Meeting Today's Needs, Planning for Tomorrow
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Emory medical faculty provide almost 4 million patient services a year, a substantial proportion of all care in Atlanta, from fetal medicine to geriatrics, from preventive and primary care to some of the most specialized care in the region. They provide this care in the six hospitals and various clinics of Emory Healthcare, the largest, most comprehensive health system in Georgia, and in Emory’s long-term affiliates: Grady Memorial Hospital, the Atlanta VA Medical Center, and Children’s Healthcare of Atlanta, with which Emory shares the largest pediatric multispecialty group practice in the state.
And while they are meeting the day-to-day needs of patients, they are also studying ways to improve health care overall, through innovations not only in diagnosis and therapy but in the way health care is provided.
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In this section Immunosupressants for diabetes Slideshow key 1. Tim Buchman is working to prototype new ways of displaying data routinely collected at the ICU bedside to foresee and prevent sudden deterioration of the patient’s condition. Tim Buchman directs all critical care medicine in Emory’s hospitals. 2. Physician-scientist Fadlo Khuri leads a study to fingerprint genetic mutations in lung cancer to help personalize therapy for individual patients. 3. Gastroenterologist Jennifer Christie has documented the benefits to low-income patients of having help from patient navigators in getting screened for colon cancer. 4. In a historic procedure last March, hand and transplant surgeon Linda Cendales (right) was part of a team that performed a hand transplant on college student Linda Lu. The 19-hour procedure involved the connection of numerous structures, including bones, tendons, nerves, vessels, and skin. Cendales joined Emory in 2007 to lead the Emory-Veterans Affairs Vascularized Composite Allograft Program, the only VA-approved limb transplant program in the country. Emory is one of only four centers to have performed a hand transplant successfully. Cendales was on the team in Louisville that performed the first such procedure in the United States in 1999. 5. Hospitalist Sigy Jacob is part of Emory’s hospice and palliative care team who help bridge the gap between emotional expectations of the patient and family and the very real, predictable realities of what medicine can and can’t do. |
Transplant milestone
Last March, surgeons at Emory University Hospital performed a hand transplant on a young college student, placing Emory among only four centers to have successfully performed the procedure. Before joining Emory to direct the Emory University-Veterans Affairs Vascularized Composite Allograft Program, the only VA-approved limb transplant program in the country, surgeon Linda Cendales trained at University of Louisville, where she was on the team that performed the nation’s first and the world’s longest surviving hand transplant. The 19-hour surgery at Emory involved connection of numerous structures, including, bones, tendons, nerves, vessels, and skin.
Immunosuppressants for diabetes
Pediatric endocrinologist Eric Felner is leading a multi-site clinical trial to study effectiveness of alefacept, an immunosuppressant that attacks a subpopulation of renegade T cells, in controlling type 1 diabetes. This drug has gained FDA approval for treatment of psoriasis, and investigators hope they can use it to deactivate overactive T cells that attack insulin-producing cells in the pancreas.
Heart and vascular disease
Valve replacement—Catheter-delivered replacement heart valves should be the new standard of care for patients too frail or sick to withstand surgical valve replacement. That’s the conclusion of cardiologist Peter Block, principal investigator of a clinical trial that followed 358 Emory University Hospital patients with severe aortic stenosis. Patients who had replacement heart valves delivered by catheter were more likely to survive a year than patients who were treated without replacing their original valves. During the transcatheter aortic valve implantation, doctors feed the new valve, mounted on a wire mesh on a catheter, into a small incision in the groin or chest wall. When the valve is expanded, it pushes aside the diseased valve, allowing blood to flow normally.
Repair of aortic aneurysm—Conventional surgical repair of abdominal aortic aneurysm is not a viable option in about half of patients with this disorder because of the complexity of their disease. With the recent arrival of vascular surgeon Joseph Ricotta, Emory became the only institution in the Southeast offering high-risk patients fenestrated and branched endografts: stents with reinforced openings (fenestrations) or branches that allow the physician to attach arteries that lead to other organs. The endograft is delivered to the site of the aneurysm by catheter. The procedure is safe and effective for high-risk patients, and it requires no incision, reduces hospital stay, and speeds recovery.
Honing in on cancer
Clinical trials—Emory’s Winship Cancer Institute has the most active clinical trials program in the state, including study of image-guided radiotherapy for painful metastasis of tumors to the spine, new techniques to improve detection of recurrent prostate cancer, and more powerful treatments for patients with recurrent, drug-resistant ovarian cancer. Winship also is leading a myeloma trial in which combination of an antibody engineered to attack a myeloma protein with standard drugs has produced a positive response in 83% of patients.
Personalizing treatment—Winship is one of 14 facilities in a National Cancer Institute-endorsed consortium formed to catalog genetic changes in lung cancer. The study’s goal, according to lung cancer specialist and principal investigator Fadlo Khuri, is to establish a fingerprint for each of the genetic changes or mutations found in as many as 50% of all lung cancers, which will aid clinicians in devising personalized, targeted therapies for individual patients.
Keeping patients safe
Emory professor of medicine Ruth Parker is known for her work on health literacy. But what if reading isn’t enough? Parker co-led a yearlong study, published in JAMA, of 200 top-selling over-the-counter (OTC) oral liquid medications for children. Most contained variable and inconsistent dosing directions; nearly half had directions that did not match the measuring device included. Medications studied included 99% of U.S. analgesic, cough/cold, allergy, and gastrointestinal OTC oral liquid products with dosing information for children younger than 12. This patient safety issue needs urgent attention, says Parker.
Predicting emergencies in the ICU
Tim Buchman, founding director of Emory’s Center for Critical Care, is taking predictive health to the bedside in Emory’s critical care units. While most predictive health focuses on preventing and managing risks of chronic illnesses, Buchman wants to predict and head off immediate threats to life—an abnormal heart rhythm, a sudden increase or drop in blood pressure, or a seizure—before they happen. The body’s capacity for moment-to-moment adaptation in response to changing physiologic demand is the true signature of health, says Buchman. And loss of adaptive capacity—increasing regularity in the face of everyday changes in the immediate environment—signals risk for sudden deterioration.
That’s why Emory Hospital uses adaptive support ventilation for patients on ventilators, varying the size of breaths and intervals between breaths while minimizing the work of breathing, just as natural physiology expects. He and his colleagues also are studying waveforms of patients who go on to have a life-threatening event to see whether patterns of heart rate and blood pressure have predictive value for other patients. The goal, he says, is to peer a few minutes into the future, just far enough to prevent disaster and guide the patient back on course.
