Improving quality on the front lines.

Name: Ulfat Shaikh
Title: UC Davis associate professor of pediatrics
Education: M.D., Goa Medical College, India; M.P.H., University of Medicine and Dentistry of New Jersey; M.S., UC Davis
Project: Integrating Patient Care and Health Professions Education to Improve Care Transitions: The UC Health Quality Improvement Network

Innovation Profile is a monthly feature highlighting the work of a UC Center for Health Quality and Innovation fellow or grantee.

By Alec Rosenberg

How do you get better health outcomes? It’s a question that drives Ulfat Shaikh, UC Davis associate professor of pediatrics.

While working at a telemedicine obesity clinic when she first arrived at UC Davis seven years ago, she had success in treating childhood obesity at rural California clinics but couldn’t keep up with demand. With 30 percent of kids in the state overweight or obese, she wanted to have a bigger impact.

Her solution: Take a systemwide approach.

Shaikh received a career development award from the federal Agency for Healthcare Research and Quality three years ago. The award enabled her to design and study a quality improvement network of rural clinics in California. She wanted to see if clinics could work together to improve preventive care for childhood obesity and get children to eat better and exercise more. Energized by the success of this learning network, she reached out to colleagues at other UC campuses to brainstorm how to apply the concept across UC’s academic medical centers.

So when the UC Center for Health Quality and Innovation issued its first request for proposals last year, “we were ready,” Shaikh said. She received an innovation center grant to develop the infrastructure for a UC Health Quality Improvement Network involving medical residents. The aim of the systemwide network is to improve transitions of care during hospital discharges for adult and pediatric patients.

By improving communication at discharge, Shaikh hopes to reduce readmissions. Almost 20 percent of Medicare patients are readmitted to the hospital within 30 days of discharge, with Medicare spending $12 billion annually on potentially preventable readmissions.

The twist is involving medical residents, who receive supervised, hands-on training in clinical specialties such as pediatrics or surgery at teaching hospitals like UC academic medical centers. Residents serve on the front lines, playing a key role in the discharge process – and as potential leaders.

“We could multiply our quality improvement workforce by thousands,” Shaikh said. “Residents are seeing this as a critical area to be trained in. They have unique insights into system problems.”

Shaikh doesn’t have to start from scratch. UC medical centers already have launched quality improvement efforts. Shaikh and co-investigators Alpesh Amin of UC Irvine, Nasim Afsarmanesh of UCLA, Brian Clay of UC San Diego and Sumant Ranji of UC San Francisco will build on those efforts to create a common curriculum to train physicians in quality improvement.

The project also will lead to a discharge toolkit for pediatrics that will be used nationally and will set the ground for future quality improvement educational efforts aligned with UC Health priorities.

“We have this untapped network of colleagues,” Shaikh said. “It’s exciting.”

Related links:

• Pediatric quality improvement efforts advance resident education, patient care
• New, interprofessional course on quality improvement to launch this fall
  
• Collobrating to improve health care quality

View Ulfat Shaikh’s talk at the UC Center for Health Quality and Innovation colloquium

Foresight is 20/20.

UC San Diego’s EyeMobile program reaches half of the low-income preschool children in San Diego County.

The future is brighter for thousands of underprivileged patients, from the very young to the very old, thanks to services provided by UC’s optometry programs.

About half of the 100,000 patients seen each year at UC Berkeley’s School of Optometry clinics come from all walks of life in the community at large. Exams and services also are provided off-campus, in schools, community clinics, nursing facilities and even homes to patients who otherwise do not have easy access to vision care.

Mobile eye clinics also are operated by UCLA, UC San Diego and UC San Francisco. The UCLA Mobile Eye Clinic, established in 1975 by an anonymous donor, remains a privately funded outreach program of UCLA’s Jules Stein Eye Institute that provides high-quality eye care to underserved populations. In a typical year, 4,000 children and 1,000 adults get exams free of charge. An additional 1,500 people receive vision and glaucoma screenings at health fairs and 400 underserved children are given free prescription eyeglasses.

UC San Diego EyeMobile manager Abel Aramburo with a patient

Since 2004, UCSF Medical Center and San Francisco General Hospital have operated a Mobile Eye Service for the San Francisco community that provides a full spectrum of eye services, including vision-saving screenings. The service sends a van that provides eye care to underserved patients — particularly the elderly, the homeless and low-income families — whose access to eye services is often limited because of a lack of transportation or cultural and language barriers.

UC San Diego’s EyeMobile program reaches half of the low-income preschool children in San Diego County. The kids receive free vision screening, exams, glasses and ophthalmic care services to give them a chance to see and learn. Since it began in 2000, the program has screened more than 107,000 San Diego preschoolers, performed more than 17,000 exams and provided more than 6,900 pairs of glasses.

The UC San Diego EyeMobile van

“A lot of them wouldn’t get glasses if we weren’t here,” EyeMobile manager Abel Aramburo said. “After they get the glasses, you see a remarkable improvement.”

Related links:

• UC Berkeley
• UCLA
• UC San Diego
• UCSF
• UC Health community impact brochure

Brown bag discussion for UCOP employees covers health reform.

Garen Corbett, director of the California Health Benefits Review Program, discusses health care reform at a brown bag event in Oakland.

By Alec Rosenberg

Health care reform is putting pressure on providers to decrease costs, increase quality and redesign the delivery of care, University of California Health Senior Vice President John Stobo said Wednesday.

President Barack Obama’s Affordable Care Act (ACA) is having a big impact on UC Health, California’s fourth-largest health care delivery system and the nation’s largest health sciences educational system. The November election will be an important milestone, but reform efforts will continue regardless of the outcome, Stobo told UC Office of the President employees at a brown bag discussion in Oakland.

UC Health has recognized the need for reform. Four years ago, UC Health’s rates of central line-associated bloodstream infections were above the national average. Through a concerted effort, those rates are now below the national average.

“Seventy patient lives were saved by preventing these infections,” Stobo said. “This is one example of what we can do when we put our minds together as a system.”

To continue UC Health’s focus on improving quality, access and value, it established the Center for Health Quality and Innovation two years ago. The center, which has hosted a colloquium and awarded a round of grants and fellowships, just issued a request for proposals for a second round of fellows.

The Affordable Care Act is a historic opportunity to improve the health status of the American people, UC Health Associate Vice President Cathryn Nation said. The law includes a number of provisions to help foster health professions training and workforce planning, though most have no funding appropriated. Meanwhile, some provisions also will heighten the nation’s existing health workforce challenges, which are particularly acute in California, where the population is increasing in size, age and diversity, she said.

“California has huge challenges because we are a large and complex state,” Nation said.

UC Health has worked to close those workforce gaps, she said. Systemwide initiatives include:

• Increasing medical student enrollment through UC PRIME (approximately 300 more students training to serve medically underserved populations);
• Planning for a new school of medicine at UC Riverside (with a goal of admitting a first class in fall 2013); and
• Establishing new nursing programs at UC Davis and UC Irvine.

The goals for health care reform – from expanding coverage to controlling costs – remain similar to those of Republican plans dating back to President Richard Nixon, said Garen Corbett, director of the California Health Benefits Review Program. But now upwards of 50 million Americans have no health insurance, including 6.9 million Californians.

The Affordable Care Act aims to extend insurance to more than 30 million people, primarily through expanding Medicaid. Those with private health insurance already are benefiting from the law’s provisions for dependent coverage to age 26, no lifetime caps and no cost sharing for preventive services, Corbett said. For the uninsured, many key provisions are scheduled to take effect in 2014, such as Medicaid expansion, health insurance exchanges, premium subsidies and the individual mandate, which requires that most Americans obtain health insurance or face a tax penalty.

While the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act’s individual mandate in June, the law’s fate could turn on the November election, said UC Health and Clinical Affairs Director David Brown. If former Massachusetts Gov. Mitt Romney is elected president and Republicans gain control of the Senate, repeal of the ACA in its entirety or, at the very least, the individual mandate would be a real possibility, Brown said. If President Obama is re-elected, implementation of the law likely would stay the course.

Either way, the push to increase quality and decrease costs will persist, as will UC Health’s efforts to address those issues, Stobo said.

UC medical centers provide vital support to health professional schools. (View chart).

John Stobo, UC Health

By John D. Stobo

At University of California Health, patient care, health professional education and biomedical research go hand in hand. The connection has become only more important during these difficult budget times.

UC’s medical centers provide vital aid to UC’s medical and other health professional schools: $522 million this year in professional services and support of research and educational programs. UC medical centers have nearly doubled their contribution over five years, helping fill in the gap from shrinking state support. Indeed, UC medical center support for UC’s health professional schools now exceeds state general fund support.

The growing support from UC medical centers has been a lifeline for UC’s aspiring doctors, dentists, nurses, optometrists, pharmacists, public health professionals and veterinarians, bolstering the nation’s largest health sciences education system. But this lifeline is under threat.

UC’s self-supporting medical centers, which receive no state general funds, operate in extremely competitive environments. Their ability to sustain support for medical education – and provide a significant amount of care to low-income people – faces key fiscal challenges:

Capital requirements: UC medical centers’ capital needs are approximately $5 billion over the next five years. To best serve patients and meet government requirements, UC medical centers have major capital commitments from electronic medical records to state-mandated seismic-safety upgrades. UC San Diego and UC San Francisco have new hospital projects under construction. UCLA’s Santa Monica medical center completed a major rebuilding project this year. UC Davis opened a new surgery and emergency services pavilion in 2010. UC Irvine opened a new hospital in 2009.

Pension costs: UC medical centers face a growing obligation to pay pension costs. Those employer costs are projected to total nearly $3 billion over the next seven years. UC medical centers receive no state support to offset these costs.

Labor costs: UC medical centers have significant labor costs. They offer competitive compensation, which is necessary to attract and retain the nurses, doctors and other health care professionals who make UC medical centers such renowned institutions.

Health care reform: Under health care reform, reimbursement for clinical services by government and private insurers could be reduced substantially, including reimbursement rates for service and payments for graduate medical education.

The combined impact of these challenges could erase medical center margins. UC Health is working hard to address these issues. As UC Health moves into the throes of health care reform, the mutually beneficial relationship that exists between our medical centers and health professional schools must be preserved.

John D. Stobo, M.D., is senior vice president for UC Health.

Resistance isn’t futile for this infection fighter.

Name: Daniel Uslan
Title: UCLA assistant clinical professor of infectious diseases, director of the Antimicrobial Stewardship Program
Education: M.D., University of Southern California; M.S., Northwestern University; B.S., UC San Diego
Project: Development of a UC-wide Antimicrobial Stewardship Program: Benchmarking and Beyond

Innovation Profile is a monthly feature highlighting the work of a UC Center for Health Quality and Innovation fellow or grantee.

By Alec Rosenberg

Daniel Uslan has cultivated his curiosity about the big impacts of tiny bugs into a career as an infection fighter.

Uslan, a UCLA assistant clinical professor of infectious diseases, was smitten by science at an early age. At 5, he made sourdough bread in a class with his father in Los Angeles called “It’s a Small World.” “I was so fascinated by these microscopic bugs being able to create food,” Uslan said.

That fascination led Uslan into the field of medicine, where he has focused on fighting the improper use of antibiotics in treating infections. Up to half of antibiotic use is inappropriate or unnecessary, he said. The consequences are steep: Antibiotic-resistant infections cost the U.S. health care system more than $20 billion a year, with problems including a dramatic rise in potentially deadly drug-resistant bacteria such as MRSA.

“Overuse or misuse of antibiotics leads directly to patient harm. It leads directly to bacterial resistance,” Uslan said. “We are really at a crisis right now. We are now seeing bacteria for which we have no effective antibiotics.”

Uslan, who joined UCLA in 2007, has worked to improve clinical outcomes of patients with infections. He directs UCLA’s Antimicrobial Stewardship Program, which has reduced antibiotic use 15 percent and saved more than $1 million over the past two years by focusing on giving the right antibiotic at the right dose for the right duration. Now Uslan is working to spread those efforts throughout the system: He received a UC Center for Health Quality and Innovation fellowship in December to explore development of a UC-wide antimicrobial stewardship program.

“These programs are absolutely essential. They provide value by increasing quality of care of patients with infections and by decreasing costs,” Uslan said.

Each UC medical center has an antimicrobial stewardship program in place, but they differ in how they are implemented. Uslan is analyzing what’s working and what could be changed. The goal is to provide substantial value. “We’re trying to learn from each other,” Uslan said. “By improving antibiotic use, you limit resistance. You limit antibiotic-associated toxicity. You improve patient outcomes. That’s sustainable.”

A successful program requires a lot of coordination, from infectious disease physicians and pharmacists to microbiologists, project managers and infection control professionals, Uslan said. Doctors have to be comfortable with someone looking over their shoulder while prescribing, he said.

While change can be uncomfortable, momentum is building to address the antibiotics issue. In 2010, California developed the only statewide antimicrobial stewardship initiative to promote appropriate antibiotic use in health care facilities. A UC-wide antimicrobial stewardship program could help set standards for other California hospitals to follow.

“The only solutions are for drug companies to develop new antibiotics or for physicians to use antibiotics appropriately,” Uslan said. “This is a really tremendous opportunity for UC to lead in the state of California. UC can be a model for the rest of the state.”

Related links:

• UCLA study to determine if copper surfaces can reduce hospital-acquired infections
• Drug-resistant infections: A new epidemic, and what you can do to help
• New program reduces antibiotic use at UCLA
• Drug-resistant superbugs (video)

View Daniel Uslan’s talk at the UC Center for Health Quality and Innovation colloquium (begins at 22:33)

Practitioner makes perfect.

Faculty and students in UC Irvine's nursing science program help those in need at a Santa Ana wellness center.

The University of California has ramped up its efforts to help address a nursing shortage, including establishing a nursing school at UC Davis and expanding nursing education classes at UC Irvine. Meanwhile, UC nurse practitioners serve on the front lines, delivering compassionate care to the community at three nurse-run clinics.

In January, UC Irvine opened Orange County’s first nurse-managed clinic at El Sol charter school in Santa Ana, an underserved, predominantly Latino community, supported by a $1.5 million federal grant.

″With nurse practitioners playing a greater role in primary care today, practices like this one are vitally important for delivering much-needed health care to underserved communities and for educating tomorrow’s nursing workforce,″ said clinic director Susanne Phillips, a UC Irvine associate clinical professor of nursing science.

UCLA’s Health Center at the Union Rescue Mission

UCLA’s Health Center at the Union Rescue Mission has provided primary health care services to the homeless and indigent on Skid Row since 1983. The clinic is an “invaluable resource” for the underserved communities of Greater Los Angeles, said UCLA School of Nursing Dean Courtney H. Lyder.

“The children and families we see have no place else to turn to for health care,” Lyder said. “Last year we had more than 8,000 patient visits, a large majority of whom were children suffering from chronic illnesses caused by an unstable home life or, in many cases, no home at all.”

For students, the clinic is “an amazing experience,” where they learn about the unique challenges of caring for vulnerable and ethnic populations, Lyder said. The students, he said, “get to witness firsthand the resilience of individuals who are overcoming hardships that most of us cannot even imagine.”

UCSF partners to provide health care services at Glide Health Services.

At Glide Health Services in San Francisco’s Tenderloin district, UCSF nurse practitioners serve the city’s homeless and poor. The nurse-run clinic receives 13,000 visits a year, from acupuncture to behavioral health to diabetes. It’s a holistic approach, so patients who visit behavioral health also get checked to see if their blood pressure is normal and their vaccinations are up to date.

“Any door is the right door,” clinic manager Karen Hill said. “A lot of people here have felt marginalized by traditional medicine. We try to work together with the patient. My focus is completely community.”

Related links:

• UC Davis
• UC Irvine
• UCLA
• UCSF
• UC Health community impact brochure
• UC nursing programs fact sheet

Internationally renowned researcher will start Jan. 1.

Jody Heymann

Dr. Jody Heymann, an internationally renowned researcher on health and social policy at McGill University in Montreal, has been appointed the new dean of the UCLA Fielding School of Public Health.

A pediatrician by training, Heymann leads the first global initiative to examine the impact of health and social policies on individuals, families and communities in all 193 countries of the United Nations.

Her appointment will take effect Jan. 1, 2013, according to an announcement made today by UCLA Executive Vice Chancellor and Provost Scott Waugh. A professor of epidemiology and of political science at McGill, Heymann will succeed Linda Rosenstock, who decided to step down as dean on July 1 after nearly 12 years of leadership.

“Public health offers tremendous tools with the capacity to make a difference in the lives of people in California, in the United States and around the world,” Heymann said. “I couldn’t be more thrilled to join the faculty, students and staff at the Fielding School of Public Health as we work together with others at UCLA and across the local and global community to tackle crucial issues at home and abroad.”

Heymann holds a B.A. in history and physics from Yale University, and an M.D., M.P.P and Ph.D. in public policy from Harvard University.

She is the founding director of the Institute for Health and Social Policy at McGill and holds a Canada Research Chair in Global Health and Social Policy. She is also founding director of the WORLD Global Data Centre, where she leads an effort to analyze how health and social policies affect the ability of people in U.N. member countries to meet health, educational, economic and other needs.

In addition, Heymann directs McGill’s Healthier Societies Initiative, a program investigating approaches to controlling health costs while improving health outcomes in the countries of the Organisation for Economic Co-operation and Development.

At McGill, Heymann has led the development of a unique multidisciplinary undergraduate and graduate training program that bridges research and policy development, enabling students from more than 40 departments to gain experience in 28 countries.

At Harvard University (1989–2008), she chaired the Project on Global Working Families and held faculty appointments at the schools of public health and medicine — in the departments of society, human development and health; health and social behavior; social medicine; and health care policy.

Heymann has authored and edited more than 200 publications, including “Children’s Chances” (Harvard University Press, forthcoming); “Making Equal Rights Real” (Cambridge University Press, 2012); “Protecting Childhood in the AIDS Pandemic” (Oxford University Press, 2012); “Lessons in Educational Equality” (Oxford University Press, 2012); and “Profit at the Bottom of the Ladder” (Harvard Business Press, 2009).

Deeply committed to translating research into policies and programs that improve individual and population health, Heymann has worked with government leaders in North America, Europe, Africa and Latin America, as well as a wide range of intergovernmental organizations, including the World Health Organization, the International Labor Organization, UNICEF, UNESCO and the U.N.’s Department of Economic and Social Affairs.

She has served as chair of the World Economic Forum’s Global Agenda Council on Education Systems and vice-chair of the Global Agenda Council on Education and Skills. Her research has been presented to heads of state and senior policymakers around the world.

She has been featured on CNN Headline News; MSNBC; ABC’s “Good Morning America”; Fox News; and National Public Radio’s “All Things Considered,” “Fresh Air” and “Marketplace.”  Among the publications in which she has been cited are the New York Times, the Washington Post, the Los Angeles Times, the Financial Times, the Wall Street Journal, Businessweek, Forbes and USA Today.

UCSF Fresno doctors have become leading specialists in wilderness medicine.

Doctors at a UCSF Fresno program don’t just provide emergency care to those who become sick or injured in the backcountry. They research life-saving techniques and have become leading specialists in wilderness medicine.

On a September day, a tall, athletic man begins his descent of 14,000-foot Mount Tyndall in the Sequoia National Park. The mountain is deep into the park — part of the stately line of peaks that frames the east side of the Sierra.

He’s alone just after lunch and perhaps a little tired. He slips, tumbling 25 feet and fracturing his femur — a potentially deadly break of the largest bone in the human body.

For two hours he waits for help until a woman hears his calls and rushes back to the trailhead, where she seeks assistance just before midnight. When she calls, a well-oiled machine slips into gear. At dawn, a search and rescue helicopter takes off with two park medics trained in the latest wilderness first-aid techniques.

By 11:a.m., they find him on an exposed ledge, still alive, but dangerously cold. They can’t get an airlift for the rest of the day and by nightfall he is getting worse. So one rescuer waits while the other goes to radio the base, which forwards the call to the regional emergency and trauma center in Fresno.

“That’s part of the difficulty of wilderness care: You don’t always have all the supplies or you may be in a tight environment where you can’t do what you might do here on the streets of Fresno,” said Lori Weichenthal, wilderness medicine director at the UCSF Fresno Medical Education Program. “It was too late in the evening for the helicopter to actually rescue him. So she (the rescuer) basically spent the night hung over a mountain with this guy.

The emergency center, a program of UCSF, is perhaps the best place in the country to receive a distress call from 14,000 feet up a mountain. The doctor on call immediately orders a saline IV drip for the struggling patient. It’s a complicated move for rangers, but these medics can do it, since UCSF Fresno trains almost all the backcountry medics in the Sierras, including these rescuers.

The man’s condition improves and the team works through the night. The next day, with the help of a burly National Guard Blackhawk helicopter, the patient enters the Fresno hospital 53 hours after his fall and fully recovers.

Started in the early 1970s, the UCSF Fresno program was one of the country’s first designed specifically for emergency medicine. More recently, it has become one of the first in the country with specialists in wilderness emergency medicine, using its proximity to the Sierra as a testing ground for saving lives in the backcountry. Today, medics from the Sierra to the Grand Canyon call UCSF Fresno for direction during emergencies.

“Unlike a lot of wilderness medicine programs, we actually have a wilderness. It’s called the Sierra Nevada,” said Jim Comes, director of emergency medicine. “If you are injured in Sequoia Kings Canyon, there’s going to be a park medic in the backcountry who is going to be calling us on the radio, and we are going to be guiding their care.”

Since its inception, the UCSF Fresno program has cut its own trail in the medical world. As the only major trauma center in the Central Valley, it’s among the busiest emergency rooms in the state, with gangland shootings, agricultural accidents and just about any kind of misfortune that can happen in the mountains.

“There are trauma centers in Stanford and in San Francisco. But they don’t see the same volume; they don’t see the same type of injuries that we see,” says Comes.

UCSF Fresno doctors have treated rattlesnake bites, high altitude edemas and a Yosemite rock climber who fell 300 feet and miraculously survived. In another case, during a particularly nasty storm, three Boy Scouts were struck by lightning near Mount Whitney. When he got to the ER, one of the boys still carried a rarely-seen lacy pattern on his back called a “Lichtenberg figure” that looks like a giant tree tattoo.

“This person was sitting there in the hallway with these lightning patterns of red traced across his body,” says Susanne Spano, a medical resident at the time who now works and conducts research at the program. “Educationally, it was unparalleled. This might be the only time in your life you are ever going to see this.”

But the young doctors from around the country don’t line up every season just for the ER cases. They mingle with expert rock climbers, river kayakers and skiers to help prevent the next emergency. They also teach backcountry medics, run disaster scenarios and deliver talks on everything from lightning strikes to hypothermia.

Naturally, the research that comes from a group like this is off the beaten path as well. One recent study created a new method to put back in place hip dislocations. It’s called the “Captain Morgan technique,” named for the position held by the pirate on the eponymous rum bottle. More recently, they tested improvised traction devices used in every wilderness medicine program in the country. These devices, often built from ski poles and rope and used on femur fractures like the one on Mount Tyndall, essentially pull the broken leg straight, relieving pain and minimizing chances of fatally slicing an artery. They found that the improvised tools indeed are highly effective.

The popular Sawyers Snake Bite Kit was not so lucky. In 2004, a team led by emergency medicine specialist Marc Shalit tested kit cups that suction poison and found they do virtually nothing to help victims. To shed more and better light is Spano’s newest project — a 10-year review of rattlesnake bites to look for patterns of continuing health problems after hospital checkout. Also, UCSF Fresno’s Rais Vhora is researching a new anti-venom treatment.

“Once you become a training center, you kind of become the hub,” said Danielle Campagne, an assistant professor and researcher. “A lot of times, the medics ask the question and we try to answer it by doing the research.”

Campagne and two other UCSF Fresno doctors now advise the National Park Service on medical procedures, pushing for rangers to carry life-saving epinephrine. This came after a UCSF Fresno survey showing that hikers rarely carry their own medicine (like insulin for diabetics), let alone emergency gear.

“They are unprepared to handle their own medical conditions, and they’re unprepared for anything more than what their current trip planned for,” she said.

Today, the UCSF Fresno program buzzes with enthusiasm. Faculty and medical residents have spread their interests into topics like global health (in countries where even bustling cities cannot give adequate care) and major disaster mitigation (Spano defines disaster as “when the needs overwhelm the resources.”)

“One of the great things about the UCSF Fresno program is that it’s very diverse. We have a lot of residents and faculty with a lot of different interests,” said Weichenthal. “Whether it’s wilderness or global health or toxicology, there’s a lot of flexibility in our residency program to allow people to pursue what they love.”

In UCTV series, UCSF Mini Medical School explores advances in primary care.

Ideal primary care is comprehensive, continuous, accessible and patient-centered with a focus on wellness that uses the best medical evidence for prevention and treatment of common clinical conditions. But great primary care also requires well-informed, motivated patients who can work with physicians and other health professionals to make the best personal medical decisions. In this UCTV series from UC San Francisco Osher Mini Medical School, faculty in primary care internal medicine present the latest information on a wide variety of common clinical dilemmas so that patients may be able to actively dialogue with their physicians and take steps to improve their health.

Programs include:

Controversies in Cancer Screening
First air date: Aug. 13

Obesity in America: Diet, Drugs or Surgery?
First air date: Aug. 20

Osteoporosis: Update on Diagnosis and Treatment
First air date: Aug. 27

Updates in the Diagnosis, Treatment and Prevention of Alzheimer’s Disease
First air date: Sept. 3

Immunizations for Adults and Adolescents
First air date: Sept. 10

The ABC and D’s of Vitamin Supplements and Health
First air date: Sept. 17

View more

Based on UC research, FDA has ID’d an arthritis treatment as an orphan drug.

Passion, inventiveness and good luck have led University of California scientists to a new use for an old drug. The discovery promises to protect millions of people and save thousands of lives.

For more than 20 years, a group of UC San Francisco and UC San Diego researchers have been on the trail of drugs to kill pernicious tropical parasites that drug companies don’t pursue.

Last year, they hit gold. They showed in lab and animal studies that an arthritis drug called auranofin can knock out a particularly aggressive parasite that disables hundreds of thousands and kills 70,000 people a year. The drug also cripples a second protozoan parasite responsible for nearly 300 million infections a year.

Auranofin has been on the market since 1985, and its safety is well established. So, the time and cost needed to develop it to treat the infectious diseases should be greatly reduced.

What’s more the UC researchers have already shown that auranofin is far more potent than the best drug currently used against the tropical infections — an antibiotic called metronidazole, known to cause side effects such as nausea, vomiting and dizziness. If clinical trials confirm its effectiveness in infected people, the arthritis drug could be used at a lower dose and at a much lower cost per person, they said.

Effective, safe and potent: So far, it’s a win-win-win. Overcoming the safety hurdle at the outset “moves us much closer to our goal of a more effective drug to treat these devastating diseases and infections,” said Jim McKerrow, professor of pathology in the UCSF Center for Discovery and Innovation in Parasitic Diseases and one of the leaders in the discovery.

McKerrow has committed his career to finding drugs to treat neglected diseases of the developing world. He is an expert on the role of certain enzymes in parasites and in the search for drugs to disrupt the enzymes to cripple the pathogens.

Co-leader in the new research is Sharon Reed, professor of pathology and medicine at UC San Diego, who shares a lifelong pursuit of finding treatments for parasitic diseases. She and McKerrow have collaborated on at least four major research projects aimed at finding causes of and treating debilitating parasitic diseases.

“My main mission over more than 25 years has been to further the understanding of how parasites cause infection,” she said. “Working with Jim, it has been very exciting to see these findings lead to potential new drugs.”

Based on the team’s research, the FDA has now officially identified auranofin as an “orphan drug,” recognizing its new potential to treat diseases that pharmaceutical companies don’t target normally because of poor prospects for profit.

The researchers now have applied for approval and funding to launch clinical trials as early as next year to test the drug in people infected by either of the two parasites.

One parasite, called Entamoeba histolytica, causes amebiasis, a spectrum of diseases ranging from diarrhea to severe intestinal inflammation, known as colitis. In some cases, it leads to infection in other organs. It is the source of more intestinal disease than any other parasite in the world. The other protozoan, Giardia lamblia, is less severe, but also causes chronic diarrhea. It often targets children in tropical countries, as well as nearly 20,000 people in the U.S due to contaminated water or fecal contact.

The discovery stems from both a serendipitous event and a new strategy to screen drugs against organisms that live in the oxygen-free environment of the gut.

The team had the good fortune to be offered a library of some 900 FDA-approved drugs — known bioactive compounds — licensed by the biotech company Iconix Biosciences, which was going out of business. The company chose to offer the drugs to McKerrow and the UCSF center because of the unit’s reputation for identifying molecular interactions underlying parasite metabolism and finding drugs to exploit them.

McKerrow’s team worked with the Small Molecule Discovery Center at UCSF to screen the drugs against the protozoan parasites in culture. Auranofin was the top “hit” from the Iconix library. It turned out that auranofin was 10 times more potent against E. histolytica than is metranidazole.

“We were startled,” McKerrow says. “And we were excited because we knew auranofin could be safely taken orally. We were already a giant step ahead.”

Screening drugs against the parasites posed a unique problem. Infectious organisms that live in the gut can’t be tested in the efficient high-volume process known as high-throughput screening. This method normally allows hundreds or thousands of promising compounds to be tested at once.  But until now, drugs against anaerobic pathogens had to be tested a few at a time.

Anjan Debnath, a UCSF postdoctoral scientist in the center, developed an automated screen that could be conducted in anaerobic conditions, and coupled it with an effective way to compare different drug’s success at blocking the action of an enzyme the scientists suspected was essential for the parasite’s survival.

Once the UCSF team had established the drug’s success in the lab, UC San Diego and Mexico research partners began experiments to test the drug’s success in infected animals. Reed’s UC San Diego team had already developed a way to study amebiasis in mice, and colleagues in Mexico had perfected a hamster model to study the amoeba in the liver. Both groups found that auranofin was the most potent drug they had ever tested against the pathogen.

McKerrow’s and Reed’s labs have since worked with scientists at the Wake Forest School of Medicine to show specifically how the drug kills parasites. It inhibits an enzyme the parasites need to protect themselves against attack by the host immune system. A molecular model of how that happens was solved by UCSF crystallographer Larissa Podust.

Research now suggests that other parasites, such as Trichomonas and Brugia, also might be vulnerable to auranofin. McKerrow and Reed hope to confirm its potential against the other diseases.

“This discovery validates the idea that ‘repurposing’ existing drugs can overcome many of the challenges inherent in developing treatments for neglected diseases,” said McKerrow.

The research was supported by the Sandler Foundation and the National Institute of Allergy and Infectious Diseases.

State-of-the-art vision care center is expected to open next summer.

James Mazzo (left) and Roger Steinert were among the first to memorialize their association with The Gavin Herbert Eye Institute at the topping out ceremony.

A special “topping-out” celebration was held Tuesday, July 24, at the site of UC Irvine’s Gavin Herbert Eye Institute, acknowledging both the completion of the frame for Orange County’s only academic eye institute and those who are driving the effort.

The 70,000-square-foot facility is being funded entirely through local private philanthropy. To date, UC Irvine Health has raised 75 percent of the $37 million goal for the “Shine the Light” capital campaign and is on schedule to open the institute next summer.

The initial naming gift came from Gavin Herbert, chairman emeritus of Allergan Inc., and his mother, Josephine Gleis, in 2007. “We’re building something special,” he said at the time. “This is something I’ve talked about for more than 30 years, and there’s certainly a need in Orange County for such a center.”

A generous $500,000 donation from philanthropists Kelly and James Mazzo set an upbeat tone at Tuesday’s topping-out ceremony.

“The university is fortunate to have friends like Jim and Kelly Mazzo, who share our vision for Orange County’s only academic eye center as a place where collaborations with local eye companies lead to groundbreaking treatments and outstanding eye care for the community and the world beyond,” said UCI Chancellor Michael Drake.

“As chairman of The Gavin Herbert Eye Institute board,” James Mazzo said, “I take great pride in seeing the completion of the structural frame and in knowing that we will have a world-class eye institute here in Orange County for many years to come.”

Other major supporters have included Abbott Medical Optics, The Allergan Foundation, Julia and George Argyros, the Arnold & Mabel Beckman Foundation, Esther and James H. Cavanaugh, Bill and Marsha Link, and Richard P. Kratz, M.D.

The new eye care facility will include patient exam and waiting areas, the campus’s first outpatient surgery center, an optical shop, faculty offices and conference space. Interior design features recommended by the Braille Institute will make it easier for low-vision patients to navigate within the building.

Roger Steinert, director of The Gavin Herbert Eye Institute, shared the center's goal of eliminating blindness by the year 2020.

“With UC Irvine located in the heart of what may be the largest concentration of eye care companies in the world, our ophthalmology group has long dreamed of a place that would allow our patients to benefit from corporate innovation and the pioneering research happening at UC Irvine’s Hewitt Hall and the Sue & Bill Gross Stem Cell Research Center,” said Dr. Roger Steinert, professor and chair of ophthalmology and director of The Gavin Herbert Eye Institute.

“This facility fulfills that dream, providing a state-of-the-art environment in which corporate scientists, researchers and physicians can collaborate on tomorrow’s sight-saving patient care today.”

Nine Gavin Herbert Eye Institute physicians are on the “Best Doctors in America” list compiled by Best Doctors Inc. The team is also recognized for pioneering medical procedures such as refractive surgery using a femtosecond laser rather than a steel blade and a laser-based approach to corneal transplant surgery. Dr. Henry Klassen is investigating stem cell therapies to preserve and restore sight in individuals with retinitis pigmentosa and macular degeneration.

About The Gavin Herbert Eye Institute: The faculty of internationally recognized physicians, surgeons and scientists at The Gavin Herbert Eye Institute and UC Irvine’s Department of Ophthalmology provide highly specialized training to future ophthalmologists, access to leading-edge clinical trials, and sight-saving treatments and therapies for virtually any eye disorder. The Gavin Herbert Eye Institute’s mission is to develop educational programs, technologies and clinical solutions that enhance visual health and performance for people in Orange County, the nation and the world through cooperation with medical professionals, industry and the community.

About the University of California, Irvine: Founded in 1965, UCI is a top-ranked university dedicated to research, scholarship and community service. Led by Chancellor Michael Drake since 2005, UCI is among the most dynamic campuses in the University of California system, with nearly 28,000 undergraduate and graduate students, 1,100 faculty and 9,000 staff. Orange County’s second-largest employer, UCI contributes an annual economic impact of $4 billion. For more UCI news, visit www.today.uci.edu.

Championing palliative care.

Name: Wendy Anderson
Title: UCSF assistant professor of medicine, clinician-investigator with the Division of Hospital Medicine and Palliative Care Program
Education: M.D., UC San Diego; M.S., University of Pittsburgh
Project: Nurse-initiated multidisciplinary patient- and family-centered communications in the ICU

Innovation Profile is a monthly feature highlighting the work of a UC Center for Health Quality and Innovation fellow or grantee.

By Alec Rosenberg

When patients find out they have a serious illness, it’s a stressful time for them and their families.

For Wendy Anderson, it’s also an inspiring time, an opportunity to build relationships with patients and their families and provide support. The UC San Francisco assistant professor of medicine is making a difference by expanding palliative care – specialized care for seriously ill patients focused on quality of life for patients and their families.

“Patients and their families have a huge need for good communication with their providers at this time,” Anderson said. “There are a lot of questions. You’re very worried about what’s happening. By giving clear information and emotional support, providers can help decrease stress.”

Anderson saw firsthand the importance of emotional support when she helped care for her grandfather while he received home hospice. “We accomplished what he wanted,” Anderson said. “That showed me the power of communication.” As a resident in the intensive care unit at Duke University Medical Center, she gained more perspective on issues involving care for patients with serious illness. “I saw the power of achieving patient and family goals as opposed to our goals as providers,” she said.

Palliative care is effective for any age or stage of serious illness, from cancer to kidney failure. Research shows it improves quality of life for families and helps ensure patients get the type of care they want.

“Do they want to be looking out their bedroom window?” Anderson said. “Do they want to try an experimental therapy, even if it has high risks?”

Each of the five UC medical centers has a palliative care team. UCSF also has trained more than 180 teams of doctors, nurses, chaplains and social workers nationally to care for seriously ill patients and their families. But access to palliative care often is limited, particularly in the ICU, where terminal stays account for significant costs to the health care system.

Anderson received a UC Center for Health Quality and Innovation fellowship to address that issue. Her project to train bedside nurses to provide palliative care in the ICU is expected to expand palliative care, increase training of palliative care providers, improve quality of care and decrease costs.

“Nurses really are patients’ closest bedside provider,” Anderson said. “If you don’t include nurses in quality improvement efforts, they won’t work very well.”

Palliative care can create an 8:1 return on investment – lowering costs to payers – by reducing unwanted care and decreasing length of stay in the ICU, all while increasing patient and family satisfaction. Anderson’s project aims to decrease length of stay in UCSF’s ICU by one to three days, which could reduce yearly expenses by more than $1 million. Also, she will analyze results of patients who receive Medicare coverage, helping to make the findings transferable to other hospitals.

“At UCSF, we have more than a decade of experience of understanding the impact of palliative care on patients, families, providers and payers,” Anderson said. “By building on that, using UCSF as a laboratory, that will demonstrate its benefits and teach us how it will be implemented at other institutions.”

View Wendy Anderson’s talk at the UC Center for Health Quality and Innovation colloquium (begins at 30 minutes)