Tag Archives: John A. Burns School of Medicine

Building a healthy core

Health studies make headlines nearly every day—and rightly so, since most of us want to read about ways to enjoy healthier lives. But what happens when the newest studies seem to yield conflicting findings?

Dr. John Chen

“You really have a medical impact if you publish a study, and you certainly do not want to mislead the public,” said Dr. John Chen of the University of Hawai’i at Mānoa’s John A. Burns School of Medicine (JABSOM). “Unfortunately, an alarming number of biomedical studies, even published studies, do not seem to have a sound study design or have handled their data inappropriately.”

Dr. Chen and his team of statistical professionals, the new Biostatistics & Data Management Core at JABSOM, are available to collaborate with investigators on grants and to provide research design and statistical analysis support to basic science, clinical and translational researchers.  Their research design and data analysis skills can be an enormous help to researchers.

Chen added that they can help researchers from very early on, at the conception of a study.  “As statisticians, we have been trained to think about randomization, bias, blinding, confounding, concepts which are critical to an investigation that biomedical researchers may or may not have thought about. Certainly as professional biostatisticians, data analysis is also our bread-and-butter.  To have us handle your data management and analysis is like having CPAs doing your tax returns.  It might cost you a little bit, but will be worry free,” said Chen.

Even better, professional biostatistics and data management support can help increase the odds that a biomedical researcher gets the opportunity in the first place to embark on a research investigation.

“A researcher’s chance of receiving funding is improved dramatically when sound statistical reasoning and design, and proper data analysis plan are employed to support the investigator,” Chen explained.  The availability and strength of biostatistics and research design expertise has been shown to result in substantive increases in the research funding and the quality of biological and health sciences research at academic centers across the country.  Chen points to institutions such as the Mayo Clinic, with more than 140 biostatisticians, and even smaller universities like Wake Forest, which has over 60.   Chen’s new team at JABSOM currently includes three other Ph.D. consultants, Hyeong Jun Ahn, James Davis, and Guangxiang (George) Zhang.

Since the reopening of the core, various types of service requests have been coming in. “We’re like a good plumber,” said Chen with a smile. “People come to us with different problems all along the research chain, from study design to interpreting findings, and we try our best to help them all go through smoothly.”

The Biostatistics & Data Management Core is trying to reach out to as many people as it can, in and out of academia.  “With strong collaborations and support from biostatistics groups at the University of Hawai’i Cancer Center, the Department of Public Health Sciences, and Hawai’i State Department of Health, we want to build a ‘Hawai’i Biostat ‘Ohana’ to encourage more communication and collaboration among biostatistical professionals working in our islands,” said Chen.  “We want to help produce the next generation of strong, independent investigators, research leaders and mentors in Hawai’i.”

The Biostatistics & Data Management Core is located on the top floor of the Medical Education Building in Kaka`ako. It’s worth the elevator ride to get there.

The Biostatistics & Data Management Core website is at http://biostat.jabsom.hawaii.edu/.

Top photo: Pictured are members of the Biostatistics & Data Management Core: Guangxiang (George) Zhang, Ph.D.; John J. Chen, Ph.D., Director; James Davis, Ph.D., Karli Taniguchi; Hyeong Jun Ahn, PhD. Photo credit: Iris Chen.

A salute to better medical care

Third-year medical students suit up for surgery. Photo by Arnold Kameda, JABSOM.
Third-year medical students suit up for surgery. Photo by Arnold Kameda, JABSOM.

There are different ways to show support for active military and veterans, ranging from throwing parades with marching bands to shaking the hands of soldiers in uniform.  Now the University of Hawai‘i at Mānoa’s John A. Burns School of Medicine (JABSOM) is thanking those who safeguard our country by participating in Joining Forces, a national program intent on improving health care for active duty military, veterans and their families.

JABSOM joins First Lady Michelle Obama, Dr. Jill Biden (wife of Vice President Biden), the Association of American Medical Colleges and the American Association of Colleges of Osteopathic Medicine as they encourage a new generation of doctors, medical schools and research facilities to make sure military heroes receive exemplary medical care. Coordinating JABSOM’s response is retired U.S. Army Colonel Larry Burgess, MD, Professor of Surgery and Director of the Telehealth Research Institute.

“Our medical school has a long history of collaboration with the military and their dependents in understanding the unique challenges faced by deploying soldiers and their families during and after deployment,” explains Dr. Burgess.  He notes that many of JABSOM’s physicians in training and medical students complete rotations at Tripler Army Medical Center and Veterans Affairs medical clinics.  “This gives trainees a first-hand experience in understanding the problems experienced by the military and veterans.” 

Dr. Lawrence Burgess
Dr. Lawrence Burgess

Dr. Burgess explains that with the advent of Joining Forces, JABSOM is modifying its medical school curriculum, particularly those involving Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI).  For example, in the past, medical students would study the symptoms of a hypothetical 35-year-old male patient suffering from TBI after being involved in a terrible car accident.  Now the scenario would involve a military patient injured in a Humvee when a roadside bomb exploded.  This emphasis will provide students with a better understanding of the post-injury sequelae faced by soldiers as they return home and transition to the community. 

It’s a natural outgrowth for JABSOM to become more involved in the treatment of military veterans, because its Ho‘oikaika (“to strive”) program already assists both military and civilians in managing PTSD and TBI. As described by Ho‘oikaika Project Director Robin Brandt, PhD, “Our mission is to help individuals with TBI to access social services and achieve greater independence through peer mentoring.” 

Joining Forces is the largest coordinated commitment from America’s medical colleges to support veterans and military families. Since 2000, the U.S. Defense Department estimates nearly 213,000 military personnel have suffered traumatic brain injuries in Iraq and Afghanistan, after more than 10 years of war.

For more information on Joining Forces, see http://www.whitehouse.gov/joiningforces and http://jabsom.hawaii.edu. For more information on Ho‘oikaika at JABSOM, see http://manoa.hawaii.edu/pbrrtc/hooikaika/?page_id=52

Mahalo to OHA

Significantly situated next to a lush and tranquil taro patch, UH Mānoa’s Hawai‘inuiākea School of Hawaiian Knowledge appropriately nurtures the roots of the native culture that makes these islands so special.  And, in four short years, there’s no question the school has also made great strides in boosting its extramural fund to $3 million in contracts and grants.  Now, the Native Hawaiian Student Services at UH Mānoa is one of five recipients of an Office of Hawaiian Affairs (OHA) grant to help improve conditions for Native Hawaiians.

OHA’s Board of Trustees recently awarded $1.8 million in grant money to a combined total of five programs aimed at helping Native Hawaiians improve their health, education and economic self-sufficiency.

One of the awards went to Hawai‘inuiākea: Namely, $180,000 over two years to Native Hawaiian Student Services to fund an internship program designed to assist about 40 Native Hawaiian students with their unified goal of graduating from college within a 2-to-4 year timeframe. The name of the program, Aka Lehulehu, refers to a well-worn path created by a mentor and literally refers to “shadowing.” Aka Lehulehu focuses on providing internships to undeclared, upper division Native Hawaiian students to help them clarify their values and work toward self-efficacy and a major—thereby, supporting the 2-to-4 year graduation time line.

Another grant of $500,000 over two years was awarded to UH Mānoa to fund the Partnerships to Improve Lifestyle Interventions (PILI) ‘Ohana Program. The aim of PILI ‘Ohana is to integrate community wisdom and expertise with scientific methods to conduct research on health disparities, with a specific emphasis on obesity, in Native Hawaiian, Filipinos, Chuukese and other Pacific Islanders.

The PILI ‘Ohana program represents a partnership between 10 community-based organizations throughout the State of Hawai‘i and a team of academic researchers from the UH Mānoa  Department of Native Hawaiian Health (DNHH) at the John A. Burns School of Medicine.

The funds cover a two-year period and target programs that are expected to directly benefit an estimated 1,810 Native Hawaiians. Each of the five programs will receive between $179,700 and $ 500,000 over the next two years.

Hawai‘inuiākea is the youngest school at UH Mānoa, established in 2007 by combining the Departments of Hawaiian Studies and Hawaiian Language. Both academic units offer bachelor’s and master’s degrees that serve an estimated 200 students majoring in Hawaiian Language, with the same number majoring in Hawaiian Studies. An additional 1,600 students take classes within the program to fulfill general requirements for other majors.

No small threat

Viruses causing epidemic vector-borne diseases are transmitted by mosquitoes.
Viruses causing epidemic vector-borne diseases are transmitted by mosquitoes.
How’s this for an unnerving statistic? Infectious diseases kill more people worldwide than any other single cause – that’s according to the National Institute of Allergy and Infectious Diseases. A dengue outbreak in Hawai‘i in 2001 and a global resurgence of vector-borne and zoonotic infectious diseases, nearly all originating in Asia, led to the establishment of the Pacific Center for Emerging Infectious Diseases Research in 2003. The Center and its activities are generously supported by institutional funds and a grant from the Institutional Development Award (IDeA) Program, of the National Center for Research Resources, of the National Institutes of Health.

Hawai‘i’s strategic location as a prominent international port and its geographic proximity and strong ties to institutions within Asia and the Pacific provide a unique setting from which to monitor the emergence and spread of newly recognized infectious diseases and to investigate outbreaks of well-known microbial infections of regional concern and global importance. The Pacific Center for Emerging Infectious Diseases Research is among a handful of research facilities in the world exploring this resurgence.

Richard Yanagihara, Director of the Pacific Center for Emerging Infectious Diseases Research.
Richard Yanagihara, Director of the Pacific Center for Emerging Infectious Diseases Research.
Said Richard Yanagihara, Director of the Pacific Center for Emerging Infectious Diseases Research, “Infectious diseases are among the most urgent public health and economic problems facing the Asia-Pacific region in the new millennium. In recent years, microbes newly emerging in Asia have caused major epidemics, resulting in significant loss of human lives and devastating economic consequences worldwide.”

Although the myriad factors responsible for the alarming global resurgence of infectious diseases are not fully understood, demographic and societal changes are likely contributors. That is, the unprecedented population growth since World War II has been one of the principal driving forces behind uncontrolled urbanization. Also, the rapid movements of people, animals (and their endo- and ecto-parasites) and commodities via jumbo jets and high-speed trains, along with the insidious breakdown of the public health infrastructure and the misplaced emphasis on curative rather than preventive medicine, have all contributed to the regional and worldwide resurgence of infectious diseases.

The NIH-funded center is a pillar program that draws on the complementary strengths and multidisciplinary expertise within the John A. Burns School of Medicine and the College of Natural Sciences. Because the prevention and control of infectious diseases demand expertise from more than a single discipline, the new center is anchored by the tenets of multi- and trans-disciplinary research, comprising elements of epidemiology and public health, community and family medicine, biobehavioral health, bioinformatics and biostatistics, and microbiology and immunology.

The Center’s overall vision is to become a regional translational science center of research excellence for new, emerging and re-emerging infectious diseases. And its mission is to develop and deploy improved rapid diagnostics, effective low-cost treatments and affordable vaccines for tropical infectious diseases, which disproportionately affect underserved ethnic minority and disadvantaged communities in the Asia-Pacific region.

For more information, visit: http://pceidr.jabsom.hawaii.edu/.

Biocontainment suite for research on vector-borne and zoonotic viruses.
Biocontainment suite for research on vector-borne and zoonotic viruses.

Solving an image problem

A close-up view of the small, custom-developed marker that is placed on the body in the revolutionary system that allows MRI machines to compensate for a patient’s slight movement.  Photo courtesy of The Queen’s Medical Center.
A close-up view of the small, custom-developed marker that is placed on the body in the revolutionary system that allows MRI machines to compensate for a patient’s slight movement. Photo courtesy of The Queen’s Medical Center.
Anyone who’s ever had a MRI (magnetic resonance imaging) scan knows the daunting procedure.  The patient must lie completely still in a tomb-like MRI chamber for up to 45 minutes while the head or body is scanned for medical diagnostic purposes.  But what if the patient is a fidgety young child, or someone writhing in pain from an injury or disease, or an elderly person suffering from dementia?  In those instances, holding completely motionless in the MRI machine—even for five minutes—is difficult if not impossible. 

The challenges associated with undergoing this demanding procedure range from the medical to economic to humanistic.  If a lot of movement occurs during MRI scans, the images become so blurry that they are not interpretable by radiologists, meaning patients must return the next day to undergo sedation or full anesthesia before trying the process again.  With the cost of an MRI billed at approximately $1,000 an hour, all of those degraded, unacceptable images result in U.S. hospitals chalking up more than $1 billion annually in lost revenues.  And families fret when their loved ones, especially keiki and the elderly, are traumatized by the claustrophobic, frightening process of an MRI, or must undergo full anesthesia and its accompanying risk of complications in order to lie completely still.

Now Dr. Thomas Ernst, a physicist at the John A. Burns School of Medicine (JABSOM) at the University of Hawai‘i at Mānoa, and his research associates in the U.S. and Germany have invented a revolutionary system to allow MRI machines to compensate for a patient’s slight movement—making the procedure less intimidating and more effective in diagnosing medical problems.

Ernst heads up JABSOM’s Neuroscience and Magnetic Resonance Imaging Research Program, whose advanced 3-Tesla MRI scanner was funded by the Office of National Drug Control Policy, a White House Office, and is located at The Queen’s Medical Center near downtown Honolulu.  The prototype is eliciting impressive early results and raves, especially from the specialists charged with reading MRI scans, whose resolutions are so high at 1 millimeter or 1/20th of an inch that it takes very little motion for the images to become degraded.  

“This is important to radiologists, because they say the patients who need the scans the most are the patients who move the most,” explains Ernst.  “These are the young or the elderly, or those who have head trauma, dementia, Parkinson’s disease, brain tumors—so it doesn’t help to tell them not to move, because they just don’t understand the instructions or are in pain.” 

Ernst’s team, part of a joint venture with The Queen’s Medical Center, has developed a novel technique in which a small, custom-developed marker is placed on the body.  This marker is read by a camera that tracks movement in real time at 100 snapshots per second and then relays that information back into the scanner.  “So, as you move, the scanner locks itself on the marker, and the result is that the MRI scan has no blurring,” says Ernst. 

Not having to lie absolutely still is welcomed by patients, and means that tykes as young as three to four years of age can lay in the MRI scanner while watching kiddie movies through little binoculars and earphones, and may be entertained in the MRI chamber for as long as 30-45 minutes without sedation or anesthesia.  “It’s a good thing, especially for the children,” says Ernst, who believes the new marker technique will be ready for commercialization within a few years.  “Plus, if you can make technology less expensive, you make it more accessible—which means more people can benefit from an MRI.”   

Team members include researchers from UH Mānoa (including his physician wife at JABSOM, Dr. Linda Chang), the Research Corporation of the University of Hawaii, University of Wisconsin, Medical College of Wisconsin, and Universities of Freiburg and Magdeburg in Germany.  Together, they are solving an image problem that can save lives.

For more information on the Neuroscience and Magnetic Resonance Imaging Research Program, contact Ernst at tmernst@hawaii.edu or see the website at http://hawaii.edu/mri/home_v6.htm.

Top photo: Dr. Thomas Ernst of JABSOM poses with a young patient at the advanced 3-Tesla MRI scanner at The Queen’s Medical Center. Photo courtesy of The Queen’s Medical Center.

Joining doctors and nurses


Joint training of nursing and medical students at JABSOM's Kaka'ako campus.

The first-ever, joint training of UH Mānoa nursing and medical students was a distinct hit with students.

Comments during a talk-story session included a nursing student saying she learned, “Doctors are people, too, not just super-human robots who know everything!” A medical student then explained that MD students sometimes feel intimidated around nurses. “There’s different levels of knowledge,” said the MD student. “There’s going to be certain things we know the nurses won’t know, and things the nurses know that we don’t. We will benefit from taking turns, covering for each other and teaching each other to have an improved understanding that will help the patient.“

The new joint curriculum between the John A. Burns School of Medicine (JABSOM) and the School of Nursing & Dental Hygiene emphasizes that both doctors and nurses need to “speak the same language” to better care for their patients. The entire first year class of 66 medical students and 56 brand-new nursing students gathered for a half-day session on interprofessional communication, led by a JABSOM physician/educator and a nursing professor.

Held at JABSOM’s Kaka’ako campus, the September 2 session was the first of a series of planned educational activities to bring the students of both schools together. 

“These students are in their first semester of health care professions study at UH Mānoa, and the intent is to have them learn each others roles at the beginning of their careers to bring an interdisciplinary approach to patient care,” said Stephanie Marshall, the nursing school’s Director of Community Partnerships.

The Institute of Medicine has estimated that the number of annual deaths in hospitals due to medical errors or “preventable adverse events” exceed the number of deaths attributable to motor vehicle accidents (43,458), breast cancer (42,297) or AIDS (16,516), according to JABSOM’s Dr. Damon Sakai, Director of the Office of Medical Education. “Many medical errors begin with poor communication. This is supported by research analyzing the chain of events that occur when mistakes are made,” he added.

“The partnership between the nursing and medical schools is one concrete way to reduce the potential for deadly errors,” said UH Mānoa Chancellor Dr. Virginia Hinshaw.

“I strive as Chancellor to fulfill our university’s goal of serving as a multi-cultural global experience in a Hawaiian place of learning,” Hinshaw said. “No programs better epitomize this ideal than the John A. Burns School of Medicine and our School of Nursing and Dental Hygiene. I can see in your faces our multi-cultural society – our mission is to provide you with training and community service programs that expose you to a multitude of international experiences, so that we produce physicians and nurses who are equipped and devoted to improving the health and well-being of Hawai’i and the Pacific.”

“Mahalo to all of you for dedicating yourselves to careers in health care,” Hinshaw told the students. “No other field more directly impacts the well-being of our families and loved ones in Hawai’i and beyond – and nothing would make me prouder than to place my own future welfare in the care of outstanding health professionals like you,” she said.

Top photo: Nursing and medical students in a small-group “breakout” session on communication.