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Thinking nationally, acting locally
Residents hold their own research
day
Streamlining treatment for
women with breast cancer
Et cetera
Fending off delirium
Carbs? It’s the calories
that count
Lisa Suter, a resident in the Clinical Scholars Program, raises a question
during a classroom session on medical statistics. |
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Thinking nationally,
acting locally
A reconfigured Clinical Scholars Program looks to strengthen partnerships
with the community.
In 1973 Yale was one of the founding sites for the Robert Wood Johnson
Foundation’s (RWJF) Clinical Scholars Program, a two-year fellowship
with rigorous methodological training, a strong mentoring component and
work in disciplines such as clinical epidemiology and health policy. The
program teaches research skills, health policy, leadership, media/communication
skills and community health. Founded under the direction of the late Alvan
R. Feinstein, M.D., HS ’54, the program has seen more than 100 physicians
complete research projects.
In 1995, when Yale’s participation in the national program received
a 10-year renewal, there was change in the air at the RWJF. Four sites
remained in the program and three new sites were added. “We knew
for some time that there would be a new competition at the end of that
funding cycle,” said Harlan M. Krumholz, M.D., director of the program
at Yale.
Early in 2002, the RWJF announced how the program would change—although
about the same number of scholars would receive training, the number of
participating institutions would drop from seven to four in 2005. Other
programs offered similar training, and the foundation decided to emphasize
community-based research by scholars.
Yale applied for a renewed grant in the new program.
The application process came at a difficult time for Yale. Feinstein,
who had served as director or co-director until 1997 when he became director
emeritus, had recently died. And shortly after the application process,
the program’s co-director and chair of internal medicine, Ralph
I. Horwitz, M.D., FW ’77, a former clinical scholar himself, announced
he would leave Yale to become dean of the medical school at Case Western
Reserve University in Ohio. “The program owes a great debt to Alvan
and Ralph,” Krumholz said. “Fortunately it had already undergone
a transition in leadership at the time of the application. Alvan and Ralph
were instrumental in setting up the program for the future and ensuring
its future success. The dean also played a critical role in demonstrating
Yale’s commitment to the program.”
In April the RWJF announced that Yale would be one of the four sites—along
with medical schools at UCLA, the University of Michigan and the University
of Pennsylvania—in the program’s new configuration. Annie
Lea Shuster, the RWJF’s national program director, said that the
foundation was looking for institutions that had a curriculum designed
specifically for clinical scholars and the ability to do research based
in the local community. Yale had both.
“This emphasis on participatory community-based research distinguishes
our program,” said Shuster. “There has to be a lot of planning
and work in establishing relationships with the community.”
Much of that effort was already under way at Yale. Then-Dean David A.
Kessler, M.D., established the Office of Community-Based Research to provide
clinical scholars with opportunities to participate in projects with community
organizations and Yale faculty. Krumholz hopes that the new office will
help unify “a great fragmentation of effort” by coordinating
the school’s myriad projects in New Haven.
The RWJF is also requiring participating programs to provide a self-contained
curriculum specifically designed for the clinical scholars, rather than
send scholars elsewhere within the university for course work. Both Krumholz
and Shuster noted that Feinstein had been adamant about doing just that.
“He always thought that the Clinical Scholars Program should be
a real center of gravity, not just an administration office. So from the
outset, we have taken on the commitment to develop a program that is most
likely to foster the professional growth of each scholar,” said
Krumholz.
—Colleen Shaddox
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New
center opens with goal of streamlining treatment for women with breast
cancer
Breast cancer is one of those frightening diseases that inspires races,
ribbons and celebrity support for those fighting it. Now, a consortium
of New Haven health care providers is doing its part by offering a user-friendly
place where women needing breast care can come for confidential medical
and emotional treatment.
The Yale-New Haven Breast Center, composed of staff from Yale-New Haven
Hospital, the Yale Cancer Center and the Yale Medical Group, promises
convenient appointments, rapid diagnoses and same-day procedures all under
one roof. The center, at 800 Howard Avenue, opened this fall.
“We want to make it an easy and good experience,” said Donald
R. Lannin, M.D., the center’s executive director. “It can
sometimes take weeks to get answers; our goal is to coordinate specialties
so we can expedite the diagnosis and start providing care quickly.”
Lannin said the center was a response to women’s frustration with
being shunted from one building and one specialist to the next in pursuit
of answers and treatment. He said the new center represents the rejuvenation
of a program that has long been recognized as a leader in breast cancer
research and treatment but which had outgrown its space and equipment.
The new center will consolidate breast care specialties with surgery and
diagnostic imaging on the lower level and oncology on the second floor.
The center will also provide counseling for patients and educational programs
for physicians, patients and the public.
“A woman who is diagnosed with breast cancer has all sorts of worries,”
he said. “There are a lot of emotional overtones, and we have to
be sensitive to that as well.”
—Jennifer Kaylin
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Et Cetera
Fending off delirium
Taking daily walks and talking about current events can lower the risk
of delirium in the elderly, according to a study published April 25 in
Archives of Internal Medicine. What’s more, sticking to a
regimen of such activities appears to be as important as taking one’s
pills on time.
“It has been well-established that compliance with drug treatments
is very important for their effectiveness, but the effect of compliance
with non-drug treatments has not been studied before this report,”
said Sharon K. Inouye, M.D., M.P.H. ’89, professor of medicine and
geriatrics. “It really does lend credence to the fact that the amount
of nonpharmacologic therapy patients receive is just as important as drug
therapy, where a dose-response relationship is expected.”
Patients ages 70 or older who complied with the intervention, which also
included word games, fluids for rehydration and improvements in sleep,
vision and hearing, showed an 89 percent reduction in delirium risk.
—John Curtis
Carbs? It’s calories that count
Researchers at Yale and Stanford have concluded that cutting out potatoes,
pasta and bread doesn’t necessarily translate into greater weight
loss than high-carbohydrate diets. At least there’s little published
evidence to support the theory behind the Atkins and other low-carb diets,
they reported this spring. “We found that calorie content and how
long you’re on the diet are the factors that predict weight loss,
and not carbohydrate content,” said Dawn M. Bravata, M.D., assistant
professor of medicine and a co-author of the study. (The lead author was
Bravata’s twin sister, Dena Bravata, M.D., who’s at Stanford.)
The study, published in JAMA: The Journal of the American Medical Association
in April, examined past research to gauge the effect of cutting back on
starch. “The medical literature is lacking studies about the long-term
safety and efficacy of low-carbohydrate diets,” Dawn Bravata said.
“We need these kinds of studies in order to counsel patients who
want to lose weight.”
—John Curtis
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