty achieve their ambitious dreams. Jane Fonda's vision will support efforts to learn more about the best ways to guide our children toward healthy adulthood.

With a $2 million gift to the School of Medicine, faculty in the new Jane Fonda Center initially will develop and implement training programs that will enable professionals to positively impact various stages of childhood and youth development, including adolescent reproductive health. The center will engage in research, education, and training activities with potential for creating needed social change or enhancing service delivery.

The Jane Fonda Fund in Adolescent Reproductive Health will support development of the center. In addition, Fonda's gift will endow a gynecology and obstetrics chair -- the Marion Howard Chair in Adolescent Reproductive Health. Howard's innovative programs are national models for educating adolescents on how to healthily manage their sexual feelings and behaviors. These programs have included effective abstinence education and creative reproductive health service delivery methods.

The new center builds on Fonda's previous support for Georgia initiatives concerning adolescent reproductive health, resulting from her long-standing interest in preventing teen pregnancy. In fall 2000, Fonda contributed $1.3 million to the Grady Health System for its teen services clinic, which focuses on preventive education and counseling to help young people establish lifetime patterns of caring for their reproductive health.

The Jane Fonda Center will have a synergistic relationship with the Grady teen services program, which Howard directed until recently. After moving to new teen-friendly space within Grady Hospital, an expanded teen center will continue to provide education, counseling, and medical services. The center also will spearhead research and evaluation studies of promising programs around the country.

In 1995, Fonda helped establish a nonprofit organization called the Georgia Campaign for Adolescent Pregnancy Prevention. The campaign works with organizations throughout the state to develop programs aimed at removing Georgia from the top 10 states in number of adolescent births.


Take the E out of exercise?



Popular consumer books on nutrition tout vitamin E, C, and beta carotene as panaceas that help prevent heart disease. But some Emory scientists suspect that taking antioxidants - at least when you first start to exercise - could possibly endanger your heart health.

Sampath Parthasarathy, director of gynecologic and obstetrics research, is an expert in antioxidants and their role in health. His research team has concluded from mice studies that exercise-induced oxidative stress may prevent atherosclerosis by stimulating the body to manufacture its own antioxidant enzymes. However, taking antioxidant supplements, specifically vitamin E, could negate this natural, heart-disease fighting process.

To find out if this theory holds up in people, Parthasarathy and cardiologist William Weintraub are seeking 500 volunteers for a clinical trial that may help answer a number of intriguing questions about the relationship between exercise and antioxidants. For example, how long, how intense, and how often should one exercise to convert oxidative stress into an antioxidant defense?

"We will also find out if vitamin E is potentially harmful," says Weintraub, director of Emory's center for outcomes research. "This goes against prevailing thought, but we want to see if it might block the body's ability to develop its own antioxidant defenses."

The Fitness 2001 study will recruit 250 women and 250 men between the ages of 18 and 70, who don't exercise or take vitamin supplements and have no evidence of heart disease. The scientists will monitor the research subjects' oxygen consumption as they work out on a treadmill to determine their fitness. After answering questions about their eating and exercise habits, participants will exercise three times a week for a half hour for two months. Scientists will measure the study participants' cholesterol levels and check their blood for specific markers of oxidative stress.

In this Issue


From the Director  /  Letters

Of mice and men

Lives on the line

Our GRA connection

Moving Forward  /  Noteworthy

On point: Perspectives on bioterrorism

Coming to a helipad near you

"We believe that the cholesterol-lowering benefit that exercisers get involves oxidative stress," says Parthasarathy. "If people don't get the oxidative stress - if they take antioxidants during this period of starting exercise - they will not lower their cholesterol."

In the late 1980s, Parthasarathy was part of a research team that concluded oxidative stress plays a major role in the development of cardiovascular disease. The theory was that constant oxidation inside cells generates molecules that form "free radicals" that can damage body cells and tissues. Oxidation of low density lipoprotein (LDL) by free radicals causes LDL to enter blood vessel walls and deposit cholesterol instead of being removed from the body through the liver. This theory gained acceptance in the cardiology community and helped promote the popularity of antioxidants -- nutrients and other substances that stabilize free radical molecules, helping prevent, inhibit, or delay oxidative damage.

"We need to recognize that not everyone may benefit by taking antioxidant supplements," adds Parthasarathy. "In fact, some may cancel out the benefits of certain drugs, such as cholesterol-lowering medication."

 


Copyright © Emory University, 2002. All Rights Reserved.
Send comments to the Editors.
Web version by Jaime Henriquez.