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A chance at life: Specialty tags help fight breast cancer

By purchasing a special license plate, Georgians can help low-income women obtain breast cancer services and treatment.

For each breast cancer awareness tag purchased or renewed, a Georgia program contributes $22 into a fund that pays for cancer screenings, education and treatment for thousands of uninsured women.

taggerThe Georgia Center for Oncology Research and Education (Georgia CORE) administers the grants to community organizations.

“We’re trying to get the message out: If you buy the tag, you’re helping indigent women in Georgia,’’ said Angie Patterson, Georgia CORE vice president, who is herself a breast cancer survivor.

An estimated 1,200 Georgia women die from breast cancer each year. About 7,000 women in Georgia are expected to be diagnosed with breast cancer this year.

The breast cancer tag program began in 2003. Last year, $1.1 million in grants went to 16 organizations and helped perform 3,289 screenings/mammograms, 2,131 clinical breast exams, 385 ultrasounds, 128 biopsies, and education and training for 15,231 medical providers in more than 60 counties in Georgia.

Six other states have breast cancer license tag programs, Patterson said.

 

Cutting down the waiting lists

 

CORE recently announced that Central Georgia Cancer Coalition and Meadows Regional Medical Center in Vidalia won grants of about $100,000 each for treatment programs.

Additional winners were Athens Regional Foundation, Center for Black Women’s Wellness, Center for Pan Asian Community Services, East Georgia Cancer Coalition, Gwinnett Medical Center, Hearts & Hands Clinic, Northside Hospital Cancer Institute, and Susan G. Komen’s Atlanta affiliate. Each won grants of about $50,000 for education programs.

“We congratulate the winners and look forward to seeing the impact of all the work that will come out of their awards, particularly in providing services to those Georgians that need it most,” said Georgia CORE President Nancy Paris.

Patterson added that $48,000 went to the Georgia Department of Public Health for its breast and cervical cancer prevention program.

“This is incredibly good news since many of these women are on waiting lists for mammograms, and the state has not been able to increase funding’’ for that program, she said.

Starting this year, supplemental funds from the license tag program have gone to administer genetic testing for those considered at risk of breast or cervical cancer. Twenty women have been tested thus far with these funds.

To find out how to purchase a breast cancer awareness license tag, please visit the Georgia Department of Revenue website or visit your local county tag office.

 

Weather disasters and medical facilities: Why readiness is vital

Upturned car in front of Sumter Regional in 2007

Some of the damage from the 2007 tornado that hit Sumter Regional Hospital.

In the event of a natural disaster, resilience is a hospital’s prescription for success.

It’s all about bouncing back, recovering and then moving forward after a violent weather event. The proper response requires developing plans, then practice, practice, practice — and then putting those measures to work when the moment calls for action.

Whether our hospitals and medical facilities are safe and ready to help communities during and after weather events is a vital topic. Some areas are more prone to disasters than others, but it takes only one serious event to ravage a normally safe area.

Hurricanes, tornadoes and floods can cause casualties on a large scale, increasing the need for hospital readiness. But some disasters in recent years, such as Hurricane Katrina in 2005 and “Superstorm Sandy” in 2012, have inflicted damage on hospitals themselves.

Members of the American Meteorological Society (AMS) have recently added their concerns about hospital resilience in the aftermath of “high-impact” weather events throughout the country.

AMS suggestions include having medical centers look at their structural designs and, in some cases, relocate critical components to higher ground. When Katrina left large stretches of low-lying New Orleans submerged for weeks, it demonstrated the importance of having facilities that remain functional and accessible.

Health care’s critical problem in disasters is supply and demand. High-impact weather events create a pragmatic paradox, according to the AMS report. Supply decreases when health infrastructure is damaged, but the demand increases as the number of victims adds up.

Charity Hospital in New Orleans suffered severe flood damage during Hurricane Katrina.

Charity Hospital in New Orleans suffered severe flood damage during Hurricane Katrina.

What the American public needs to know is that “each hospital has the job of seeing how well they are prepared,” said Jim Blair, president of the Center for HealthCare Emergency Readiness, a consulting firm. “It’s a journey, not a destination.”

Blair questions whether hospitals are really ready to handle disasters when it’s been many years since their communities were struck. Institutional memories can fade, and a hospital’s vulnerabilities can become less obvious.

He refers to location intelligence when he’s working with health care clients. “Is there a dam nearby, or is the hospital close to an earthquake fault line?” asks Blair. “Where are the air conditioning, heating and ventilation power systems located?”

What about cesium-137, the most common radioactive material used in radiation therapy? Is it protected?

Sandy hit huge metropolitan areas of the Northeast in late October, leaving many communities in tatters and more vulnerable to the approaching cold weather. The storm did considerable damage to New York hospitals and other health care organizations.

Five acute-care hospitals in New York City alone were closed because of electrical and mechanical system failures, flooding and other storm-related issues. The closures were temporary, but all patients had to be evacuated.

Weeks after Sandy, four hospitals in the nation’s largest city remained closed for inpatients, leaving thousands of patients scrambling to find other medical centers.

Katrina was far worse for hospitals. According to a FEMA report, New Orleans hospitals suffered major interior damage such as collapsed ceilings, and emergency power generators became nonfunctional and shut down HVAC systems used to control temperature and humidity.

The bodies of 45 patients were found at Memorial Medical Center in New Orleans after the 2005 storm. Overall, more than 200 bodies ‘’were recovered from New Orleans hospitals and nursing homes as a result of the hurricane.

Blair says hospitals and health care facilities, in the midst of a disaster, must make the right decisions about sheltering in place or evacuating patients and staff.

 

It can happen here

 

History shows that Georgia hospitals are not immune to violent weather.

A communications tower dangles from the Grady Memorial Hospital roof after a tornado hit Downtown Atlanta.

A communications tower dangles from the Grady Memorial Hospital roof after a tornado hit Downtown Atlanta.

 

In March 2008, Grady Memorial Hospital, downtown Atlanta’s largest and most famous hospital, was damaged by a tornado that hit the heart of the city. According to claims reports, 15 buildings suffered significant damage, including the radiation/oncology center, Georgia Hall, Florida Hall, and the Hughes Spalding Medical Center of Children’s Healthcare of Atlanta.

Other health facilities have also met weather damage head on.

Seven years ago, severe thunderstorms moved across central Georgia, producing tornadoes that resulted in significant damage in several counties. Some of the heaviest destruction occurred at Sumter Regional Hospital in Americus.

That particular tornado’s path measured about 38 miles in length, with a maximum width of 1 mile, as it ripped through Americus. The hospital was evacuated after the tornado hit.

Fifty-five to 60 patients were in the building when it was hit. Three of them were in critical condition. All the patients were transferred to other hospitals.

Sumter Regional suffered major damage and later was demolished to make way for a new facility.

Dr. Thomas Frieden, the CDC director, recently reminded a Rockefeller Foundation audience that the first lesson is to build resilient systems that can be “scaled up” quickly.

In other words, know which systems are already in place that can be expanded on short notice to serve more people in a hurry.

“During the 2014 winter storms in Augusta, we lost power to several area nursing homes,” said Adrianne Feinberg, director of emergency preparedness at Georgia Hospital Association.

“A concerted effort among health care partners and emergency management agencies resulted in generators and other resources being allocated to the affected facilities,” Feinberg said. “Now we are working with a new federal program to help supply generators in the future — ensuring nursing home residents always have heat.”

Medical offices of all varieties and sizes are vulnerable to weather-related problems.

The same ice storm that brought Augusta to a halt also paralyzed Atlanta. There, in vitro fertilization (IVF) specialist Dr. Mark Perloe faced a time-critical challenge. “Retrieving eggs and caring for fertilized embryos are my first priority, no matter what the weather is doing in Atlanta,” he said.

All scheduled egg retrievals must occur as planned. IVF timing is critical for life. Because he and his staff planned ahead for access to the clinic (with some staff and patients staying in hotels close by), their backup system worked.

“You can close schools, banks and post offices, but when eggs are ready for their debut, we cannot let a little ice storm get in the way,” said Perloe.

Now that’s resilience.

 

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

 

Ga. researchers may have found effective weapon against dry mouth

Georgia Regents University researchers Stephen Hsu (left) and Scott DeRossi say a clinical trial showed their lozenge containing green tea antioxidants produced a fourfold increase in saliva.

Researchers Stephen Hsu (left) and Scott DeRossi say a clinical trial showed their lozenge containing green tea antioxidants produced a fourfold increase in saliva.

Millions of patients suffer from dry mouth, a condition generally caused by a decrease in saliva.

Everyone’s mouth occasionally feels dry, and for many it’s simply a matter of being thirsty. For a long time, there was little public awareness of dry mouth as a chronic health problem. But that has changed in recent years.

Dry mouth is frequently a side effect of medication and cancer therapy. It can range from being simply a nuisance to having a major impact on general health and the health of teeth, as well as appetite and enjoyment of food, according to the Mayo Clinic.

A product developed by researchers at Georgia Regents University in Augusta may help dry mouth sufferers.

The GRU researchers say a clinical trial showed their lozenge containing green tea antioxidants produced a fourfold increase in saliva.

 

Looking at the data

 

Dr. Scott DeRossi, chairman of oral health and diagnostic sciences in the College of Dental Medicine, says the formula “increases a patient’s salivary flow statistically and clinically to a significant level without any adverse side effects.”

DeRossi and Dr. Stephen Hsu, professor of oral biology in the College of Dental Medicine, co-authors of the study, presented their findings in April at an international gathering of oral medicine professionals in Orlando.

Researchers asked 60 patients with dry mouth symptoms to consume one lozenge every four hours. Half received lozenges containing the patented MighTeaFlow formula, and the other half received a placebo.

After eight weeks, the group receiving the active lozenges experienced a 419 percent increase in “unstimulated” saliva production, such as while resting or sleeping. The same group also experienced a 218 percent increase in “stimulated” saliva production, such as while chewing.

The group receiving the placebo experienced no significant change in saliva production.

 

Marketing has begun

 

The products, which include chewing gum, rinse, oral spray, and the lozenges used in the study, are already on the market as over-the-counter items available at such websites as www.camellix.com and www.amazon.com.

The researchers plan larger-scale clinical trials next, along with possibilities of developing new prescription drugs based on the formula.

Hsu and DeRossi are encountering more patients with dry mouth symptoms, and say the increase in public awareness has been gradual.

“People are living longer with more chronic diseases and more medicines, resulting in more patients with dry mouth complaints and complications,” DeRossi said. “Ongoing education is needed to increase awareness of the problem.”

The dry mouth products were developed and patented at the GRU Life Sciences Business Development Center in the Office of Innovation Commercialization, which takes research from the laboratory to the marketplace.

Emory’s EMTs combine learning, lifesaving and community outreach

Emory EMT student Elizabeth Rodgers learns to use all of her  senses during a simulation exercise.

Emory EMT student Elizabeth Rodgers learns to use all of her senses during a simulation exercise. Photos by Rachel Barnhard.

 

The normal sounds of classes at Emory University are occasionally interrupted by something even more important — emergency tones erupting from a radio clipped to the shirt of a student EMT.

“We really try to minimize distractions by sitting near the exit and turning the radios down low so that we don’t disrupt the room when we need to leave,” said Alison Yarp, who volunteered as an EMT for three out of her four years at Emory. “It can be difficult sometimes to jump back and forth between being a student and being an EMT, but it’s so worth it.”

According to the National Collegiate Emergency Medical Services Foundation, there are more than 250 colleges and universities in the United States with accredited collegiate EMS programs. But Emory is the only school in Georgia with a fully functioning collegiate EMS program.

Emory Emergency Medical Services, or EEMS, is an entirely volunteer-based organization staffed by students trained through the program to become Georgia-licensed advanced emergency medical technicians (AEMTs).

Student AEMTs respond to calls not only on campus but also in the surrounding community in east metro Atlanta. The EEMS response area is extremely diverse, including the CDC Roybal campus, Wesley Woods Geriatric Hospital, several schools and shopping centers and the entire university campus.

Whether it is a cardiac arrest or a car accident, the Emory AEMTs may be on the scene 5 to 10 minutes before other local medical responders arrive, according to Rachel Barnhard, full-time director for EEMS.

In their white Ford SUV with “Emory EMS” emblazoned across the side, EEMS can respond to a scene with lights, sirens, and a full trunk of medical equipment.

“Our student volunteers provide invasive medical care in a very stressful environment alongside local EMS and public safety workers in the area,” Barnhard said. “Their goal is to help people, but they are truly making a difference in someone’s life.”

The course consists of two four-hour training sessions each week plus two eight-hour Saturday sessions each month. Each student must complete more than 100 hours of clinical rotations in different hospital emergency departments and time as a “third rider” in an ambulance with two preceptors. Clinical rotations cannot take place during regular Emory class hours, so the students have to find time to do them outside class.

“For the students in the course, it’s like a yearlong job interview,” Barnhard said. “The students go through a ton of pathophysiology and clinical skills training. The curriculum is very in-depth and we take this course really seriously.”

Upon completion of each portion of the course (EMT & AEMT, respectively), students are eligible to sit for the National Registry of EMTs exam, divided into a written portion and a hands-on psychomotor portion.

 

A yearlong commitment

 

Since EEMS is staffed solely by graduates of the course, students are asked to volunteer a minimum of one year of their time upon completion of the program requirements and earning their AEMT certification.

During her time as an AEMT, Yarp earned the rank of supervisor. Like most EEMS students, she delicately balanced her clinical hours with other commitments — in her case, organic chemistry exams and playing the viola in the Emory orchestra.

Gabe Gan, as a student in EMT class, learns about being "backboarded" during an exercise.

Gabe Gan, as a student in EMT class, learns about being “backboarded” during an exercise.

All in all, Yarp worked 1,500 hours of EMS shift time as an undergrad, which is an impressive figure to include on her medical school applications. (She is currently taking a “gap year” to work and apply to medical schools.)

Her EEMS experience is far more than a number of hours, however. The aspiring pediatric emergency medicine physician said her time with the program not only confirmed her career goals, but expanded them as well.

“I’ve always had an interest in emergency medicine, but getting to be one of the first patient care providers on scene showed me that I did enjoy that environment,” she said. “However, I didn’t know I’d be so interested in emergency preparedness until I got indirectly exposed to it through EEMS, so that’s a newer interest of mine.”

Gabe Gan, a rising junior, came to Emory with extensive EMS experience after working as an EMT during high school in his home state of Maryland. Gan, who was recently appointed assistant chief of operations for EEMS, was especially attracted to Emory for the EMS program. He enjoys learning on the job, and he likes how it supplements his major in human health.

“Through interacting with patients, I am able to see the effects of chronic disease that I learned in my nutrition and chronic disease class or understand better how the mental health problem I learned about in class actually presents.” Gan said.

He has completed about 600 hours of EMS shift time at Emory so far.

John Harper is a sergeant with the Emory Police Department. During his four years on the force, he has worked extensively with the EEMS students while they pull their overnight shifts from midnight to 8 a.m. During these shifts, the students work out of a special EEMS squad room in the police department building.

“They provide patients with a really high level of care in such a timely manner,” Harper said. “One really big advantage to having them on campus is that they are extremely familiar with the area. They know the names of buildings and locations that non-campus personnel may not know.”

From the scene of an emergency, EEMS can provide specific directions over the radio for emergency responders coming from outside the Emory campus.

Harper noted that EEMS had a presence at Emory’s graduation ceremony May 12. Some families felt unsure about the Atlanta heat and its impact on elderly guests at the ceremony, and the EMTs set up a medical tent.

“At the request of families and friends, the EMTs will take the blood pressure or vital signs to ensure that guests are safe and healthy before the ceremony begins,” Harper said. “They have a great attitude about it and they are extremely professional. Their presence gives guests peace of mind.”

Detective Anthony ReFour is another member of the Emory Police Department who has spent time working with the EEMS students.

“The EEMS unit provides rapid medical attention that may otherwise be delayed in such a large, busy county,” he said. “Being an all-volunteer unit, they do this selflessly and with astonishing attention to detail. I feel as though their work ethic and desire to be of service to their community espouse the values that Emory University was built on. In short, the altruistic nature of the program is a beacon of strength in the community.”

 

Camaraderie and dedication

 

Outside of responding to calls, the EEMS has always put priority on outreach and engagement with the community. In February 2014, it hosted its first-ever regional EMS for Children conference on the Emory campus, and drew more than 100 health care providers from across the state.

While Emory EMS requires a significant commitment of time, students still make room in their schedules to pursue interests outside the program.

DSC_0991

“It is amazing to see and learn about all that our volunteers do outside of EEMS, from performing in Emory’s music, dance, and theater ensembles to playing on club sports teams,” Gan said. “Not all of our members are pre-med or science majors. One of our members is actually a professor in the Goizueta Business School.”

After going through so much training and moving up through the ranks together, EEMS students have become a tight-knit group. They call themselves “the Unit,” Yarp said, adding that as diverse as they may be in other ways, they are united in their love for EMS work.

“We’re just all brought together by our interest and passion and dedication to pre-hospital care. It’s a special field and it takes certain people to do it. That interest and dedication is probably the most common thread that runs through all of us.”

Whether students go on to enroll in medical school or become paramedics in their hometowns, many continue providing care and spreading knowledge long after their four years are over.

“We’ve had international students who are interested in going back to their country and establishing EMS programs there,” Barnhard said. “Maybe a student is working to be an emergency room physician, but because of EEMS, they’re going to understand the process that led up to a patient arriving in their care.”

 

Natalie Duggan, a GHN intern, is a recent graduate of Emory University, where she majored in journalism and anthropology with an emphasis in health writing. She has previously interned at the CDC, the CNN Medical Unit, and was a summer 2013 ORISE research fellow at the National Institute of Allergy & Infectious Diseases.

 

 

Life-or-death debate: Proposal could hurt Georgia on liver transplants

A transplant operation at Piedmont Atlanta Hospital

A transplant operation at Piedmont Atlanta Hospital

 

Susan Honea didn’t expect to live beyond her 30s.

She was diagnosed at age 29 with primary biliary cirrhosis, a chronic disease that slowly destroys the medium-sized bile ducts in the liver.

Honea, a Hiram resident, was put on a liver transplant list last year, and she got the transplant at Piedmont Atlanta Hospital in March. “You don’t realize how bad you were until you get one,’’ she said. “I didn’t think I would make it to my 40th birthday.’’

Susan Honea

Susan Honea

Though she got an opportunity for a normal life, Honea fears that some other Georgians won’t. She believes a proposed federal change to liver transplant distribution policies, if it had already been in effect, could have prevented her from getting the lifesaving operation.

The United Network for Organ Sharing (UNOS), the organization that manages the nation’s organ transplant system under contract with the federal government, is considering changes to the liver transplant districts in the country.

The nation is currently divided into 11 transplant regions that have wide variations in patients and available organs. Livers generally are allocated within each locality or region.

Putting Georgia into a new district would change the calculus of whether a patient here gets a transplant.

 

Don’t meddle with a good thing?

 

Right now, the region that includes Georgia works efficiently in terms of organ donations and distribution, Emory and Piedmont transplant chiefs contend.

“Organ donation is working quite well in Georgia,’’ said Dr. Stuart Knechtle, director of liver transplantation at Emory University Hospital, and chief of transplant services at Children’s Healthcare of Atlanta.

Dr. Mark Johnson, program director of Piedmont Transplant Institute, said other regions have donor rates that are not as strong as Georgia’s.

But a remapping could put Georgia in a region of Northeastern states.

A bipartisan group of 11 Georgia congressmen signed an April letter to the Health Resources and Services Administration saying the idea of remapping the regional set-up for liver transplant allocation would hurt the state. Redistricting, the congressmen argued, “would reduce the number of liver transplants performed in Georgia by 25 percent, reducing access to this lifesaving procedure for Georgians.”

It would also disproportionately harm minorities and poorer patients in Georgia and the Southeast, the congressmen said.

The letter asked Mary Wakefield, the HRSA administrator, to put a hold on the process by UNOS.

Rep. Lynn Westmoreland (R-Ga.) told GHN in a statement, “Including Georgia among Northeastern states proposes not only a higher health risk to patients, but the survival time for the liver. In order to keep costs, health risks, and travel time low for Georgia and the surrounding regions, remapping needs to be considered with the needs of the patients as a priority.”

 

Determining the greater need

 

The current transplantation process is based largely on severity of disease. Because the number of people waiting for new livers far exceeds the number of livers available, a transplant is reserved for a critically ill patient. Thousands of people nationally are waiting for a liver transplant at any given time, and each year hundreds die before receiving one.

The purpose of remapping would be to level out the geographic disparities and equalize the MELD scores, a measure of severity of liver disease. That system is a numerical scale used for adult liver transplant candidates. The range is from 6 (less ill) to 40 (gravely ill).

The organs generally go to the sickest (by MELD score) within a region.

The Associated Press reported last year that UNOS figures show that in three regions stretching from Michigan and Ohio down to Florida (including Georgia), adults receiving new livers over the past two years had median MELD scores of 22 to 23.

But in the region that includes California, recipients were far sicker, with a median score of 33, AP reported. Almost as high were regions that include New York, the Dakotas and Illinois.

Current liver transplant districts

Current liver transplant districts

 

(Last year, UNOS made one change to the way livers are allocated. The policy change, called Share 35, offers livers broadly to people on the wait list with MELD scores of 35 or higher.)

Dr. David C. Mulligan, chairman of the UNOS Liver and Intestinal Organ Transplantation Committee, noted in April that there are significant geographic disparities in the current system.

“Our committee is reviewing alternate distribution methods to both increase the number of lives saved through liver transplantation, and decrease overall variation in [MELD] scores at which candidates receive a transplant opportunity,” Mulligan said. “Statistical modeling strongly suggests these optimized maps would result in more lives saved overall and reduced variation in the [MELD] scores at transplant.’’

A UNOS spokeswoman said the earliest time an actual proposal for a change would go out for public comment would be spring 2015.

 

Demographics and geography

 

More than 300 Georgians are currently waiting for a liver transplant. Emory and Piedmont, along with Children’s Healthcare of Atlanta, perform a total of more than 250 a year.

Under the current set-up, the wait time in Georgia for a liver transplant is less than six months, Piedmont’s Johnson said. And he added that Georgia is now a net exporter of livers, sending 10 to 12 to other states each year.

“Using wait-list mortality as sole metric for reallocating a scarce gift is not maximizing the value of that gift to society, nor is always transplanting to the sickest first,” Johnson added. “Some patients are too sick to survive even one year after transplantation, and that takes away from the donor’s wishes of giving the gift of life.”

markjohnson

Dr. Mark Johnson

The proposed remapping is “too shortsighted and simplistic a fix to the inequities across the country,’’ Johnson said.

Emory’s Knechtle pointed out that Georgia has a higher disease burden than other states. “We have a poor population and poor access to health care,’’ he said.

A high percentage of donated livers in Georgia are from African-Americans, Knechtle says. With a remapping, “you’re going to take from a poor, African-American population and send to a wealthier, whiter population. I’d have a hard time with that.”

Travel times for a donated organ is also a factor, he said. If transported, “the liver will be older by the time it gets there. Ideally, it should be transplanted less than eight hours’’ after the donation, Knechtle said.

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