Impact includes caring for uninsured patients, training professionals and conducting research.

For the first time, University of California Health has measured the collective impact it has in caring for uninsured patients, educating tomorrow’s health leaders and advancing science to tackle medicine’s toughest challenges.

The estimated community benefit of UC Health’s five medical centers totaled $3.3 billion last year.

“As a public university and cornerstone of the safety net, UC Health is committed to serve California’s health needs,” said Dr. John Stobo, UC senior vice president for health sciences and services.” Our combined community benefit demonstrates the powerful impact UC Health has as a system.”

Throughout UC Health, student-run clinics collaborate across their campuses and within their communities to treat patients from the working poor to the homeless and their pets. UC’s three nurse-run clinics provide compassionate care to underserved patients in Los Angeles, Orange County and San Francisco. UC’s innovative Programs in Medical Education (PRIME) train doctors where they are most needed with programs focused on rural health and telemedicine (UC Davis), the Latino community (UC Irvine), the diverse disadvantaged (UCLA, UC Riverside), the San Joaquin Valley (UC Merced, UC Davis, UCSF), health equity (UC San Diego), and the urban underserved (UCSF, UC Berkeley).

UC Health has the nation’s largest health sciences educational system, with 18 professional schools and programs on seven campuses. Its community impact is felt in all corners of the state, through telemedicine services, clinical trials, classroom collaborations and affiliations such as UCLA’s partnership with the Venice Family Clinic, the nation’s largest free clinic.

Community benefits include programs or activities that improve access to care, enhance community health, advance medical knowledge and reduce the burden of government or other community efforts.

Here is a breakdown of UC Health’s community benefit in fiscal 2011, with totals from the health sciences campuses that have medical centers – UC Davis, UC Irvine, UCLA, UC San Diego and UCSF:

-Charity care and unreimbursed care: $560.7 million
Free medical services for patients who had no source of payment for urgently needed care and the unpaid cost of Medicare, Medi-Cal, State Children’s Health Insurance Program, indigent care programs and other safety net programs.

-Education: $174.7 million
Health professions education encompasses teaching physicians, nurses and students as well as scholarships and funding for education.

-Donations/sponsorships: $1.8 million
Through financial and in-kind contributions, UC Health offers support to community organizations to improve community health.

-Research: $2.6 billion
UC research gives local residents access to the latest treatments and therapies for advanced illness and complex health conditions.

For more information, view UC Health’s community impact brochure.

Related links:

• UC Davis community benefit report
• UC San Diego community benefit fact sheet
• UCSF: committed to the city
  

Sensors have many applications from measuring pulse to monitoring intraocular pressure.

Flexible, transparent pressure sensors invented by UC Davis biomedical engineers

A new kind of flexible, transparent pressure sensor, developed at the University of California, Davis, for use in medical applications, relies on a drop of liquid.

The droplet goes in a flexible sandwich of the substance polydimethylsiloxane, or PDMS. The sensor acts as a variable electrical capacitor. When the sensor is pressed down, the sensing droplet is squeezed over conductive electrodes, increasing its capacitance.

“There’s a huge need for flexible sensors in biosensing,” said professor Tingrui Pan, who led the research project.

He and his colleagues used the sensor successfully in measuring the pulse in the human neck. The sensor also could be used in “smart gloves,” giving physicians an enhanced ability to measure the firmness of tissues and detect tumors, and in “smart contact lenses,” to monitor intraocular pressure without affecting vision.

Pan’s research paper — for which graduate students Baoqing Nie and Siyuan Xing and ophthalmology professor James Brandt served as co-authors — appeared in the December issue of the journal Lab on a Chip.

The National Science Foundation gave partial support to the project.

UC Santa Barbara research pinpoints genes that identify patients with age-related macular degeneration.

Monte Radeke, UC Santa Barbara

Age-related macular degeneration (AMD) is one of the leading causes of blindness worldwide, especially in developed countries. There is currently no known cure or treatment for the vast majority of AMD patients.

A new study led by scientists at UC Santa Barbara has identified genes whose expression levels can identify people with AMD, as well as genes that distinguish clinical AMD subtypes. The findings, which appear in BioMed Central’s journal Genome Medicine, could offer new candidate targets for the development of AMD diagnostics and therapies.

It is estimated that 6.5 percent of people over age 40 in the U.S. have AMD. While smoking and UV light exposure are both risk factors for the disease, most of the risk for AMD is heritable. Several genes, including those involved in the innate immune system and fat metabolism, have been associated with altered risk for AMD. However, a detailed molecular description of the disease has yet to emerge.

“In large part, previous studies of AMD have taken a reductionist approach, focusing on one or a handful of genes or gene products at a time,” said Monte Radeke, research scientist with UC Santa Barbara’s Neuroscience Research Institute and one of the project leaders. “We have taken a more holistic approach, directed at characterizing the entire scope of changes associated with AMD. By coupling this with a bioinformatic-driven analysis we can assemble a detailed, testable model that explains AMD.”

Researchers at UC Santa Barbara, the University of Utah’s John Moran Eye Center, and the University of Iowa combined forces to tackle the issue. Tissue samples from a human donor eye repository were used to identify genes up-regulated in AMD. The ability of these genes to recognize AMD was tested on a separate set of samples obtained from the Lions Eye Bank of Oregon.

The team led by UC Santa Barbara scientists discovered hundreds of genes with altered levels in AMD, the top 20 of which were able to predict a clinical AMD diagnosis. Genes over-expressed in the RPE-choroid (a tissue complex located beneath the retina) include components of cell-mediated inflammatory responses; while in the retina, the researchers found genes that function in wound healing and the complement cascade, a part of the innate immune system previously linked to AMD.

In donors with advanced stages of AMD, the researchers found extensive gene networks associated with neovascular AMD (in which the growth of new blood vessels obliterates the retina) and geographic atrophy (where the photoreceptors and RPE waste away). Consistent with the loss of vision in these advanced AMD stages, they found a decreased expression of a number of genes responsible for the detection of light.

Radeke explained: “Not only are these genes able to identify people with clinically recognized AMD and distinguish between different advanced types, some of these genes appear to be associated with pre-clinical stages of AMD. This suggests that they may be involved in key processes that drive the disease. Now that we know the identity and function of many of the genes involved in the disease, we can start to look among them to develop new diagnostic methods, and for new targets for the development of treatments for all forms of AMD.”

UC San Diego receives $100,000 grant from Research to Prevent Blindness.

UC San Diego Shiley Eye Center

Research to Prevent Blindness (RPB) has awarded a grant of $100,000 to the Department of Ophthalmology at the University of California, San Diego, School of Medicine to support research into the causes, treatment, and prevention of blinding eye diseases. The research will be directed by Robert N. Weinreb, M.D., chairman of the Department of Ophthalmology and director of the Shiley Eye Center.

RPB is the world’s leading voluntary organization supporting eye research. Since 1984, the organization has awarded grants totaling $3,065,000 to the UC San Diego School of Medicine. Over the past 28 years, this funding has supported research in glaucoma, cornea and retinal diseases.

“These funds are particularly invaluable for enhancing our ability to conduct the most impactful vision research,” said Weinreb. “They will facilitate existing research, support cross-disciplinary investigative programs and assist in the translation of our research to prevent and cure blindness.”

Since it was founded in 1960, RPB has channeled hundreds of millions of dollars to medical institutions throughout the United States for research into all blinding eye diseases. For information on RPB, RPB-funded research, eye disorders and the RPB Grants Program, go to rpbusa.org.

Based at the Shiley Eye Center, the UC San Diego Ophthalmology Department includes a complement of outstanding clinicians who provide comprehensive and specialized eye care for the full spectrum of diseases of the eye. During the past decade, departmental teams of clinicians and scientists have translated their research to improve management of a variety of vision-impairing conditions including glaucoma, macular degeneration, ophthalmic plastic surgery, childhood eye disease, diabetic eye disease, and cataracts.

UCLA early findings may pave way for new therapy to treat eye diseases.

UCLA's Steven Schwartz performs stem cell transplant

Researchers at UCLA’s Jules Stein Eye Institute and colleagues who successfully transplanted specialized retinal cells derived from human embryonic stem cells into the eyes of two legally blind patients report that the transplants appear safe and that both patients have experienced modest improvement in their vision.

The preliminary findings, published online today (Jan. 23) in the journal The Lancet, represent a milestone in the therapeutic use of stem cells and may pave the way for a new therapy to treat eye diseases, the researchers said. Because this is the first time physicians have applied the power of regenerative medicine to eye disease, the clinical trials are being watched closely by scientists, stem-cell therapy advocates and the public.

The patients — a woman in her 50s with Stargardt’s macular dystrophy and a woman in her 70s with dry age-related macular degeneration — underwent outpatient transplantation surgeries last July, said principal investigator Dr. Steven Schwartz, chief of the retinal division at the Jules Stein Institute and the Ahmanson Professor of Ophthalmology at the David Geffen School of Medicine at UCLA.

Both patients received relatively low doses of stem cell–derived retinal pigment epithelial (RPE) cells, which were transplanted into the space under the retina. The patients then received low-dose immunosuppression therapy over a number of weeks. The researchers monitored the patients’ progress over four months and found no safety concerns, no signs of rejection and no abnormal cell growth.

In the Lancet, Schwartz and a team of doctors from UCLA and Advanced Cell Technology Inc., which manufactured the stem cells used in the surgery, report that standard vision tests suggested some improvement in the vision of both patients. The woman with Stargardt’s disease, for example, went from only being able to discern hand movements to seeing a single finger move, according to the Lancet article. On a visual acuity letter-chart, she went from being unable to read any letters prior to treatment to reading five letters.

The patient with macular degeneration also showed some improvement after the therapy. Where once she was only able to make out 21 letters on the chart, her reading level stabilized at 28 letters — after peaking at 33 letters just a couple of weeks after the transplantation.

“The ultimate therapeutic goal will be to treat patients earlier in the disease processes, potentially increasing the likelihood of photoreceptor and central visual rescue,” the authors of the paper wrote.

The patients are part of two separate clinical trials, each of which will eventually include 12 patients, Schwartz said. The trials will aim to determine the safety of this particular use of stem cell therapy, as well as the patients’ ability to tolerate the treatment.

No standard treatments exist for either of these eye diseases. The dry form of macular degeneration, the most common form of the disease and the leading cause of blindness in the developed world, affects as many as 30 million people in the United States and Europe, especially those over age 55; the number of people affected is expected to double over the next 20 years as the population ages. Stargardt’s disease causes progressive vision loss, usually starting when patients are between 10 to 20 years old.

In both conditions, the layer of retinal pigment epithelial cells located beneath the retina deteriorates and atrophies. These cells support, protect and provide nutrition for light-sensitive photoreceptors in the eye. Over time, the death of these cells and the eventual loss of the photoreceptors can lead to blindness as central vision is gradually destroyed.

The preliminary report in Lancet is accompanied by a commentary on the findings.

The Jules Stein Eye Institute at UCLA, established in 1966, is a world-renowned center dedicated to the comprehensive preservation of vision, care of eye disorders and prevention of blindness. Through community outreach, the institute has provided free ophthalmic care to hundreds of people who otherwise could not afford contact lenses, glasses, eye care or surgery, including uninsured families, low-income youth and children who require contact lenses for congenital and infantile cataracts. For more information or to make an appointment, call (310) 825-5000 or visit www.jsei.org.

UCSF study shows same result can be achieved with half the antibiotics.

UCSF's Bruce Gaynor examines a patient in Ethiopia, where there is a high prevalence of trachoma, the world’s leading cause of preventable blindness.

A UC San Francisco study shows a popular treatment for a potentially blinding eye infection is just as effective if given every six months versus annually. This randomized study on trachoma, the leading cause of infection-caused blindness in the world, could potentially treat twice the number of patients using the same amount of medication.

“The idea is we can do more with less,” said Bruce Gaynor, M.D., assistant professor of ophthalmology at the Francis I. Proctor Foundation for Research in Ophthalmology. “We are trying to get as much out of the medicine as we can because of the cost and the repercussions of mass treatments.”

In a paper published this month in The Lancet, researchers conducted a cluster-randomized trial, using an antibiotic called azithromycin to treat trachoma in Ethiopia, which has among the highest prevalence in the world. They picked 24 communities and randomized the two treatment options: 12 villages were given azithromycin every six months and the other 12 were treated every 12 months.

“What we found was the prevalence of trachoma is very high at baseline. Forty to 50 percent of the children in these communities have this condition,” Gaynor said. “They are the most susceptible and it can quickly spread from person to person by direct or even indirect contact.”

Researchers tracked both groups and found the prevalence of infection decreased dramatically.

“We found that from as high as 40 percent, the prevalence of trachoma went way down, even eliminated in some villages regardless of whether it was treated in an annual way or a biannual way,” Gaynor said. “You can genuinely get same with less.”

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UC Santa Barbara’s retinal research reveals how neighboring cells regulate neuronal size, connectivity.

Ben Reese, UC Santa Barbara

Thanks to a new study of the retina, scientists at UC Santa Barbara have developed a greater understanding of how the nervous system becomes wired during early development.

The findings reflect the expansion of developmental neurobiology and vision research at UC Santa Barbara. The work is described in a recent publication of the Journal of Neuroscience.

The research team examined the connectivity of nerve cells, called neurons, in mice. Neurons communicate with one another via synapses where the dendrites and axon terminals of different cells form contacts. This is where nerve signals are transmitted from one neuron to another.

Scientists have understood for some time how neuronal activation at developing synapses contributes to the patterns of connectivity observed in maturity, explained Ben Reese, senior author and professor in UC Santa Barbara’s Neuroscience Research Institute and the Department of Psychological & Brain Sciences.

Incoming activity plays a critical role in sculpting neuronal form and the elaboration of synaptic connections. The new research shows, by contrast, how relationships between neighboring cells of the same type independently regulate neuronal size and connectivity.

The researchers circumvented the difficulty of visualizing the three-dimensional relationships between neurons within the brain by working within the retina. The retina is an outgrowth of the brain during embryonic development, and is a precisely layered structure in which the cells, their dendrites and their axons are restricted to discrete strata. “This makes the visualization and analysis of neuronal morphology and connectivity far simpler,” said Reese.

The scientists used two genetically modified mouse models to modulate the density of one particular type of retinal neuron, a class of cone bipolar cell. Cone bipolar cells relay information from the population of cone photoreceptors to the retinal ganglion cells. The latter are neurons that in turn project information to locations within the brain where further visual processing of the retinal image takes place.

The lead author on the study, Sammy Lee, was a postdoctoral researcher working in Reese’s lab and supported by a C.J. Martin National Health & Medical Research Council fellowship from Australia during the course of the study. Lee labeled individual cone bipolar cells with a fluorescent dye through a new microinjection procedure developed by Patrick Keeley, a graduate student in the Reese lab.

“What Dr. Lee has shown is that cone bipolar cells modulate the size of their dendritic fields (branched extensions of the neuron) in association with the local density of like-type neurons,” said Reese. “One line of mice has conspicuously fewer cone bipolar cells, each now with a larger dendritic territory, while the other line shows heightened densities and correspondingly smaller dendritic fields.”

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UC San Diego turns to stem cells for solutions.

Kevin Churchill with his son Benny, who was born visually impaired.

As a UC San Diego alumnus, Kevin Churchill, ’96, already knew that the university had a reputation for cutting-edge research and advanced medical care. However, it wasn’t until his son Benny was born visually impaired that Churchill discovered the remarkable breadth of leading research taking place at his alma mater.

Benny has optic nerve hypoplasia (ONH), a cause of visual impairment in newborns that can also be associated with hormone deficiencies, developmental delay, sleep dysfunction and seizures. ONH is an underdevelopment of the optic nerve (the nerve that carries visual information from the eye to the brain) in one or both eyes.  The degree of vision impairment with ONH varies, from near-normal vision to no light perception at all.

Benny’s first ophthalmologist told Churchill and his wife, Ziki, that nothing could be done for their son. Frustrated by this answer, the Churchills turned to the UC San Diego Department of Ophthalmology at the Shiley Eye Center. There they met Dr. David Granet, director of the Anne F. and Abraham Ratner Children’s Eye Center. Granet provided patient care above and beyond the Churchills’ expectations, and also talked to them about the potential for scientific research and discoveries to one day help their son, and children like him around the world.

“At UC San Diego, we first ensure that each child gets the best possible personalized care and treatment while each family gets the most up to date information,” said Granet. “Then we think about new paradigms and how to do better.”

Churchill recalls, “We were so relieved to meet Dr. Granet. We have found him to be nothing short of brilliant with the utmost care and love for children with eye related conditions, all packaged with a great personality.”

Granet introduced the Churchills to UC San Diego’s Dr. Kang Zhang, director of the Institute for Genomic Medicine and professor of ophthalmology and genetics at UC San Diego. Zhang is internationally renowned for his work in genetic and stem cell research. Zhang’s work focuses on understanding the genetics of blindness, specifically, using molecular genetic techniques to identify genes that predispose patients to retinal diseases and developing drug therapies to prevent these diseases. Zhang’s research also involves using stem cells to repair retinal damage, and Zhang is optimistic that stem cells will eventually be developed to regenerate optic nerve tissue for ONH patients.

Inspired by the doctors at the Shiley Eye Center and their progressive work, the Churchills decided to help seed a new research fund — The Optic Nerve Regeneration Fund — with the ultimate goal of helping ONH patients to regain their sight. With sufficient funding, the Optic Nerve Regeneration Fund will enable Zhang and his team to put together an aggressive and groundbreaking research project to develop biotechnology that may one day partially or completely restore vision in ONH patients by using genetic science and stem cells to generate new, usable optic nerve tissue.

“It is an ambitious goal, but one we feel is attainable if we can spread the word and through fundraising get enough support for the research,” said Churchill. While donations have been received from friends and family, additional funding is needed in order for the research to take off.

“My wife and I are just ordinary people who give because we know that research leads to practical, every-day applications that advance our health and way of living,” said Churchill. “In our case, genetic and stem cell research at UC San Diego has the potential to transform our son’s life, and the lives of children like him all over the world. As an alumnus, having UC San Diego lead the way toward that goal is tremendously rewarding.”

Granet added, “The donations and support from families like the Churchills make change possible. They literally can impact the treatment for their own child and others like them. We think of that as another way of empowering families.”

In their spare time, Churchill and his wife also do outreach in the local community to educate people about Optic Nerve Hypoplasia and the exciting new research at the Shiley Eye Center. Their son Benny, soon to be three years old, is still under the care of Granet and the family looks forward to seeing what science, research and UC San Diego will accomplish in the future to improve treatments for visual impairment.

To learn more about supporting the Optic Nerve Regeneration Fund and other initiatives at the Shiley Eye Center, please call (858) 534-8017 or visit http://shileyeye.ucsd.edu/giving.

Growth strengthens position for San Diego’s only academic medical center.

UC San Diego Health Sciences has entered a period of remarkable growth, one that will strengthen its position as a destination academic medical center. In addition to the recent addition of the Sulpizio Cardiovascular Center and Medical Education & Telemedicine Building, plans are under way for the Altman Clinical and Translational Research Institute building (projected to open in 2015) and the Jacobs Medical Center (with a planned 2016 opening.)

The location of these new facilities – in the heart of UC San Diego’s booming life sciences research and teaching campus – strategically positions UC San Diego Health System to further integrate patient care with research. It builds upon UC San Diego’s legacy of bench-to-bedside collaboration among scientists, clinical researchers, physicians and trainees.

The addition of the Jacobs Medical Center to the already thriving UC San Diego La Jolla campus will create the epicenter of advanced clinical care and pioneer new ways of advancing health, such as patient safety and leading-edge technology. It will become a hub for translational medicine and a tangible symbol of UC San Diego Health System’s commitment to compassionate patient care, discovery and delivery of the next generation therapies. The Jacobs Medical Center will be the catalyst that attracts multidisciplinary endeavors to the hub and a magnet for talented researchers, physicians and nurses.

UC San Diego is creating additional opportunities to facilitate biomedical research, drug discovery and health care delivery. The Clinical and Translational Research Institute, the Institute for Engineering in Medicine and the Institute for Genomic Medicine were created in recent years to synergize the interactions between UC San Diego Health Sciences, the Jacobs School of Engineering, Scripps Institution of Oceanography, Calit2, the San Diego Supercomputer Center and the Division of Biological Sciences, allowing researchers to cross major scientific thresholds on a daily basis, particularly in the areas of bioengineering, genomics and regenerative medicine – of particular relevance in a new era of personalized medicine.

The only academic medical center in San Diego, UC San Diego Health System boasts combined clinical and research strengths in major specialty areas including cardiovascular care and advanced surgery, along with clinical and basic cancer research and treatment at the UC San Diego Moores Cancer Center – the region’s only National Cancer Institute-designated comprehensive cancer center –  and the Shiley Eye Center, which provides comprehensive eye care, advanced diagnostics and sophisticated surgery, along with basic research into the underlying causes of and treatment for eye disease and blindness.

U.S. News & World Report consistently recognizes UC San Diego Health System among the nation’s best, ranking it as the No. 1 health system in San Diego in the magazine’s first-ever “Best Hospital” metro rankings.  It is also the region’s only adult hospital ranked among the best in the nation in six specialty areas (cancer, diabetes, nephrology, orthopedics, psychiatry and pulmonology) in the 2011 “Best Hospitals” issue.

UC San Diego Health System is also nationally recognized for its information technology initiatives, as well as an advanced infrastructure that seamlessly integrates clinical systems to improve the quality and efficiency of health care delivery and positively impacted patient safety and outcomes. In addition, this year UC San Diego was named one of the top 10 institutions in the world for medicine by QS (Quacquarelli Symonds), rankings, published last week by London’s The Guardian.

“Our goal is to become a destination health system that addresses the most urgent health needs for the people of San Diego, the nation, and the world, while also attracting the best and brightest physicians, researchers and surgeons to our faculty,” said Dr. David A. Brenner, vice chancellor for health sciences and dean of the School of Medicine. “By building on our reputation for clinical, research and teaching excellence – particularly in core areas such as surgery, cardiovascular and cancer care – we are well on our way to achieving this vision.”

New UC Santa Barbara center brings together research and teaching in biology, engineering and physical sciences.

Frank Doyle (left) and Samir Mitragotri, UC Santa Barbara

A new center at UC Santa Barbara has the development of an artificial pancreas in its sights, as well as new biomaterials, new tools for the detection and diagnosis of disease, and new mechanisms for drug delivery, among other cutting-edge scientific developments.

UC Santa Barbara’s new Center for BioEngineering (CBE), proposed by Frank Doyle, associate dean of research in the College of Engineering, was approved earlier this year by the Academic Senate. The center is a locus of research and teaching — at the interface of biology, engineering and physical sciences — that is already producing results that benefit industry and medicine. Research at the CBE is yielding important advances in the understanding, diagnosis, and treatment of common and devastating diseases such as cancer, diabetes, Alzheimer’s and macular degeneration.

CBE builds on UC Santa Barbara’s interdisciplinary strengths in biophysics, biomaterials, biomolecular discovery and systems biology, which allow for fundamental scientific discoveries to be transitioned to applications in medicine and biotechnology.

“UC Santa Barbara is very proud to be the home of the new Center for BioEngineering,” said Chancellor Henry T. Yang. “The creation of the CBE marks a major step forward for our campus. In this highly interdisciplinary field, UCSB is already at the forefront. Our new center will consolidate our position and support groundbreaking research aimed at finding innovative solutions for the diagnosis, treatment and prevention of disease.”

Samir Mitragotri, the founding director of the center and professor of chemical engineering, emphasizes the importance of CBE as a “home” for bioengineering on campus, since bioengineering is already an area of research in many of UC Santa Barbara’s centers, institutes, departments and colleges.

“I expect that the center will enable opportunities in terms of new fundamental understanding of disease mechanisms, and research at the interface of physical sciences, engineering sciences, medicine and biology,” said Mitragotri. “That includes understanding and development of new technologies to either diagnose or treat a disease.”

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CareNow clinic delivers health care of last resort.

Four-year-old Nayeli Valdez lay back in a dental chair Friday morning, gazing up at the cavernous ceiling of the L.A. Sports Arena during her very first trip to the dentist.

She was one of an estimated 1,200 people at the arena receiving free medical, dental and eye care that day at the CareNow/LA health clinic, to which UCLA sent scores of volunteer health care providers and students.

While UCLA dentist Edmond Hewlett cleaned Nayeli’s teeth and filled a cavity, her father Francisco Valdez said through an interpreter that the clinic was his only option for dental care.

“He’s very happy that they were able to be seen,” the interpreter said. “They’re from a low-income family, so they can’t afford stuff like this.”

UCLA Dentist Edmond Hewlett treats a 4-year-old girl.

It was one of many wrenching cases for Hewlett that day. He wanted to do more to help Nayeli, who had “a mouthful of cavities.” Although Hewlett filled one, the others would need attention soon, he said. For the UCLA dentist, helping people like Nayeli was one of the joys — and pains — of volunteering at the clinic.

“On the one hand, it’s gratifying, and on the other hand, you see how much more need there is, and we can’t do enough,” said Hewlett. “It breaks your heart.”

It was a sentiment repeated by several of the more than 70 UCLA health care providers — physicians, dentists, ophthalmologists and more — volunteering at the CareNow/LA free clinic from Oct. 20 to 23. They and hundreds of other L.A. area doctors filled cavities, provided mammograms, screened patients for cancer, glaucoma and cataracts, and donated many other services.

The four-day clinic, which CareNow described as the largest free health care clinic in the country, served an estimated 5,000 patients who waited in line for hours earlier in the week to claim one of the coveted appointments.

Michelle Bholat, UCLA

The clinic brought much-needed assistance to people who had fallen through the cracks, said Dr. Michelle Bholat, the vice chair of the UCLA Department of Family Medicine. She estimated that more than half of those she had seen said they had been incarcerated, making it harder for them to get work and health coverage. Bholat recalled one such patient in her early 30s who recently lost her job and health insurance. The woman had high blood pressure, diabetes and high cholesterol.

“She was the typical patient at the clinic, the one who’s falling through the cracks, and if we don’t help her, in two years we’ll see her in the emergency room for kidney failure or a stroke,” Bholat said. The physician was able to give her some important screening tests and connect her to clinics that could provide follow-up care. But that’s not enough, she said.

“We really have a crisis on our hands,” Bholat said. “This clinic is fantastic, but we need care that’s sustainable.”

Patients were touchingly grateful to her and to her colleagues, she noted.

“Everyone said they were so impressed by our bedside manner,” Bholat said. “So many of them said this was the first time they felt like they had a personal physician — even in an arena with thousands of other people.”

Ravi Dave, UCLA

UCLA cardiologist Dr. Ravi Dave (pronounced Da-vay) spent his day helping patients like Edmund Dominguez, a 53-year-old whose blood pressure was so high that Dave warned him it was only a matter of time until he had a stroke if he didn’t take medication.

Treating patients in such serious need of care makes him feel like he’s really contributing, Dave said. When he works in UCLA hospitals, his patients are somewhat self-selecting, he said — only patients with insurance come in.

“Normally we see people who are doing things right and who have plenty of resources,” Dave said. “Today is special because we get to help the people who need help the most. It’s a little concerning because we’re seeing the big problem with health care in America. With so many resources, how are we finding so many people here today who have nowhere else to turn?”

But there was a silver lining, he noted: For Dave’s students, who normally see relatively healthy patients, the free clinic gave them months’ worth of experience examining different health problems in a few days.

Virginia Lalata was one of hundreds at the clinic on Friday who came for glasses and other eye care. After using hand-me-down glasses for years, she now needed a new prescription. “Without this, I don’t know what I’d do,” she said.

Lalata was one of about 500 vision patients over the weekend who received follow-up screenings from ophthalmologists in UCLA’s Mobile Eye Clinic for cataracts, glaucoma, macular degeneration and other eye disorders. UCLA selected 10 lucky patients for free eye surgery at the Jules Stein Eye Institute, said Faye Oelrich, the mobile clinic’s program manager.

“We’re seeing so many people whose vision has been blurry for years,” Oelrich said. “One of our most touching cases was a young woman who has had a crossed eye since childhood, which you could tell she was very self-conscious about. She came to tears when we told her we could correct her eye with free surgery.”

That wasn’t the only case of tears, Oelrich continued.

“I had another woman yesterday who has needed cataract surgery for years,” she said. “She wouldn’t have been able to pass the eye exam at the DMV, even with glasses, but she can’t afford surgery. She didn’t speak much English, but broke down sobbing when she understood we would give her the surgery, and said, ‘I’m crying because I’m so happy.’”

Several of the two dozen ophthalmologists volunteering at the clinic signed up for extra shifts, Oelrich said. “The work is so gratifying,” she said.

Dr. Laura Syniuta, an ophthalmologist with the mobile clinic, agreed.

“It’s a wonderful opportunity to make a difference to people with no other options right now,” Syniuta said. “I’m so proud of my colleagues.”

Use of topical corticosteroids helped patients who had more serious forms of bacterial corneal ulcers.

Nisha Acharya, UC San Francisco

A UC San Francisco study gives hope to those suffering from severe cases of bacterial corneal ulcers, which can lead to blindness if left untreated. The use of topical corticosteroids in a randomized controlled trial was found to be neither beneficial nor harmful in the overall patient population in the study. However, it helped patients who had more serious forms of bacterial corneal ulcers, according to UCSF researchers.

In a paper published this month in the Archives of Ophthalmology, one of the JAMA/Archives journals, researchers found significant vision improvement — one and a half to two lines of improvement on an eye chart — by using steroid therapy on patients with severe ulcers.

“We consider this finding very significant; it’s a clinically meaningful difference,” said the paper’s co-author, Nisha Acharya, M.D., M.S., associate professor and director of the Uveitis Service in the UCSF Department of Ophthalmology. Although secondary to the study’s original purpose, Acharya said the results in severe cases were identified early on, so “we didn’t start doing all of these analyses after the fact. It was of interest. So I think there is something there.”

The use of topical corticosteroids is somewhat controversial within the ophthalmology community, with no specific evidence pointing one way or the other. Concerns include corneal perforation and worsening vision.

“It’s important to note that in the worst ulcer group, not only do we not find a safety problem, we actually found that steroids resulted in a benefit in vision,” Acharya said. “So I think that is really reassuring because those were the people with whom we were most scared to use steroids.”

UCSF researchers collaborated with colleagues at the Aravind Eye Care System in Madurai, India. They studied 500 participants from the United States and India between September 2006 and February 2010 in the Steroids for Corneal Ulcers Trial (SCUT). Half of the patients received corticosteroid treatment and the other half received placebos.

Complications from contact lens use are the most common culprit in corneal ulcers in the United States, while agriculture-related injuries are the most common in India. Researchers checked participants three months after the start of the trial, testing for visual acuity and corneal perforations. Patients showed no significant improvement in their vision for participants in the corticosteroid treatment group versus those in the control group.

The study also reinforced the use of steroids in treatment of the ulcers because it found that they were not harmful.

“There was no increase in cornea perforations in our patient population,” Acharya said. “I’m reassured to know that it’s not associated with harm.”

Building on their findings, Acharya and her colleagues intend to continue their work, studying patients with even more severe corneal ulcers.

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