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Study: Regular aerobic exercise and prevention of drug abuse relapse

Exercise provides health benefits

Researchers at Emory University and the University of Georgia have received funding from the National Institutes of Health to study the neurobiological mechanisms for how regular aerobic exercise may prevent drug abuse relapse. The grant is for $1.9 million over the next five years.

David Weinshenker, PhD, associate professor of human genetics, Emory School of Medicine, is a co-principal investigator on the project.

David Weinshenker, PhD

“This research will provide new insight into how regular exercise may attenuate drug abuse in humans,” Weinshenker says “More importantly, it may reveal a neural mechanism through which exercise may prevent the relapse into drug-seeking behavior.”

During the study, Weinshenker and UGA co-investigator Philip Holmes, professor of psychology in the Franklin College of Arts and Sciences, will measure exercise-induced increases of the galanin gene activity in the rat brain.

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Reflection and compassion go hand-in-hand

Kimberly Manning, MD, Lisa Bernstein, MD, and William Branch, MD, leading the way

Kimberly Manning, MD, an internist at Grady Memorial Hospital who directs Emory’s Transitional Year Residency Program, asks her residents to write about an experience – good or bad – that made a lasting impression on them.

Manning herself regularly writes about her experiences as a doctor. She calls it “habitual reflection” and believes that the practice is vital to developing good doctors. She regularly asks herself about interactions with patients and imagines herself in their place. What was the patient feeling? How would I feel in the same situation? Did the patient process everything I said?

These are the kinds of questions she wants medical students and residents to ask themselves regularly. By examining experiences that were rewarding, saddening or even frustrating, they can become better doctors, she says in the new issue of Emory Medicine magazine.

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Studying the doctor and nursing shortage

An increase in the number of the nation’s elderly and the aging population of doctors is causing a doctor shortage in the United States, with estimates that the demand for doctors will outstrip supply by 2020, according to the Association of American Medical Colleges.

The Association of Colleges of Nursing notes a similar dilemma for the nation’s registered nurses. Read Knowledge@Emory for the full article. 

Fred Sanfilippo, MD, PhD

Fred Sanfilippo, MD, PhD, executive vice president for health affairs at Emory, CEO of Emory’s Woodruff Health Sciences Center and chairman of Emory Healthcare, says, “There is an ever-changing cycle of shortages. Advances in technology and treatment can reduce or increase demand for specialists needed in one area or another much more quickly than it takes to train or absorb them.”

For instance, the demand for cardiac surgeons has slowed dramatically as a result of better medications and stents. Changes in insurance and Medicare/Medicaid reimbursement can also impact specialties, he says.

“Since medical school graduates now carry so much debt, the specialty they choose is often influenced by potential income, which is most evident in the low numbers going into primary care.”

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Experts review global health care programs for answers

A recent Knowledge@Emory article looks at a new book titled The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, by author and journalist T.R. Reid. The book provides an in-depth look at the health care systems in a number of Western nations, including Germany, France, the U.K, Japan and Canada. The countries he profiles offer a mix of public and semi-public health care options.

In addition to interviewing Reid, experts from Emory Healthcare, Emory’s Woodruff Health Sciences Center and the Rollins School of Public Health Department of Health Policy and Management, weigh in on the problem of U.S. health care reform and what can be learned from the examples abroad.

Joseph Lipscomb, PhD

According to Joseph Lipscomb, PhD, a Georgia Cancer Coalition Distinguished Cancer Scholar and a professor in the Department of Health Policy and Management, quality of care, outcomes and cost analysis must be factored into the reform process. Looking abroad, Lipscomb gives generally high marks to the outcome and cost analysis done by the National Health Service and the National Institute for Health and Clinical Excellence (NICE) in the U.K. He applauds NICE’s ongoing efforts to estimate the cost-effectiveness of new, expensive technologies by using decision processes that are transparent and solicit input from private citizens, providers and industry.

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Working for health around the globe

Emory faculty, staff and students travel the globe, providing care and establishing partnerships within other countries to address intractable health challenges like tobacco use, diabetes and AIDS.

What they do there helps both individuals and populations, now and for generations to come. What they learn from these experiences has indelible effect on their own lives and on the collective life of Emory as a whole.

 

Emory Healthcare working with MedShare

For example, working to support global from home in Atlanta, Emory Healthcare has works hard to reduce, reuse and recycle, including working with MedShare International, a nonprofit organization dedicated to improving the environment and health care through redistribution of surplus medical supplies and equipment to underserved health care facilities in more than 75 developing countries.

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Providing complex care for individuals in need

Emory Healthcare physicians provided $48.9 million in charity care in fiscal year 2008–2009, a total that does not include uncompensated care provided by Emory physicians practicing at publicly funded Grady Memorial Hospital and other affiliate institutions.

Charity care includes two types of care. Indigent care refers to care provided to patients with no health insurance, not even Medicare or Medicaid. Catastrophic care refers to care provided to patients who have some coverage but whose medical bills are so large that paying them would be permanently life-shattering. People without ability to pay for care are not faceless statistics to Emory clinicians but patients in need of care.

In fact, Emory’s Wesley Woods Center exemplifies Emory Healthcare’s commitment to serving patients and their families who are facing issues related to aging. The majority of the 30,000 patients treated last year at Wesley Woods’ 100-bed hospital and outpatient clinic were elderly, in their 70s, 80s, 90s and older.

But Wesley Woods also is a life-saver for many younger patients who require chronic care and specialty services for which the center is known, including wound care, rehabilitation and respiratory care, such as weaning from ventilator therapy.

Patient receives care at Wesley Woods

Patient receives care at Wesley Woods

For example, patient Sherry Smith’s CT scan at Emory University Hospital showed large blood clots blocking the vessels leading to her spleen and kidneys. Over the next two weeks, she had four operations. Surgeons removed the clots and her spleen and cut out portions of her bowel that had been destroyed by lack of oxygenated blood. She required a feeding tube and a tracheotomy to help with breathing as she recovered.

Patients can move seamlessly between the two Emory Healthcare facilities for needed care. Smith moved back and forth between Emory and Wesley Woods as she improved. She also got some unexpected help in paying for her care. When she got sick, Smith lost her job. During the six months she spent moving between the two hospitals, her bill at Wesley Woods was more than $120,000, and that at Emory University Hospital, almost $130,000.

Community Benefits Report

Community Benefits Report

 

To her relief, Emory offered to pay her COBRA insurance fees to help her maintain her insurance for the time allowed. Payments would cover only part of the actual cost of care. Wesley Woods social workers also helped Smith apply for Medicaid to cover health care costs while she continues her recovery in a rehab facility closer to her home.

Read more about charity care at Emory in the Community Benefits Report 2009.

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Academic medicine at the table in health care debate

As the debate on health care reform legislation continues to move forward in Congress, Association of American Medical Colleges President and CEO Darrell G. Kirch, MD, urges leaders of the nation’s medical schools and teaching hospitals to be the standard bearers for innovation in health care delivery.

Darrell G. Kirch, MD

Darrell G. Kirch, MD

Kirch says that a year ago he was asked if he believed that academic medicine would have any voice in the health care reform debate. He answered that academic medical centers do have a strong voice in ensuring that the special contributions of our members are recognized in any proposed changes in the current legislation.

Kirch, who recently presented at Emory’s Woodruff Health Sciences Center Future Makers Lecture Series, says, “Just as we have a moral imperative to give people basic health insurance, we have an innovation imperative, as educators, researchers and clinicians, to finally make our health care system work well for everyone.”

In his presentation, Kirch pointed out that, by establishing new models of high-performance, high-value, integrated health systems, academic medical centers across the country are already undertaking clinical care innovations. Similar efforts are also occurring in research, where greater collaboration helps to address complex problems, and in medical education, where cutting-edge technologies are used to train physicians and promote lifelong learning, he noted.

AAMC-supported legislation, introduced by Rep. Allyson Schwartz (D-Pa.), to establish Healthcare Innovation Zones (HIZs), would promote the rapid expansion of successful pioneering efforts. These zones would empower centers to partner with local providers and hospitals to conduct large-scale experiments in health care delivery for specific patient populations.

Combining innovations in health care delivery, critically studying the effectiveness of these innovations and educating professionals to work in these new models play to the strengths of academic medicine, continues Kirch. The innovation imperative will allow academic medical centers to finally attain alignment of all three missions, while truly fulfilling their goal to improve the health of communities.

Listen to Kirch’s Emory presentation or read his recent address to the American Association of Medical Colleges.

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Sanjay Gupta shares stories on near-death experiences

Yesterday, Sanjay Gupta, MD, assistant professor of neurosurgery at Emory School of Medicine and associate chief of neurosurgery service at Grady Memorial Hospital, joined Emory and its community in a book-signing event to celebrate his newest book Cheating Death: The Doctors and Medical Miracles that Are Saving Lives Against All Odds.

Dr. Gupta signs his book

Dr. Gupta signs his book

It is hard to imagine having a busier schedule than the one Gupta has. On Wednesday he started his day as chief medical correspondent at CNN by discussing the new breast cancer recommendations issued by the U.S. Preventive Services Task Force. He, like other health reporters and doctors across the nation, had hundreds of questions pouring in about the controversial recommendations.

As the late afternoon approached, Gupta packed up for his visit to Emory where several hundred faculty, staff, students and neighbors awaited him for the book-signing event. After spending time presenting and answering questions, and then signing books for many people, Gupta again packed up and headed back to the CNN studio for a live show with Larry King.

Dr. Gupta presents

Dr. Gupta presents

During his presentation at Emory, Gupta talked about his experiences that led to his book. He notes one CNN story took him to Norway to meet the woman who had been skiing and slipped through a hole in the ice with her head caught under freezing water for an hour.

After an amazing rescue, Anna BÃ¥genholm was taken to the emergency room where the doctors did not give up. A doctor on the helicopter said there was a completely flat line. No signs of life whatsoever. But the team persevered and saved her life by warming her body very slowly. Even though BÃ¥genholm was alive, months of recovery lay ahead. Paralyzed for almost a year until her damaged nerves healed, she today is a radiologist at the hospital where she was saved. She has returned to skiing and other sports.

Read more about Gupta in Emory Magazine. Learn more about Gupta’s stories from on the road.

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Biomedical informatics impact on health care outcomes

Biomedical informatics is a multi-disciplinary field, involving the collection, management, analysis and integration of data in biomedicine used for research and healthcare delivery.

DNA double helix

DNA double helix

According to Joel H. Saltz, MD, PhD, director of Emory’s Center for Comprehensive Informatics, biomedical informatics enhances medical research via technology by making it possible to collect, weed through and analyze widespread data on patient treatments and outcomes.

Saltz is a Georgia Research Alliance Eminent Scholar and serves as chief medical information officer at Emory Healthcare and as a professor in the departments of pathology, biostatistics and bioinformatics, and mathematics and computer science at Emory.

Joel H. Saltz, MD, PhD

Joel H. Saltz, MD, PhD

A recent essay excerpted below, published by Knowledge@Emory, says advances in information technology are becoming increasingly critical to disease treatment and administrative efficiency at healthcare facilities.

Given the national debate over costs in the healthcare system, medical practitioners and IT experts say that the evolving field of biomedical informatics can provide large scale improvements in treatment processes, and ultimately, in the price tag for care.

Saltz notes in the article that biomedical informatics can be applied to any subset of medical research, giving clinicians access to “rich” or large pools of patient data and applying technological solutions and mathematical modeling to the process.

He says that the overarching goal of the Center is to foster collaboration between scientific and software systems researchers. However, the synthesis of medical information from disparate and numerous sources remains a key research effort at the Center and for other institutions and companies in the biomedical informatics field

The Center was selected recently as an In Silico Brain Tumor Research Center and will use advanced informatics tools and databases to discover more effective brain tumor treatments. Read here for more information about projects at the Center.

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Malpractice insurance rates examined

A recent article published by Knowledge@Emory, an online business journal, presented the view of a leading Emory expert on health care reform regarding malpractice insurance rates. The article is titled “Will Medical Practices Survive Malpractice Insurance Rates?” and covers recent health care reform news including a discussion of medical malpractice insurance rates.

Excerpts from the article:

  • President Barack Obama’s planned overhaul of America’s healthcare system took a step forward October 13 when the powerful Senate Finance Committee voted 14 to 9 along party lines, except for Republican Senator Olympia Snowe, to move its healthcare bill along for broader consideration. While this vote is a positive sign in a debate that has raged on for years, it comes too late for many physicians in high-risk specialties who have made the difficult choice to either restrict their practice, relocate to friendlier states, or to shut down shop altogether because of galloping increases in malpractice and other liability insurance.
  • Kenneth E. Thorpe, PhD

    Kenneth E. Thorpe, PhD

  • Kenneth E. Thorpe, Robert W. Woodruff professor and chair of health policy and management at Emory’s Rollins School of Public Health, said, “In response to rising medical malpractice insurance rates, many physicians feel compelled to practice so-called defensive medicine, which may involve ordering extensive patient tests primarily to help defend their decisions in case the physician is later sued. Concern over malpractice insurance costs are also driving more specialists like obstetricians and gynecologists, and neurosurgeons, to restrict, sell or close their practices, leading to some question about whether or not there will be enough specialists available to meet the demand for their services.
  • Part of the challenge is that the standard rules of a business model don’t always apply to medical providers, according to Thorpe.
  • In a traditional business model, a larger organization can generally reduce many costs with economies of scale, but even if a doctor sells his or her practice to a larger group practice or a hospital, the insurance rates are still set by state commissioners,” he notes. “So even though a hospital practice may be substantially larger than a typical physician group practice, a hospital generally can’t exercise any more leverage when it comes to med-mal rates.”
  • Regulatory restrictions on the medical business model may limit the ability of medical practitioners to respond to liability insurance rates, but Thorpe says other approaches could put a dent in the costs.
  • “To begin with, more than 60 percent of med-mal claims go to identifying fault and administering the medical malpractice system leaving only 40 percent of the premium dollar paid to injured patients,” he says. At the same time 70 to in some states up to 90 percent of claims filed never receive any payment and are dismissed or dropped. “So it would likely be helpful if regulatory authorities or the courts can weed out the frivolous ones. Setting up specialized courts—similar to tax and other highly focused courts that already exist—might help to fast track the adjudication of these claims, which would cut down on administrative and other overhead costs. Will the proposed healthcare reforms address these issues? It remains to be seen if true reform can overcome the efforts of special interest groups that are trying to place their own interests above the public good.”
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