Researchers Chart Quicker Path to Patients with IGLOO
Leaders at the Wake Forest School of Medicine are demonstrating how to move research outcomes into patient care more rapidly than ever before through a project known as IGLOO, as they aim to prevent strokes and cardiovascular events.
IGLOO stands for Implementation of Guidelines for Lowering Blood Pressure. It is a major initiative of the Center for Healthcare Innovation (CHI), a group spanning the School of Medicine and Wake Forest Baptist Health that acts as “air traffic control” for scientists, digital experts, project managers and others who work together to accelerate discovery into practice.
The goal is to close what is known as the translational gap, a period of perhaps 15 to 20 years it often takes for major discoveries to reach the care environment. The promising results of the Systolic Blood Pressure Intervention Trial (SPRINT) encouraged researchers to start implementing its findings as soon as possible. Those findings included new protocols for measuring blood pressure – two periods of rest and the average of two measurements – that produce more accurate readings, which could help prevent strokes and cardiovascular events.
“IGLOO was designed to more rapidly get these new findings into the patient care environment,” said Jeff Williamson, MD, CHI’s director, section chief of gerontology at Wake Forest Baptist and one of the leaders of SPRINT, which Wake Forest served as the national coordinating center. “I’m not aware of any other health system in the United States that is actually doing a project like this.”
IGLOO is rolling out the updated blood pressure measurement protocol in Wake Forest Baptist’s network of 125 clinics and 450 providers. During that rollout, new data is being gathered that is helping adoption and implementation. The goal is to implement this new protocol in all of Wake Forest Baptist’s patient-facing clinics and services, not just the network clinics, and eventually across the Southeast through partner Atrium Health.
IGLOO represents an important growing trend in medicine called learning health systems – organizations or networks that continuously self-study and adapt using data and analytics to generate knowledge, engage stakeholders and implement behavior change to transform practice.
“This is an amazing opportunity to be on the forefront of truly providing better care in blood pressure management and having a positive effect on a large population of patients,” said Elisabeth Stambaugh, MD, chief medical officer of the Wake Forest Health Network. “If we can learn as we implement and try to refine the process, then we can spread that process that we’ve proven as a better way to do things across the Wake Forest Baptist Health family, across the larger Atrium Health enterprise family and then further across the entire country – and really show some amazing turnarounds in terms of blood pressure control.”
Researchers from medical schools at Wake Forest, Duke and Thomas Jefferson universities have found that a novel approach to rehabilitation can help hospitalized older patients with acute heart failure (HF) see significant gains in physical function, including balance, mobility, strength and endurance, compared with those receiving usual care, regardless of their heart’s squeezing ability (ejection fraction).
The novel approach focused on tailoring rehabilitation treatment to the individual and beginning it while the patient was still recovering in the hospital, which is not standard care for these older HF patients. The findings were published in May in the New England Journal of Medicine and reported simultaneously at the annual meeting of the American Association of Cardiologists.
“The study was not large enough to really look at clinical events” said the study’s lead author, Dalane Kitzman, MD, the Kermit Glenn Phillips II Chair in Cardiology and professor of cardiovascular medicine and gerontology at Wake Forest School of Medicine. “But by improving quality of life and physical functioning, the patient feels better, which is a positive outcome.”
Kitzman and his collaborators are now investigating whether certain subgroups of patients saw more benefits, which could inform a subsequent larger trial designed to definitively examine effects on clinical events.
Wake Forest Institute for Regenerative Medicine (WFIRM) scientists report promising results from a therapeutic strategy that uses human placental-derived stem cells (hPSC) to treat necrotizing enterocolitis, a life-threatening intestinal bowel disease that affects up to 10% of premature infants.
Based on recent cell therapy studies, WFIRM scientists investigated the effect of hPSC therapy on intestinal damage in a pre-clinical animal model. The researchers found that the therapy stopped disease progression and promoted healing of the intestinal damage at both the cellular and whole tissue levels.
“These findings open exciting new avenues for advanced therapeutic development that could hopefully one day contribute to the advancement of medical care for this disease and help set the foundation for a long and healthy life for these babies,” said Victoria G. Weis, PhD, a lead author of the paper, which was published by the American Journal of Physiology’s Gastrointestinal and Liver Physiology section and selected by the American Physiological Society as among the best recently published articles in physiological research.
Anthony Atala, MD, senior study author, director of WFIRM and the George Link Jr. Professorship in Regenerative Medicine, said, “Our results show that stem cell treatment can promote intestinal healing. In this disease model, utilizing them as an early intervention may be better tolerated in the infant and, further, may decrease disease progression to advanced stages that require surgery.”
Wake Forest School of Medicine investigators have identified a set of new genetic markers that could potentially lead to new personalized treatments for lung cancer.
This study was built on a previous discovery by the precision oncology team at Wake Forest Baptist’s Comprehensive Cancer Center, directed by Wei Zhang, PhD, the Hanes and Willis Professor in Cancer Research, professor of cancer biology at the School of Medicine and a co-corresponding author of the study. Using DNA sequencing technologies, Zhang’s team found that tumors with mutated KMT2 genes, a family of proteins, exhibit a feature of genetic instability with numerous mutations in the genome.
“These findings suggest that KMT2 genes may be required for the repair of DNA damages caused by carcinogen exposure such as excess tobacco smoking. We speculate that tumor cells containing mutations in KMT2 genes are unable to repair these DNA damages, causing accumulation of mutations in the genome,” said Peiqing Sun, PhD, co-corresponding author of the study, the Anderson Oncology Research Professor and professor of cancer biology.
The study appears online in the journal Cancer Research.
A new study from the School of Medicine suggests removing additional tissue around the tumor cavity, a technique known as cavity shave margin resection, reduces the rate of positive margins in breast cancer patients with ductal carcinoma in situ (DCIS).
DCIS is a noninvasive cancer that accounts for approximately one of every four new breast cancer cases in the United States, according to the American Cancer Society. If left untreated, DCIS has the potential to evolve into invasive cancer, so many patients choose to have breast-conserving surgery or mastectomy after a diagnosis.
However, obtaining clear or negative margins – no cancer cells in the outer edge of removed tissue – is critical to mastectomy success as positive margins are associated with higher rates of recurrence. The results of the randomized trial showed a nearly 65% reduction in the positive-margin rate.
“Our previous clinical trial showed that this technique can reduce positive-margin rates in invasive disease by at least 50%, but to my knowledge, this is the first analysis involving pure DCIS,” said Marissa Howard-McNatt, MD, director of Wake Forest Baptist’s Breast Cancer Center and associate professor of surgical oncology. “Our study shows a significant reduction in positive margins. This technique should be considered for DCIS patients.”
The findings were published online in the April issue of the Journal of the American College of Surgeons.
Lifestyle intervention, including weight loss and increased physical activity, can benefit many people with type 2 diabetes, but it can be detrimental for people who have poor blood sugar control, according to a study conducted by Wake Forest School of Medicine researchers.
In the study, published in the May issue of the journal Diabetes Care, researchers re-evaluated the National Institutes of Health Action for Health in Diabetes (Look AHEAD) study that found intensive lifestyle intervention neither helped nor hurt people with diabetes.
“Contrary to the initial findings of Look AHEAD, our work found that lifestyle interventions reduced potential cardiovascular harm and optimized benefits for 85% of those in the trial,” said the study’s lead investigator, Michael P. Bancks, PhD, assistant professor of public health sciences at the School of Medicine. “However, for those who had poor blood sugar control, lifestyle intervention increased the risk of major cardiovascular events. Based on our findings, doctors may want to consider alternative options, such as glucose-lowering drugs, before trying lifestyle modification for those people.”