A hormone produced by fat cells could be a tool for diagnosing and treating liver cancer, scientists at Emory University School of Medicine have shown.
Fat cells secrete a variety of hormones, some of which can have tumor growth-stimulating effects. However, scientists have dubbed adiponectin a “guardian angel” hormone because it appears to protect against the effects of obesity on metabolism and cardiovascular health.
The results, scheduled for publication in the November issue of the journal Hepatology, suggest that treatments that mimic or enhance adiponectin’s effects could enhance survival for obese individuals with liver cancer.
“Our study presents important clinical implications since hepatocellular carcinoma has the highest increased risk associated with obesity compared to other cancers such as prostate, kidney, colon, and stomach,” says senior author Neeraj Saxena, PhD, assistant professor of medicine (digestive diseases) at Emory University School of Medicine.
The first author of the paper is Dipali Sharma, PhD, assistant professor of hematology and medical oncology at Emory University School of Medicine and Winship Cancer Institute.
Hepatocellular carcinoma is one of the most common tumor types worldwide, but is relatively rare in the United States. The rate is increasing because of hepatitis C and obesity. Obesity is associated with increased risk and progression of a number of cancers including colon, prostate, breast, and liver cancers. Obese people have about a 1.5-fold increase in their risk of all types of cancer, but for liver cancer, obesity increases the risk 4.5-fold.
Obese populations tend to have higher circulating levels of the hormone leptin, but they may be resistant to some of its appetite-controlling effects. Weight loss tends to increase adiponectin, and low levels of adiponectin are found in patients with aggressive tumors.
One of the main roles of adiponectin is to counteract the effects of leptin. Adiponectin also regulates glucose levels and the breakdown of fatty acids. The levels of adiponectin can partially predict tumor growth, size and disease-free survival in human liver cancers, the authors found. In addition, they found that exposing liver cancer cells to adiponectin can reduce their ability to proliferate and invade other tissues, both in cell culture and in animal models.
“Taken together our results suggest an attractive molecular strategy: employing adiponectin analogues for potential therapy of metastatic hepatocellular carcinoma,” Saxena says.
Previous research by Sharma and Saxena has shown that adiponectin can also inhibit migration and invasion by breast cancer cells. (LINK)
Anti-diabetic drugs known as thiazolidinediones can increase adiponectin’s activity, but they have side effects on the heart that has led to their restriction by the FDA. The effects of injecting high levels of the hormone directly are unknown and need to be tested. Scientists are investigating other ways to increase a patient’s adiponectin, as wells as mutant forms of the leptin protein that may block leptin’s effects on cancer cells. Some natural compounds, such as those found in green tea, may be able to mimic the effects of adiponectin.
The research was supported by the National Cancer Institute and the National Institute of Diabetes and Digestive and Kidney Diseases.
Reference: D. Sharma et al. Adiponectin antagonizes the oncogenic actions of leptin in hepatocellular carcinogenesis. Page #’s. Hepatology (Nov 2010).
Only 45 percent of the 354 million annual visits for acute care in the United States are made to patients’ personal physicians, as Americans increasingly make busy emergency departments, specialists or outpatient care departments their first point of contact for treatment of new health problems or a flare up of a chronic condition like asthma or diabetes.
The findings, which appear in the September edition of Health Affairs, do not bode well for the nation’s already busy and frequently undermanned emergency rooms. While fewer than five percent of doctors across the U.S. are emergency physicians, they handle more than 28 percent of all acute care encounters – and more than half of acute care visits by the under-and uninsured.
According to co-authors including Steven Pitts, MD, associate professor of medicine in the Emory School of Medicine and a staff physician at Emory University Hospital Midtown, and Arthur Kellermann, MD, the Paul O’Neill Alcoa Chair in Policy Analysis at the RAND Corporation and previous associate dean for health policy at Emory University, health reform provisions in the Patient Protection and Affordable Care Act that advance patient-centered medical homes and accountable care organizations are intended to improve access to acute care. However, the challenge for reform, according to study authors, will be to succeed in the complex acute care landscape that already exists.
“Timely access to care is important, especially for those who are acutely ill. First-contact care has been a central tenet of primary care. But over the past few decades, the focus of primary care has shifted as a result of a growing elderly population, the growing burden of chronic disease and the challenge of coordinating care across multiple physicians,” says Pitts. “Low rates of reimbursement have accelerated this trend by forcing many primary care physicians to pack their daily schedules with 15-minute office visits – leaving little time for patients with acute health problems.”
The study, which took place between 2001 and 2004, shows that Americans made an average of 1.09 billion outpatient visits per year to physicians, averaging 321 visits per 1,000 people each month. Slightly more than a third of all encounters, or 354 million per year, were for acute care — treatment of new problems or a flare-up of a chronic health condition.
Twenty-two percent of acute care visits were managed by general/family practitioners, 10 percent by general internists and 13 percent by general pediatricians. Many involved treatment of minor upper respiratory problems, such as cough and sore throat. Office-based specialists handled 20 percent of acute care visits, generally for conditions in their respective areas of expertise (e.g., skin, eye and orthopedic problems). Twenty-eight percent of acute care visits were managed by hospital emergency departments, typically for more complex and potentially dangerous conditions such as stomach and abdominal pain, chest pain and fever.
“One of the biggest barriers to providing acute care in primary care practice is that many primary care doctors have packed schedules. This makes ”same day” scheduling, much less treatment of walk-in patients, extremely difficult,” says Kellermann.
“Busy schedules also discourage primary care physicians from taking the time they need to treat patients with complex, undifferentiated complaints. It is faster and simpler to refer them to a specialist or the nearest emergency department. Ensuring timely access to primary care is a desirable goal, because it increases a person’s odds of finding a “medical home”. Unfortunately, for many years now, primary care in the U.S. has been in decline,” Kellermann says. “Patients have adapted by seeking care elsewhere when they get sick.”
Our data indicate that more than half of acute visits today involve a doctor other than the patient’s personal physician. Dr. Pitts adds, “More than a quarter of all acute care visits, including virtually all weekend and “after hours” encounters, occur in hospital emergency departments. Heavy use of emergency departments for problems that a primary care provider could treat, if their patients could get in to see them, is not desirable from a societal perspective,” says Pitts. “Too often, emergency care is disconnected from patients’ ongoing health care needs.”
“Hospital emergency departments are vital, particularly when your life is on the line.” Kellermann says. “Americans know that when they can’t get care elsewhere, the ER is the one place in our nation’s healthcare system where the doctor is always “in”. Strengthening primary care is a major goal of healthcare reform. If successful, it will be a win for everybody.”
In addition to Pitts and Kellermann, other study authors included Emily R. Carrier, a senior health researcher at the Center for Studying Health System Change in Washington, D.C., and Eugene C. Rich, a senior fellow at Mathematica Policy Research, also in Washington, D.C.
In June, thoracic surgeon Saeid Khansarinia, M.D., implanted a diaphragm pacing system using a minimally invasive thoracic surgery technique, as opposed to an abdominal procedure due to the patient’s specific needs. The modified surgical method will make it possible for Lynn Wheeler of Fayetteville, Ga., to breathe more naturally using an implanted diaphragm pacer instead of a ventilator.
Diaphragm pacing first gained national attention in 2003, when Raymond Onders, M.D., of University Hospitals Case Medical Center implanted a diaphragm pacing system in actor Christopher Reeve via an abdominal surgery. The device eventually enabled Reeve to breathe without the use of a ventilator.
Dr. Khansarinia is one of the latest additions to Piedmont Heart Institute Physicians as part of its expanding cardiothoracic surgery services. He is one of only 18 surgeons performing this procedure through the abdomen and the only surgeon who has performed this operation through the chest. Specializing in thoracic surgery, Dr. Khansarinia is a graduate of St. Louis University and completed his residency at the University of Florida Health Science Center. He is board certified in both general and thoracic surgery.
Functioning in a way similar to heart pacemakers, small electrodes are placed on the diaphragm where they stimulate the muscle to contract, pulling in air through the lungs. The patient carries a small external device that allows them more mobility than the larger machines and breathing tube necessary with a ventilator.
Wheeler, now 63 years old, was left paralyzed after a car accident five years ago and has required the assistance of a breathing tube. However, abdominal surgery was not an option for her. Unfortunately, due to multiple previous surgeries on her abdomen and the nature of her injuries, access to the diaphragm through the chest was the only option for this kind of procedure.
Determined to find a way to help his patient achieve a better quality of life, Dr. Khansarinia and his team in collaboration with Dr. Onders, developed a method to implant a diaphragm pacer through the chest.
As Wheeler’s diaphragm learns to contract and relax again over the next few months, she will be able to rest at home while the diaphragm pacing device works along with the ventilator. Eventually patients with diaphragm pacers are weaned off their ventilators as the diaphragm strengthens and breathing occurs more normally.
“Mrs. Wheeler is doing well. Currently she is off the ventilator and breathing with the pacer over four hours per day,” Dr. Khansarinia said. “She is very happy with her outcome and within a few months to a year, we hope she will be able to breathe without the need of a ventilator.”
For patients with quadriplegia, a diaphragm pacing system can mean a greatly improved quality of life. Communication becomes easier as speech is no longer hindered with the operation of a breathing tube. Sense of taste and smell will also improve for many patients. The risk of infection and pneumonia is significantly decreased for patients who are not dependent on a ventilator.
“What we’ve found is that the sooner we can approach patients with quadriplegia and implant the device, the quicker they recover to a more normal breathing state,” Dr. Khansarinia said. “With older patients and with patients that have been on a ventilator for a longer period of time, it will take a little longer for their diaphragm to relearn its original function with the assistance of a diaphragm pacing system.”
“This procedure has a lasting effect patients’ quality of life,” Dr. Khansirania said. “Their sense of smell and taste often return as air is no longer being forced into the lungs and can now flow freely through the nose and mouth. Most importantly, it gives them an improved sense of self and freedom as their speech pattern returns and they are able to communicate more naturally.”
Dr. Bruce Bode, a diabetes specialist with Atlanta Diabetes Associates with special expertise and interest in insulin delivery and glucose sensing, announced that he is now recruiting adults with newly diagnosed type 1 diabetes for Protégé Encore, a randomized, placebo-controlled Phase III clinical trial. This is the second of two Phase III studies testing the safety and efficacy of an investigational drug called teplizumab. The first study, known as Protégé, has completed enrollment of more than 530 subjects with type 1 diabetes. There is currently no approved therapy to slow the progression of type 1 diabetes.
In patients with type 1 diabetes, T cells of the immune system attack and destroy beta cells that are located in the pancreas and make insulin. Teplizumab works by binding to CD3 receptors on the surface of the T cells and, by doing so, may modulate the autoimmune attack on pancreatic beta cells and preserve or protect these cells. If effective, patients may require less injected insulin and their blood glucose levels may be easier to control.
In an earlier trial of teplizumab, a small group of subjects with diabetes of recent onset were noted to have improved function of their beta cells, improved glucose control, and reduced insulin requirements for up to two years. These findings are being further studied in the Protégé and Protégé Encore clinical trials.
The Protégé Encore trial is designed to determine if teplizumab can preserve pancreatic insulin production, which may make diabetes easier to manage. “We have a lot of enthusiasm about the teplizumab studies and their implications. It is hoped that one day we can offer a new treatment option to help patients better manage their disease,” Dr. Bode commented.
Dr. Bode obtained his bachelor’s degree in biology at the College of Wooster in Ohio, and his doctorate of medicine at Emory University School of Medicine in Atlanta. He completed his internship and residency at Emory University Affiliated Hospitals and a fellowship in diabetes with Paul C. Davidson, M.D. Dr. Bode is a clinical associate professor of medicine at Emory University, has served as president of the Atlanta chapter of the American Diabetes Association, and is on the board of directors of the Atlanta chapter of the Juvenile Diabetes Foundation. He is a fellow of the American College of Endocrinology and is board certified in internal medicine. Dr. Bode has written, co-written, or contributed to more than 100 books, articles, and abstracts.
Approximately 125 study sites across 16 countries will be enrolling 400 individuals who have been to a physician with signs and symptoms of type 1 diabetes within the past 12 weeks. Most study sites are enrolling individuals 8-35 years old, and Dr. Bode is enrolling individuals 18-35 years old. Subjects will receive one of three treatment regimens, or placebo. Subjects will be followed over a 2-year period.
Additional information on Protégé Encore and all participating study sites is available at www.protegediabetes.org/news or 1-866-874-2516.
Imaging epicardial adipose tissue, or the layer of fat around the heart, can provide extra information compared with standard diagnostic techniques such as coronary artery calcium scoring, according to research by cardiologists at Emory University School of Medicine. The size of the layer of fat around the heart can be measured by X-ray imaging techniques such as CT or MRI.
“This information may be used as a ‘gate keeper’, in that it could help a cardiologist decide whether a patient should go on to have a nuclear stress test,” says Paolo Raggi, MD, professor of medicine (cardiology) and radiology and director of Emory’s cardiac imaging center.
Results from two studies were presented at the American College of Cardiology meeting in Atlanta.
The first study, presented by cardiology fellow Nikolaos Alexopoulos, MD, now at the University of Athens, Greece, shows that patients with a larger volume of epicardial adipose tissue tend to have the types of atherosclerotic plaques cardiologists deem most dangerous: non-calcified plaques.
Calcium tends to build up in atherosclerotic plaques. Even though the heart’s overall coronary calcium burden is a good predictor of heart disease, calcium in an individual plaque doesn’t necessarily mean imminent trouble, Raggi says. Researchers have been learning that non-calcified plaques indicate active buildup in that coronary artery, and studies suggest that the fat around the heart secretes more inflammatory hormones, compared to the fat just under the skin.
“Release of inflammatory factors from epicardial adipose tissue may be promoting an active atherosclerotic process, and this is indicated by the presence of non-calcified plaques,” Raggi says.
Emory researchers examined 214 patients through cardiac CT, and performed coronary artery scoring as well as assessing the patients’ epicardial adipose tissue volume and the plaque in their coronary arteries. The epicardial adipose tissue volume was highest in the patients with non-calcified plaques (roughly 60 percent more than those with calcified plaques).
The second study, presented by Emory cardiology fellow Matthew Janik, MD, measured epicardial fat in patients receiving a nuclear stress test. The 382 patients had chest pain but did not have known cardiovascular disease. A nuclear stress test picks up signs of inducible ischemia: deficiencies in blood flow in the heart muscle.
Here, the researchers found that the presence of ischemia correlated more closely with epicardial adipose tissue volume than with the coronary calcium score.
References:
N. Alexopoulos et al. Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis, in press (2009).
N. Alexopoulos and P. Raggi. Calcification in atherosclerosis. Nature Reviews Cardiology 6, 681-688 (Nov 2009).
A five-year, multi-site international study has shown that human papillomavirus (HPV) vaccinations given to adolescents and young women decrease the number of abnormal Pap smears, biopsies and cases of genital warts.
Since some of these genital abnormalities are identified as precursors to cancer, it is anticipated that these findings will eventually translate into lower rates of cervical, vulvar and vaginal cancers.
HPV is one of the most common sexually transmitted infections. Although most infections will clear up without intervention, some infections with low-risk HPV (types 6 and 11) can cause genital warts and abnormal cervical cells, while high-risk types of HPV (types 16 and 18) can progress to cancers of the cervix, vulva or vagina.
“Cervical cancer is the second leading cause of cancer death in women worldwide, right behind breast cancer in women,” says Kevin Ault, MD, associate professor in the Department of Gynecology and Obstetrics, Emory University School of Medicine, and a co-investigator on this study. “This vaccine has been shown to reduce the number of biopsies and painful treatments in women, while also reducing cancer risks in a woman’s life.”
The researchers studied 17, 622 women aged 15 to 26 years who were enrolled in one of two randomized, placebo-controlled, efficacy trials for the vaccine targeting HPV types 6, 11, 16 and 18 (known as a quadrivalent vaccine). Women in one group were uninfected with HPV (negative to 14 HPV types), while another group had a mixed population of HPV-exposed and -unexposed women (intention to treat group). All women underwent cervicovaginal sampling and Pap testing.
In the group that was uninfected with HPV, vaccination was up to 100 percent effective in reducing the risk of HPV 16/18-related high-grade cervical, vulvar and vaginal lesions and of HPV 6/11-related genital warts. In the mixed group, vaccination was statistically significant in reducing the risk of any high-grade cervical, vulvar and vaginal lesions, genital warts, Pap abnormalities and cervical therapy, irrespective of HPV type.
“The HPV vaccine is specifically designed to prevent cancer in its earliest stages,” says Ault. “Researchers were aware of the tight link between HPV and cancer, which helped in the development of this vaccine.”
Ault continues, “Many of the treatments for HPV today can cause problems later in life for pregnant women, which can lead to premature delivery of their babies. We hope getting this vaccine during a woman’s younger years will prevent those complications, as well.”
The U.S. Food and Drug Administration approved the preventative vaccine, known as Gardasil, in 2006 for use in females nine to 26 years of age. To date, there is no vaccine specifically designed to treat HPV, once infected.
With this data now complete, the researchers are looking at the possibility of second-generation vaccinations for more types of HPV not covered by the quadrivalent vaccine.
Cleansing a patient’s skin prior to surgery with chlorhexidine alcohol – instead of the more commonly used povidone iodine – has proven to be a more effective and powerful barrier to reducing or preventing infections after surgery.
Research comparing the two strategies was reported in the Jan. 7, 2010, issue of the New England Journal of Medicine. The study was co-authored by Alexandra Webb, MD, assistant professor of surgery, Emory School of Medicine, and chief of general surgery at the Atlanta Veterans Affairs Medical Center. The findings by Webb and her team are important, as hospitals and health care providers are continuously striving to reduce and eliminate surgical site infections in patients.
The study was a randomized clinical trial between April 2004 and May 2008 at six university-affiliated hospitals across the United States, including the Atlanta Veterans Affairs Medical Center, which is affiliated with Emory School of Medicine. A total of 897 patients were randomly assigned to a study group: 431 to the chlorhexidine–alcohol group and 466 to the povidone–iodine group. Of the 849 patients who qualified for the intention-to-treat analysis, 409 received chlorhexidine alcohol and 440 received povidone iodine.
Webb and the team found that using chlorhexidine as the preoperative skin cleanser reduced infections by 41 percent compared with povidone iodine.
“This is a very important study on skin preparation to prevent surgical site infection on many levels and should be evaluated for consideration of change of practice in surgical protocol,” says Christian Larsen, MD, chair of the Department of Surgery, Emory School of Medicine. “This is an example of research that directly impacts the quality of patient care. A reduction of the surgical site infections of this magnitude would greatly reduce morbidity and have a major economic impact for hospitals, patients and employers around the country.”
More than 27 million surgical procedures are performed each year in the United States. According to the Centers for Disease Control and Prevention, there are approximately 1.7 million health care-associated infections each year in U.S. hospitals. Of these infections, 22 percent – or about 400,000 – are surgical site infections, which result in longer hospital stays, readmission or sometimes death.
Clinicians in Georgia can make an important contribution to cancer research by supporting and advocating for the collection of biospecimens from their patients. When patients undergo surgery to remove a tumor or part of a diseased organ, any specimen not needed by pathologists for diagnosis, can be saved instead in a biorepository for future research use. Patients are asked to provide their approval, or “informed consent, for use of specimens, and many appreciate the opportunity to contribute to scientific progress that may lead to better and earlier cancer detection methods and treatments.
According to Dr. Carolyn Compton, director of the Biorepositories and Biospecimen Research Office at the National Cancer Institute, having a biorepository is essential to the type of cancer research that will “take us into this new era of medicine.” Modern molecular-based research includes genomics, proteomics, and molecular imaging. Together, they will drive the development of a new generation of targeted, personalized diagnostics and therapies that will ultimately improve clinical outcomes for patients.
In Georgia, the Biorepository Alliance of Georgia for Oncology (BRAG-Onc) is working to provide researchers in the state with access to high quality specimens, appropriate for molecular analysis, and richly annotated with clinical information. The availability of biospecimens of appropriate quality supports cancer research studies from cancer biology to discovering and validating new therapeutic targets and biomarkers.
The Medical College of Georgia (MCG) serves as the central repository for this statewide network, which is supported by the Georgia Cancer Coalition (GCC). BRAG-Onc supports the mission of the Coalition to improve cancer control and reduce cancer deaths in Georgia through statewide collaborations. Georgia’s Biorepository is unique in its mission to represent diverse cancer populations of the state, in its multi-institutional organization, as well as its non-profit status. Judith Giri, Ph.D. is Director of the Biorepository Alliance of Georgia for Oncology. She is an Associate Professor in the Department of Pathology and a member of the Cancer Center at MCG.
Thanks to participating institutions, BRAG-Onc now has samples representing more than 3400 cancer patients in the state. Participating institutions include major urban centers as well as community hospitals, providing researchers access to a unique of collection of specimens.
The Biorepository has strict oversight to ensure that specimens are collected ethically, and valuable specimens are utilized for appropriate research. Institutional Review Boards (IRBs) and Advisory Committees provide local oversight within each institution. Governance and overall guidance for the statewide biorepository is provided by an external Advisory Board and a Steering Committee comprised of Principal Investigators from each participating institution. The Georgia Cancer Coalition established BRAG-Onc and provides continuing support of its operations.
The BRAG-Onc tissue and tumor bank is a resource to academic cancer research scientists, including the 118 active Scholars funded by the Georgia Cancer Coalition as Distinguished Cancer Clinicians and Scientists. Having a statewide biorepository supports the recruitment of cancer researchers to Georgia and investigators can include the BRAG-Onc services in their grant applications. BRAG-Onc is also crucial to the Georgia Center for Oncology Research and Education (Georgia CORE) which is working in concert with partners such as the Georgia Society of Clinical Oncology (GASCO) to build a statewide research network and clinical trials registry.
The biorepository’s main function is to provide centralized specimen banking services, with ethical patient consent, standardized and controlled conditions for procurement, long-term low temperature storage facilities with monitoring and back-up, appropriate quality control measures and a web-based database for informatics. BRAG-Onc follows Best Practices recommendations for biorepositories from the National Cancer Institute.
The process of procurement, handling and storage of specimens for research involves several steps and many contributors, including: medical oncologists and surgeons, OR and research nurses, pathologists and the biorepository staff. The first and most important contributors are the patients who donate the specimens.
“The value of the cancer biorepository depends not only on the quality of specimens but also on the associated clinical information. When collecting information about patients’ medical conditions and relevant history (from the Cancer Registry, for example), one of the biorepository’s highest priority is maintaining the privacy and confidentiality of personal and medical information,” says Dr. Giri. “The patients’ reward is in knowing that they are helping researchers find new ways to prevent and treat this terrible disease in the future.”
Procurement sites and multiple regional procurement centers cover the state and include:
EAST: Coordinating Center/Medical College of Georgia,
WEST CENTRAL: John B. Amos Cancer Center at Columbus Regional Medical Center, Columbus
METRO ATLANTA: Dekalb Medical, Decatur; Piedmont Hospital, Atlanta; St. Joseph’s Hospital, Atlanta (future site)
NORTHWEST: Hamilton Medical Center, Dalton (NW hub); Redmond Medical Center, Rome; Floyd Medical Center, Rome; Gordon Hospital, Calhoun; Hutcheson Medical Center, Fort Oglethorpe
SOUTHWEST: Phoebe Putney Memorial Hospital, Albany (SW hub); Archbold Medical Center, Thomasville
SOUTHEAST: Nancy N. and J.C. Lewis Cancer and Research Pavilion at St. Joseph’s/Candler Health System, Savannah; Memorial Health System, Savannah
For information about BRAG-Onc, contact Dr. Judith Giri at jgiri@mcg.edu or 706-721-5279.
National and state experts in the field of pain management discussed topics ranging from patient and prescriber perspectives on pain to the state of pain management in Georgia at the Georgia Pain Initiative’s recent conference, “Connecting Pain Management Policy and Practice to Serve Our Communities.”
The Georgia Pain Initiative was founded to improve the quality of life of Georgia’s children and adults affected by pain through education, advocacy, public policy and the promotion of excellence in clinical practice. It is a project of the American Cancer Society and is a member of the Alliance for State Pain Initiatives. The Georgia Pain Initiative is led by a steering committee that includes representatives from the Georgia Composite Board of Medical Examiners, Georgia Association of Health Plans, Georgia Cancer Coalition, Georgia Drugs and Narcotics Agency, and the American College of Physicians, along with physicians, pharmacists, nurses, social workers and caregivers
The GPI was instrumental in helping improve Georgia’s national pain policy grade, issued by the University of Wisconsin’s Pain and Policy Studies Group, from a D+ to a B in one year. The work of GPI has received commendation from Governor Sonny Perdue and recognition nationally from the Alliance of State Pain Initiatives.
Featured speakers at the day-long conference on May 18 included national speakers Scott M. Fishman, M.D., chief of the division of Pain Medicine and professor of anesthesiology at the University of California, Davis; Rebecca Kirch, associate director of policy, American Cancer Society Cancer Action Network; Aaron Gilson, MS, MSSW, Ph.D., director of U.S. Program, Pain and Policy Studies Group, University of Wisconsin; and June L. Dahl, Ph.D., Alliance of State Pain Initiatives, University of Wisconsin School of Medicine and Public Health. Expert presenters from Georgia included Kelly Erola, M.D., chief medical director, Hospice Savannah; Steven House, M.D., Assistant Professor of Family Medicine, Mercer University School of Medicine; and Sarah Leahy, RN, Clinical Operations Manager of the Center for Pain Relief Children’s Healthcare of Atlanta
Speakers said some key barriers to pain control are fear, misperceptions and confusion on the part of physicians and patients about addiction, dependence and pain medicines; lack of knowledge among patients and their families; and insufficient training for healthcare professionals.
They also said physicians are often reluctant to prescribe pain medications or renew prescriptions because they are unaware of what laws and policies allow and fear possible investigations and legal consequences.
“The stories that you read and hear about are the ones where a doctor has prescribed opioids or other medications for a patient and the results have been negative,” Gilson said. “Those rare cases are the ones that make the news. Stories of patients suffering pain most often don’t make the news. We don’t hear about the cases where patients are in constant pain because their physicians are worried about the possible consequences of prescribing opioids and other medications.”
Ms. Kirch pointed to a pain research survey conducted among Georgia physicians to gauge their knowledge, attitudes and practices regarding pain management. All physicians licensed in Georgia received the written survey, and 12 percent responded.
The survey also pointed to a communications gap between physicians and their patients. According to the survey, 58 percent of patients say they are asked regularly by their doctors about their pain levels, while 93 percent of physicians say they regularly ask about and assess pain.
Addressing pain in cancer patients, Ms. Kirch said, “Patients should not accept pain as a normal part of cancer. Controlling pain is part of quality cancer treatment.”
The Georgia Pain Initiative is now offering “Pain Management: Providing Effective Treatment for Your Patients,” a one-hour training designed for medical residents, nursing students and pharmacy students. The course addresses myths and misconceptions about treating pain; proper assessment of pain; pharmacological treatments, including opioid use; treating chronic and disease-related pain; and pain in palliative care. For more information on this training; for resources and information about pain management; or to become involved in the work of the Georgia Pain Initiative, please visit the website at www.georgiapaininitiative.org or contact Brittany Freeman at (404) 949-6495.
A five-year, $8 million National Institutes of Health grant to Emory University School of Medicine researchers will fund a regional clinical trial examining the best ways to protect low birth weight infants from transfusion-related viral infections, and a study of new strategies for rebuilding the immune systems of bone marrow transplant recipients.
“The goal of these projects is to make transfusion and bone marrow transplant recipients safer,” says Christopher Hillyer, MD, director of the Emory Center for Transfusion and Cellular Therapies. “Although they are distinct projects, each one builds on the knowledge generated by the other.”
In a clinical trial covering the greater Atlanta area, transfusion specialists at Emory are teaming up with doctors at Northside Hospital and Children’s Healthcare of Atlanta to screen for cytomegalovirus (CMV) in blood given to low birth weight infants.
Low birth weight infants have incomplete immune systems and are vulnerable to CMV infection, which can lead to liver or lung damage, permanent disability or even death, says Hillyer, a professor of pathology and laboratory medicine at Emory.
The study will test whether a combination of screening blood by DNA and antibody methods and removing white blood cells before transfusion is enough to eliminate CMV infection.
CMV is also an example of a threat facing bone marrow transplant recipients: infections that take advantage of the patient’s weakened immune system. Doctors have to balance strengthening the patient’s new white blood cells against the cells’ ability to attack their surroundings in “graft-versus-host” disease.
Two projects funded by the grant will address bone marrow transplants. One, led by John Roback, MD, PhD, Emory associate professor of pathology and laboratory medicine and co-director of the transfusion center, tests a new vaccine against CMV in animals, with an eye towards adapting the vaccine to protect against other opportunistic infections in people.
Another, led by Edmund Waller, MD, PhD, professor of hematology/oncology and director of Emory’s Bone Marrow and Stem Cell Transplant Center, is a clinical trial where doctors will treat white blood cells with a suppressive drug before they are given to a patient post-transplant.
A fourth project, led by James Zimring, assistant professor of pathology and laboratory medicine, will advance an animal model for studying immune responses sometimes developed against red blood cells by repeat transfusion recipients.
