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UNC leverages clinical data to improve bariatric patient care

The UNC Health Care System (UNCHCS) is part of an effort to determine the best ways to perform surgery for obesity. Working with a national collaboration, we are examining weight loss outcomes of bariatric surgery as part of a consortium that can efficiently and securely examine tens of thousands of patient records. Sponsored by the Patient Centered Outcome Research Institute (PCORI), the effort will provide needed information to patients and their physicians regarding the best type of surgery for a given individual.

Jessica Craddock, a patient who knows firsthand what it is like to have this kind of surgery, shares that "Bariatric surgery has the promise of not only changing people's lives but saving them as well. In under a year and a half I have lost nearly 300 lbs., and am cured of uncontrollable diabetes and hypertension. My arthritis and psoriasis are all but gone and my quality of life is what it should be for a 26 year old female."

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Starting the conversation to improve diabetes care

Anna Kahkoska and Nick Brazeau
Anna Kahkoska and Nick Brazeau

Anna Kahkoska and Nick Brazeau, students in UNC’s MD-PhD program, have developed an innovative approach to patient care at the Open Door Clinic, a free clinic in Burlington staffed by students from the UNC School of Medicine, Elon University, and Alamance Community College that treats a large number of patients with diabetes.

In North Carolina, 1 in 10 people have diabetes. That includes a large number of patients at the Open Door Clinic, a free, student-run clinic in Burlington staffed by volunteers from Elon University, Alamance Community College, and the UNC School of Medicine. Two years ago, Anna Kahkoska and Nick Brazeau took a direct leadership role in the Diabetes Maintenance and Prevention Program, where they were responsible for coordinating a monthly Endocrinology clinic for patients with diabetes referred from the general clinic for specialized care.

What started as a way to do some good in the community while also gaining valuable clinical skills quickly morphed into something much larger. When they began working at Open Door, Brazeau said the continuity of care was lacking. Patients would come to clinic one month, and then miss several subsequent visits due to changes in work hours, childcare responsibilities or other issues. When they did come back, they were frustrated with long waits.

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Tackling Human Brain Tumors by First Growing Them in a Dish

UNC and Duke researchers receive CTSA Consortium Collaborative Pilot Award to develop a new way to study cancer

Dr. Donald Lo (left) & Dr. Al Baldwin (right).

For doctors and patients, the fight against cancer can be a lot like an exceedingly tricky version of the classic arcade game of whack-a-mole. You might beat back a tumor or part of a tumor, only to have another one pop up. To make matters worse, the "mallet" or treatment that successfully whacks the first tumor cells doesn't always work on those arising later. You might need a new strategy or even an entirely different drug. It's a tough game to win.

The reason it is often unsuccessful to apply a singular approach to beating cancer is that cancer cells evolve and change over time as cells divide and tumors expand. That ever-changing, increasingly heterogeneous nature of cancer has been a particular problem in effectively treating glioblastoma multiforme, a common and aggressive form of brain cancer. Even when treated with cancer-fighting drugs, only one out of three patients with glioblastoma multiforme are alive two years after their diagnosis.

"There might be a drug that works against the founding mutation in a tumor, but now this branch diverged and might then show resistance," explained Albert Baldwin, Professor and Associate Director of Basic Research at University of North Carolina at Chapel Hill's Lineberger Comprehensive Cancer Center.

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Peer support makes all the difference for diabetic patients

When University of North Carolina MD/PhD students Nick Brazeau and Anna Kahkoska volunteered at the Open Door Clinic, which provides free medical care to residents of Alamance County who do not have health insurance, they were surprised to see just how many patients with diabetes were unable to control their blood sugar levels. Brazeau was taken aback by the overwhelming challenges patients faced even though they desired to be healthy.

Fellow Anna Kahkoska, Open Door Clinic Director Tracy Salisbury, and Fellow Nick Brazeau
Fellow Anna Kahkoska, Open Door Clinic Director Tracy Salisbury, and Fellow Nick Brazeau

"Many of them are limited by time, resources, and even access to necessary medications and health care," said Brazeau, who is a doctoral student in the Department of Epidemiology in the UNC Gillings School of Public Health. "These barriers are immense and often seem insurmountable, which speaks to the tenacity and capacity of patients who strive to overcome them."

The students wanted to change the entire clinic structure by transitioning from individual appointments to shared medical appointments so they applied to the Schweitzer Fellowship to implement their vision. The process involved collaboration from the clinic directors, the visiting endocrinologists, and all of the students who work at the clinic, including undergraduate students, PA students, and pharmacy residents. After almost a year of running shared medical appointments, they are seeing great signs of improvement among patients in their clinic.

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Michelle Maclay, Communications Director