D epartment
of
M edicine
Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine
Vol. 5, Issue 1: Jan. 2016
The Breath of Life
practices for delivering inhaled medications under different conditions are still being developed. Several members of our pulmonary division have been investigating how different variables change the effectiveness of medications for patients who use noninvasive positive pressure breathing support. One recent trial, which used a manikin with a test lung in our Sim Center, investigated the efficiency of aerosol delivery of medication depending on the pressure settings of the ventilator, the type of aerosol device, and their position in the circuit. Their data suggests that there is significant variability of efficiency of medication delivery depending on the device used. Several members of the pulmonary division also contributed to a multi-institution trial concerning treatment for cystic fibrosis patients who have the most common genetic mutation that causes the disease in the US. This study, which was published in the New England Journal of Medicine in July of this year, assessed effectiveness of the combination of two medications, lumacaftor and ivacaftor, to change
East Tennessee is home to the scenic Smoky Mountains, Southern hospitality, and Big Orange football. However, due to high levels of pollen, air pollution, and tobacco use, it is also home to unusually high incidences of obstructive lung disease. As the region’s top academic medical center, UT has ample opportunity to study these debilitating diseases and a heightened sense of responsibility to our community to understand the conditions with which they live. “Obstructive lung diseases are difficult to prevent and difficult to treat,” notes Dr. Michael McCormack. Patients with these conditions are prone to exacerbations, which can lead to recurrent hospital admissions. Moreover, some treatments are difficult for patients to manage at home. Research into different treatment medications and modalities continually improves the lives of these patients. For example, inhalation medications are a promising area of research, as this route may be safer, more effective, and easier to administer than intravenous or oral methods of delivery. Best
continued on page 2
Points of View
foundations, telethons, races and walks to promote interest and research in a variety of illnesses, there has been little organization of a grassroots campaign to promote wellness and comprehensive development of a community-wide network that includes the active collaboration of hospitals and clinics with social workers, health departments, pharmacies, charities, municipalities, insurance agencies, and regional and federal governments in providing effective health care. The concept of involving communities in effective delivery of health care has been proposed since the 1970s, but change has been slow and inconsistently implemented. The emphasis on seeking greater community participation stems from the belated realization that health care delivery cannot be heavily dependent on the health care establishment, and improving the population’s health cannot be achieved by focusing our efforts on developing better treatments and therapies to treat diseases. Increasingly, we need alternatives which are more practical, less expensive, and share the concerns of the public at large. We need an integrated system of health care
In clinical practice, we deal on a daily basis with patients who present enormous barriers to effective health care delivery. These individuals include the poor, illiterate, homeless, mentally ill, underinsured or uninsured, and illegal immigrants who seek treatment at “safety net” hospitals. In addition, addicts, those in chronic pain, or the extremely obese present additional challenges. In these Rajiv Dhand, MD, Chair patients, we find frequent instances of malnutrition, unhygienic living conditions, incarceration, a sketchy record of clinic visits, inadequate adherence to treatment resulting in frequent Emergency Department visits, hospitalizations, and poorer outcomes in terms of disease morbidity and mortality. Despite the active involvement of charities, 1
continued on page 3