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Better Ways to Heal Bones

Julie Bartucca

illustration of engineers going over blueprint of human skeleton with engineering notes on the hip bones

UConn Health is engineering innovative solutions for bone and joint problems, promoting faster recovery and less trauma to the body.


We’ve all signed a child’s colorful cast on their broken arm, gotten a call to inform us an elderly relative fell and broke a hip, or been laid up with back spasms ourselves. Maybe you’ve had a knee replacement or dealt with joint pain from years of athletic activity. It’s practically inescapable — 1 in 2 American adults suffers from a musculoskeletal disorder or injury such as arthritis, chronic back pain, fractures, or osteoporosis, according to 2016 data from the United States Bone and Joint Initiative (USBJI).

This is compounded by the fact that the U.S. has a rapidly aging population and, as people age, they lose bone density and the risks increase. Experts say the incidence of and costs to treat such issues are in danger of spiraling out of control.

But researchers at UConn and UConn Health are using a host of materials and technologies — from stem cells to spider-spun silk fibers to hydrogel to ultrasound waves — to strengthen bones and joints and accelerate recovery from musculoskeletal diseases and injuries.

“Musculoskeletal injuries are among the most common reasons to see a doctor. If we can take care of those faster and more effectively, patients can get back to their activities and work faster.”

“Musculoskeletal injuries are among the most common reasons to see a doctor. If we can take care of those faster and more effectively, patients can get back to their activities and work faster, which helps everybody,” says Dr. Augustus D. Mazzocca, director of the UConn Musculoskeletal Institute (MSI) and chair of the Department of Orthopaedic Surgery at UConn Health.

“There’s the economic impact of having people out of work, and the emotional problems of people who lose mobility and are isolated,” he says. “We’re trying to bring you back into society and get you back to what you like to do.”

To that end, UConn Health doctors also are developing ways to get you home faster after any musculoskeletal procedure, including spearheading same-day joint replacements.

Faster, Safer Recovery

UConn Health hip and knee replacement patients don’t have to wait for our clinical innovations to come to market. They can benefit from new approaches to the surgeries right now — and “right now” might also describe when they can go home post-op.

“Nearly 100 percent of my patients go home within 24 hours, and some now the same day,” says Dr. Mo Halawi, a new UConn Health orthopaedic surgeon who specializes in joint reconstruction and is spearheading an effort to minimize the time these patients spend in the hospital recuperating.

“The criteria for discharge are identical whether a patient leaves on the day of surgery or several days later. But with minimally invasive techniques, regional anesthesia, blood-conserving strategies, opioid-sparing analgesia, and immediate mobilization, patients are now achieving recovery milestones a lot quicker than before,” he says.

According to Halawi, the ideal candidate for same-day total joint replacement is one who is independent, motivated, has a good support system, and has no major risk factors for surgical complications. Much of the work is done in advance to optimize patients’ health and prepare them for surgery, allowing for the
speedy discharge.

After surgery, Halawi takes a less-is-more approach. Patients get on their feet right away and have no IV medications, drains, catheters, dressing changes, braces, or laboratory tests. Very rarely do his patients get discharged to nursing homes or rehabilitation facilities. Studies have shown that “patients recover better and have fewer complications in the comfort
of their homes,” he says.

“Hip- and knee-replacement surgery is constantly evolving, and we need to always deliver safe, effective, efficient, and evidence-based medicine to our patients. Soon, more surgeons and patients will realize that long hospital stays and recovery times are outdated,” Halawi says.

Engineering Cartilage

Though it is in the very early stages of development, UConn Health tissue engineer Syam Nukavarapu and his team have created a hybrid hydrogel system that they hope is the first step toward forming a hypertrophic cartilage template with all the right ingredients to initiate bone tissue formation, vascularization, remodeling, and ultimately the establishment of functional bone marrow to repair long bone defects.

How the more than 200 bones in an adult human skeleton form and how they are repaired if injured varies and has posed a challenge for many researchers in the field of regenerative medicine.

The cartilage template Nukavarapu and his team created appears to overcome hurdles that make it difficult for regenerative scientists to help the body’s long bones regenerate.

Two processes involved with human skeletal development help all the bones in our body form and grow. These processes are called intramembranous and endochondral ossification: IO and EO respectively.

While they are both critical, IO is the process responsible for the formation of flat bones, and EO is the process that forms long bones like femurs and humeri.

For both processes, generic mesenchymal stem cells (MSCs) are needed to trigger the growth of new bone. Despite this similarity, IO is significantly easier to re-create in the lab since MSCs can directly differentiate, or become specialized, into bone-forming cells without any additional steps.

However, this relative simplicity comes with limitations. To circumvent the issues associated with IO, Nukavarapu’s team set out to develop an engineered extracellular matrix that uses hydrogels to guide and support the formation of bone through EO.

“Thus far, very few studies have been focused on matrix designs for endochondral ossification to regenerate and repair long bone,” says Nukavarapu, who holds joint appointments in the departments of Biomedical Engineering and Materials Science and Engineering. “By developing a hybrid hydrogel combination, we were able to form an engineered extracellular matrix that could support cartilage-template formation.”

Nukavarapu’s team’s findings could be the first step to initiating the proper healing of long bones with biomedical help.

Using the Wisdom of Spider Webs

When someone breaks a load-bearing bone — the femur, for instance — doctors might install a metal plate to support the bone as it fuses and heals. But the metal can cause inflammation and irritation, and since metals are very stiff, the new bone may grow back weaker and more vulnerable to fracture.

UConn materials scientist and biomedical engineer Mei Wei and her team have developed an alternative to metal: a composite made with silk fibroin, a protein found in the silk fibers spun by spiders and moths and a common component in medical sutures and tissue engineering because of its strength and biodegradability.

Wei’s study found that the high-performance biodegradable composite showed strength and flexibility characteristics that are among the highest ever recorded for similar bioresorbable materials.

Working with UConn mechanical engineer Dianyun Zhang, Wei’s lab created a mix of silk and polylactic acid fibers coated in bioceramic particles. The new composite lasts about a year — large, adult leg bones can take many months to heal — and then starts to degrade. No surgery is required for removal.


Tissue engineer Syam Nukavarapu (left) examines a specimen of his hybrid hydrogel in his UConn Health lab.


Capturing the Power of Ultrasound

In the Department of Orthopaedic Surgery and the Institute for Regenerative Engineering at the UConn School of Medicine, researchers Yusuf Khan, Bryan Huey, and Lakshmi Nair are studying the combined power of gel-encapsulated bone cells and ultrasound waves to help fractured bones heal.

Physical force has been shown to stimulate bone cell regeneration for full healing, but immobilizing the fracture with a cast doesn’t allow for any movement. Khan believes that adding cells to the fracture site early on, and then directing a transdermal physical force toward the cells via low-intensity ultrasound, could accelerate fracture repair. In cases where a fracture can’t heal on its own, the therapy could provide the necessary stimulus to complete the healing process.

The team’s lab has already demonstrated the successful placement of bone cell hydrogels in mice and is working with the Department of Materials Science and Engineering to optimize the gel capsules for human use.

Harnessing Stem and Amniotic Cell Strength

Dr. Cato T. Laurencin, the Albert and Wilda Van Dusen Distinguished Professor of Orthopaedic Surgery and the director of the Institute for Regenerative Engineering at UConn Health, is developing clinical therapies to treat — and potentially reverse the effects of — osteoarthritis using human amniotic tissue, stem cells, and new combinations of the two.

An estimated 20 percent of Americans suffer from osteoarthritis, the most common degenerative joint disease and the leading cause of disability worldwide. Although current surgical and non-surgical therapies can provide some relief, none treat the root cause of the disease.

Stem cells have been proven to reduce pain and improve function in osteoarthritis patients. New studies suggest that the use of stem cells may heal cartilage, but results vary. Thanks to the host of powerful cytokines contained in amniotic tissue, many of which have been shown to decrease inflammation, Laurencin believes human amniotic tissue may overcome the limitations of current stem cell therapies, providing an ideal delivery system with added benefits.

“Soon, more surgeons and patients will realize that long hospital stays and recovery times are outdated.”

In its initial studies, Laurencin’s team has found its amnion-based delivery system can support stem cell survival, growth, and proliferation, and that the combination of amnion matrices and stem cells have immunosuppressive and anti-inflammatory effects on knee tissue cells.

“We believe amniotic tissue growth factors help drive human development and regeneration,” says Laurencin. “We are hopeful that harnessing this powerful new cell combination will help us further advance regenerative engineering for patients, especially those with arthritis or sports injuries, who want to avoid steroid treatments or are interested in next-generation therapies.”

Although it is not yet covered by insurance, amnion tissue treatment is available now to Laurencin’s patients. Laurencin’s team hopes to make the combination amnion¬stem cell therapy available within the next three years.

From the advanced research that’s changing the care of the future to the clinical changes happening now, Musculoskeletal Institute head Mazzocca says the Institute is uniquely positioned to provide the best possible care to patients.

“We try to take all the clinical people that treat musculoskeletal disease — rheumatology, osteoporosis, comprehensive spine, orthopaedics — and put it in one place, and combine them with all the researchers so they can cross-pollinate and make care better for the people of the state of Connecticut,” he says. “And there’s nobody else in the state of Connecticut that does what we do.”

Jessica McBride, Colin Poitras, and Lauren Woods contributed to this story.

Unraveling

By Kim Krieger | Illustrations by Yesenia Carrero

illustration; two silhouettes, one with a scribble pattern overlayed over top. looks to scribbled circular dot between them

PTSD can undo a sufferer’s life. MDMA may help patients untangle their trauma and find their way back to mental health.


When lasting trauma is caused by callous acts of violence, the key to recovery can be making meaning from meaninglessness.

This year UConn Health will host a phase 3 FDA trial that tests whether the drug MDMA, known on the street as ecstasy or molly, is a safe and effective treatment for post-traumatic stress disorder. The disorder is difficult to treat, and many people have a tough time handling the treatment. MDMA not only might make therapy more tolerable but it also may help open a window for patients into their own mind. The insight allows them to process a shattering, horrific event into something that makes them stronger.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders defines post-traumatic stress disorder, or PTSD, as when a person is traumatized in some way and then continues to reexperience the trauma through flashbacks, nightmares, or unwanted intrusive memories. The person with PTSD avoids people or places associated with the trauma; becomes overly negative in thoughts and speech about themselves and other people; and has heightened arousal that can include a hair-trigger startle reflex, inability to sleep, hypervigilance, irritability, and aggression. At its worst, people are unable to cope with everyday life and may even become suicidal.

Often the source of the trauma is a shocking event involving interpersonal violence, such as rape, combat, or sexual abuse. Racial discrimination and harassment, particularly when it is shocking or pervasive, can also cause PTSD. UConn psychologist Monnica Williams began focusing on race-based trauma when she was at the University of Pennsylvania and had a very successful, high-achieving, black client come in with PTSD stemming from racial discrimination she’d suffered on the job. Williams was taken aback and began studying the link between racism and post-traumatic stress disorder.

Deconstructing the Trauma

But no matter what type of trauma causes the PTSD, the most effective treatment for it is exposure-based therapy, such as “prolonged exposure.” Essentially, the therapist has the patient discuss the traumatic event in excruciating detail, over and over again, until it ceases to cause overwhelming fear and anxiety.

Prolonged exposure works — indeed, it has the most evidence behind it. But it’s terribly difficult for the patients, who often get visibly upset during sessions, and many quit therapy because the experience is too much like the original trauma.

The MDMA-assisted therapy session was utterly without the distress, tension, and fear PTSD patients typically show during prolonged exposure treatment.

MDMA-assisted psychotherapy could be one way to change that. The drug stimulates the release of neurotransmitters that promote a feeling of trust and well-being and might also help the brain rewire itself. But when Williams first heard of it, she was skeptical.

“It sounded weird, like junk science, and I didn’t want to be part of that,” she says. But she agreed to take a look at an article in Psychopharmacology. She was fascinated to see that researchers had used MDMA as an adjunct to psychotherapy for PTSD and had gotten really good results. She was pleasantly surprised again when she first watched a video of an MDMA-assisted therapy session.

“People were sitting in a chair, relaxed. They’re processing it on their own, and would sometimes share new insights with the therapist,” Williams says. It was utterly unlike the distress, tension, and fear PTSD patients typically show during prolonged exposure. “They would say things like, ‘Wow. Now I understand the trauma didn’t happen to me because I’m a bad person — I was just in the wrong place at the wrong time.’ And we’re like, ‘Yes! Yes! They finally get it!’” she recalls. The MDMA helps them look at the big picture, to understand that the violence against them didn’t mean what they thought it had.

‘It’s got to come out’

It takes a while for psychoactive drugs to work their way through the FDA approval process. MAPS has been testing MDMA-assisted therapy for PTSD for more than a decade. Many of the early participants experienced lasting improvement.

Rachel Hope, who experienced a cascade of abusive events as a child that left her with severe PTSD, “did 20 years of psychotherapy” prior to participating in an MDMA-assisted therapy session. “When I got into the outer limits of the really hardcore stuff, I’d start to destabilize and get sicker … I’d start vomiting or have to leave the room. I knew that I had to tell it — the story has a soul of its own. It’s got to be seen, got to be known. It’s got to come out. But I couldn’t get it out,” she says.

Hope had had good therapists and managed to run a real estate development company, but eventually the PTSD got so bad she couldn’t leave the house. Finally her personal assistant threatened to quit if she didn’t go back into therapy. And that’s how she came to participate in an MDMA-assisted psychotherapy trial in 2005. It was a revelation.

“The MDMA was a terrific antianxiety medicine,” she says; it didn’t make her fuzzy-headed like most antianxiety meds had. “It amplified access to memories and, really, I had access to everything, and I wasn’t terrified. I could actually tell someone, for the first time in my life, what had happened to me. I had so much access to my own mind.” She describes it as the perfect tool to help work through the trauma. “I was rebooting my mind under my own directive,” Hope says.

“They would say things like, ‘Wow. Now I understand the trauma didn’t happen to me because I’m a bad person — I was just in the wrong place at the wrong time.’ And we’re like, ‘Yes! Yes! They finally get it!’”

Williams agrees that the MDMA seems to help patients rapidly make connections and breakthroughs in a single therapy session. Typically, a patient in psychotherapy might have just one such realization every few months.

The participants in the phase 3 trial at UConn Health will have a total of 20 therapy sessions, three of which will include MDMA. Each session will have two therapists present. The MDMA-assisted sessions will be six to eight hours long, after which the participant will stay overnight in the hospital to rest, supervised by a night attendant. And as part of the effort to involve participants from communities of color, all but one of the therapists at UConn Health identifies as an ethnic, racial, and/or sexual minority.

“In Singapore, I was part of the majority, but I was curious how it felt to be Malay, Indian, or one of the other minorities,” says Terence Ching, a clinical psychology doctoral student involved in the study. Ching has also lived in Australia, New Zealand, and Kentucky, where he was not part of the majority ethnic group. “That led me to critically introspect my place in society as someone with many different identities. Having that multifaceted perspective allows me to experience a lot of empathy for people from marginalized groups in the U.S.,” Ching says.

To get a better understanding of what the MDMA-assisted psychotherapy would be like for study participants, Ching participated in a session himself as part of his training.

“It felt like a lot of insights happening constantly,” Ching says. “It’s been a year since the session, and every now and then I have a moment where I remember an insight from it, and/or have another one. It’s a wonderful thing.” Ching hopes that the participants benefit from their MDMA-assisted psychotherapy in the same way he did.

“For someone who has experienced trauma, MDMA-assisted psychotherapy might help them be able to make meaning of it. I really believe in this work,” Ching says.

New Neuroscience Chair Establishes UConn’s First Alzheimer’s Lab

a digital rendering of orange amyloid plaque on blue healthy neurons.

In this rendering, healthy neurons afflicted with amyloid plaques are colored orange. Studies suggest this plaque leads to cognitive decline in patients with Alzheimer’s.


Internationally recognized neurodegenerative disease researcher Riqiang Yan, Ph.D., joined the UConn School of Medicine this spring as chair of the Department of Neuroscience. He has established the medical school’s first research laboratory dedicated to studying and discovering new treatments for Alzheimer’s disease and other neurodegenerative diseases.

Prior to his appointment, Yan served as the Cleveland Clinic’s Morris R. and Ruth V. Graham Endowed Chair Professor and Vice Chair of Neurosciences and professor of molecular medicine at Case Western Reserve University. His five studies that focus on identifying the biological culprits behind Alzheimer’s disease are funded by the National Institutes of Health (NIH).

Yan’s studies build upon his co-discovery of the BACE-1 protein, the critical molecule that he revealed fuels the production of β-amyloid peptides, or plaque buildup, in the brains of Alzheimer’s disease patients. Studies suggest that these peptides are toxic and lead to cognitive decline in patients with Alzheimer’s.

Yan and his team are currently testing in mouse models the power and safety of several promising molecules to target BACE-1 and inhibit its biological function in order to prevent or stop further β-amyloid growth. Just before he arrived at UConn Health, Yan’s team published significant findings in the Journal of Experimental Medicine that showed that removing the BACE-1 enzyme in adult mice with Alzheimer’s reverses the plaque formation that inhibits cognitive function. The study was widely covered by national media.

In addition, Yan and his team are gaining greater insight into the important role reticulon 3 protein (RTN3) plays in the formation of dystrophic neurites in the brain, which can lead to memory loss, dementia, and Alzheimer’s disease in the elderly. The Yan lab is also exploring treatment that aims to enhance neurogenesis to replenish the loss of brain cells in patients with Alzheimer’s and other neurodegenerative diseases.

“We welcome Dr. Yan to UConn School of Medicine and Connecticut, as he and his research programs are very highly respected by leaders and other scientists in the field,” says Dr. Bruce T. Liang, dean of UConn School of Medicine.

Yan’s recruitment brings with it a host of research collaboration opportunities across the School of Medicine and its departments of Neurology, Neurosurgery, and Psychiatry; with the UConn Center on Aging; with neurobiology and brain investigators at the University; as well as with the Jackson Laboratory for Genomic Medicine on UConn Health’s campus.

“I look forward to working with my colleagues at UConn to expand creative research in neurosciences,” says Yan, who earned his Ph.D. from the University of Kentucky and completed a postdoctoral fellowship at The Rockefeller University. “It is my passion and desire to mentor our talented UConn neuroscientists and staff and watch their lists of research, discoveries, and accomplishments grow even greater, along with more national recognition of their efforts.”

He adds: “We all have a hope that in 5 to 10 years, with academia collaborating with pharmaceutical companies, we will indeed have an effective drug to finally treat Alzheimer’s disease.”

There has not been an FDA-approved drug to try to treat the disease since 2002, Yan says. “It’s our big hope, and we will continue to try hard at UConn to discover and test a new, effective drug therapy to make this hope a reality to help those struggling with Alzheimer’s and ease the burden of future patients and their families.”

Class of 2009 Med Students Return to Practice at UConn Health

Class of 2009 reunite. From left: Dr. Sara Tabtabai, Dr. Ben Ristau, Dr. Todd Falcone, and Dr. Marilyn Katz

From left: Dr. Sara Tabtabai, Dr. Ben Ristau, Dr. Todd Falcone, and Dr. Marilyn Katz


TThe UConn School of Medicine graduating class of 2009 is experiencing a mini-reunion at UConn Health, with five doctors from the class now practicing here.

Dr. Todd Falcone (ear, nose, and throat), Dr. Marilyn Katz (internal medicine), Dr. Ben Ristau (urologic oncology), Dr. Sara Tabtabai (cardiology), and Dr. Rafael Pacheco (radiology) came back with fond memories of their time as UConn medical students.

Katz says she knew the UConn School of Medicine was a match right away. “I loved everyone I met on my interview day — students, faculty, and staff — and canceled all my other interviews once I received my acceptance.”

Falcone joined UConn Health in 2014. “I had an excellent time here, and I credit the School of Medicine for preparing me to match into a competitive residency program and become a competent and caring physician and educator. I do not believe I could have received a better medical school education anywhere else.”

The five physicians say their medical school connections help them deliver better patient care today. “Rafael Pacheco and I were medical interns together as he was doing his prelim year prior to radiology,” Katz shares. “It was great to discuss similar patient cases with him then, and knowing I can call him now to discuss testing is a huge benefit as a primary care physician.”

Hybrid OR Expands Surgical Capabilities


This spring, neurosurgery chief Dr. Ketan Bulsara and his team were the first to perform surgery in UConn John Dempsey Hospital’s 1,200-square-foot hybrid operating room.

The team leveraged the new high-tech room and its dual advanced X-ray imaging capabilities to guide a successful minimally invasive neurological procedure.

“There are not many biplane hybrid operating rooms in the United States, and there are only a handful along the East Coast,” says Bulsara. “The biplane imaging provides surgeons multiple views and not only makes patient care safer but also allows surgeons to do things that we could not ordinarily do inside the operating room.”

The hybrid room gives surgeons the ability to perform a range of procedures in one setting, from minimally invasive treatments to the most complex neurosurgery, interventional cardiology, and vascular procedures.

“The hybrid operating room allows surgeons to choose what they feel is the best treatment for that patient,” says Bulsara.

According to Bulsara, the hybrid room enables UConn Health to continue providing world-class care to its patients while shaping the future of surgery and medicine and optimizing the personalized care given to each individual patient.

The hybrid operating room is a new tool for us that allows us to deliver health care in ways we have never been able to before.

UConn Health’s Dr. Stephen Lahey, chief of the Department of Cardiothoracic Surgery, says he couldn’t agree more.

“The hybrid operating room enables us to deliver health care in ways we have never been able to before,” says Lahey. “We now have all the advanced radiological equipment inside a huge operating room.”

All the high-tech equipment in the hybrid OR hangs from the ceiling, including imaging equipment, large plasma screens, and LED boom lights that assist surgeons with brighter and sharper lighting of the surgical field. A high-resolution video system provides real-time video and photo imaging during surgery for direct communication with the Department of Pathology or teleconferencing and live broadcasts of surgery for physician training and medical education.

For Anxiety, Single Intervention Is Not Enough

illustration on the concept of anxiety. Features a male with hands held to forhead in slumped possition. Mans face is scribbled.


No matter which treatment they get, only 20 percent of young people diagnosed with anxiety will stay well over the long term, UConn Health researchers report in the Journal of the American Academy of Child and Adolescent Psychiatry.

“When you see so few kids stay non-symptomatic after receiving the best treatments we have, that’s discouraging,” says UConn Health psychologist Golda Ginsburg. She suggests that regular mental health checkups may be a better way to treat anxiety than the current model.

The study followed 319 young people aged 10 to 25 who had been diagnosed with separation, social, or general anxiety disorders at sites in California, North Carolina, Maryland, and Pennsylvania.
They received evidence-based treatment with either sertraline (the generic form of Zoloft) or cognitive behavioral therapy or a combination of the two and then had follow-ups with the researchers every year for four years.

The follow-ups assessed anxiety levels but did not provide treatment. Other studies have done a single follow-up after one, two, five, or 10 years, but those were essentially snapshots in time. This is the first study to reassess youth treated for anxiety every year for four years.

We need a different model for mental health, one that includes regular checkups.

The sequential follow-ups meant that the researchers could identify people who relapsed, recovered, and relapsed again as well as people who stayed anxious and people who stayed well. They found that 20 percent of patients got well after treatment and stayed well, rating low on anxiety at each follow-up. But about half the patients relapsed at least once, and 30 percent were chronically anxious, meeting the diagnostic criteria for an anxiety disorder at every follow-up. Females were more likely to be chronically ill than males. Other predictors of chronic illness were experiencing more negative life events, having poor family communication, and having a diagnosis of social phobia.

On the bright side, the study found that young people who responded to treatment were more likely to stay well. The study also found no difference in long-term outcomes between treatment types. This means that if there is no cognitive behavioral therapist nearby, treatment with medication is just as likely to be effective.

The study also found that kids did better if their families were supportive and had positive communication styles. Parents should talk to their child and ask the therapist questions: Why do they suggest this treatment? (It should be supported by evidence.) Have they been trained in cognitive behavioral therapy? How can we reinforce what was learned in therapy this week?

But parents should also be aware that a single intervention may not be enough.

“If we can get them well, how do we keep them well?” says Ginsburg. “We need a different model for mental health, one that includes regular checkups.”

Enhancing Delivery of Care with UConn HealthOne

UConn Health ONE - one place. One Record. One Reason. You.


UConn Health’s new integrated electronic health record (EHR), UConn HealthOne, launched this spring, making patient records easily accessible to all members of care teams and to the patient.

HealthOne represents a technological, clinical, and operational transformation aimed at enhancing the patient experience. At its heart is an EHR platform, powered by health care software company Epic, that facilitates collaboration, knowledge-driven care coordination, and continuous improvement.

The integrated EHR takes most paper — and the turnaround times associated with paper — out of the clinical process, making provider notes available in real time and lab and test results available quickly. For providers, that means a seamless flow of information following the patient throughout their encounter not only with UConn Health but also with other health care systems through HealthOne’s interoperable Care Everywhere tool. All members of a care team, including referring physicians, will have access to the same up-to-date patient information at the same time.

Patients using HealthOne get more efficient care and can access their test results and other health information at any time. Through myHealthOne, the new, secure online portal, patients can access tools they can use to message their care team, request prescription refills, and manage appointments.

Bridging the Health Care Gap

Q&A with Wizdom Powell, director of the UConn Health Disparities Institute

Q

What are your top priorities for the Health Disparities Institute (HDI) at UConn Health as you begin your second year as director?

During my first nine months, HDI underwent an internal, strategic refocusing process. This process involved conducting an organizational 360-degree assessment and reviewing state-level data on health disparities outcomes and populations. It resulted in the identification of four complementary strategic focus areas: health systems change, utilization, and finance; behavioral health; chronic disease prevention and control; and neighborhoods, housing, and health.

HDI is committed to advancing health equity and works explicitly to connect, support, and serve populations at greatest risk for poor health and social outcomes. These goals are accomplished by generating rigorous evidence for action, building multisector coalitions, translating data for policy impact, and accelerating community-sourced innovations. We apply an explicit racial equity lens to our work. We value social justice, youth engagement, and the power of art to amplify community voice and disrupt single stories about the truly underserved.


Q

What initiatives has HDI put in place or advanced in the past year, and how are they helping people?

Boys and men of color (BMoC) in our nation are uniquely underserved across a number of health indicators. Currently, HDI is developing several initiatives designed to address social determinants of health, well-being, and health equity among BMoC. Recognizing this critical gap, the HDI has established a multisector alliance composed of private, public, academic, and community leaders to provide high-level strategic guidance and accelerate systems change for BMoC in Connecticut. HDI recently launched a series of overlapping research, policy translation, and programmatic initiatives focused on advancing health equity for boys and men of color in the state.


Q

What can physicians do to better serve men and boys?

I think it is important for health care providers to be aware of the gendered help-seeking barriers men and boys experience. Such barriers include shared cultural norms and values that discourage men from disclosing vulnerability and distress. These norms may lead some men to avoid health care altogether or “watch and wait” even when health symptoms are present. It is important for health care providers to maximize appointments with men and boys, for example, by screening for behavioral health symptoms during a primary care visit.


Q

Recently, public figures like Jay-Z and NBA star Kevin Love have spoken out about mental health struggles and the stigma surrounding them. Are we on the verge of a sea change? What more needs to be done on a cultural and policy level?

It is always encouraging when public figures leverage their influence to promote mental health awareness. They have a bigger platform than scientists and far fewer structural constraints on their media engagement. In my more than a decade in the men’s health space, I have witnessed ebbs and flows in the scientific and public discourse about these issues. We are definitely in a flow period. To achieve a sea change, we also need to change systems, culture, and policy.

We certainly need mental health parity in the way we pay for services. A lot could be accomplished by the systemwide integration of behavioral and primary care services. We would also benefit tremendously from changing norms. Men and boys (and the women and girls who love them) would be healthier if they had fewer social sanctions around displaying emotional vulnerability. We encourage men and boys to be strong, stoic, and silent. If we are going to have a real sea change, those norms have to be disrupted.

A Team Approach Improves Lung Cancer Care

illustration; team of people overlook blue lineart in the shape of a human lung


As director of thoracic oncology and interventional pulmonology at UConn Health, Dr. Omar Ibrahim has been working hard to personalize and improve the experience of lung cancer patients.

“As a result of enhancing individualized care, the number of lung cancer patients UConn Health cares for has been rapidly increasing,” says Ibrahim. “We have immensely improved a patient’s time to diagnosis and treatment, as well as the overall quality of care they receive. Plus, our program’s advanced diagnostic imaging and rapid-sequence genetic testing has allowed us to get patients proper therapy in the most effective way possible.”

According to Ibrahim, UConn Health is one of a few institutions in the Northeast to consolidate how they care for lung cancer patients.

“Rather than having patients visit multiple physicians in different locations on our campus, we focus all our care for lung cancer patients in one multidisciplinary clinic,” says Ibrahim, who led the specialized clinic’s development. “This allows for ease of care and greater patient satisfaction and increases the patient’s knowledge.”

We have immensely improved a patient’s time to diagnosis and treatment, as well as the overall quality of care they receive.

The biggest risk factor for lung cancer, which kills more Americans than breast, colon, and prostate cancers combined, is smoking. Ibrahim passionately urges current and former heavy smokers to get screened for the disease with a low-dose computed tomography (CT) scan at UConn Health’s Lung Cancer Screening Program at the Carole and Ray Neag Comprehensive Cancer Center.

“Our goal is to find lung cancer at its earliest stage so we can have options to treat it and cure it,” Ibrahim says.

If a low-dose CT scan catches a suspicious lung nodule or growth, Ibrahim leverages minimally invasive techniques to rule out lung cancer, or diagnose and identify what stage the disease is at. He uses video-guided 3-D navigational bronchoscopy technology and ultrasound in the exam room to closely examine a patient’s lung tissue using a thin, flexible tube via the nose or mouth. The technology also allows for small lung tissue biopsy samples to be taken.

But Ibrahim is not only proud of improving his patient’s experience and outcomes.

“What I am truly proud of is the team effort of everyone involved with a lung cancer patient’s care, from the staffer greeting them at the door to the nurse infusing their chemotherapy. They all are doing an immense job.”

Lab Notes – Summer 2018

Gout Drug Increases Risk of Death in Some

A study of gout patients taking one of two medications used to prevent excess buildup of uric acid has linked the drug febuxostat to an increased risk of death for users with heart disease when compared to the medication allopurinol. In contrast, the study found no difference between the two medications when considering the risk of nonfatal coronary events, including hospitalizations for heart failure, arrhythmias, pulmonary embolism, myocardial infarction, or stroke. The findings of the trial (commonly referred to as the CARES trial), led by UConn School of Medicine’s Dr. William B. White, were released at the American College of Cardiology’s 67th Annual Scientific Session and published in the New England Journal of Medicine. Previously, no cardiovascular clinical trial has ever demonstrated an increased risk of cardiovascular death without also showing a heightened risk of other cardiovascular outcomes.


Prostate Medication Ups Dementia Threat

Tamsulosin

Tamsulosin, a medication prescribed to treat benign prostatic hyperplasia (BPH), may increase the risk of dementia in men ages 65 or older, a recent UConn study published in Pharmacoepidemiology and Drug Safety found. The risk of developing dementia increased by as much as 17 percent when compared to similar patients who were not taking any medication to treat BPH. According to Dr. Helen Wu of the Connecticut Institute for Clinical and Translational Science and UConn Health, tamsulosin may also quicken the decline of those with early memory loss.


New Compound Stimulates Immune Response Against Cancer

A new synthetic compound created by a team of top immunologists, molecular biologists, and chemists has proven to be highly effective in activating human invariant natural killer T cells (iNKT). The compound called AH10-7 also causes the cells to release a specific set of proteins that stimulate anti-tumor immunity. One of the limitations of earlier compounds was their tendency to cause iNKT cells to release a rush of different cytokines with conflicting immune responses. The study, led by UConn chemistry professor Amy Howell, Ph.D., was published in Cell Chemical Biology. The findings could lead to more effective cancer treatments and vaccines.


Type of Dwarfism Linked to Infertility

human egg and sperm

UConn Health cell biologists Laurinda Jaffe and Leia Shuhaibar were studying fertility when they noticed unusually long bones in their mice. Upon further examination, they discovered that a mutated gene for the NPR2 enzyme, which controls how eggs mature in the ovaries, blocks an enzyme called the fibroblast growth factor receptor, resulting in abnormally long bones. In contrast, the fibroblast growth factor receptor is always “on” in individuals diagnosed with achondroplastic dwarfism, causing decreased bone growth and shortened limbs. The study, funded in part by the NIH and published in eLife, may lead to new drug therapies to treat achondroplasia.