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Highlights:
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Next-generation
genomics
On the company agenda
Caring for the invisible
Hospital room with a view
Behind
the scenes of "Grady's Anatomy"
The
big brown bear and the two blind mice
Milestones |
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Next-generation
genomics
The
sequencing of the Human Genome Project was necessarily enormous
(involving 25,000 to 30,000 genes and 3 billion base pairs), deliberately
anonymous, and prohibitively expensive. By contrast, Emory human
geneticist Mike Zwick is developing a practical alternative technique
of genetic analysis that is focused, individualized, fast, and cheap.
The technology and software he is developing will enable small laboratories
to rapidly and inexpensively generate large quantities of genetic
data for individuals.
Zwick’s methodology involves
gene resequencing, in which the genome of individuals or groups
(such as patients with a specific disease) is compared with the
human genome. The goal is to identify where differences occur and
whether a larger-than-expected number of people with the same condition
have the same differences.
Zwick
is using resequencing to search for autism-susceptibility genes,
looking specifically at how the genes of boys affected by
autism and their healthy fathers differ both from the human genome
and each other. The family samples come from the Autism Genetic
Resource Exchange, a gene bank with phenotype information, pedigrees,
and genetic DNA samples of almost 600 families with more than one
member diagnosed with some form of autism.
From
this wealth of information, Zwick has selected 314 families with
two affected sons, both of whom share the same portion of the X
chromosome from their mother. Each father and son’s genetic
material is placed on a computer chip, no thicker than a microscope
slide and three-quarters of an inch square. The chip contains a
swath of DNA fragments, and the subject’s DNA is mixed in
liquid form over this field. The sequences of the two sets of matching
DNA “find each other,” or hybridize. The chip is washed
so that nonspecific DNA fragments are removed, leaving only matched,
or paired, fragments. The subject’s DNA can then be visualized
by scanning the chip with a laser.
From
this picture, scientists can determine the DNA sequence of the hybridized
fragments using software developed by Zwick and colleagues at Johns
Hopkins. When entered into a computer, the information fills the
screen with colored dots, the bright lights marking the areas where
the subject’s DNA sequence differs from the norm. Statistical
analysis of all 314 sets will determine how common, rare, and meaningful
such differences are in relation to autism.
The
cost of using the new technology is less than .001 cent per base
pair. That’s a large return on investment given the possible
benefits—the ability to develop new diagnostic tests and provide
a greater understanding of possible environmental exposures contributing
to autism. An understanding of the genes involved could even guide
development of a treatment, leading to a drug therapy for autism.
However,
the implications of this technology go beyond one disorder. As individualized
medicine and predictive health increasingly become realities, there
is growing need for rapid, inexpensive identification of genetic
differences in people to tailor therapy and eventually lower risk
of disease. Next-generation genomics technologies like Zwick’s
can help deliver a genome-sequencing center to every lab, whether
large or small. –Sylvia Wrobel |
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On
the company agenda
The popularity of so-called executive health programs is
growing across the nation as high-powered CEOs seek preventive and
tailored health care that fits into busy schedules.
According to Dave Roberts, medical
director of Emory’s Executive Health, “Delta will get
you to the exact same destination at the exact same time whether
you fly coach or first class. But the Crown Room and in-flight care
in the first class cabin can make the flight more enjoyable—not
to mention more convenient, with a personalized travel agent to
arrange your itinerary and activities once you arrive.” In
other words, the care at Emory is the same whether you come through
the executive health program or the more traditional route.
However, with this program, there
are some perks as well as certain preventive tests that are not
part of a routine exam. Patients wait in an elegant lounge with
freshly brewed coffee, new magazines, and a staff focused on anticipating
their needs. Two rotating Emory
physicians see only six patients a day, offering a half-day health
experience that features personalized evaluations and the latest
medical technology.
The executive health program differs
from concierge medicine, which provides 24/7 access to a specific
doctor for a monthly fee. Executive Health at Emory does provide
a higher level of service and convenience but has no upfront membership
fee.
“Frankly, the concierge label
has a bad ring to it as a fad or elitist,” says Roberts, Charles
F. Evans Professor of Medicine. “It doesn’t apply in
our case. We are providing extra service in reaction to the patient’s
schedule and needs rather than solely as an entrepreneurial effort
aimed at increasing revenue.”
Specifically, the physical offered
through Emory Executive Health includes the coordination of an extensive
exam, lipid panel, health risk assessment, ECG, exercise treadmill
test, CT scan of the heart, prostate screening or mammogram, and
other diagnostic and preventive tests and procedures—some
standard and others ordered depending on the needs of the individual
patient. According to administrator Reid Willingham, tests results
are typically available the same day, and patients are able to review
the results during their visit. Patients also receive personalized
counseling and participate in a behavior modification program that
helps them make lifestyle changes to reduce the risk of heart disease,
diabetes, and other preventable diseases. Approximately two weeks
after the appointment, the participant receives a bound copy of
the exam and other test results as well as a personalized letter
from the physician.
The executive health concept, emphasizing
preventive care, makes sense to an ever-increasing number of CEOs,
presidents, and other high-level executives. “Emory Executive
Health volumes are snowballing, posting a 25% growth in physicals
over the past two years, with many referrals from participants who
are pleased with the program,” says Willingham. Currently,
the program sees 1,000 patients from around the world per year and
is competing successfully with similar services at Mayo and the
Cleveland Clinic.
Emory Executive Health bypasses insurance
billing. The service is an out-of-pocket expense (starting at $1,386
for men and $1,394 for women) that is usually covered by large corporations
for their high-level executives or increasingly by people willing
to pay the extra cost. “About 70% of our participants are
covered by their company, and the other 30% are self-pay,”
says Willingham. “Corporations realize this is not only good
health care for the executive but also good for the company’s
bottom line.”
The core population for the program
may give health care exams low priority to their busy schedules,
especially if they are having no symptoms, says Roberts. “Our
greatest benefit is in partnering with the company to get these
key people to take a morning off to focus on the most important
thing they have going for them, their health, and to make sure that
they stay in peak condition.” –Sherry
Baker |
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Caring
for the invisible
Conducting
a health fair in a homeless shelter wasn’t exactly what Mercedes
Rice had in mind when she declared her nursing major. But
soon into her first semester at Emory’s Nell Hodgson Woodruff
School of Nursing, that’s exactly where Rice found herself:
teaching homeless clients of downtown Atlanta’s Gateway Center
about nutrition and dental hygiene.
“It was a great experience,”
says Rice. “Doing service learning with the homeless would
change anybody’s outlook about the homeless or about themselves.
It’s something I’ll take with me.”
Service
learning connects community service with academic education and
is one way that Emory’s nursing students are getting real-world
experience long before they graduate. That’s the goal of
Monica Donohue, coordinator of the school’s program with Gateway.
She teams with professors to provide graduate and undergraduate
students with experiences that are unavailable in a classroom.
“Our
ultimate purpose is to meet the clients’ needs at Gateway,”
says Donohue. “We don’t want to place our students just
so they can meet the requirements for a course. We want to provide
something meaningful for the community.”
For
Emory’s partnership with Gateway, “something meaningful”
includes education and prevention that can complement an on-site,
acute care clinic operated by St. Joseph’s Mercy Care Services.
As Donohue says, “Clients can go to St. Joseph’s and
receive medications, but how do we identify those who don’t
yet know they have high blood pressure?
Or
how do we educate the homeless to let them know that hypertension
is a big issue with their population? That’s where the students
come in. They can do a lot of health promotion and disease prevention
via health education.”
The
education goes both ways. After four years of working in an emergency
room, Amanda Goodwin completed her MSN at Emory this past December.
Doing hand clinics at Gateway before graduation
connected her to why she chose this work. In the clinic, students
wash the clients’ hands, trim nails, and do an assessment
of their skin, finishing with a hand massage. They also offer foot
clinics, which are particularly valuable for people who spend most
of their time on their feet. “The experience reinforced my
desire to work with the indigent,” Goodwin says. “I
am reminded of how we are all human—and worthy of respect.”
Cheryl
Dukas, who also worked in hand clinics at Gateway while finishing
her MSN, came away with a similar insight. “The thing I remember
about the people I served was that I saw a lot of dignity and grace
under tremendous pressure and vulnerability,” she says. “Most
clients showed evidence of good hygiene—an indicator of all
kinds of physical and mental health conditions—which was interesting
considering the challenges of keeping clean if you’re homeless.
These people wanted to share their lives and their stories,”
she adds. “They wanted to not be invisible.”
The
clinics emphasize the importance of touch, says Donohue. “They
are about one human connecting with another.”
As
Emory’s partnership with the Gateway Center enters its second
year, Donohue has plans for the program to expand. More students
will have an opportunity to provide long-term health counseling,
monthly health education, regular health screenings, and first aid
training for Gateway staff.
That’s
welcome news to Vince Smith, executive director of Gateway. “This
community needs to know that people care and that new beginnings
are a real option,” Smith says. “Bringing Emory’s
strengths to this community can make a dramatic and eternal difference.”
—Dana Goldman
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Hospital
room with a view
The head architect needed to know if the design for a patient room
in Emory University Hospital’s new neuro ICU would suit how
nurses work. So while he lay on the hospital bed in the full-scale
model, he had himself intubated. Or rather, a nurse pretended to
intubate him. The drill was videotaped and later used in a feedback
session to refine the design.
The nurse, Michelle Ossmann, a neuro-critical
care nurse practitioner at Emory Hospital, is an undergraduate and
graduate alumnus of the Nell Hodgson Woodruff School of Nursing
(SON) and currently a PhD student in architecture at Georgia Tech.
In December, along with other students, she presented her final
project in a collaborative Emory/Tech course that for the first
time incorporated the disciplines of nursing, industrial design,
architecture, computer science, systems engineering, and human computer
interaction to design the patient room of the future. Working in
teams, graduate students from all of these disciplines designed
new ways to address the needs of hospitalized patients, their families,
and staff.
Gerri Lamb, Visiting Independence
Foundation and Wesley Woods Scholar and one of the instructors for
the course, took students on hospital tours to see rooms and talk
with nurses about what works and what doesn’t work in the
hospital environment. The students saw plenty of what fails to work,
Lamb says—bathtubs that are inaccessible, awkward arrangements
of patient beds, limited space for family members, and lack of work
surfaces for nurses, for starters.
Nursing Dean Marla Salmon says patient
care and hospital design are intrinsically linked, with the physical
and emotional environment contributing to patient safety and healing.
Salmon also notes that hospital design is especially important in
light of the nursing shortage and aging workforce. She hopes the
class will lead to a joint nursing and architecture degree between
Emory and Tech.
Will Ossmann continue to work as a
nurse after earning her architecture degree? “Absolutely.
My concern is patient care. The best way to influence the physical
environment for my patients and colleagues is to know what’s
happening on the ground,” she says. She predicts the field
of health care architecture and design will continue to grow, attracting
not only nurses but also other health care professionals.
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What
does the new patient room look like?
A large, widescreen TV/computer monitor hangs on the wall
facing the bed. Doctors access it to videotape an update for
the patient’s medical records or leave a message for
the family.
A smaller screen sits in front of the patient, which can play
the radio and television or display a clock when not in use.
It also serves as the nurse call system with video chat capability.
Behind the bed is a wall of cabinets and drawers for clothing
storage, a Murphy twin bed for a family member, with a privacy
screen and a fold-down desk for a computer.
The shower is equipped with a seat that slides on a support
rail that wraps around the perimeter of the bathroom. A vinyl
screen can be pulled out from the wall to provide privacy
for the patient but is only waist high to enable help from
a caregiver. A narrow drain snakes around the floor for easy
cleaning.
A “care cart” provides for patient needs throughout
the room and has mobile and stationary components. The mobile
cart has an over-the-bed work surface for procedures and allows
immediate access to gloves, needle disposal,
and supplies. |
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Behind
the scenes of "Grady's Anatomy"
When
CNN began filming at Grady Hospital last winter, the Emory residents
at the center of its focus were in for a few surprises.
Robin Lowan, Lou Tumialan, and Andrea Meinerz (center, l to r) appeared
on air on March 24 and 25 as stars of the docu-drama that explored
the lives of residents at work and home. Here’s how two of
the residents described the experience.
First-year ER intern Lowman:
“I was shocked at how closely the camera crews were following
me. I had thought the camera would be in the corner during my shift,
but it was only 6 inches away. At first I was skeptical but after
a couple of hours into the shift, the camera crew had learned how
to move fast.
“It was a little exhausting.
I’m used to getting off my shift and going home to decompress.
However, after the shifts, I had to debrief for one to two hours.
It also was draining to explain each patient to the camera. Grady’s
ER is so busy that anything that slows you down can throw your entire
night off. So I tried to explain as quickly and accurately as possible.
“I would certainly do it again.
Any opportunity to showcase the dire needs of emergency care, the
needs of the uninsured, and the work ethic of physicians is one
that I will never pass up.
“I haven’t gotten any
movie star treatment, only a lot of jovial teasing. I have to be
at the hospital at 5:30 AM every day, along with the colleagues
on my rotation. In the end, I’m another resident trying to
learn as much as I can, do no harm to my patients, help heal the
wounded, mentally and physically, and give African-American girls
hope that they too can achieve in a society in which there are many
negative images on TV.”
Fifth-year neurosurgery resident Tumialan:
“At first, [the filming] was a little unnerving. You became
overly conscious about every word that came out of your mouth. However,
by the end of the first day of a camera on your tail, you hardly
noticed it.
“The questions asked by the
producers during the debriefs prompted a lot of introspection. I
found myself reflecting more and more about what it is that we do
as resident physicians at Grady and our role in society at this
point in our medical careers.”
When asked if he’d do it again,
Tumialan says, “without hesitation.” And is he now a
star at work? “No movie star treatment, still taking as much
call as I did before this whole thing started. With regard to my
family and friends, I decided to surprise them.” |
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The
big brown bear and the two blind mice
Eastern
medicine discovered it first, but now scientists in the West have
validated the finding. A component of bear bile is promising in
fighting some eye conditions that lead to blindness. Researchers
at the Emory Eye Center have found that a synthetic version of bear
bile—used to treat visual disorders in Asia for more than
3,000 years—has the potential to treat age-related macular
degeneration, retinitis pigmentosa, and glaucoma. Their study appeared
in the December 29, 2006, edition of Molecular Vision.
Working with scientists at the Atlanta
Veterans Affairs Medical Center, the University of Minnesota, and
the University of Lisbon, Emory ophthalmologist Jeffrey Boatright
found that systemic injection of a primary component of bear bile
prevents programmed cell death in the eye. It also preserves function
and structure of retinal photoreceptor cells in two different mouse
models of human retinal degeneration. The researchers hope that
their results will lead to clinical trials in humans and ultimately
use of the substance to treat diseases that lead to blindness.
The
compounds tested are synthetic and relatively inexpensive
and do not come from bears, says Boatright. |
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Milestones
The
2005 Faculty Scholarly Productivity Index, produced
by Academic Analytics and reported in the Chronicle of Higher Education,
measured faculty productivity in universities across the country,
based on publications, federal grant funding, and honors/awards.
Emory was included in the top 10 ranks for immunology (3), microbiology
(5), nursing (2), pathology (1), pharmacology (5), and public health
(8).
Recent
NIH recognition has come on two different fronts.
Emory’s HIV/AIDS Clinical Trials Unit is a primary site in
both the cinical trials and vaccine section of NIH’s premier
networks. The NIH also chose Emory as one of six new Centers of
Excellence for Influenza Research and Surveillance, which will expand
and improve surveillance of seasonal and avian flu and determine
how flu viruses mutate to infect different species.
Through
a collaboration between the School of Medicine and
Goizueta Business School, Emory will offer a new joint doctor of
physical therapy (DPT) and MBA degree. Business decisions are having
a broad impact on the way health care is provided, and physical
therapists equipped with management and financial skills will be
better positioned to succeed. In U.S. News & World Report rankings,
Emory’s DPT program ranks 8th in the nation, and its MBA program
ranks 18th. Few DPT programs in the nation offer dual degrees.
Atlanta
businessman J. Rex Fuqua has donated $2 million
to create an endowment for a chair for Emory’s new Childhood
and Mood Disorders Program. Suicide is the third leading cause of
death for American children and adolescents, but little is known
about what causes depression and mood disorders in the young. Emory’s
program will provide outpatient and inpatient short-term care; engage
in research using neurobiology; explore brain imaging and genetics;
and train future child and adolescent psychiatrists and psychologists.
The
Emory Vaccine Center received the Georgia Biomedical
Partnership’s 2007 Biomedical Community Award. As a member
of the partnership’s 2006 legislative response team, Marie
Csete, director of Emory’s human embryonic stem cell lab,
was honored for efforts related to cloning and stem cell legislation
in Georgia. The organization also recognized Emory, Georgia Tech,
and the Medical College of Georgia with a Deal of the Year award
for the NIH grant to create a Nanomedicine Development Center focused
on repair of DNA damage. |
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