Town Hall with the EVPHA
|Jonathan S. Lewin
Thank you to everyone who braved a damp and blustery day to attend my first town hall event here at Emory. It was a real pleasure to meet so many of you in person, and I look forward to meeting many more of you soon as I hold similar events on multiple Emory campuses.
If you were unable to join us in the auditorium, I hope you'll take a few moments to view a video of the event, in which I had the opportunity to share the path that brought me to Emory, my leadership principles, and a set of five-year aspirations for the Woodruff Health Sciences Center that I hope we'll be able to build upon as, together, we develop a shared vision and broad-based strategy.
As Mr. Robert W. Woodruff was fond of saying, "There is no way that any organization or individual, at any stage of its life, can sit back, rest on its laurels, and be content to collect the rewards already won. You continue to grow or you deteriorate." The Woodruff Health Sciences Center and Emory Healthcare have achieved extraordinary success, and I am confident that our best days lie ahead and that we have many opportunities to grow as we move forward together.
Emory efforts against Zika virus
|Mehul Suthar (pediatric infectious diseases)
The Emory Vaccine Center and Yerkes have assembled a team of scientists, including Mehul Suthar, Jens Wrammert, Anita McElroy, Mark Mulligan, Paul Johnson, Bali Pulendran, and Rafi Ahmed, who are studying the pathogenesis of Zika virus.
"We know very little about how Zika virus causes disease in humans," says Suthar, an expert on flaviviruses, which include West Nile, dengue, and Zika. "Our team is studying the immune response to Zika virus infection and developing an animal model to study the pathogenesis and transmission of the virus from mother to child during pregnancy. Combining these studies will help us develop an effective vaccine and therapeutic against Zika virus."
|George Painter, Abel de la Rosa
In addition, Emory-affiliated nonprofits DRIVE and EIDD are working to identify and develop antivirals to treat Zika infection, for which no treatment currently exists. The Georgia Research Alliance is providing support for this Zika project.
"For the past three years, we have been synthesizing and developing antivirals against alphaviruses, such as chikungunya, and flaviviruses," says George Painter, CEO of DRIVE and director of EIDD. "Since Zika is in the same family as dengue and hepatitis C, we can apply what we've learned working on alphaviruses and flaviviruses as well as from our past success with treatments for HIV, hepatitis B and C, and herpesviruses in our search for an effective drug."
"We are making progress developing a Zika RNA polymerase assay,” says Abel de la Rosa, chief scientific officer of DRIVE and EIDD. "This assay would allow us to rapidly screen our nucleoside/nucleotide library of compounds against Zika, some of which have shown activity against other flaviviruses. Lessons learned from other viral diseases, where vaccine development lagged behind effective antiviral treatment successes, suggest the best rationale against emerging viral diseases is a parallel development path for both vaccines and antivirals."
In the meantime, vaccine expert Saad Omer (global health, epidemiology, pediatrics) co-authored a just-published Viewpoint article in JAMA highlighting the need for priority Zika vaccine research and guidelines for pregnant women and barriers to such efforts. Read more.
Study shows belatacept improves kidney transplant survival rates
|Chris Larsen (medical dean) and Tom Pearson (transplant center director) played a key role in development of belatacept.
Results from a worldwide study published in the Jan. 28 issue of New England Journal of Medicine showed that belatacept has a better record of patient and organ survival in preventing kidney transplant rejection than calcineurin inhibitors such as cyclosporine and tacrolimus, which have been the standard of care.
The seven-year, multi-center study was led by medical dean Chris Larsen and UCSF transplant specialist Flavio Vincenti and was sponsored by Bristol-Myers Squibb.* FDA approval of belatacept in 2011 was based partly on the first three years of results.
Belatacept acts as a "co-stimulation blocker," inhibiting one of two signals T cells needed to trigger an immune response. Belatacept carries short-term risks that include an increased possibility for a certain cancer, and research continues at Emory on the best regimens for kidney transplant patients.
"While its best uses still need additional definition, these results indicate that using belatacept as standard of care has the potential to improve long-term outcomes that matter to patients,” says Larsen. "Unlike calcineurin inhibitors, belatacept is not toxic to the kidney and is more effective at suppressing antibodies against the kidney," says Vincenti. Read more.
*Larsen has received research support from this company.
Creating a standard in health care for physical activity
|As a member of the US Medical Soccer Team, RSPH faculty member Felipe Lobelo practices what he preaches about physical activity. Read more.
A new center in the Rollins School of Public Health aims to elevate the status of physical activity so that it becomes a standard in health care.
The Exercise is Medicine Global Research and Collaboration Center (EIM-GRCC), led by Felipe Lobelo (Hubert Department of Global Health), is a collaboration between the American College of Sports Medicine (ACSM) and RSPH.
The center is part of ACSM’s global initiative to make physical activity a routine component of health care. The EIM-GRCC is the academic hub in charge of evaluating the EIM initiative, in collaboration with partnering health care systems, community organizations, and fitness and technology companies.
“Physical inactivity is a leading cause of poor health, mortality, and higher health care costs in the US and throughout the world," says Lobelo, who is also an EIM advisory board member. "Too few health systems and health care providers routinely include physical activity as part of their patient’s treatment plans. If we truly believe that exercise is indeed medicine, then physical activity-related care needs to be standardized, from patient activity assessments, to counseling and referrals to community resources, just as other medical therapies and interventions are standardized.” Read more.
Improving medical management for elderly veterans
|Certified geriatric pharmacist LaWanda Kemp (right) with a patient and his daughter at the Atlanta VAMC.
When geriatric specialist Anna Mirk and her team at the Atlanta VA Medical Center set out to improve care for their elderly veteran patients, they identified barriers to proper medication use that involved not only the patient but also the network of caregivers surrounding the patient, including family members, caregivers, pharmacists, and primary care providers. The solution they implemented, called IMPROVE (integrated management and polypharmacy review of vulnerable elders), benefited all those involved.
To evaluate the situation, they set up a pilot clinic targeting patients 85 to 94 who were taking 10 or more medications (more than half also had a dementia diagnosis) and quickly identified some key issues: improper administration and dosing of medication, difficulties getting medication, problems related to poor vision and manual dexterity, and caregiver stress. Mirk and her team offered veterans and their caregivers a one-hour, face-to-face conference with a pharmacist that focused on education and problem-solving.
Describing her conference, one patient said, "The pharmacist talked to me about the way my medication works and the reasons for changing the way I take the medication. I used to take all of my medications together at one time." All of the patients and caregivers found that knowledge really is power: 87% had at least one medication discontinued, and 77% had one or more dosing or timing adjustments made. In addition to improvements in each patient's condition, pharmacy costs and health care utilization rates were reduced. Pharmacy costs alone declined by an average of $64 per veteran, per month.
"When I listen to taped interviews with the veterans and caregivers after their one-on-one sessions with the pharmacist, I can hear new confidence in their voices," says Mirk. "They feel empowered and engaged in their own health care. That’s the ultimate goal for patient-aligned health care and a great measure of our success." Mirk and colleagues are now rolling the project out to four rural VA community-based outpatient clinics, and they are developing a procedural manual and educational tool kit, so that other primary care providers can implement similar services in their clinics.
This article appeared first in Emory Daily Pulse.