Vital Record » Medicine Your source for health news from the Texas A&M Health Science Center Thu, 05 Mar 2015 16:41:22 +0000 en-US hourly 1 Understanding the immune system provides new ways to treat diseases Thu, 05 Mar 2015 16:14:22 +0000 A growing team of researchers in the Texas A&M College of Medicine is trying to understand the basic mechanisms of how the immune system works. This knowledge could be used to develop new treatments for diseases such as multiple sclerosis and inflammatory bowel disease (IBD). It also has broad implications for infectious diseases such as tuberculosis]]>
photo of Dr. Kobayashi

Koichi Kobayashi, M.D., Ph.D.

As a physician in his native Japan, Koichi Kobayashi felt he had a direct impact on the patients he treated. But he believed there had to be a way to have a wider impact – a way to reach people around the world.

As a result, Kobayashi – who holds both an M.D. and a Ph.D. – decided to switch from treating patients with immunology-related diseases to trying to find new cures for such diseases.

His desire to pursue immunology research led Kobayashi to the United States, where he did a postdoctoral fellowship at Yale University School of Medicine and then spent eight years at Harvard Medical School before joining the Texas A&M College of Medicine in 2012.

As a researcher in the College of Medicine’s Department of Microbial Pathogenesis and Immunology, Kobayashi is part of a team that is trying to understand the basic mechanisms of how the immune system works.

This knowledge could be used to develop new treatments for an array of diseases, including multiple sclerosis and inflammatory bowel disease (IBD), which presents as either Crohn’s disease or ulcerative colitis. It also has broad implications for infectious diseases such as tuberculosis.

Kobayashi is working in a variety of areas, but one he is perhaps most noted for is his research related to Crohn’s disease, which is the most common form of inflammatory bowel disease. Crohn’s disease is genetically related and there is no effective cure. Anti-inflammatory drugs can help control the symptoms, but the illness typically re-occurs, repeatedly. Long-term use of anti-inflammatory drugs to minimize this acute disease can have a variety of side effects.

While he was at Harvard, Kobayashi discovered a function of a gene called NOD2 that is particularly associated with Crohn’s disease in the small intestine.

“If there is a mutation in this gene, the small intestine can’t control bacterial flora,” Kobayashi explains. “This means the intestine will have more bacteria in it, and it is more susceptible to Crohn’s disease.”

To conduct further research on the relationship between NOD2 and Crohn’s disease, Kobayashi developed an animal model of Crohn’s disease with mice that lack the NOD2 gene. By using this mouse model, Kobayashi hopes to be able to identify fundamental mechanisms that lead to Crohn’s disease, which in turn will help in the development of new ways to treat the disease.

James Samuel, Ph.D., professor and chair of the Department of Microbial Pathogenesis and Immunology, says he was delighted that Kobayashi decided to move his laboratory to Texas A&M.

“Bringing in someone like Dr. Kobayashi really establishes our credibility in the world of innate immunology,” Samuel says. “He has a stellar publication record in some of the most prestigious journals and is making a significant contribution to the basic understanding of immunology.”

Samuel says Kobayashi’s recruitment was part of a larger plan to build a team of investigators who study the broad field of innate immunity. The innate immune system is programmed to recognize common signals from invading pathogens and activate the body’s response to them.

Another new member of this team is Robert Watson, Ph.D, M.P.H., who recently joined the department from the University of California, San Francisco. Watson is trying to understand the mechanisms by which the bacteria that causes tuberculosis is able to modulate the innate immune response to establish an infection. He joins two other tuberculosis researchers in the department – Jeffrey Cirillo, Ph.D., and Regents Professor David McMurray, Ph.D.

“We are trying to bring together a collection of investigators who enhance our ability to complete at the national level in the area of innate responses to infections and other diseases,” Samuel says. He notes that these researchers are part of a growing interdisciplinary group of immunologists that is forming across Texas A&M University.

Since leaving the clinic for the research bench, Kobayashi says there will only be one drawback if his research ultimately leads to new treatments – he won’t get to see the impact on patients firsthand.

“But I will know the impact by the number of patients with these serious diseases who are able to be treated,” he says with a smile.

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Program that screens low-income Texans for colon cancer expands to 17 counties Mon, 02 Mar 2015 14:14:39 +0000 The Texas A&M Health Science Center has received a $1.5 million grant that will enable a colorectal screening program for low-income Texans to continue for another three years and expand its outreach to 17 counties]]>

When Janet Helduser and her husband turned 50, she suggested that they both get colonoscopies to screen for colon cancer, since that is the age at which an initial colonoscopy is recommended.

“He was a tough guy and didn’t really want to have a colonoscopy,” Helduser recalls.

Two years later, her husband died from colon cancer.

“By the time he felt the first pain, the cancer was stage IV (the most advanced), and had already spread to his lungs and liver,” Helduser says.

Stories such as her own make Helduser even more passionate about her role managing a colon cancer screening program in central Texas that is run by the Texas A&M Health Science Center. The program is called C-STEP, which stands for Cancer Screening, Training, Education and Prevention.

The C-STEP program was started in 2011 with a three-year, $2.7 million grant from the Cancer Prevention and Research Institute of Texas (CPRIT). The Texas A&M Health Science Center recently received another $1.5 million grant from CPRIT that will enable the colorectal screening program to continue for another three years and expand its outreach to an additional 10 counties.

David McClellan, M.D., proposed the C-STEP program to make colon cancer screening available to Texans living in rural areas.

David McClellan, M.D., proposed the C-STEP program to make colon cancer screening available to Texans living in rural areas.

The idea to start the C-STEP program came from David McClellan, M.D., an assistant professor of family and community medicine in the Texas A&M College of Medicine. McClellan also has a personal reason for being interested in colon cancer – his mother died of the disease when she was 67.

“If she had had a screening colonoscopy, she might be alive today,” McClellan says.

McClellan believes one way to make screening colonoscopies more widely available is to increase the number of family physicians who are trained to perform them – as he himself did when he worked as a family physician in the small town of Spearman, Texas.

“In some towns, the nearest gastrointestinal (GI) specialist might be 150 miles away,” McClellan says.

For help in developing the C-STEP program, McClellan turned to Jane Bolin, Ph.D., J.D., R.N., who is a professor of health policy and management at the Texas A&M School of Public Health. Like McClellan, Bolin also lost her mother to colon cancer.

“It was a very painful thing to watch,” she says.

Colorectal cancer currently ranks third in cancer incidence and cancer-related deaths for men and women in the United States. The incidence of colon cancer is higher in rural communities, and African-Americans tend to have higher rates of colon cancer than some other population groups.

While colonoscopies are recommended every 10 years beginning at age 50, only about half the people who should be screened for colorectal cancer actually get a colonoscopy. One reason for this, Bolin says, is that while Medicaid often covers cancer treatment for the uninsured, it doesn’t provide for routine screenings such as colonoscopies, which can cost anywhere from $800 to more than $3,000.

A recent study by one of Bolin’s doctoral students, Chinedum Ojinnaka, M.P.H., suggested that providing free or subsidized colonoscopies to people in rural areas should be explored as a means of reducing the higher incidence of the disease.

The C-STEP program has two main components – it provides funding to help low-income people receive colonoscopies and it trains young physicians in the Texas A&M College of Medicine’s family medicine residency program how to perform colonoscopies.

A portion of the funds from the initial CPRIT grant were used to purchase colonoscopy equipment for the Texas A&M Physicians clinic in Bryan, Texas, which serves a training ground for the family medicine residency program.

In the first three years of the C-STEP program, family medicine residents performed more than 1,200 colonoscopies, of which more than 800 were funded by CPRIT. Through these colonoscopies, polyps were discovered in 275 people and 11 cases of cancer were found.

Polyps are unwanted growths that, over time, develop into cancerous cells. Colonoscopies can help detect polyps early before they develop into cancer, and the family medicine residents have been trained in how to remove them.

The C-STEP program does not cover cancer treatment, but it does help patients try to identify possible sources of help such as Medicare or Medicaid. Of the 11 cases of cancer that have been found, McClellan says all of them were found early enough that the patients have a good chance of surviving. Patients who had polyps removed are being monitored to make sure they do not develop cancer.

The original CPRIT grant covered colorectal cancer screenings for people in the 7-county Brazos Valley region. The program has recently been expanded to cover a 17-county area and a second screening location has been established in Crockett, Texas, under the direction of J. Patrick Walker, M.D., who also works with physicians in the Texas A&M Family Medicine Residency program.

“We are very excited about this opportunity for our residents,” Walker says.

Walker volunteers regularly at the C.O. Murray Community Clinic in Crockett and says he anticipates many referrals from patients who come to this clinic.

Bolin and McClennan have put together a team of about 50 clinical partners such as Walker who keep an eye out for patients who might need colorectal screenings. They also have 200 community partners such as churches and social service agencies who help get the word out about the availability of the free colorectal screenings.

Bolin, Helduser and McClellan say they hope the C-STEP program will serve as a national model for reducing the incidence of colon cancer, as well as incorporating cancer prevention, screening and education into family medicine residency training programs.

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Alpini named the 2016 Takeda Distinguished Scientist, honored for work in gastrointestinal field Thu, 26 Feb 2015 15:24:46 +0000 Alipini, Gianfranco

Gianfranco Alpini, Ph.D., distinguished professor of internal medicine and medical physiology at the Texas A&M Health Science Center College of Medicine.

Gianfranco Alpini, Ph.D., distinguished professor of internal medicine and medical physiology at the Texas A&M Health Science Center (TAMHSC) College of Medicine, was recently named the 2016 Takeda Distinguished Scientist by the Gastrointestinal & Liver Section of the American Physiological Society.

The second most prestigious recognition offered by the Gastrointestinal & Liver Section of the American Physiological Society, the Takeda award is given annually to an outstanding investigator who is internationally recognized for contributions to research in gastrointestinal and liver physiology.

Alpini joined the Texas A&M College of Medicine faculty in 1994 and holds the Nicholas C. Hightower Centennial Chair in Gastroenterology at Scott & White.  Just last year, Alpini was appointed a university distinguished professor, which is among the highest honors awarded to Texas A&M University faculty members.

As a Department of Veterans Affairs (VA) Research Scholar Award recipient, he also serves as a research scientist with the Central Texas Veterans Health Care System (CTVHCS) as well as director of the Digestive Disease Research Center (DDRC) at Baylor Scott & White Health (BSWH).  The major goal and objective of the DDRC is to discover novel ideas and research findings regarding the digestive system and the liver diseases that affect millions in the United States.

“It is a great honor to represent the university with this distinguished award, and I hope to continue promoting excellence through research and education for many years to come,” Alpini said.  “Thank you for all of the support that I and the DDRC have received from TAMHSC, BSWH and CTVHCS.”

Throughout his career, Alpini has made novel contributions to the science of cholangiocytes (epithelial cells that line the bile duct), the biliary system, melatonin synthesis, clock gene regulation, and the understanding of the role of secretin, a hormone that regulates secretions of the stomach and pancreas and other functions.  His work has led to the development of therapies for specific cholangiocyte/biliary disorders including a biliary and liver cancer, alcoholic liver injury, liver regeneration, primary sclerosing cholangitis and primary biliary cirrhosis.

The goal of Alpini’s current research is to determine the molecular mechanisms by which stem cell derived microvesicles contribute to the recovery of biliary injury through non-coding eRNA and cellular senescence related mechanisms. Alpini’s research program is funded by the National Institutes of Health, VA Merit Award and Research Career Scientist Award and the Hightower S&W endowed chair in Gastroenterology.

Alpini has authored more than 200 peer-reviewed scientific articles, reviews and book chapters, as well as more than 300 abstracts.  He is a Fellow of the American Gastroenterological Association and serves as an editor or on the editorial board of a number of prestigious scientific journals.  He is also a permanent member of the Hepatobiliary Pathophysiology (HBPP) NIH Study Section.  His research team was recognized with a prestigious Research and Development Award for Department of Veterans Affairs Scientists by the Association of Military Surgeons of the United States.

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Texas A&M, DeTar receive accreditation for Family Medicine Residency Program in Victoria Mon, 23 Feb 2015 20:01:51 +0000 Texas A&M College of Medicine and DeTar Hospital in Victoria have received accreditation for a Family Medicine Residency Program that will train more primary care physicians for South Texas]]>

In collaboration with Texas A&M Health Science Center, the DeTar Healthcare System Family Medicine Residency in Victoria has received approval from the Accreditation Council for Graduate Medical Education (ACGME), effective July 1, 2015. The three-year program – which addresses a critical need for more primary care physicians in South Texas – will accept its first six residents in July 2016.

Family Medicine Residency at DeTar creates more physicians for South Texas

Texas A&M College of Medicine and DeTar Hospital in Victoria have received accreditation for a Family Medicine Residency Program that will train more primary care physicians for South Texas.

“As a land-grant university, Texas A&M has always embodied a service-oriented mentality,” said John Sharp, chancellor of The Texas A&M University System. “The DeTar collaboration, and this latest accreditation milestone, brings us one step closer to serving more patients in this community and improving the health of South Texans for years to come.”

Cliff Thomas of Victoria, who serves as Vice Chairman of The Texas A&M University System Board of Regents, also expressed his appreciation for the residency program. “This program will make a big difference in the quality of health care, and in the quality of life, for the citizens of our region,” Regent Thomas said.

As part of the Region 5 Texas 1115 Medicaid Transformation Waiver, DeTar requested to establish a Family Medicine Residency Program in South Texas to serve this population, cited as Medicaid underserved by the U.S. Department of Health and Human Services. A 304-bed two-hospital system, DeTar provides care for Victoria and its surrounding counties, a 5,200 square mile area with a population of 164,467.

“The DeTar Healthcare System has recruited physicians to this community for more than 80 years as part of our commitment to provide quality medical care to the Crossroads area,” said William R. Blanchard, chief executive officer for the DeTar Healthcare System. “The family medicine residency program allows us to continue this tradition for many years to come.”

The three-year curriculum will train residents to provide comprehensive primary care within a patient-centered medical home environment and encourages graduates to continue practicing in the underserved area. The program will enroll an additional six residents per year, for a total program size of 18 family medicine residents training at DeTar in 2018.

“We have designed our program to meet the unique needs of South Texas, with full spectrum family medicine with obstetrics; tropical and international medicine; cutting edge lifestyle intervention to prevent and reverse diabetes and heart disease; and rural telemedicine experiences,” said Sidney Ontai, M.D., DeTar Family Medicine Residency program director and assistant professor at the Texas A&M College of Medicine. “Studies show that the majority of matriculating residents locate within 60 miles of their residency programs, so our curriculum should equip our graduates to serve South Texans well.”

The program received a $150,000 planning grant from the Texas Higher Education Coordinating Board, part of the $16 million appropriated to graduate medical education by the 83rd Texas Legislature. Partnerships such as this increase access to physicians in underserved areas and are a critical component to growing the health care workforce across the state.

“The Family Medicine Residency Program in Victoria will play a key role in the development of a comprehensive physician workforce solution for the entire state,” said Paul Ogden, M.D., interim dean of the Texas A&M College of Medicine. “Texas A&M is piecing together the puzzle, working with partners like DeTar to develop new programs to alleviate the current primary care shortage, and thus ensuring that all Texans are getting the best care possible.”


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Diet high in red meat may make kidney disease worse Thu, 19 Feb 2015 21:06:35 +0000 Diet can play a key role in whether kidney disease progresses to kidney failure, according to research conducted by a professor at the Texas A&M Health Science Center College of Medicine]]>

A diet high in red meat may speed the progression of kidney disease.

An estimated 26 million people in the United States have chronic kidney disease, which can lead to complete kidney failure. Once the kidneys fail, patients either need to undergo dialysis treatments three times a week or have a kidney transplant to remain alive. In 2013, more than 47,000 Americans died from kidney disease.

Diet can play a key role in whether kidney disease progresses to kidney failure, according to research conducted by a professor at the Texas A&M Health Science Center College of Medicine.

Donald Wesson, M.D., was among the authors of a study that was recently published online by the Journal of the American Society of Nephrology. The study suggests that a diet high in animal proteins – especially red meat – can worsen the progression of kidney disease.

“Our study found that patients with chronic kidney disease who consumed diets high in animal protein were three times more likely to develop kidney failure than patients who consumed diets high in fruits and vegetables,” Wesson says.

The findings were based on data collected from 1,486 adults with chronic kidney disease who were participating in the National Health and Nutrition Examination Survey III. The study is believed to be the largest one to look at the long-term impact of diet on kidney disease in humans.

Wesson explains that when humans eat animal proteins such as red meat, the body metabolizes these proteins into acids. The kidneys produce substances to help the body rid itself of this acid, but these substances can hurt kidney function if they remain at high levels in the body over long periods of time.

“It’s like a double-edge sword,” Wesson says. “In the short term these substances can help the kidneys get rid of acid, but in the long-term they can reduce kidney function.”

Wesson has spent more than 30 years studying the impact of diet on kidney disease. His studies have shown that when animals or humans switch from a diet high in animal protein to one high in plant proteins such as fruits and vegetables, kidney function is protected. This is because the body metabolizes plant proteins into bases, not acids.

Wesson currently is a co-investigator on a multi-center, $2 million grant from the National Institutes of Health to conduct a national study to confirm if reducing dietary acid slows or prevents worsening of kidney disease.

Wesson says that while studies have yet to prove that eating a diet high in fruits and vegetables can prevent kidney disease, such diets have already been shown to help to maintain overall good health.

He notes that diets high in fruits and vegetables reduce blood pressure, which is very beneficial to patients with chronic kidney disease because most of these patients have higher than normal blood pressure without treatment.

“We know that fruits and vegetables are ‘heart friendly’ and these ongoing studies will help confirm if they are also ‘kidney friendly’,” Wesson says. “Stay tuned.”


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College of Medicine professor brings medical care, education to thousands in Haiti Fri, 13 Feb 2015 21:12:15 +0000 A medical clinic in Haiti started by David M. Vanderpool, M.D., from the Texas A&M College of Medicine, is serving thousands of patients annually and providing a valuable learning experience for medical students]]>

When an earthquake hit Haiti in January 2010, more than 330,000 people were killed and one million people were injured.

Dr. Vanderpool and medical students

Dr. David Vanderpool (left) visits with medical students on a mission trip to Haiti.

David M. Vanderpool, M.D., adjunct assistant professor at the Texas A&M Health Science Center College of Medicine, was one of the physicians who arrived within 48 hours of the disaster to oversee and administer care to thousands of patients.

After the earthquake, Vanderpool returned to Haiti on a monthly basis, organizing mobile medical clinics that treated more than 1,000 patients a week.

In 2013, Vanderpool and his wife, Laurie, decided to sell their home and his medical practice to create Live Beyond, a humanitarian organization and compound in Thomazeau, Haiti, one of the poorest regions of the country. They moved with their children to the LiveBeyond compound, where they now serve the medical, educational and spiritual needs of Haitians full-time.

LiveBeyond provides medical and maternal health care, clean water, orphanage support and community development to the oppressed. While locals can visit the compound themselves, LiveBeyond utilizes trucks and vans to transport patients in to the compound for health care and education – an opportunity they otherwise would not receive in their remote locations.

medical student with baby

A medical student works with a child at the clinic Vanderpool has set up in Haiti.

The base includes a fully functional surgical hospital, demonstration farm, chapel, and missionary housing. The LiveBeyond compound has created a long-term presence in the community, allowing the Vanderpools to fight disease, provide clean water, care for local orphans, support expectant mothers and implement development projects.

In July 2014, a group of faculty and students from the College of Medicine participated in a medical mission trip to assist the LiveBeyond organization by providing medical care and humanitarian aid to the residents of Thomazeau. The trip also provided medical students invaluable education and inspiration.

Ruth Bush, M.D., J.D, M.P.H., vice dean for academic affairs and vice dean for the Bryan/College Station Campus, and Lee Ann Ray, Ed.D., associate dean for external relations and chief of staff, led a group of students on the trip that included research on a recent outbreak of Chikungunya virus.

“For our students, this type of experience is invaluable,” Bush said. “The students gain real-world experience in international medicine and enhance their medical knowledge, interpersonal and communication skills while serving the underserved. These opportunities increase their flexibility and adaptability to new and different situations.“

Four more teams of faculty members and medical students will be participating in mission trips to Haiti this year.

On Feb. 18, Vanderpool will share his experiences in Haiti as part of an Education Grand Round lecture titled “Developing a Health Care System in Haiti.” The lecture will begin at noon in HPEB LL11A, which is located on the Bryan campus. The presentation will also be livestreamed to other TAMHSC campuses.

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Compound found in grapes, red wine may help prevent memory loss Thu, 29 Jan 2015 20:09:49 +0000 College of Medicine researcher publishes new findings on the benefits resveratrol may offer for treating memory loss in the elderly]]>

grapes and red wineA compound found in common foods such as red grapes and peanuts may help prevent age-related decline in memory, according to new research published by a faculty member in the Texas A&M Health Science Center College of Medicine.

Ashok K. Shetty, Ph.D., a professor in the Department of Molecular and Cellular Medicine and Director of Neurosciences at the Institute for Regenerative Medicine, has been studying the potential benefit of resveratrol, an antioxidant that is found in the skin of red grapes, as well as in red wine, peanuts and some berries.

Resveratrol has been widely touted for its potential to prevent heart disease, but Shetty and a team that includes other researchers from the health science center believe it also has positive effects on the hippocampus, an area of the brain that is critical to functions such as memory, learning and mood.

Because both humans and animals show a decline in cognitive capacity after middle age, the findings may have implications for treating memory loss in the elderly. Resveratrol may even be able to help people afflicted with severe neurodegenerative conditions such as Alzheimer’s disease.

In a study published online Jan. 28 in Scientific Reports, Shetty and his research team members reported that treatment with resveratrol had apparent benefits in terms of learning, memory and mood function in aged rats.

“The results of the study were striking,” Shetty said. “They indicated that for the control rats who did not receive resveratrol, spatial learning ability was largely maintained but ability to make new spatial memories significantly declined between 22 and 25 months. By contrast, both spatial learning and memory improved in the resveratrol-treated rats.”

Shetty said neurogenesis (the growth and development of neurons) approximately doubled in the rats given resveratrol compared to the control rats. The resveratrol-treated rats also had significantly improved microvasculature, indicating improved blood flow, and had a lower level of chronic inflammation in the hippocampus.

“The study provides novel evidence that resveratrol treatment in late middle age can help improve memory and mood function in old age,” Shetty said.

This study was funded primarily by the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health. Shetty’s lab is now examining the molecular mechanisms that underlie the improved cognitive function following resveratrol treatment. He also plans to conduct studies to see whether lower doses of resveratrol in the diet for prolonged periods would offer similar benefits to the aged brain.

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A new model for rural health care delivery Wed, 28 Jan 2015 15:04:53 +0000 In rural communities, gaining access to health care can pose a challenge. The Holland Rural Health Rotations program, led by Catherine McNeal, M.D., Ph.D., exposes first-year medical students to the everyday struggles rural families face. Now in it's fifth year, the program has established a strong relationship with the community of Holland, providing health care where it was previously difficult to find]]>
Faculty and students who participated in the Rural Health Rotations Program outside of the HISD school clinic

Approximately 15 medical students are paired with families in Holland and meet once a month at the school-based clinic.

In rural communities, it can be a long way to the nearest doctor’s office or pharmacy.

Such is the case in Holland, Texas, a small town of about 1,200 residents that is located 21 miles south of Temple. Poverty is common and access to a major grocery store, let alone health care, is limited. For some families, going to a larger city to get groceries or to see a physician is a real struggle because they may not have time, or the money, to do both.

An appreciation for the challenges facing populations like those in Holland inspired Catherine McNeal, M.D., Ph.D., associate professor of internal medicine and pediatrics at the Texas A&M Health Science Center College of Medicine in Temple, to create a Rural Health Rotation program aimed at teaching medical students and nursing students about the barriers to health faced by rural populations. Ultimately she hopes that through this program, more TAMHSC graduates will choose to practice in rural areas.

Holland was a natural choice for the program because of an existing school-based clinic that was established in 1992 through a partnership between the Holland Independent School District (HISD) and Scott & White (now Baylor Scott & White Health).  The clinic received initial funding from the State of Texas and the Robert Wood Johnson Foundation.

Although school-based clinics exist in other communities, the one in Holland is unique because it provides care for people of all ages and from any community. It is staffed by resident physicians from Baylor Scott & White, including those in the pediatric and family medicine programs.

In addition to exposing first-year medical students to the concerns that people in rural communities face, the Rural Health Rotation program gives them practical clinical experience, which is unique for early medical education when most of students’ time is usually spent in the classroom learning anatomy and other health care basics.

Now in its fifth year, the program also pairs medical students with nursing students from the University of Mary Hardin-Baylor (UMHB) so they can learn the importance of working together as a team to deliver the best patient care and also learn to appreciate the unique skills from each profession that can be combined to enhance patient care, especially for rural residents.

The program is based at the HISD campus, and the HISD superintendent and school nurse recommend families that could benefit from it. Approximately 15 medical students and an equal number of nursing students are paired in groups of two or three with each family.

For the past two years, second-year medical students who participated in the program as first-year students have been asked to help lead the program, which provides an additional learning opportunity.

“Student leaders bring fresh ideas and energy to the rotation,” McNeal said.

Texas A&M College of Medicine faculty members from Baylor Scott & White and the Central Texas Veterans Health Care System, as well as faculty members from UMHB, work with each team of medical and nursing students to provide direction and guidance when the students have their monthly meetings with the families.

“This rotation has really established a two-way education,” McNeal said. “The families do a wonderful job teaching the students about the real-life struggles they face and, on the other end, the students provide information about health topics and clarify any misconceptions the families might have.”

Each of the participating families has special health care issues such as asthma or diabetes that their student groups help them manage. All of the families have children as well, many with special needs, exposing the students to the even greater challenges faced by families who need pediatric care.

“What I have noticed is that one of the largest struggles for our patients is finding the support to take that first step toward improving their health,” said Andy Marshall, a second-year medical student who currently serves as one of two student advisors for the program. “This program does a wonderful job of not only allowing us to develop a relationship and support system with the family, but also gives the families an opportunity to network and create a support system within the community.”

Katherine Rendon, a current third-year medical student, participated in the program during her first year of medical school and served as a student advisor during her second year.

“One of the aspects that I think we benefitted from was that we got access to patients so early on in our education,” Rendon said. “Since we had very little education in medicine at that time, we started out with the basics—speaking with the families to become comfortable interacting with our patients. Getting to know the families gave me a more patient-centered focus that I know I will carry into my practice, and it allowed our families to take a more active role in their health care.”

McNeal said she is delighted to see how fully the community of Holland has embraced the idea of accessible health care. “I think the Holland ISD has solved the problem of delivering health care to rural residents through its unique school-based clinic and by supporting the training of young doctors and nurses. If our nation wants to improve health care delivery, it needs to look at a tiny town in Central Texas to find the answers.”

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The cost of taking (or not taking) flu antivirals Tue, 27 Jan 2015 21:14:58 +0000 With the uptick in flu cases and only a 23 percent effectiveness among the flu vaccine this year, the flu is beginning to reach epidemic proportions. Antivirals, including Tamiflu, are one of the biggest lines of defense against the flu, but some are questioning if they really work]]>
Sick woman blowing her nose next to medications and water.

Tamiflu and other antivirals can reduce the length of the flu by one-half to two days.

Should I take Tamiflu? It’s a common question this flu season, which is shaping up to be a real doozy. With a vaccine that doesn’t protect well against the more virulent-than-usual circulating flu strain – H3N2 – influenza is quickly reaching epidemic levels, leaving patients perplexed on the best remedies.  Antiviral medications are one option, but many question whether or not they are necessary, or even helpful at all.

While antivirals won’t cure flu the way an antibiotic might be used to cure a sinus infection, experts say they are still useful. This month, the Centers for Disease Control and Prevention (CDC) endorsed the use of antivirals to combat the spread of the flu, especially for patients at a high risk of complications. And infectious disease physicians like Cristie Columbus, M.D., vice dean of the Texas A&M Health Science Center College of Medicine in Dallas, agree.

“I’m a big proponent of flu antivirals, which shorten the duration of illness and, perhaps more importantly, reduce the amount of contagious virus (or viral shedding), which can potentially help prevent secondary cases, particularly in vulnerable populations,” she said.

The CDC has three recommended antiviral drugs:

  • Tamiflu (oseltamivir) – Comes in liquid or pill form and is the most popular influenza antiviral medication; side effects include nausea, vomiting, dizziness and headaches.
  • Relenza (zanamivir) – Comes as an inhalable powder; not recommended for people with breathing problems, because it could cause bronchial spasms.
  • Rapivab (peramivir) – An intravenous medication, given as a single dose, and recommended for people who are unable to tolerate Tamiflu or Relenza due to side effects.

All three antiviral drugs work by inhibiting neuraminidase, the protein that allows the virus to spread from cell to cell, which plays a key role in reducing the amount of contagious virus. The antiviral drugs could also reduce the duration of the flu by one-half to two days, especially if started within the first 48 hours of symptoms.

“If we can get antiviral medicines to patients as soon as the first symptoms are displayed, it could mean the difference between hospitalization and home-based care,” Columbus said.

This is especially important for those at a high risk for flu complications, including aging adults, pregnant women, and those with underlying conditions, such as asthma or other chronic lung problems, and those who are already hospitalized. While there are differing opinions on the use of antivirals due to side effects in pediatric patients, Columbus recommends that children also be treated with antivirals.

“I recommend antivirals be prescribed for pediatric patients as per CDC guidelines, with symptom control for nausea if needed,” Columbus said. “Particularly for high-risk pediatric patients, the benefit of antiviral treatment outweighs the risk of side effects.”

For otherwise healthy individuals, starting antivirals in the first 48 hours can speed their recovery time, allowing for a quicker return to work and normal daily activities and, theoretically, preventing spread to others.

“Even if it’s past the 48-hour window, previously healthy people who are exhibiting severe or progressive symptoms might benefit from antivirals,” Columbus noted.

Because flu is so widespread this season, the CDC recommends a decision to treat for influenza should not depend on a positive flu test. However, this has led to complications with some insurance companies, who require a positive test result before they will cover the cost of Tamiflu.

“It’s unfortunate, because, depending on the test used and availability of testing, results can be falsely negative or delayed, all of which contributes to the flu spreading further,” Columbus said. “Tamiflu can be expensive, especially if you have to pay out-of-pocket, but it may be the difference between a relatively mild illness and a trip to the hospital for some.”

When deciding whether or not to fill a Tamiflu prescription, consider this: One less day of feeling sick could help reduce the spread of the H3N2 virus this season and could keep you or a loved one out of the hospital and ultimately, it might even save your life.

For more information on antiviral medications, visit the CDC website.

Dr. Columbus has particular interest in health care epidemiology and infection control and prevention. A diplomate of the American Board of Internal Medicine and of the Subspecialty Board of Infectious Diseases, Dr. Columbus is also a member of several national professional organizations including the American Medical Association, the American College of Physicians, the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. She is also a member of the Texas Infectious Disease Society, Texas Club of Internists and active regionally in the Texas Medical Association, where she served on the Committee on Infectious Diseases.

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