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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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Hong Kong is Bright Spot of Tobacco Control in China

Jeffrey Koplan, MD, MPH

A remarkably successful 20-year program of tobacco control in Hong Kong can serve as a best-practices example for China and other nations, says Jeffrey Koplan in an article published online today in The Lancet. Koplan is vice president for global health at Emory and director of the Emory Global Health Institute.

Hong Kong’s successful tobacco control program began with a 1982 health ordinance launching a multi-step approach including legislative amendments (regulation of indoor smoking, pack warnings, ban on tobacco advertising), a steeply increased tobacco tax, school-based education, mass-media campaigns, community events, and leadership from the medical community.

Smoking prevalence in Hong Kong fell from 23.3 percent in 1982 to 11.8 percent in 2008 through the efforts of the Tobacco Control office of the Department of Health and NGOs such as the Hong Kong Council on Smoking and Health.

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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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Stereotactic radiosurgery: fast, friendly, focused

Cynthia Anderson, MD

When Cynthia Anderson, MD, prepares her patients for stereotactic radiosurgery she emphasizes three things: the surgery is fast, friendly and focused. Initially used to treat the part of the brain associated with brain tumors, stereotactic radiosurgery has gained currency as a treatment for various types of cancer. This type of surgery uses x-ray beams instead of scalpels to eliminate tumors of the liver, lung and spine.

“It’s fast because the actual radiation treatment itself is very short,” says Anderson, a radiation oncologist at the Winship Cancer Institute of Emory University. “It’s friendly because it’s all done as an outpatient. And it’s focused because these targeted radiation beams get the maximum dose of radiation to a tumor and give the most minimal dose of radiation to the critical organs that surround the tumor.”

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Looking at quality of life in visually impaired children

Vision loss can affect one’s daily function and quality of life (QOL), but few research studies have actually looked at the impact of visual impairments on children’s quality of life.

An Emory project aims to develop an instrument that will measure the effect of vision loss on the quality of life of children age 8 to 18.

Pictured from left to right: J. Devn Cornish, MD, professor and vice chair, Department of Pediatrics, Emory University School of Medicine; Andy Lovas, grand recorder, Knights Templar Eye Foundation; Sheila Angeles-Han, MD, MSc, assistant professor, Pediatric Rheumatology and Immunology, Emory University School of Medicine; Larry Vogler, MD, division chief, Pediatric Rheumatology and Immunology, Emory University School of Medicine; and Tim Taylor, director of marketing, Knights Templar Eye Foundation

The project is being led by Emory pediatric rheumatologist Sheila Angeles-Han, MD, MSc. Han recently received a $40,000 grant from the Knights Templar Eye Foundation to augment her work in this area. She is collaborating with pediatric ophthalmologists at the Emory Eye Center.

Currently, there are no validated questionnaires or tools to determine how children in these age groups cope with their visual impairments and the impact of vision loss on their daily lives. This knowledge can enhance physicians’ understanding of diseases that affect vision.

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Nursing students give health care in the Dominican Republic

Recently, a group of Nell Hodgson Woodruff School of Nursing students traveled to the Dominican Republic for Alternative Spring Break.

Students team up to provide care in the Dominican Republic

Armed with food, medicine and clothing, the Emory students partnered with Dominican nursing and medical students to serve Haitians now living there after being displaced by the devastating Jan. 12 earthquake in Haiti.

Hunter Keys and Abby Weil were among the team of nursing students that journeyed to Santo Domingo, D.R. to provide health screenings and educational outreach. They also accompanied Dominican nursing students on home visits and elementary school visits.

Hunter and Abby blogged about their transformative experience.  On the second day of their travels, they wrote:

“…there is a huge need for ongoing care, including wound care, physical therapy, and mental health treatment. Dealing with these health issues on top of the terrible tragedy of losing loved ones, homes, and jobs is almost unimaginable. The process of healing will be long and difficult, both mentally and physically. One of the take home messages of the team was that while the great amount of aid pouring into Haiti directly after the earthquake is so useful and greatly needed, there will need to be a sustained effort to provide the services needed to facilitate this healing process.”

Learn more about Hunter and Abby’s travels and see photos from the field.

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New education model for real-world health care

 

Emory’s Nell Hodgson Woodruff School of Nursing has started a new educational concept called the Dedicated Education Unit (DEU).

Launched by the School of Nursing and Emory Healthcare last fall, the DEU pairs a nursing student with a staff nurse for one-on-one clinical instruction in the medical-surgical unit at Emory University Hospital or Emory University Hospital Midtown.

Nursing senior Ivey Milton (left) checks on a patient’s medication, guided by Jackie Kandaya, her medical-surgical instructor at Emory University Hospital Midtown

A first at Emory and in Georgia, the DEU is based on the model implemented by the University of Portland School of Nursing and its clinical partners in the early 2000s.

Kelly Brewer, who holds a joint appointment with the School of Nursing and Emory Healthcare as DEU coordinator, says, “Our DEU initiative relies on these concepts and the skills of nurses and faculty to help students transition into the real world of nursing. It’s a win-win situation for both sets of professionals since faculty and clinical nurses are in short supply because of the nursing shortage.

“Both of our hospitals are committed to making students feel that they are part of the unit so they’ll want to work there after they graduate,” she adds. “They will already have a sense of what Emory’s health care system is about, and their transition into the real world of health care will be less stressful.”

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Looking at simple foods to protect against breast cancer

Researchers at the Winship Cancer Institute of Emory University have found that the hormone adiponectin may reduce the ability of cancer cells to migrate from the breast and invade other tissues. Adiponectin appears to protect against the effects of obesity on metabolism, the heart and blood vessels, the researchers say.

Fat cells make up most of the breast tissue, and some of the hormones produced by fat cells can have tumor-stimulating effects. Previous studies have shown that women with high body mass index (highest fifth) have double the death rate from breast cancer compared to those in the lowest fifth.

Dipali Sharma, PhD

The key to translating this research for patient care lies in finding a way to increase a person’s adiponectin, says Dipali Sharma, PhD, assistant professor of hematology and medical oncology at Winship.

Currently, Winship scientists are testing a molecule found in certain foods that appears to mimic the effects of adiponectin. The molecule is found in grapes, cabbage and green tea.

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Improving measurement of pesticides in breast milk

Little is known about the exposure of infants to pesticides, despite their vulnerability and evidence of widespread dietary exposure among older children and adults. A study led by Emory Rollins School of Public Health researchers P. Barry Ryan, PhD, and Anne Riederer, ScD, seeks to improve methods for measuring pesticides in breast milk and infant formula.

“We really don’t know about how babies are exposed to pesticides in their everyday life,” says Riederer, assistant research professor, Department of Environmental and Occupational Health. “There are very few published studies on this topic, and we’d like to be one of the groups that actually publishes an analytical method that can be used by researchers in any country to be able to detect these different types of pesticides in breast milk.”

Although the breast milk method will be pilot tested on samples collected from a birth cohort in Thailand, it will have broad applications for the U.S. population.  Insight Pest Control Wilmington says that because these pesticides are widely distributed in the food supply, all U.S. infants are potentially exposed.

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University global alliance partners with Rollins

Rollins School of Public Health

Emory’s Rollins School of Public Health is one of five organizations that have joined to form the University Global Alliance Program (UGAP).

The initiative, launched March 2 by the Northrop Grumman Corporation, aims to unite higher education and the private sector to accelerate the application of thought leadership to global public health informatics, policy development, strategic planning, programmatic implementation and evaluation.

In addition to Emory, the UGAP alliance includes The Satcher Leadership Institute of the Morehouse School of Medicine, Georgia State University, the Georgia Institute of Technology and the Colorado School of Public Health. The universities were chosen for their innovative research in public health and their interest in advancing public health practice through applied technology and informatics.

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