DHSA conference provides forum for sharing research, exploring issues in health care
Keynote speaker John Nance shares with participants his vision for reforming health care delivery through collegiality, cooperation, and collaboration.
DHSA Executive Director Kathleen Matt welcomes attendees to the conference.
Gov. Jack Markell talks about the importance of DHSA to Delaware’s economic future.
TJU’s Steven McKenzie shares his idea with the group at a breakout session.
Stephen Bernhardt, Andrew Kirkpatrick Professor of Writing at UD, browses through research posters during a break.
Delaware Gov. Jack Markell, third from left, joins DHSA leaders, from left, Patrick Harker, Robert Laskowski, Kathleen Matt, Robert Barchi, and Tom Ferry.
Keynote speaker Michael Lauer offered lessons from the age of bloodletting.

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3:24 p.m., May 5, 2010----More than 275 people from the health sciences research and education community turned out for the 2010 Delaware Health Sciences Alliance (DHSA) Conference on Tuesday, May 4.

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Held at Christiana Care Health Systems' John H. Ammon Medical Education Center, the conference attracted representatives of not only the four DHSA partners but also a number of other organizations, including the U.S. Department of Commerce, the Delaware Division of Public Health, Delaware State University, Delaware Technical & Community College, the Medical Society of Delaware, the Christina School District, Johnson & Johnson, the Delaware Health Care Commission, the VA Medical Center in Wilmington, and Georgetown Medical Center.

The program began with brief presentations by Delaware Gov. Jack Markell, DHSA Executive Director Kathleen Matt, and the heads of the four partner institutions -- the University of Delaware (UD), Thomas Jefferson University (TJU), Christiana Care Health Systems (CCHS), and Nemours/Alfred I. duPont Hospital for Children (Nemours).

Markell spoke of the tremendous potential the alliance has to impact the state economically. “When it comes to innovation, workforce development, and science and technology, this alliance just has it nailed,” he said. “Efforts like this don't start with the government -- they start with people who have not only tremendous vision but also the ability to execute.”

“The government's role is to listen carefully to see where entrepreneurs want to go and what they want to do. Delaware can't afford to write the biggest check, so we have to be more flexible and more agile to attract companies.”

Matt, who is also dean of the College of Health Sciences at UD, said that one of the alliance's most important goals will be to establish a translational research pipeline characterized by intellectual fusion and social embeddedness. “When I was in Arizona,” she said, “I saw what cutting-edge research could do for patients and populations, and I look forward to seeing this happen in Delaware.”

Robert Laskowski, president and CEO of CCHS, said that he is repeatedly asked, “When are you going to build a medical school in Delaware.” His reply: “We already have one at TJU.”

“In the past two years,” he said, “that relationship has turned into so much more. In true Delaware fashion, we formed a partnership that has the creativity of four very different but complementary organizations to focus on caring for our neighbors. To do that effectively, we need to be well educated and well informed. We also need creative ideas, and those are embedded in the fabric of the DHSA.”

UD President Patrick Harker spoke about the University's recent purchase of the former Chrysler auto assembly plant, which will be transformed into a major science and technology campus.

“We wanted to put the land back to work for the people of Delaware and the region,” he said, “and have it serve as a locus of discovery, invention, and innovation -- all those things that drive the 21st-century economy. It's literally a once-in-a-lifetime opportunity to develop land that can power local and regional economic growth for many, many decades.”

TJU President Robert Barchi talked about the changes that will accompany health care reform in the U.S., which will add some 30 million people to the system over the next few years. Barchi predicted a shortage of health care professionals, especially in rural areas, and a transformation in how services will be delivered. Rather than a linear chain in which patients are passed from doctors down to nurses, pharmacists, and physical and occupational therapists, he envisions care by teams of professionals who are trained together and work together.

The new health sciences campus at UD will facilitate this by providing an administrative infrastructure, a venue for synchronous education, and a residential area that will enable students to spend extended stays at clinical training sites in Delaware. The latter is critical, Barchi said, because individuals in health care tend to practice where they're trained.

Tom Ferry, CEO of Nemours, pointed to the potential of the partnership to shorten the time between theory and applications by pairing clinical sites and research institutions. “The ultimate test of this,” he said, “will be bringing services to the citizens of Delaware.”

The program was anchored by two keynote speakers: author and aviator John Nance and Michael Lauer, director of the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute.

John Nance: Lessons from Aviation

Nance's 18th book, Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care, won the American College of Healthcare Executives' 2009 Book of the Year Award. In it, Nance tells the story of fictitious St. Michael's Hospital, which undergoes a revolutionary cultural change based on a foundation of collegiality, cooperation, and collaboration.

Nance entertained the conference audience by incorporating anecdotes and video clips into a talk that had a serious message: “This is the way we've always done it” is not a valid argument for maintaining a dysfunctional system.

He emphasized that the pipeline between discovery and delivery has to include not only hard science but also sociology, psychology, and anthropology. “We have a lot to do in the area of people dealing with people,” he said.

According to Nance, it's a myth that human perfection in medicine is achievable. However, he said, we can come much closer to creating an error-free medical system if health care professionals work in teams where everyone's opinion is sought and valued and where no member of the team is afraid to speak up when something appears to be wrong.

Collegiality is a critical component of this approach, he said, because it promotes communication without barriers. “When you care about someone,” he said,” it's hard to put barriers between you. And in the end, we have to ask ourselves, 'What we are we here for?' The answer is 'We're here for the patient.' We're not here to mark our territory or to argue about who's right.”

The primary lessons that medicine can take from aviation, Nance said, are teamwork and the use of best practices. As an example he cited U.S. Airways Flight 1549, which experienced an emergency landing on the Hudson River and turned pilot Sully Sullenberger into an overnight hero for saving the lives of all 155 people on board.

“There was no miracle on the Hudson,” Nance said. “Surviving the landing was not a miracle -- it's a procedure you can read in a manual. Aviation is not smarter than medicine, but we got bloodied enough times to realize the importance of using best practices and understanding the difference between leadership and commandership.”

According to Nance, part of the problem in the field of medicine is that doctors have been trained to work “out on the prairie,” called to a patient's bedside at 2:00 in the morning with black bag in hand.

“The issue now is that we need to train them to work in teams in these marvelous modern institutions like Christiana Care,” he said. “We can't do it the way we've always done it -- we have to move on if we want to build a unified system. What we have now is a nonsystem with wonderful parts.”

Michael Lauer: Lessons from Bloodletting

After experiencing good health for most of his life, America's first president died at the age of 67, when two of the three doctors attending him decided that the best treatment for his throat infection was bloodletting to eliminate the “bad humors” from his body. George Washington lost eight pints of blood in as many hours and almost immediately succumbed to shock and dehydration.

Despite his death -- and many others -- bloodletting was a common therapy for a wide range of ills well into the 19th century, and, according to Lauer, it remains a symbol for a paradigm within the medical system where treatments whose usefulness is questionable continue to be administered by doctors and requested by patients.

With health care costs skyrocketing, the American Reinvestment and Recovery Act of 2009, also known as the stimulus bill, includes funds for the National Institutes of Health to support comparative effectiveness research. CER is aimed at containing costs and improving health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision-makers.

Much of the current focus is on tests. “With the tremendous proliferation of imaging techniques,” said Lauer, “the issue of whether they're adding value or just adding cost is under close scrutiny. Just because a test can predict an outcome doesn't mean its use will prevent the outcome.”

CER is aimed at determining whether screenings are actually life saving and whether there is solid evidence to support their use.

Lauer cited an example from his own field, cardiovascular medicine, where a study initiated in the late 1990s focused on the wisdom of discharging patients who have been successfully treated for an acute event but still have occluded arteries. The treatment of choice has traditionally been percutaneous coronary intervention, or PCI, a term referring to one of several procedures such as balloon angioplasty that are used to open blocked arteries.

“Many doctors were so convinced of the value of PCI,” Lauer said, “that they actually thought it would be unethical to assign any patients to the control group, which was slated to receive all of the best medicines but no artery reopening procedure.”

It took millions of research dollars and more than a decade to reach the conclusion that PCI of a totally occluded artery is not recommended after a heart attack if the patient shows no sign of ischemia, or limited blood flow.

“This moved a little faster than bloodletting,” Lauer said, “but even so, one could argue that 11 years is too long.”

Debate about evidence-based medicine is fierce for a variety of reasons, including patients' desire to have the most technologically advanced tests and therapies available, doctors' fear of malpractice, and insurers' efforts to contain costs.

As for bloodletting? In 1809, a surgeon named Alexander Hamilton (no relation to the statesman) actually conducted an early version of a randomized controlled trial that demonstrated just how deadly the practice was. Hamilton and two other Army surgeons rotated treatment of 366 injured soldiers at a hospital in Portugal during the Peninsular Wars. He and one of his colleagues lost only four and two cases, respectively, while the surgeon who “employed the lancet” lost 35 patients.

Despite the evidence, it took more than a century for the practice to be abandoned, and as Lauer asserted, it lives on as an icon of the medical profession's reluctance to give up commonly accepted tests and therapies.

Breakout sessions

Individual breakout sessions in the morning addressed opportunities to enhance translational research across the DHSA in seven areas: cancer, cardiovascular, neurosciences, rehabilitation sciences, bioinformatics, community engagement and outcomes, and interprofessional education and research.

In the afternoon, the groups provided feedback to the audience highlighting project ideas, barriers, and opportunities for collaboration.

The sessions yielded a number of ideas to facilitate collaboration and share resources, including periodic video conferences, shared speakers, a DHSA website blog, streamlined IRB and proposal submission processes, and expansion of social science representation on research and education teams.

The groups also suggested the need for new models of data sharing, delivery of health care to diverse populations, patient recruitment, wellness promotion, interprofessional education, and professional networking.

“At this point, the successful collaborations that we have are idiosyncratic and piecemeal,” said Lynn Snyder-Mackler, Alumni Distinguished Professor of Physical Therapy at UD and one of the leaders of the rehabilitation sciences breakout group. “We need to institutionalize them.”

Poster session

More than 50 research projects were on display in the lobby during the lunchtime poster session. Based on votes cast by those in attendance, the following were selected for awards:

First Place

“Novel Gait Rehabilitation Intervention Improves Walking Performance Post-Stroke,” Trisha Kesar, D. Reisman, M. Roos, R. Perumal, W. Farquhar, J. Higginson, K. Randolph, and S. Binder-Macleod.

Second Place

“Suppressing Cancer Cell Motility and Invasiveness Through Small Molecule Enhancers of NaK-ATPase,” Thu Huynh, R. McSpadden, R. Damoiseaux, S. Rajasekaran, and A. Rajasekaran.

Third Place (tie)

“Community-Based Participatory Research: Expanding, Evaluating, and Modeling Outreach for Elders with Cancer,” Paula Klemm, V. Rempusheski, J. Teixeira, C. Jurkovitz, J. Perry, C. Domroski, and M. Alligood.

“Biomechanical Investigation of the Concussion Dilemma in the Olympic Sport of Taekwondo: A Collaborative Study with UD and Seoul National University,” Gabriel Fife, T.W. Kaminski, D. O'Sullivan, W. Pieter, J. Glutting, T.H. Im, and I.S. Shin.

Next DHSA conference Dec. 10

The next DHSA-sponsored conference, scheduled for Dec. 10, 2010, at the University of Delaware's Clayton Hall, will focus on women's and children's health. Contact Kathleen Matt at [ksmatt@udel.edu] for more information.

Article by Diane Kukich
Photos by Kathy Atkinson and Ambre Alexander

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