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Panel: Improving Healthcare Research Through Collaboration
May 9th, 2018
11:30 AM – 12:30 PM
ASC 118
RonaldPirrallo,M.D.ViceChairforAcademics
DepartmentofEmergencyMedicineGreenvilleHealthSystem
ResearchTargetMap
HumanResponse
SystemAnalysis
ClinicalEffectiveness
Strategic Development of a Research Experience Enrichment Program (REEP) in the Department of Emergency Medicine
Dotan Shvorin PhD, Ronald Pirrallo MD, MHSA, Kevin Taaffe PhD, Phillip Moschella MD, PhD
ObjectiveTo establish a GHS-CU collaboration that
generates health care inquiries, aimed to improve
patient care processes by applying engineering
methods, within the GHS Department of
Emergency Medicine.
BackgroundThe Creative Inquiry (CI) program matches
motivated undergraduate and graduate students
with CU Faculty to facilitate imaginative engaged
learning and cross-disciplinary interactions to
produce the next generation of scholars.
HypothesisCan the CU CI program be adapted to the GHS
health care environment to advance GHS
scholarship and workforce development?
MethodsUnder the leadership of an embedded CU scholar, 6 teams of CI students were
matched with GHS EM Clinical Faculty and EM Residents to investigate topics
ranging from CPR training effectiveness to quantifying physician distractions to clinician
decision making under fatigue to describing clinician physiologic biomarker variability
during a shift to understanding the effect of consultant use on ED operations to TB
screening modelling.
Outcomes6 teams incorporating 12 EM GHS Faculty, 6 EM
residents, 18 Undergraduates and 5 graduate
students formed the Research Experience Enrichment Program (REEP) to answer 6
research questions in this academic year. The 6
teams generated 6 confirmed abstract conference
presentations that secured a CU internal award of $6k for dissemination.
ConclusionThe REEP appears to have successful built upon
the CU CI framework to produce promising
scholarly work and expose nearly 2 dozen CU students to the health care environment this
year. Future work will evaluate if these teams
generate peer reviewed manuscripts and track
how many CU REEP participants pursue careers
in health care.
Emergency Medicine Research Target MapMotivation Streamline Research Project: Yearly Cycle of Scholarly Activities
AlainLitwin,M.D.ViceChairforAcademics
DepartmentofInternalMedicineGreenvilleHealthSystem
Department of MedicineResearch Efforts
May 9, 2018Alain Litwin, MD, MPH
Vice Chair of Academics and ResearchDepartment of Medicine
Medicine Research Areas
ClinicalTrials OpentoEnrollment GHSEnrolled
Total Enrolled/ Goal
PIONEER-HF - PhaseIIIB/IVstudyofEntresto vs.enalapril onchangesinNT-proBNP instabilizedinpts withacutedecompensatedHF,EF<40%
9 642/882
Evolve ShortDAPT
- Assess safetyof3monthDAPTinptsw/highbleedingriskwhohadPCIwithSynergystent
22(1ScreenFailure)
1,457/2,000
TAILOR-PCI - Randomizedpost-PCItoprospectiveordelayedgenotypingtodeterminesensitivitytoplavix
50 4,450/5,270
GALACTIC-HF - PhaseIIIstudyofOmecamtiv Mecarbil inptswithchronicHFandreducedEF
- Eligibility:HFadmissionwithinthelastyearandEF< 35%
4(1ScreenFailure)
1,865/8,000
MINT(MyocardialIschemiaandInfusion)
AMIwithhemoglobin<10g/dL randomizedto1)LiberalTransfusionStrategy– transfuse
whenhemoglobin<102)RestrictiveTransfusionStrategy– transfuse
whenhemoglobin7-8
0 208/3500
Cardiovascular ResearchEnrolling Trials
Cardiovascular Research
InvestigatorInitiatedStudies Enrollment
AFib RotorMapping
Pilotstudyof compassmappingduringablationtoidentifyAFibrotors
26
5Trials inFollow-up
• ABSORBIII&IV(Abbott)• PROMUSRegistry(BostonSci)• CABANAAFib trial(DCRI/MayoClinic)
• Bioflow-VDES(Biotronik)• CardioMems PAS(St.Jude)
Ongoing Trials
Memory Health: Caring for Self, Caring for Others
Investigating the effects of the stress of caring for loved ones with Alzheimer’s Disease on caregivers, and developing solutions to support caregivers
Initially:•Duke Endowment grant•July 2014 – July 2017•$990,470
New Funding:•Administration for Community Living grant•September 2015 – September 2018•$995,890
Partnering to Transform Health Care
• NCORP: Adults and PediatricsØ 342 Clinical Trials (330 adult, 12 pediatric)
o Treatmento Preventiono Cancer Care Delivery
• Institute for Translational Oncology Research (ITOR)Ø Phase I Clinical Research Unit (CRU)Ø BiorepositoryØ Clinical Genomics CenterØ Innovation Zone
• Center for Integrative Oncology and Survivorship (CIOS)Ø Integrative Therapies
GHS Cancer Research
11
ITOR Biorepository Services• 2900 + unique patients • > 20,000 aliquots – cancer center
Ø fresh snap frozenØ live cell cryopreservationØ formalin-fixed paraffin embeddedØ blood (whole, plasma, serum)
• Genomic annotation with 50 gene hot spot panel• Legal Framework in place
• allows sharing of tissue and clinical annotation in research projects
• >20,000 aliquots – other DOM investigators
ITOR Innovation Zone
InnovationZone
NUBAD LLCNUCLEIC ACID BASED DRUGS
Center for Cancer Prevention and Wellness
14
CenterforCancerPreventionand
WellnessRiskStratification
NP-MDEvaluation/ManagementNavigationRegistry
Endocrine
GUProstate
Chemoprevention
HighRiskSurveillance
BreastPrevention
Multi-modality LungLowDose
CTScreening
Head/NeckScreeningGYN
EndometrialOvarian
BestChanceClinics
Screening
SkinMole
MappingScreening
GIColon&GEHighRiskLiver
Screening
Hereditary
Cancer
Prevention
Clinic
Hypothesis: • Abnormal RNA expression (nc RNA’s) precedes
protein (Biomarker) expression • Change in protein expression triggers clinical
expression of cancerGoal: • Establish predictive libraries of nc RNA that
precede clinical diagnosis of cancer and precede threat of host death of cancer
15
Solution:• Create Biorepository effort within CCPW to enroll tens of thousands of
our population with yearly blood banking to create hundreds of thousands of samples for ultimate transcriptionomic interpretation of cancer evolution.
• Dedicated enhanced effort to Biobank high risk (BRCA, Hep B, MDS) to characterize the pre-clinical molecular events, the associated environmental triggers and potential portals of intervention for achieving pre-clinical “Molecular Arrest” and even “Molecular Reversal” of the process.
• “Molecular Arrest” and even “Molecular Reversal” of oncogenic progression could be Environmental/Lifestyle alteration of nc RNA expansion in targeted therapy for neutralization of alteration nc RNA portfolio.
16
Variablesincluded•Ageatonset•Diseaseduration•HY•Subscores fromMDS-UPDRSpartn3and2•Subscores derivedjustwithpart3•MDS-UPDRSpart2– totalscore•MDS-UPDRSpart1– isolatedquestions
Variablesincluded•Ageatonset•Diseaseduration•HY•Subscores fromMDS-UPDRSpartn3and2•Subscores derivedjustwithpart3•MDS-UPDRSpart2– totalscore•MDS-UPDRSpart1– isolatedquestions
TPAoutcome
NIHSSextended
ARCADIA
PACESETTER MaRISS
ARAMIS
RESPECTESUS Fullerton
TARGET TIA
TimetoTPAanalysis
RESEARCH PIPELINESSTROKE CENTER
Startupactivities
EnrollmentPhase
Closeoutactivities
Waitingapproval
Observationalstudies
PhaseIIIrandomized
devices
INVESTIGATORINITIATED
SPONSORINITIATED
GRANT
Parkinson’s Disease Subtypes
18
Wearable Sensors QuantifyParkinson’s Disease Symptoms
19
Accelerating the Revolution in Population Health(care)
Healthcare Professional Performance Satisfaction
Patient Reported
Outcomes & Engagement
Clinical Outcomes &
Costs
Community Behavior Health & Environ
Data
Step 1: Capture clinical & population data
Data (360o View& Learning)• Clinical processes & outcomes• Patient-reported outcomes• Behavior, Socioeconomic,
Environment, Geospatial• Cost (cost effectiveness)
Step 2:Obtain 360o
view of data
Analysis• Prioritize community and
healthcare delivery system objectives and outcomes
• Identify key modifiable social and medical determinants impacting priority outcomes
Step 3:Analyze &
models data
Model & TranslateTranslate key determinants into effective action programs for :• Integrated health system• Patients• Communities
Step 4:Identify areas
to apply discoveries
Step 6:Analytics,
*research & services impact
* ≥75% of research is rapid learning health system (RLHS)
Implementation (interface with Clinics & Healthcare Systems / Communities to):• Conduct Pilot Interventions -----------------------------------------------------• Support Broad Implementation
Step 5: Implementati
on impact
CCI Pharmacological Treatment Algorithm
Regimen-13 pills; 3 meds
Regimen- 22 pills; 3 meds
Lisinopril 40 (Free)Benazepril /
Amlodipine 40 / 10 ($4/Mo)
Amlodipine 10($4/mo)
Indapamide 2.5 ($4/mo)
Indapamide 2.5($4/mo)
Total Cost:$8 / mo
Total Cost:$8 / mo
Regimen- 33 pills; 3 meds
Regimen – 4 2 pills; 4 meds
Losartan 100($4/mo)
Benazepril / Amlodipine 40 / 10
($4/mo)
Amlodipine 10($4/mo)
HCTZ / Spironolactone (25
/ 25, generic co-pay)
Indapamide 2.5($4/mo)
Total Cost:$12 / mo
Total Cost:Est. $8 - $20 / mo
Notes:1. Treatment algorithm should control 80%–90% of hypertensives to
<140/<902. If patients have compelling indications for specific BP med
classes, include them
64.6
75.3
50.0
55.0
60.0
65.0
70.0
75.0
80.0
85.0
90.0
Baseline Visit
Last MAP Visit
Perc
enta
ge
Impact of MAP / Target: BP on BP Control in Family Medicine: Phase 1/2 Results.
Phase 1 – Single Site
Phase 2 – 16 Sites
Hanlin RB, et al. J Clin Hypertension. 2018: in press (DOI: 10.1111/jch.13141).
Patients graduating from JUMP session with our residents and dietician
60.0
65.0
70.0
75.0
80.0
85.0
90.0
Week1-2
Week3-4
Week5-6
Week7-8
Week9-10
Week11-12
Adhe
rencerates,%
Studyweeks
DailyadherencetoDAAs
DOT
Group
Individual
1– 3– 5– 7– 9– 11–
Community-basedHCVtreatmentcolocatedwithOATprograms
PREVAIL: Intensive models of HCV care for people who inject drugs
Litwin AH,etal.EASL2017,Amsterdam.#PS-130
StudyArm ETR SVR12DOT 98.0%(50/51) 98.0%(50/51)Group 93.8%(48/51) 93.8% (48/51)Individual 96.1% (49/51) 90.2%(46/51)Total 96.0%(144/150) 94.0%(141/150)
Overalladherence:DOT(82.8%),Group(77.5%),Individual(74.4%)
NoSVRin9patients:3ingroup,5inindividualand1inDOT§ 3patientsdidnotachieve
undetectableHCVRNA§ 2patientsdiedduringtreatment§ 4patientswithHCVRNAnotdetected
atEOT
§ National study - 8 states, 16 sites§ Enrolling 750 Current PWID (injected within 3
months)§ 600 initiating HCV treatment with once daily
sofosbuvir/velpatasvir x 12 weeks
§ On-site HCV treatment at either:§ community health centers or § methadone treatment programs
§ Outcomes: Initiation, Adherence, Completion, SVR, Resistance, Reinfection (over 2 years)
§ Stakeholders: National advocacy & medical organizations (HRC, NVHR, AATOD, NATAP), government (CDC), clinicians, patients, industry
Real world DAA outcomes among PWIDHepatitis C Real Options
DAA-treatment naïveGt 1-6With and without HIV
Study Design
Randomization
v
mDOT
Patient Navigation Tx
Initiation
TxInitiatio
n
EOT
EOT SVR 12
SVR 12
ConsentBaseline Week 0
Up to 12 weeks to initiate treatment
Week 12
12 weeks sof/vel
Arm A: 1) OTP, N=150; 2) CHC, N=150Arm B: 1) OTP, N=150; 2) CHC, N=150
Week 24
Week 120Monthly follow up Quarterly follow up
Virtual DOT (vDOT) may be as effective as in-person modified DOT (mDOT) for people who use drugs
• 17patientstreatedwithSOF/LDV• 12/17(71%)usedillict drugswithin6
months;14/17(82%)haveinjecteddrugs
• 16/17(94%)achievedETR• vDOT adherence91%vs mDOT 83%
• .
AiCure
Some ways to bridge the cultural divide• Meet and Greet with Divisions of Medicine (e.g neurology, geriatrics,
and primary care).• Develop virtual networking spaces – for initial one-on-one and group
meetings and ongoing collaborations – new Clemson Building and/or Zoom
• Identify resources at CUSHR that are of interest to GHS Clinical Researchers
• Monthly Department of Medicine Research Seminar to be launched –will invite CUSHR investigators
• Web-based directory of researchers, mentors, and resources within HSC
AngelaSharkey,M.D.SeniorAssociateDeanofAcademicAffairs
USC School ofMedicine– Greenville
IntroductiontotheBiomedicalResearchersatUSCSOM-Greenville
May9,2018
AreasofExpertise• Microbiology:ESKAPEpathogens,mutagenesis,drugdiscovery,
growthanalysis,virulenceassays,QCofinstrumentationforprivatesector,antimicrobialpropertiesofproteins
• Cellbiology:cellculture,microscopy,flowcytometry• Biochemistry:proteindetection,proteinpurification,structure-
functionanalysis,enzymeassays,proteinsasbiomarkersofdisease,glycan-proteininteractions
• Molecularbiology:PCR,RT-PCR,molecularcloning,assessepigeneticmodifications,genemutationsindisease
• DevelopmentalBiology:IVF, embryoculture• ReproductivePhysiology:endocrinology(e.g.hormoneassays),
semenanalysis• Immunology:Flowcytometry,cellsorting,magneticcellseparation,
immunoassays,lymphocytefunctionassays
BMSFacultyResearchFocusAreasUSCSOMG– BiomedicalSciences Faculty FocusAreasSergioArce,M.D.,Ph.D. ImmunologyandpathogenesisofmultiplemyelomaandsarcoidosisAsaC.Black,Jr.,M.D. Pluripotentadultstemcellsandmultiplesclerosis
AnnaV.Blenda,Ph.D. Antimicrobialpropertiesofhumangalactinproteins;geneticspfSplitHandFootMalformation(SFHM)
ReneeJ.Chosed,Ph.D. Genetics/epigeneticsposttranslationalmodificationsanddiseaseprogression;molecularmechanismsofhumanembryodevelopment
StevenE.Fiester,Ph.D. Microbiology/infectiousdisease;virulenceofmultidrug-resistantbacterialpathogens
LaurenA.Gonzales,Ph.D. Vertebratepaleontology;evolutionofprimatebrain
RichardL.Goodwin,Ph.D. Mechanismsofcardiovasculardevelopmentandmalformation;cell-basedtherapies
RichardL.Hodinka,Ph.D.,F(AAM) Clinicalmicrobiology,infectiousdiseases;moleculardiagnostics,identificationandmonitoringofmicrobialpathogens
AnnBlairKennedy,LMT,BCTMB,DrPH Patientandstakeholderengagement;behavioralchangeinterventionsandintegrativemedicine
MohammedK.Khalil,DVM,M.S.Ed.,Ph.D. Medicaleducationandinnovativelearningstrategies;learningandinstructionaltechnology
ThomasI.Nathaniel,Ph.D. Neurology;stroke/telestrokeprogram;medicaleducationWilliamE.Roudebush,Ph.D. Embryology;preimplantationembryomorphometricsRebeccaRuss-Sellers,Ph.D. Healthservicesresearch;medicaleducation
JenniferTrilk,Ph.D. Exercisescience;ExerciseisMedicineGreenville;improvingpatienthealththroughexercise
MatthewTucker,Ph.D. Sleepandmemoryprocessing;medicaleducationShannaWilliams,Ph.D. Craniofacialstudy;medicaleducationWilliamWright,Ph.D. Diabeticretinopathy;medicaleducationassessmentpractices;curriculumdesign
SergioArce,MDPhDClinicalAssociateProfessor,[email protected]
SergioArce,MDPhD- ImmunologySARCOIDOSIS MULTIPLEMYELOMA
3D-COLLAGENMATRICES
AnnaBlenda,PhDClinicalAssociateProfessor,[email protected]
AnnaBlenda, PhDGeneticsCurrent/ActiveResearchProjects
1. Antimicrobialproperties ofhumangalectinproteins,specificallygalectin-9:- collaborationwithDr.Stowell,MDPhD,EmoryUSOM,- USCSOMGstudents:AnitaVenkatesh (M2)andMaryKMontesdeOca (M3)
2. Useofgalectin-9 proteinasabiomarker innon-invasivediagnosisofendometriosis:- collaborationwithDr.Lessey,MDPhD,GHS,- Aspire-Igrantproposalsubmitted,patientsamplesavailable,pilotstudyinitiated
3.FacultysponsorsupervisingcurrentM3studentRonnieFunkatEmorySOMinthesplithand-footmalformation geneticstudy:- collaborationwithDr.Schwartz,PhD,GreenwoodGeneticCenter
AnnaBlenda, PhDGeneticsResearchProjectsinDiscussionPhase
1. Roleofgalectin-9 inregulationofmultiplemyelomabiology:- collaborationwithDr.Arce,MDPhD,USCSOMG
2.Roleofgalectin-9 ingranulomaformation insarcoidosis:- collaborationwithDr.ArceandDr.Kornev,PhD,ClemsonU
3. Strokeresearch (roleofgalectins,metabolomicsprofiling,microbiomestudy):- collaborationwithDr.ThomasNathaniel,PhD,USCSOMG
ReneeJ.Chosed, PhDClinicalAssistantProfessor,[email protected]
ReneeJ.Chosed, PhDBiochemistryCurrentProject1:ModelthehumanMixed-lineageleukemia(MLL)multi-proteincomplexinyeast(Saccharomycescerevisiae)• Molecularbiologytechniquestoaltertheyeastgenome• Analyzehistonemodificationstatusinthegeneticallyalteredyeast
strains• Assessprotein-proteininteractionswithintheMLLproteincomplex
CurrentProject2:Investigatethemolecularmechanismsresponsiblefor“self-correction”ofaneuploid humanembryospriortoimplantation• Measuregeneexpression(RT-PCR)inpre-implantationembryo
blastocoelfluid• Enzymeassaystodetectapoptosisinblastocoelfluid
StevenE.Fiester,PhDClinicalAssistantProfessor,[email protected]
StevenE.Fiester, Ph.D.Microbiology• Research interests:
– Elucidation of virulence mechanisms in ESKAPE (Enterococcus faecium,Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii,Pseudomonas aeruginosa and Enterobacter species) pathogens allowingfor the development of therapeutics
– Collaborative investigation of atypical ESKAPE infections and ESKAPEpathogens with multidrug- and pandrug-resistances
• Key research accomplishments:– Recharacterized A. baumannii as
hemolytic– Demonstrated ability of A. baumannii to
utilize heme-b as an iron source• Demonstrated efficacy of galliumprotoporphyrin IX as an effectivetherapeutic against multidrug-resistantA. baumannii
RBCsaloneRBCswithA.baumannii
• CurrentResearch:– TargetingphospholipaseCofA.
baumannii fortherapeuticpurposes
– InvestigatinglocalizationofGa-PPIXinA.baumannii atArgonneNationalLabs
– CharacterizingA.baumannii isolatescausingnecrotizingfasciitis
• Privatecollaborations:– DevelopmentofaTrojanhorse
antibiotictotreatmultidrug-resistantK.pneumoniae
Contactinfo:[email protected]
WilliamE.Roudebush, PhDClinicalAssociateProfessor,DevelopmentalBiology,[email protected]
WilliamE.Roudebush,PhD• Developmentalbiology
– Fertilization• Enhancingsperm-egginteractions
– Roleofgrowthfactors(Platelet-activatingfactor;PAF)– Preimplantationembryodevelopment
• Roleofgrowthfactors(PAF)• Molecularmechanisms
– Self-correctionofaneuploidy
• Reproductivephysiology– Endocrinology
• Assaydevelopment&utilization– AMH;InhibinB;PAPP-A
– Therapeutics• EnhancingIUIoutcomes
– PAF
ToFindOutMoreAboutourBMSFacultyandTheirResearchInterests
• http://sc.edu/study/colleges_schools/medicine_greenville/faculty/faculty/index.php
– FilterbyDepartment• BiomedicalSciences
Guest Panelistsu Ronald Pirrallo, M.D., Vice Chair for Academics,
Department of Emergency MedicineGreenville Health System
u Alain Litwin, M.D., Vice Chair for Academics, Department of Internal MedicineGreenville Health System
u Angela Sharkey, M.D., Senior Associate Dean of Academic Affairs, USC School of Medicine – Greenville