It takes two
Two weeks is all it took for deadly, late-stage head and neck tumors to shrink in mouse models. The cause: a combination of two targeted treatments already approved by the Food and Drug Administration.
Ninety percent of head and neck cancers are squamous cell carcinoma. Individuals with late-stage cancer have a five-year survival rate as low as 34 percent. Traditionally, this type of cancer has been treated with a combination of surgery, radiation and/or chemotherapy.
New research aimed at developing targeted chemotherapy for squamous cell carcinoma has focused on a protein called the epidermal growth factor receptor (EGFR), which is found at high levels in more than 80 percent of head and neck squamous cell cancers. Unfortunately, EGFR-targeted treatments have been clinically unsuccessful.
Nameer B. Kirma, Ph.D., associate professor of molecular medicine, discovered a role for anaplastic lymphoma kinase (ALK) in oral cancers that metastasize. Therapies targeting ALK have been successful in treating those tumor types, as well as other cancer types such as non-small cell lung cancers.
Dr. Kirma and Cara Gonzales, D.D.S., Ph.D., assistant professor of comprehensive dentistry, began testing the effectiveness of ALK inhibitors in head-and-neck cancer mouse models. They found when they combined the therapies, the tumors shrank by 50 percent in a 14-day test period.
Results were seen in both human cancer cells and in human tumors developed in mice. No adverse side effects were noted. Both proteins use the same pathway to drive tumor growth, Dr. Gonzales said.
“Targeting only one of these receptors does not completely block their shared pathway,” she said. “Imagine two lanes of traffic merging. You would have to put up a roadblock across both lanes in order to completely stop the flow of traffic. We believe that blocking both ALK and EGFR effectively eliminates their ability to signal to the cells to grow and spread to other parts of the body.”
The researchers are now applying for grants to move the therapy into clinical trials.
The study was published in Oral Oncology.
Quantum leap in cancer care
UT Health San Antonio and The University of Texas MD Anderson Cancer Center announced an affiliation agreement Nov. 1 that will create a comprehensive and clinically integrated cancer care program in San Antonio.
Beginning later this year, the UT Health San Antonio MD Anderson Cancer Center will provide adult cancer patients in South Texas greater access to the most advanced oncology care available.
Through this affiliation, the Cancer Therapy & Research Center (CTRC) will collaborate with MD Anderson as part of an international network of hospitals and health care systems dedicated to ending cancer globally. The affiliation will build on MD Anderson’s knowledge and capabilities and UT Health San Antonio’s expertise and the Institute for Drug Development, one of the largest early phase drug development programs in the world. It will benefit patients in the 38 South Texas counties already served by UT Health San Antonio.
The agreement aligns with the vision of UT System Chancellor Bill McRaven to create a “quantum leap” by building collaborative teams of UT System institutions based on the respective strengths and expertise of the institutions.
“MD Anderson is the top-ranked cancer center in America, with unparalleled experience, resources and expertise,” McRaven said. “This is a fine example of how we can leverage the expertise of our individual institutions with the size and excellence of the UT System to better serve people in our region, the state and beyond.”
The affiliation will provide increased access to MD Anderson’s treatment protocols, standards of care, extensive clinical trials and translational research in San Antonio. UT Health San Antonio will deliver research-driven, patient-centered care that mirrors MD Anderson’s multidisciplinary model, which will provide a new dimension of innovative care and treatment options. Through joint tumor boards, MD Anderson physicians will provide additional multidisciplinary opinions for diagnosis and treatment.
The agreement also will bring new funding from the UT System and private sources to improve the infrastructure at the CTRC, including a newly renovated Patient and Family Welcome Center, an expanded and more efficient pharmacy, an infusion center designed around the patient experience, a diagnostic suite and a wayfinding system to help patients more easily navigate around the facility.
“These improvements will take time, which is why we will not offer the collaborative services until later this year,” said UT Health San Antonio President William L. Henrich, M.D., MACP. “We have looked at the projected need for cancer care in our region, and over the next 10 years we are expecting a significant growth in population. Unfortunately, with that growth will come many more cancer cases. This affiliation will help us improve our facility and patient care to be ready to serve the needs of our region with the best care possible.”
Ronald A. DePinho, M.D., president of MD Anderson, said the affiliation will dramatically reduce the suffering caused by cancer.
“We are proud to partner with UT Health San Antonio,” he said. “Through this affiliation, we are working to deliver groundbreaking clinical advances focused on prevention, early detection, treatment and research.”
A national search is underway to hire a director to lead the new program.
“Beyond all of these obvious advantages is that we will be able to offer our region the very best care close to home,” Dr. Henrich said. “I know firsthand what it is like to leave my home for treatment, away from family and friends at a crucial time. This is why we want this affiliation for South Texas.”
The CTRC and MD Anderson are among only four National Cancer Institute-designated cancer centers in Texas.
Off the crooked path
PHOTOS BY JOEL SPRING
Moms recovering from substance abuse choose the straight road for their babies
Coming into the world was the easy part for Nevaeh Aldana.
Born July 7, 10 weeks premature, the baby girl with dark, wispy hair was immediately whisked away to the hospital’s neonatal intensive care unit, where she was evaluated and put on a respirator to support her underdeveloped lungs.
But in addition to observing Nevaeh for health issues related to prematurity, the nurses were watching to see if she would develop neonatal abstinence syndrome (NAS), withdrawal from the methadone her mother had been prescribed during pregnancy to manage her heroin addiction. Even though methadone may still cause NAS, it is considered safer during pregnancy than heroin use or abrupt withdrawal, which can lead to miscarriage.
Before long, the tiny newborn began withdrawing. She cried inconsolably and had trouble sleeping for longer than an hour at a time. Already weighing less than 4 pounds, she had little interest in eating. She vomited and had diarrhea. Like many babies with NAS, she was sensitive to being touched, making it difficult to comfort her.
The nurses began the standard treatment, giving Nevaeh medication similar to the methadone her mother had been taking. The goal: gradually weaning her off of the drug. It took five weeks. On Aug. 20, Nevaeh went home.
But her care didn’t stop there.
Soothing babies through science
The majority of babies exposed to opioid drugs while in the womb, between 60 and 94 percent, develop neonatal abstinence syndrome. NAS often includes symptoms such as Nevaeh’s, but can also result in seizures and, in rare cases, death.
Yet nationwide, opioid use among pregnant women has skyrocketed, resulting in a 300 percent increase in babies born with the syndrome since 2000.
“Often, women with substance use disorders have experienced trauma, such as childhood abuse and neglect, and have co-occurring mental illness,” said Lisa Cleveland, Ph.D., RN, PNP-BC, IBCLC, assistant professor in the School of Nursing.
Over the past five years, Texas has seen a 60 percent increase in NAS cases, with Bexar County leading the state in the number of babies born with the syndrome.
In 2007, the Mommies Program was created to offer these mothers and their babies a wide range of support, including methadone treatment for mothers during pregnancy, a recovery program after the baby’s birth, counseling and a 13-week series of parenting and life-skills classes.
Nevaeh’s mother, Yolanda Aldana, 25, is one of the more than 600 women who have participated in the community-based counseling and parenting program, a partnership among the Center for Health Care Services, University Health System, the Department of State Health Services and the School of Nursing.
“There is such a stigma associated with being a mother who has a substance use disorder, particularly when interfacing with health care providers. This can create additional barriers for women seeking treatment,” said Dr. Cleveland, a NICU nurse for 12 years before becoming a pediatric nurse practitioner and researcher.
It can also interfere with the mother-child bonding process. Although mothers are discharged from the hospital within a few days, most babies with NAS stay in the NICU for more than two weeks.
“After interviewing several mothers whose infants had NAS, I realized that their experiences were different than other NICU mothers,” Dr. Cleveland said. “They had overwhelming feelings of shame and guilt. These feelings could be so strong that some mothers wouldn’t come to the NICU to visit their babies.”
Since the Mommies Program began, the time babies with NAS stay in the NICU has decreased by 33 percent. Aiding in the process are medications to alleviate some symptoms and soothing techniques such as Kangaroo Mother Care, often used with premature babies that promotes continuous skin-to-skin contact between the mom and baby and provides comfort to both.
“[Kangaroo Mother Care] has been used for years with preterm infants, resulting in dramatically improved outcomes for mothers and infants. It is often recommended for infants with NAS, but there has been little evidence to show if it’s effective,” Dr. Cleveland said.
In 2014, Dr. Cleveland received $204,000 from the Department of State Health Services to investigate the impact of Kangaroo Mother Care on stress and attachment in mothers and babies suffering from the effects of substance abuse.
Dr. Cleveland’s project is multipronged. First, she teaches mothers about Kangaroo Mother Care. The idea behind the technique is to snuggle the baby, dressed in only a diaper, against the mother’s bare skin, allowing the baby to smell her mother and hear her mother’s heartbeat. This also makes on-demand breastfeeding, an important aspect of NAS recovery, more likely.
Then, using the School of Nursing’s Biobehavioral Research Laboratory, the saliva of both mothers and the infants is tested to measure cortisol levels. Cortisol is a biomarker of stress. Samples are collected before Kangaroo Mother Care begins and again 20 minutes later. The data will determine if the technique improves attachment and reduces stress reactivity in mothers and babies with NAS.
Dr. Cleveland is also evaluating whether Kangaroo Mother Care further lowers infants’ need for medication, lessens the length and cost of hospital stays and reduces placement of the children in foster care or with other relatives.
Based on the study’s early success, Dr. Cleveland has been awarded an additional $50,000 from the Department of State Health Services to expand the Mommies Program to other area hospitals and include more mother and baby pairs.
The grant is also helping the Mommies Program expand to other areas of the state. A writing team led by Dr. Cleveland published The Mommies Toolkit for the Department of State Health Services, outlining how other communities can add resources similar to the Mommies Program. They held workshops about the program with community agencies from the counties with the highest rates of NAS, such as Dallas, Harris, Nueces and Tarrant counties.
Heart to heart
On a recent morning, Yolanda demonstrated Kangaroo Mother Care with Nevaeh. Yolanda undressed Nevaeh to her diaper, tucked her inside of her blouse and placed her on her bare chest. Nevaeh quickly fell into a deep sleep.
With Nevaeh safely snuggled to her chest, Yolanda said she feels grateful for the opportunity to participate in the Mommies Program and be part of the Kangaroo Mother Care study. It has helped the pair bond.
“I love the feeling of Vaeh’s heartbeat. It’s like she’s still in my womb,” she said. “I remember the first time I held her like this. My heart just melted.”
She also remembers the day she was discharged from the hospital, forced to leave her baby behind.
“I felt horrible. Seeing what Vaeh was going through was terrible,” she said. “My mother said that the reason I was in this situation was because I took the crooked path. I am never going to put myself in this situation again.”
She is continuing with the Mommies Program and still uses Kangaroo Mother Care with Nevaeh, even after bringing her home.
“These mothers are so strong. They never cease to amaze and inspire me,” Dr. Cleveland said. “Their strength comes from their children.”
School of Nursing faculty and students collaborate with nurses from Mexico
Teachers relish “aha! moments,” when students understand a complex concept for the first time. These moments are coming from both sides of the border with a new educational program between nursing schools at the UT Health Science Center and Universidad Autonoma de Nuevo Leon in Monterrey, Mexico.
The Salud: Nuevas Fronteras program is bringing eight faculty members from UANL to the Health Science Center to learn teaching methods based on U.S. standards. They are enrolled in graduate-level coursework in the School of Nursing three weeks each semester for four semesters. The program began in fall 2014.
The program allows them to better coordinate their clinical and educational programs, and integrate research into the process. But it’s not a one-sided relationship, said Eileen T. Breslin, Ph.D., RN, FAAN, dean of the School of Nursing.
“This partnership is enriching both of our educational programs,” she said. “These are some of the best clinical faculty members at UANL. All of them have a master’s degree and some have doctoral degrees or are pursuing a Ph.D. UANL is one of the best universities in Mexico,” known for promoting graduate education and research.
At the Health Science Center, the Mexican faculty members have focused on palliative care, health assessments, clinical education and educational theory. This spring, the UANL nurses saw how Health Science Center faculty teach nursing students to interview patients and take medical histories, use simulation for clinical training and learn to care for patients in clinics and hospitals.
“We don’t have the same level of simulation training [in Mexico],” said Dani Amaro Hinojosa, a Mexican faculty member. “It is much more intensive here. I definitely want to take this [knowledge] back to Mexico.”
In the Center for Simulation Innovation, students practice caring for patients using computerized manikins programmed to exhibit various health issues, such as cardiac arrest, the birthing process and emergency blood transfusion.
During one simulation, the Mexican faculty members observed undergraduate nursing students as they assessed a manikin simulating respiratory failure, which led to inserting a breathing tube in the manikin. The Mexican nurses then participated in the exercise themselves, as if they were students. Finally, they took the helm as instructors, guiding the students as they would teach their own students in Mexico.
“Our students learn from their mistakes here before working with real patients,” said Clinical Assistant Professor Lark Ford, M.A., M.S.N., RN. “And we link what our students are learning in theory to their clinical training. They teach these separately in Mexico, so this was a new concept for the Mexican faculty members.”
Salud: Nuevas Fronteras is supported by $600,000 from the Mexicans and Americans Thinking Together Foundation. The universities of Michigan and Pennsylvania are partners in the program.
Grant helps advance the education of nurses
More students will be entering the School of Nursing, thanks to a $700,000 grant from Methodist Healthcare Ministries of South Texas, Inc.
The grant, which continues a three-year pilot program, will help advance the education of nurses to meet national guidelines and address the nursing shortage by providing more highly educated nurses.
“These grants have helped us partner with community colleges and universities to encourage students to enter into our bachelor’s, master’s and doctoral programs,” said School of Nursing Dean Eileen T. Breslin, Ph.D., RN, FAAN. “We are committed to advancing nursing education at all levels.”
One example of this is at San Antonio College, where office space has been reserved for the School of Nursing faculty to regularly advise prospective students on prerequisites needed to enter UT Health Science Center nursing programs.
As a result, 52.3 percent of the students entering the School of Nursing’s Bachelor of Science in Nursing program in fall 2014 completed their prerequisites at SAC, Dr. Breslin said.
The grant also provides funds for three scholarships each for the Doctor of Nursing Practice and Doctor of Philosophy degree programs.
The program supports the Institute of Medicine’s recommendation that 80 percent of nurses have at least a bachelor’s degree by 2020. Only 54 percent of nurses in Texas and 55 percent in Bexar County hold a B.S.N. or a more advanced degree.
Stress test: Researchers studying soaring stress levels among nurses
Ashley Byrd, B.S.N., RN, became interested in mental health nursing while earning her bachelor’s degree.
“I noticed that there was a shortage of nurses in this field and I wanted to help make a difference,” she said. “There is still such a stigma attached to mental health issues, but these are our mothers, fathers, brothers and sisters. Who knows when we might be stressed because of what happens in life or depressed because of a traumatic event? I want to be there for my patients, to help them and guide them.”
Working in the mental health field for three years, Byrd couldn’t help but notice that nurses also suffer from stress while caring for patients, regardless of the area in the hospital where they work.
“There are a lot of things in the hospital culture that can cause stress. In my field, acutely ill psychiatric patients can cause nurses stress,” she said.
Other common examples of stress in the nursing workforce include not having the right supplies, frequent interruptions while preparing patient medications, long or varying shifts, demanding workloads, and having fewer nurses than are needed on a shift. Physical manifestations of this stress include a higher risk of infection because of compromised immune systems and frequent exposure to ill patients. Stress in the nursing workforce is also associated with other occupational hazards such as neck, shoulder and lower-back injuries from lifting and positioning patients, and foot and leg problems from being constantly on their feet.
“Stress actually is an epidemic in nursing. It’s a psychological problem and a physiological problem. And in the end, it can affect the quality of patient care,” said Byrd, who is seeking a master’s degree and certification as a psychiatric mental health nurse practitioner in the School of Nursing.
Stress often leads to absenteeism, burnout, and for some nurses, leaving the profession, she added.
Through her master’s coursework, Byrd was introduced to evidence-based quality improvement—how to use and conduct research to improve the quality of care for patients. Because of her background, it was a natural fit for Byrd to become a research assistant on a study conducted by Frank Puga, Ph.D., that examines the psychological and physical factors of stress.
“From the national perspective, there is an awareness of stress in the nursing workforce, but there have been few systematic investigations that quantitatively measure the causes and effects of stress, and what we can do to improve the nursing work environment from a systems approach,” said Dr. Puga, an assistant research professor in the Center for Advancing Clinical Excellence (ACE), a center of excellence in the School of Nursing.
This is a critical issue, he said. There is increasing evidence that unhealthy work environments can contribute to stress among health professionals as well as medical errors and ineffective delivery of care, according to the American Association of Critical Care Nurses, which is leading a national initiative to encourage healthier nursing work environments. Improvements are essential for patient safety, the association found, and could enhance staff recruitment and retention.
Dr. Puga and Byrd are studying stress with nurses from San Antonio’s Methodist Hospital. They will be collecting saliva samples to measure cortisol, a physiological biomarker of stress. Nurses also will fill out surveys and routinely document the stressors in their work environment, such as disruptions in workflow processes and problems with teamwork. Data will be collected on organizational culture, job satisfaction and turnover rates to better understand the relationship between system variables, stress and staffing outcomes.
Wanda Gibbons, RN, B.S.N., M.H.A., NEA-BC-FACHE, chief nursing officer at Methodist Hospital and interim chief nurse executive for Methodist Healthcare, said stress in frontline nurses is an important research topic that hospital officials were eager to help explore.
“Most of our research on stress has been qualitative,” she said. “This study will give us the opportunity to collect direct, quantitative data to provide a better environment for our nurses. It will help our nurses become more aware of how they deal with stress and will help advance nursing research.”
This pilot study is funded by a $10,000 research grant from the American Organization of Nurse Executives, which promotes leadership, professional development, advocacy and research to advance nursing practice and patient care.
Once the process for data collection is refined in the pilot study, Dr. Puga plans to conduct a full-scale national study on this topic through the Improvement Science Research Network (ISRN), a national, interprofessional research network based in the ACE.
“The ISRN helps establish best practices by taking studies that have been proven to work in one or a few hospitals and conducting them across the country at many different sites,” explained Kathleen Stevens, Ed.D., RN, ANEF, FAAN, director of the ACE and ISRN. “When a new idea is proven to work well in many environments, it can become a new model of improved care, reflecting best practices.”
Byrd, who will collect saliva samples from nurses and communicate frequently with them about the study, said she’s excited to be working with Dr. Puga to investigate a major issue that plays a part in clinical excellence.
“And as a future mental health nurse practitioner,” she said, “I am looking forward to consulting the literature and conducting evidence-based practice to help my patients and contribute to the body of knowledge for health professionals.”
Curing invisible wounds
While deployed as an Air Force clinical psychologist in Iraq, Lt. Col. Alan Peterson, Ph.D., experienced firsthand the toll war can take on the mental health of service members.
Serving in 2004 during the bloody Battle of Fallujah, Dr. Peterson’s mission, with his military medical colleagues from San Antonio, was to establish an Air Force Hospital in Balad. His seven-member team was responsible for providing mental health services.
"When the helicopters came in with mass casualties it was ‘all hands on deck.’ We unloaded the victims, brought them to the ER and stayed to help the doctors and nurses caring for them," said Dr. Peterson, who is now a professor of psychiatry and chief of the Division of Behavioral Medicine in the Long School of Medicine.
"Blasts are the most common type of trauma and there is a lot of carnage," he said. Besides the fear of ambushes, roadside bombs and mortar attacks, service members frequently see their buddies suffering from gruesome injuries.
"Emotions can range from fear to anger, depression and remorse," he said. And when they come home, some experience flashbacks and other serious symptoms, making it difficult to adapt to normal life.
Post-traumatic stress disorder, which affects about 14 percent of Iraq and Afghanistan war veterans, is one of the most well-known mental injuries of war. Because published studies have all been conducted with civilians or Vietnam War veterans, there are no research-based guidelines for treating combat-related PTSD among active-duty military.
So Dr. Peterson relied on his background as a clinical practitioner and researcher to use proven therapies for civilians with PTSD. Two types of cognitive behavioral therapy, prolonged exposure and cognitive processing therapy, have been shown in research studies to treat 80 percent of civilians to the point of remission.
Prolonged exposure helps patients confront and process traumatic memories through education about normal reactions to traumatic events, relaxation techniques, repeated retelling of the traumatic event and homework that involves confronting reminders of the trauma in a safe environment.
Cognitive processing therapy helps patients understand how their thoughts about a traumatic event influence their feelings and reactions. The therapy helps them develop new ways of thinking about the event that alleviate their distress and show them how to regain control over their lives.
Dr. Peterson and his colleagues found that these methods worked well, but they needed to be adapted for the military.
"[Both therapies] typically require eight to 12 sessions of 90 minutes each. With the homework they do between sessions, the whole series usually lasts several weeks. This is not realistic for a war zone and can even be difficult with demanding military schedules back home," he said.
And the type of trauma experienced in the military is different.
"Civilians with PTSD usually have one traumatic event that severely affects them, such as a rape, major accident or natural disaster. Deployed military members may experience graphic and highly stressful events daily—and they are deployed numerous times," Dr. Peterson said.
Another consideration is that military training for survival in a war zone, such as being on constant alert for danger, can conflict with PTSD therapy. Therapy tries to alleviate the symptom of hypervigilance, or that feeling of always being "on edge." So the appropriate application of that training may need to be addressed in therapy.
Dr. Peterson, who had been trained in prolonged exposure therapy, began adapting it to fit the military environment.
"After a few sessions I had people telling me, ‘I’m good to go. I’m ready to go back on convoys with my unit,’" he said.
After retiring from the military, Dr. Peterson joined the Health Science Center in 2006 and wanted to continue helping military members suffering from PTSD. He gained an unprecedented opportunity in 2008 when he and his collaborators received approximately $35 million from the Department of Defense through its Congressionally Directed Medical Research Programs to form STRONG STAR.
STRONG STAR, which stands for the South Texas Research Organizational Network Guiding Studies on Trauma And Resilience, is a multidisciplinary, multi-institutional research consortium designed to understand, prevent and treat combat-related PTSD. Under Dr. Peterson’s direction and the leadership of the UT Health Science Center San Antonio, the consortium brings together more than 100 of the world’s top research investigators from over 20 collaborating civilian, military and Veterans Affairs institutions.
The consortium is conducting 25 clinical trials in Central and South Texas evaluating both prolonged exposure therapy and cognitive processing therapy, as well as similar therapies in active-duty military and recently discharged veterans who served in Afghanistan and Iraq. Genetic, epidemiological and biological studies also are underway to learn more about biological influences on PTSD and related conditions to develop new and improved prevention and treatment methods.
The studies are being conducted at four San Antonio locations: San Antonio Military Medical Center, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Randolph and the South Texas Veterans Health Care System, Audie L. Murphy Division. Other locations include Fort Hood’s Carl R. Darnall Army Medical Center, the Central Texas Veterans Health Care System in Waco and locations in Afghanistan.
STRONG STAR also has received $27 million in supplemental funding for new studies investigating PTSD and related conditions, such as insomnia, suicide risk and traumatic brain injury.
The biggest affirmation of STRONG STAR’s success came in August 2013, when the group received $45 million from the Department of Defense and VA for the Consortium to Alleviate PTSD. President Barack Obama announced the award as part of a National Research Action Plan for improving access to mental health services for veterans, service members and military families.
The consortium, called CAP, involves STRONG STAR’s original collaborators plus some new ones, including all seven divisions of the VA’s National Center for PTSD. Dr. Peterson directs the CAP and its coordinating center, based at the Health Science Center. Dr. Terence Keane of the National Center for PTSD at the Boston VA is co-director.
Guided by a government steering committee, the CAP is charged with addressing research gaps and developing and evaluating new diagnostics, therapeutics and preventions for PTSD and conditions associated with it, emphasizing genetic and biological markers.
In the future, Dr. Peterson would like to expand the Health Science Center’s work through a PTSD-related residency program and large clinical practice in this specialty.
"We are formulating ideas for these programs but will need funding to move forward," he said.
Dr. Peterson said the work his consortia are doing will have far-reaching effects that could significantly improve PTSD treatment not only for military personnel, but also for the general public.
"I feel like I’m doing the most important work of my career," Dr. Peterson added. "I’ve helped hundreds of people through what I’ve learned and done as a clinician and researcher, but now we have the potential through STRONG STAR and CAP to help thousands of military members and families. We plan to test lots of theories over the next seven years and have the opportunity to develop the standard of care for military members and veterans who deserve our help. My overall goal is that one day we will not only know how to prevent and treat PTSD, but also how to cure it."
How to enroll in research studies
STRONG STAR and affiliated studies are located in San Antonio, Fort Hood and Waco, where there is a large concentration of active-duty, retired and former military members.
San Antonio-area studies include:
- Individual PTSD treatment compared with couples therapy that addresses PTSD and relationship issues with active-duty military
- PTSD and alcoholism in veterans
- In-home treatment compared with in-office treatment of PTSD for active-duty military and veterans
- PTSD treatment delivered in the primary-care doctor’s office for active-duty military
- Dog adoption in veterans with PTSD
If you or someone you know needs help with service-related post-traumatic stress disorder, visit STRONG STAR and click on the red "Get Treatment" button in the upper right corner to learn more.
A neurological boost
Neuroscience projects receive a $1 million gift
Pain is a growing epidemic. More than 116 million Americans suffer from chronic pain, and the numbers are expected to rise as the population ages.
It comes at a cost. The Institute of Medicine estimates the annual cost of pain management is around $600 billion a year. So Kenneth M. Hargreaves, D.D.S., Ph.D.,and his team are trying to understand how changes in the way genes are expressed, or epigenetics, might lead to chronic pain. That knowledge might help develop a new class of nonaddictive painkillers.
"This could change how we diagnose and manage chronic pain in many conditions besides burns. This is such a major problem," said Dr. Hargreaves, professor and chair of the Department of Endodontics in the School of Dentistry and professor in the departments of Pharmacology, Physiology and Surgery in the Long School of Medicine.
Kenneth M. Hargreaves, D.D.S., Ph.D.
Dr. Hargreaves’ research is just one neuroscience project benefiting from a $1 million gift from the J.M.R. Barker Foundation. The gift also funds the UT Health Science Center’s South Texas ALS Clinic, and preliminary research involving humans and the drug rapamycin for dementia and Alzheimer’s disease.
"The Health Science Center is an outstanding gem," said Ben Barker, a member of the President’s Development Board who helped arrange the foundation’s support. "The neurosciences research being conducted here has the potential to yield a future Nobel Prize. I anticipate that efforts such as these will help to attract the next generation of bright, aspiring doctors and researchers to the Health Science Center."
Dr. Hargreaves’ research will receive $600,000 from the gift. Developing new nonaddictive painkillers is critical, he said, because more Americans suffer from chronic pain than those with diabetes, heart disease and cancer combined, according to Institute of Medicine research.
By studying chemicals that give chili peppers their burning sensation, Dr. Hargreaves’ team has discovered a major class of pain mediators released when an injury occurs. The mediators are the "go-betweens" communicating the pain message from the site of an injury though the nervous system to the brain.
The researchers have identified the molecule released at the site of the injury. They understand how the pain signal is transmitted to the brain—and how to block it. Dr. Hargreaves’ team will use the Barker Foundation funds to create a screening method to develop and optimize new drugs that can be used to alleviate pain at its source.
"This gift is the catalyst for our research," said Dr. Hargreaves, who holds The USAA Foundation President’s Distinguished University Chair in Neurosciences. "This is a rocket booster in terms of research because this is allowing us to rapidly and dramatically focus on developing new types of nonaddictive analgesics in a way we could not have fathomed last year."
Pain is not the only area of neuroscience that causes significant human suffering and costs millions of dollars to treat.
The worldwide cost of dementia was $604 billion in 2010. The World Alzheimer’s Report 2010 notes that the number of people affected by dementia was 35.6 million and projects that number will rise 85 percent by 2030 and another 75 percent by 2050.
The Barker Foundation gift is providing $65,000 to Veronica Galvan, Ph.D., and Tyler J. Curiel, M.D., M.P.H., for preliminary research involving humans and the drug rapamycin for dementia and Alzheimer’s disease.
Rapamycin is approved by the U.S. Food and Drug Administration as an anti-rejection drug for organ transplants, but has shown promise as an anti-aging drug that can increase healthy life spans in mice.
Veronica Galvan, Ph.D.
Barker Foundation funding will permit the doctors to collaborate in studies evaluating whether rapamycin could be a useful and safe treatment for Alzheimer’s disease or other age-related neurological diseases in humans.
"This is really encouraging for us," said Dr. Galvan, assistant professor in physiology at the Health Science Center’s Sam and Ann Barshop Institute for Longevity & Aging Studies. "With this important funding, we can gather the data we need to push therapy forward."
As a person ages, vascular dysfunction occurs. It can range from mild to severe, but when it affects the brain, it can shut down blood vessels’ ability to carry necessary amounts of oxygenated blood to the brain. Areas of the blood-starved brain start to shut down, which can contribute to dementia and Alzheimer’s disease.
"Blood flow in the brain is precisely controlled," Dr. Galvan said. "You can have changes in blood pressure and perfusion elsewhere in the body with no major implications. However, if a change of the same magnitude happens to the brain, this can have serious consequences. The brain is critically sensitive to changes in perfusion, that is why much smaller changes such as the ones we study have a major impact on brain function."
The rate of occurrence of dementia and Alzheimer’s disease is increasing, she said.
"This problem is extremely urgent. This is not going to stop anytime soon," Dr. Galvan said. "This funding will allow us to find out more about how [rapamycin] works to restore brain blood flow in Alzheimer’s. The more we know about how the drug works, the more options become available to achieve the same beneficial effect. Countless possibilities open up with greater understanding."
A less common but equally debilitating disease, amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease, affects about 5,600 people each year, according to the ALS Association. About 30,000 Americans may have the disease at any given time.
ALS is a progressive disease that impacts nerve cells in the brain and spinal cord. As these nerve cells die, patients have difficulty controlling muscle movement and eventually become paralyzed. There is no cure.
The Barker Foundation gift allocates $335,000 to continuing support for operations of the Health Science Center’s South Texas ALS Clinic, led by Carlayne Jackson, M.D.The clinic is part of UT Health Physicians, the clinical practice of the Long School of Medicine.
"We offer treatment, education and opportunities to participate in clinical trials, but the most important thing we may offer our patients is hope," said Dr. Jackson, professor in the departments of Neurology and Otolaryngology, assistant dean for ambulatory services in the Long School of Medicine and chief medical officer at UT Medicine. "My patients, and the hope that through our work here we can make their lives better in the future, are what drive me every day."
Offering 10 different disciplines to treat patients, the ALS Clinic is accredited by the National ALS Association and is an ALS Association Certified Center of Excellence. Patients are seen at the Medical Arts & Research Center in San Antonio.
Carlayne Jackson, M.D.
Health Science Center President William L. Henrich, M.D., MACP, said all three research areas are significant because they have far-reaching impact.
"All three of these areas cause significant human suffering and cost millions of dollars to treat," he said. "We thank the Barker Foundation for believing in our groundbreaking research and clinical care that will improve the human condition."
Faculty members respond to disaster in West
One of the first to hear about the fertilizer plant explosion in West, Texas, was Emily Kidd, M.D. The emergency physician and assistant professor at The University of Texas Health Science Center at San Antonio arrived in the northeast Texas town within a few hours, at midnight on Wednesday, April 17. She found that emergency medical responders had already transported the most severely injured patients to area hospitals.
While she did not treat patients, her work was far from over. Dr. Kidd wears several hats due to her assignments in the Department of Emergency Health Sciences (EHS), part of the School of Health Professions, and the Department of Emergency Medicine (EM) in the Long School of Medicine. Because the EHS department has a contract to provide paramedic training for the San Antonio Fire Department, Dr. Kidd serves as its interim medical director. This role also places her in regional and state leadership positions in emergency planning and response.
After deploying to West, Dr. Kidd worked in the state medical operations center in Austin, where she helped deploy disaster resources to West, including a Mobile Medical Unit (MMU) - a hospital emergency room on wheels. She returned to West as medical director for the state’s Emergency Medical Task Force to assess medical needs until the state medical resources were no longer needed.
Working in a similar advisory role was Craig Manifold, D.O., assistant professor in the EM and EHS, who serves as a colonel in the Texas Air National Guard and joint surgeon for Texas Military Forces. Dr. Manifold said, "As the senior physician and adviser to the adjutant general, I observed response activities and assured that military medical assets were available to help with the disaster."
In addition, three faculty members provided care for patients in the MMU:
- David Wampler, Ph.D., LP, assistant professor of EHS, helped set up the MMU and worked as a paramedic there on April 18 and 19.
- Craig Cooley, M.D., M.P.H., EMT-P, FACEP, assistant professor/clinical and program director of the EM’s emergency medicine fellowship, assisted with setting up the MMU and was the only physician seeing patients there from 6 p.m. April 18 until 4 p.m. April 18. "In the MMU, we are capable of evaluating and treating injuries ranging from minor bumps and bruises to stabilizing critical patients. Most everything I saw while I was there were relatively minor symptoms related to the blast or other minor injuries," Dr. Cooley said.
- Todd Burgbacher, D.O., clinical instructor and an emergency medical services fellow, relieved Dr. Cooley until the MMU was no longer needed, around 6 p.m. April 19.
Dr. Manifold pointed out that Dr. Burgbacher received an invaluable educational experience. "In addition to treating patients, he was able to actively participate in planning and deploying in a complex multiagency response to a live disaster," he said. "This is something that few programs in the country are able to provide and that few emergency medicine residents are able to participate in."
Emergency Health Sciences receives $8.3 million to train flight medics
May 17, 2010, is a day Army Sgt. Eric Emmons will never forget. One of his brothers-in-arms died after stepping on an explosive device while their unit was en route for clearance operations in Afghanistan.
"He died instantly, so thankfully he did not have to suffer. But from that point forward I knew I would need to further my medical knowledge to ensure I could do everything possible for wounded soldiers in the future," said Sgt. Emmons, the unit’s medic.
Now a flight medic, Sgt. Emmons volunteered for the new U.S. Army Critical Care Flight Paramedic Program offered through the Department of Emergency Health Sciences (EHS), part of the School of Health Professions.
"The Army conducted a data analysis over the past 12 years on battlefield injuries. It showed there was a training gap in the care offered before we got injured soldiers to our surgical hospitals," explained Lt. Col. Brian Krakover, M.D., an Army emergency medicine physician.
The new flight medic program at the Health Science Center provides seven and a half months of intensive, in-depth medical training and critical thinking skills that flight medics need to keep severely injured soldiers alive during helicopter transport to a surgical hospital for stabilization. Following a successful pilot program at the Health Science Center in 2012, the Army signed a five-year, $8.3 million contract with the EHS to train 120 flight medics through four classes each year, for a total of 600 flight medics.
"These courses teach the ‘why’ behind what needs to be done," explained EHS Community Education Director Leslie Hernandez, M.A., Ed.D., who was recruited to lead the new program. "All of the students in our courses are volunteers, and most have had significant combat experience in Afghanistan. They are highly motivated."
Lance Villers, Ph.D., EHS chair and associate professor, added, "Our department has had a long history of working with the military. We have a great sense of pride in being able to have a role in improving the model of care for our soldiers."