Comprehensive Center Saves Children's Hearts
|BY ADAR NOVAK
AFTER A TEAM FROM COLUMBIA’S DEPARTMENT OF SURGERY carried out the world’s first successful pediatric heart transplant in 1984, Columbia became the leading institution for the care of children in need of heart transplants. Since then, P&S physicians have found that if heart muscle dysfunction or heart failure is recognized early, transplantation often can be delayed and sometimes avoided. Recognizing the need for a more multidisciplinary approach to caring for these sick children, Columbia pooled its expertise in various fields, establishing the Program for Pediatric Cardiomyopathy, Heart Failure, and Transplantation.
Families throughout New York State, the tri-state area, and even as far away as Israel and Japan have brought children to be evaluated and treated by teams that can include cardiologists, heart surgeons, cardiac nurses, geneticists, psychiatrists, neurologists, endocrinologists, nutritionists, infectious disease specialists, and social workers.
“Our multidisciplinary approach often involves treating the whole family,” says Linda Addonizio, M.D., professor of pediatrics and medical director of the pediatric cardiac transplant program. “A sick child can become the focus of the family, and, not infrequently, more than one family member may have cardiomyopathy.”
Because the program sees so many children with poor ventricular function about 200 annually specialists are able to reassure families that they are getting the right care. “In many instances we are able to offer hope because there is not much we haven’t seen and haven’t had experience with,” Dr. Addonizio says.
Before an initial evaluation, clinic coordinators gather information from the patient’s family and referring physician. Patients are then evaluated and appropriate diagnostic tests performed to delineate the potential etiology of the disease and prognosis. The full medical team then discusses the child’s condition and makes treatment recommendations.
The center carries out a number of research studies in collaboration with the molecular diagnostic laboratory. It also participates in the pediatric heart transplant study registry to identify risk factors for outcomes in pediatric heart transplant patients and the pediatric cardiomyopathy registry. It also is a member of the multi-center pediatric heart network supported by the NIH. It is one of only a few centers in New York that offers enzyme replacement therapy to treat Pompe’s disease, a genetic defect that previously caused death in early infancy.
“We’ve now grown to the point that we are often able to provide the referring physician and family with a specifically tailored comprehensive care plan that allows both the child and family to thrive, not just to cope with illness,” Dr. Addonizio says.
|The Program for Pediatric Cardiomyopathy, Heart Failure, and Transplantation can be reached through Dr. Addonizio at 212-305-6575.
|Clinical Imperative: Preventing Falls in the Elderly
AN AGING BABY BOOMER POPULATION BRINGS TO THE FOREFRONT a new public health issue: falling.
“Falling is now a clinical imperative a major public health issue,” says Mathew Maurer, M.D., associate professor of clinical medicine. “About one-third of people over 65 will fall every year, and about 5 percent of falls result in a serious clinical event, like a fracture. Falling is the fifth leading cause of death for older adults.”
Dr. Maurer and P&S colleagues are addressing the issue through the Syncope and Falls in the Elderly SAFE Clinic at the Allen Pavilion in the newly established Division of Geriatric Medicine and Aging. With a two-year grant from the Fan Fox and Leslie R. Samuels Foundation, Dr. Maurer and his interdisciplinary team hope to help as many as 500 local elderly patients by uncovering the medical reasons for their falls and preventing future falls. Since the program began in January 2007, the team has enrolled 39 patients in the program through referrals from physicians, family, and friends.
The SAFE clinic the only clinical program of its kind in the New York area has a staff of experienced geriatricians and geriatric nurse practitioners and works closely with top Columbia neurologists, otolaryngologists, ophthalmologists, cardiologists, and occupational therapists.
“As an academic medical center, we’re fortunate to have the resources to practice geriatrics at a high level,” Dr. Maurer says. “Since falls may be caused by anything from a previous stroke or visual problems to cardiovascular trouble or problems with the central nervous system, our team evaluates each patient in depth to get to the bottom of why the person is falling.”
A SAFE examination includes a review of history of falls; a gait and mobility assessment; a vision evaluation; cognitive and mood assessments; measurements of blood pressure while lying and standing; a full neurological assessment; hearing test; and foot examination. Other specialized evaluations, including one for home safety, also are available. In addition, the program provides some unconventional interventions, such as Pilates or Tai Chi. These disciplines can play a significant role in improving confidence and awareness and, ultimately, reduce the risk of falling. Based on the findings, patients are referred to the specialist (or specialists) who can best address their risk factors and reduce the risk of falls.
“With a team approach, we can often find simple interventions that produce dramatic results,” Dr. Maurer says. “This is a very positive model for what modern geriatrics is all about.”
The SAFE program can by reached at 212-932-4537.
|Research Consortium Makes Gains in Tuberculosis Treatment and Prevention
THOUGH TUBERCULOSIS IS A DISEASE OF RELATIVELY LOW incidence in the United States, it remains a significant problem worldwide. In this country, about 13,700 people contract TB each year, with about 950 of those cases in New York City; worldwide about 8 million people contract the disease each year. TB is the eighth leading cause of death worldwide, with most of the burden in developing countries.
Despite its prevalence, significant advancements in treatment and testing have only recently begun, says Neil Schluger, M.D., professor of medicine at P&S, who has been a leader in the field for 14 years. “We’re now entering a very exciting time for clinical research for tuberculosis,” says Dr. Schluger, also professor of environmental health sciences and of epidemiology at the Mailman School of Public Health. “Those of us who work in TB are hopeful that in the next five to 10 years we’ll have dramatically more effective, stronger treatment than we have today. This is exciting because there hasn’t been a fundamentally new treatment for tuberculosis for about 40 years.”
Through the Tuberculosis Trials Consortium (TBTC), an international group of medical centers participating in tuberculosis research funded by the Centers for Disease Control and Prevention, Dr. Schluger and colleagues are investigating new treatments for both the active and latent forms of TB. The CUMC site is one of the most active and largest of the 26 centers involved. Dr. Schluger is principal investigator for the CUMC site, which is run in conjunction with the New York Department of Health and Mental Hygiene’s Tuberculosis Control Division. He began his career in tuberculosis care and research at NYU and Bellevue Hospitals at the height of what was considered a tuberculosis epidemic in New York City in the early 1990s.
The clinical trials that Dr. Schluger oversees include about 8,000 subjects worldwide, who are given new drug regimens to both prevent and treat tuberculosis. A typical treatment for latent tuberculosis includes a dose of the drug, isoniazid, every day for nine months 270 doses in total. In one TBTC study, this regimen is being compared with a regimen administered just once a week for 12 weeks.
The clinical trials also include a Phase II study that seeks to identify new combinations of antibiotics that could be effective in treating active pulmonary tuberculosis. Dr. Schluger and colleagues are interested in examining the role of the antibiotic moxifloxacin in combination with standard TB drugs, in hopes that such treatment can be more potent and given for a shorter time, from three to six months. A recent TBTC study of some of these regimens was published in the American Journal of Respiratory and Critical Care Medicine in May 2006; the journal Nature Medicine listed it among one of the top 20 papers on TB since 2003.
The Centers for Disease Control and Prevention also has sponsored a study into the efficacy of blood tests to replace standard skin tests for TB. This analysis, which Dr. Schluger expects will begin this fall, will compare the two tests for the latent form of the disease in health care workers.
“These advances could potentially revolutionize the way both latent and active tuberculosis is discovered and treated around the world,” Dr. Schluger says.
Dr. Schluger can be reached at 212-305-9817.