Camera with an indispensable view
Breaking language barriers
Rankings: High marks
21st century western medicine looks East
  for centuries-old martial arts
Eye-opening rotations
Where tobacco money goes
Teens, sex, and the Internet
New clinic offers high hopes for AIDS vaccine
Islets and 'trickery' for diabetes
Insulin doses in your Palm
Surviving the 'stroke belt'
How to conduct clinical trials



Moving Forward

 

 

It's not that physicians at the Atlanta Veterans Affairs Medical Center aren't excited about being among the first in the nation to provide patients with a tiny digital camera that helps diagnose colon problems. It's just that they don't want the camera back.

The camera, along with a miniature battery, transmitter and light source, fits into a plastic capsule the size of a vitamin. It's so small that the patient simply swallows the pill, letting the camera find its own way through the digestive system as it sends two images per second to a receiver strapped to the patient's belly. Doctors download the photos for examination, leaving the camera behind.

"Basically, it's a $400 disposable digital camera," laughs Peter Bloom, chief of the gastrointestinal section at the VA Medical Center and an assistant professor at Emory.

The camera -- developed by Norcross-based Given Imaging and recently approved by the Food and Drug Administration -- may be dispensable, but the view it provides the doctors is not. More common diagnostic tools like enteroscopy reveal only about a third of the small intestine's 25-foot length. The capsule, with a battery life of nearly eight hours, travels through the entire organ, making it easier to diagnose problems such as obscure bleeding and to identify inflammatory bowel disease. And it's much more comfortable for the patient to swallow a pill than handle a scope inserted through the mouth, says Bloom.

In fact, a patient simply swallows the capsule, leaves the hospital, and forgets about the procedure, returning only to drop off the receiver. "As long as you don't do jumping jacks, dive in the swimming pool, or use a jackhammer," he says, "it should be fine."

Camera with an indispensable view




A communication breakdown can be a disaster when seeking medical care. Language barriers between health care provider and patient can lead to missed diagnoses, confused prescription instructions, and other dangerous slip-ups. But the troubles can start a long time before a patient even sees the doctor.

"It can affect whether the patient even comes in," says internist Inginia Genao, assistant professor of medicine at Emory and director of multicultural affairs at Grady Hospital. "It affects whether they can find out where to go, whether they can pay their bill at the end of the visit, whether they can even make an appointment. It affects everything."

Bridging that language gap is why Genao -- a native of the Dominican Republic -- has created a Latino Clinic at Grady. It is staffed by a team of bilingual physicians, residents, and support personnel to serve patients who communicate better in Spanish.

Initially, it will be open two days a week with both primary care physicians and pediatricians on staff, but Genao hopes to add other services soon.

It's unclear exactly how many Latino patients visit Grady, but Genao says the number is large, with patients seeking treatment everywhere from the emergency room to specialized clinics. They often can't find anyone who speaks Spanish. The hospital uses a translator telephone service, but the results are "less than desirable," she says.

"Concentrating our resources in one place will mean better health care for these people."

For more information about the Latino Clinic, call Grady's department of multicultural affairs at 404-616-0437.

Breaking language barriers



Emory Hospitals were the only ones in Georgia to make the AARP's top 50 list. In a survey of some 20,000 physicians, 83% rated Emory University Hospital very good or excellent (42nd place), while 68% gave Emory Crawford Long Hospital (49th) high marks. The national average was 33%. The survey considered mortality rates, physician training programs, and Joint Commission on Health Care Accreditation scores.

In another poll, the Emory School of Medicine moved up in rankings issued by US News & World Report's annual "Best Graduate School" edition. Emory ranked 20th in the nation (up from 22nd) among research-oriented schools and jumped to 25th from 41st last year among primary-care oriented schools.

Rankings: High marks



Two walnuts revolve clockwise in one student's right hand. The movement is deliberate. But for a few faint clacks, the room is quiet. The student moves the walnuts to the left hand and turns them counterclockwise. Right hand, clockwise; left hand, counterclockwise.

Another Tai Chi class has begun, this one designed by Tai Chi grand master Tingsen Xu specifically for patients weakened by Parkinson's disease. Xu, an associate professor of neurology in the School of Medicine, requires participants' concentration as he tests their coordination and tries to calm their nervous systems. Students stand straight, then slowly shift their weight to the left leg, then to the right. They slowly walk forward, arms gently swinging in rhythm, then backward. They turn their torsos left, then right -- arms always following the torso. They grasp an imaginary ball, left hand over right, and push the ball away . . . right hand over left, push it away.

With slow motions, Xu returns again and again to the central principle of achieving and maintaining balance in mind and body.

But can Chinese mind-body modalities truly benefit patients crippled by Parkinson's?

Neurologist Jorge Juncos and rehabilitation medicine specialist Steven Wolf are asking the question formally. Their 16-week, double-blind trial randomly divides the group of 18 initial participants with Parkinson's (patients who may fall on occasion or use a cane, but are still independent) into one of three courses of exercise: Tai Chi, Qi Gong and walk/cycle, higher-energy aerobic exercises. Their caloric expenditure is measured and considered in relation to motor function changes that may result from exercise. Through exercises, "patients learn ways to become better tuned in to their limitations, their sense of balance," Juncos says.

Advocates for Tai Chi (low-energy physical and mental exercises) and Qi Gong (visualization exercises) say that the inner calm they find through their methods can restore balance for patients. "Western medicine can help people relieve their symptoms, it's true," Xu says. "But you yourself have to create the ability to overcome the disease. That is the point."

The study, based at Emory's Center for Research on Complementary and Alternative Medicine in Neurodegenerative Diseases, is funded through a $5.7 million grant from the National Center for Complementary and Alternative Medicine at the National Institutes of Health.

21st century western medicine looks East for centuries-old martial arts


Can Chinese mind-body modalities truly benefit patients crippled by Parkinson's disease?



In places like India, young physicians learn quickly how to do a lot with a little. A group of Emory faculty and residents in rehabilitation medicine recently witnessed firsthand how Indian physicians produce good outcomes in a low-cost environment.

V. R. Rao, medical director for rehabilitation therapy services at Grady Health System, says American physicians can learn a lot from their colleagues in the developing world.

"At Emory, we're all about producing global physicians with global capabilities," he says. "We also want to show our physicians how other cultures use rehabilitation medicine and give them a chance to see diseases they wouldn't normally see here."

Rao and other physicians and residents from rehab therapy recently observed doctors at a medical college and hospital in Bombay, as they treated polio, cerebral palsy, gait abnormalities, and congenital orthopedic deformities. The trip was part of an Emory pilot program called "International Rotation: Global Perspectives in Human Care."

Alaric Van Dam, chief resident in physical medicine and rehabilitation, says the trip was eye-opening. "The people of India don't have many resources or high-tech equipment, yet they have low infection rates," he says.

International rotations, funded by public and private donations, help medical residents learn to communicate with and understand patients of many backgrounds. Besides offering medical education, the program also serves as an academic exchange. An Indian physician who helped lead the recent trip will visit Emory to lecture and demonstrate surgical techniques.

"We want to put Emory on the map as producing global physicians," Rau says. "It's a great opportunity to broaden the experience of young physicians."

Eye-opening rotation



Chief resident Alaric Van Dam (left) and
Grady physician V.R. Rao worked with
patients and other clinicians in Bombay
as part of a new international
rotation program.


In 1998, 46 states and five US territories won a $206 billion settlement with the tobacco industry. But the burning question is: Where should the money go?

Dearell Niemeyer wants a lot of it to go toward reducing tobacco use and consequently shrinking the tobacco market. But some communities may miss this multibillion-dollar opportunity. The tobacco dollars come with no conditions, and many states have used the money for everything from making up budget shortfalls to building roads.The landmark settlement will mean less, Niemeyer says, if the lessons on tobacco prevention are not learned, allowing big tobacco to recoup its losses.

Niemeyer is executive director of the newly formed Tobacco Technical Assistance Consortium (TTAC), housed at the Rollins School of Public Health. TTAC's mission is to consult with state and local public health workers responsible for tobacco-control programs -- to shorten the learning curve for implementing effective tobacco control and prevention programs and to make the most of the windfall.

In the spirit of the agreement, some state legislatures have funded health-related programs: in Pennsylvania, a health-insurance program for low-income adults; in Florida, multimedia ad campaigns against smoking; and in Georgia, new cancer research and treatment initiatives under the Georgia Cancer Coalition as well as more than $20 million in tobacco prevention programs.

Other states aren't sure what to do: Help tobacco farmers find alternate crops? Establish nicotine addition centers? Pay for indigent health care? Or build sidewalks and finance public schools and elder care? With limited staffs and thin expertise, states need help.

The American Cancer Society, Robert Wood Johnson Foundation, and the American Legacy Foundation (the repository for the tobacco settlement money) will give TTAC $15.3 million in grants over the next three years to provide blueprints for community tobacco control and prevention programs, to train staff, and to evaluate existing services. States will look to TTAC for the nuts and bolts of effective strategies to reduce tobacco use, using proven models, such as Florida's "truth campaign." Just two years into that edgy, anti-smoking ad campaign, smoking rates dropped 47% in middle school students and 30% in high-schoolers.

Niemeyer knows such success stories well. The former chief of the CDC's Office of Smoking and Health helped write the CDC guide Best Practices for Comprehensive Tobacco Control Programs and led California's initiatives to prevent and reduce tobacco use through increased taxes, school curricula, and institution of nonsmoking policies in restaurants and work places.

He especially worries that budget shortfalls might affect how settlement funds are used. "You're not going to get a chance to sue Big Tobacco again," Niemeyer tells state legislators and governors. "Don't you want to invest in reducing future tobacco-related costs?"

Where tobacco money goes




With information technology experts predicting that today's youth may spend as much as 20 years of their lives connected to the Internet, it's no surprise that 45% of teenagers, ages 14 to 17, say they have viewed a sexually erotic site, intentionally or inadvertently, according to a recent study conducted by National Public Radio, the Kaiser Family Foundation, and the Harvard Kennedy School. The effects of such exposure is just what Rollins School of Public Health (RSPH) behavioral scientist Ralph DiClemente is examining with a five-year grant of more than $3 million from the National Institutes of Health.

To track the Internet usage of 865 adolescents, 14 to 16 years old, the RSPH is collaborating with the public health information technology laboratory at the University of Georgia and with Harris Interactive, a leading Internet research company with extensive experience in conducting studies on media exposure and adolescent health.

"There is a lot of controversy surrounding this issue, but very little empirical research," says DiClemente. "Media is inundated with sexual images and content. It's very likely that adolescents' exposure to this content may influence their conceptions and intentions about their sexual behaviors and attitudes. Unfortunately, for every accurate, positive, and sexual health-promoting message on the web, there are countless inaccurate, negative, and sexually explicit messages that may be inappropriate and harmful for adolescents."

Teens, sex, and the Internet




The primary question in the search for a successful AIDS vaccine has shifted from "whether" to "when." That day has drawn closer with the opening of the Hope Clinic in downtown Decatur, where one of the most promising AIDS vaccines on the horizon has begun clinical trials.

The new clinic is the only one in the nation specifically designed to test new generation vaccines and perform translational research studies of human immune system function. Investigators hope to translate basic research findings into useful clinical advances to prevent and treat some of the world's most challenging infectious diseases, including AIDS and malaria.

Part of the Emory Vaccine Research Center, the new clinic provides much-needed administrative and laboratory space for vaccine clinical trials and translational immunology studies. Its location at 603 Church Street offers easy access for trial volunteers. Beside having its own parking lot, the building is within walking distance of the Decatur MARTA station.

The Hope Clinic is already conducting clinical trials in healthy volunteers of three promising HIV vaccines manufactured by Merck. These studies seek to evaluate the safety of the vaccines and assess their ability to stimulate immune responses against HIV. Early results indicate that these vaccines are more effective than any previously studied candidate AIDS vaccines in raising the types of immune responses believed to be important for controlling HIV infection, and hopefully preventing HIV transmission.

Mark Feinberg, medical director of the Hope Clinic and director of the clinical core of the Emory Center for AIDS Research, believes an effective AIDS vaccine is on the horizon. It cannot come too soon. By the end of last year, more than 40 million adults and children were living with HIV infections, and more than 15,000 people are newly infected each day. In the absence of effective therapy, more than 98% of those will ultimately die of AIDS -- a fate suffered by an estimated 3 million adults and children last year alone.

Work at Emory, he says, is central to the AIDS vaccine effort. "Atlanta seems to be a receptive place to do HIV vaccine trials," Feinberg says. "The community here really wants to make a difference."

New clinic offers high hopes for AIDS vaccine



It's a classic "Catch 22." More than 1 million people with juvenile diabetes can't produce insulin because their immune systems destroy the islets cells that make that hormone. While scientists have learned how to transplant islets so people can make their own insulin again, the drugs they must take to keep their bodies from rejecting those cells greatly increase the risk of infection and cancer.

What to do? That's what scientists in the new Center for Islet Transplantation at Emory hope to figure out with the help of a three-year, $4.1 million grant from the Juvenile Diabetes Research Foundation (JDRF).

The grant will boost research into making islet replacement a viable cure for people with juvenile diabetes. Center co-directors Collin Weber and Chris Larsen along with researchers Tom Pearson and Elliott Chaikof are investigating the use of drugs less toxic than current therapies and also whether donor islets transplanted from animals can be protected in a sheath-like membrane from the body's immune response. They will also explore transplanting stem cells at the same time or before they transplant islet cells.

Islets and 'trickery' for diabetes




Grady Hospital's diabetes clinic is the first in the nation to use new Palm Pilot software to calculate how much insulin (or any other drug used to control diabetes) will bring patients to their target blood sugar level quickly.

"Before now, determining dosages has just been guesswork and the doctor's experience," says Emory endocrinologist Curtiss Cook. At the Grady clinic, nurse practitioners and diabetes educators simply enter prior doses and responses, the most recent dose, and the current and target measurement of blood sugar. The Palm Pilot figures the most accurate dosage.

If the Intelligent Dosing System proves effective, Cook hopes the software will find itself in the hands of primary care physicians, who treat the majority of diabetic patients nationwide.

Insulin doses in your Palm



When you live in Georgia -- also known as the "stroke belt" because of its higher incidence of death and disability due to stroke than any other region of the country -- survival depends on getting coordinated care from the exam room to radiology to the operating room.

A $7.5 million gift from MBNA America Bank has created the Emory-MBNA Stroke Center, a multidisciplinary consortium of specialists in neurology, neurosurgery, neurocritical care, and interventional neuroradiology. The new center will focus on prevention of stroke -- the leading cause of adult disability and third leading cause of death in the United States -- by educating patients and future doctors about the many risk factors for stroke. Another primary focus will be cutting-edge stroke research, says Daniel Barrow, chair of neurosurgery and director of the new center.

The MBNA gift will fund an endowed chair of neurosurgery and the hiring of a second neurointensivist, a specialist in neurocritical care.

Surviving the 'stroke belt'

Did you know...

Emory employs the only neurointensivist
in Georgia. Owen Samuels is trained in
neurology with a subspecialty in stroke
and in critical care medicine.
Emory offers one of just a handful of
fellowship training programs in neuro-
critical care and stroke in the nation.



It's increasingly complicated to navigate the approval, contracting, and budgeting of clinical trials, says neurologist Ray Watts, who heads the new Clinical Trials Office (CTO) in the School of Medicine. That might account for the popularity of the first symposium on "How to conduct clinical trials" held in March. More than triple the expected numbers of new and experienced investigators, coordinators, and clinical trials administrators signed up for the one-day workshop.

Participants were introduced to Siteworks, a new web-based software tool that will help investigators and coordinators negotiate all the steps involved in clinical trials, including building a budget, submitting IRB forms electronically, submitting contracts electronically, tracking patient recruitment, and managing the entire process online. Eventually, all clinical trials at Emory should be developed using the new software over the next two years.

A second symposium next fall is part of Emory's plan to become an "academic health center of choice" for industrial, government, and foundation-sponsored clinical research, to help ensure that Emory patient volunteers have access to the newest and most innovative therapies.

How to conduct clinical trials


In addition to federal grants for research, many clinical trials are sponsored by the pharmaceutical industry, medical device companies, and biotechnology companies. Such corporate research needs to be handled differently from publicly funded research, so Emory created a separate Office of Industrial Contracting and Liaison, explains director Vic Lampasona. "Contracting with private industry gives us the ability to cover our direct costs and a small part of our indirect costs for clinical trials."

Together, the two offices will serve as catalysts to bring together all the Emory entities involved in clinical trials. "We want to streamline the clinical trials process and help our faculty and departments navigate all the regulatory, financial, and operational issues expeditiously," says Watts.

To learn more about the CTO, see www.emory.edu/WHSC/MED/RESEARCH/CTO.

In this Issue


From the Director  /  Letters

Hazardous duty

Code blue

Dropping Pulaskis

Class 'A' space

Moving Forward  /  Noteworthy

On point: Very private matters

Cleaning Mickey's mess

 


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