The Virginia Commonwealth University Medical Center has received the American Stroke Association's Get with the Guidelines -Stroke Silver Performance Achievement Award.

The award recognizes the VCU Medical Center's commitment and success in implementing a higher standard of stroke care by ensuring that stroke patients receive treatment according to nationally accepted standards and recommendations.

The award is meant to acknowledge the importance of time. VCU Medical Center has a system for rapid diagnosis and treatment of stroke patients admitted to the emergency department.

To receive the award, the VCU Medical Center consistently complied for a year with the requirements in the Get with the Guidelines- Stroke program. These include aggressive use of medications for stroke care, cholesterol reduction and smoking cessation. VCU Medical Center will continue with self-evaluations to ensure the 85 percent compliance level needed to sustain the award.

According to the American Stroke Association, each year approximately 795,000 people suffer a stroke -- 610,000 are first attacks and 185,000 are recurrent. This condition accounts for one out of every 18 deaths in the United States.

See VCU News Release.

Studies and an editorial published in today's Annals of Internal Medicine suggest that mammograms are not beneficial to women ages 40 - 49. These reports contradict volumes of science with regards to mammography's proven record of saving and extending lives.

Gilda Cardeñosa, M.D., director of breast imaging at Virginia Commonwealth University Medical Center and a world-class clinician, researcher and medical textbook author, has thoroughly reviewed the reports and provides important insight on this topic. She is also a key member of the Breast Health Center at VCU Massey Cancer Center.
Dr. Cardeñosa's Statement:

The current best standard of care for women ages 40 - 49 who are at average risk for breast cancer is to get annual screening mammograms.

A new report runs counter to the scientific information that the worldwide breast imaging research community has acquired over the last several decades. The report relies on computer models for its data and includes many assumptions.

The gold standard for medical research is through clinical trials on human subjects in which one group of participants are randomly assigned a treatment or procedure, and another group, the control group, is not.

Data from seven randomized clinical trials have demonstrated that screening mammography in women ages 40 - 74 reduces breast cancer mortality. For the 50 years prior to the introduction of mammography in 1990, breast cancer mortality rates were flat. Since routine screening guidelines were adopted in the United States in 1990, we have seen mortality from breast cancer decrease by 30 percent.

I join many other physicians, researchers and breast cancer awareness advocates in urging women to not be alarmed by this new report, and to continue to get annual mammograms.

For additional information or to see a video of Dr. Cardenosa addressing this topic, visit http://www.vcubreastimaging.com.

See VCU News Release.

Virginia Commonwealth University Medical Center and the Richmond Ambulance Authority have improved resuscitation and survival rates dramatically for cardiac arrest patients by training and equipping paramedics to begin lowering a patient's body temperature in the field during resuscitation and following up at the hospital with a host of high-tech strategies to improve the odds of survival.

The VCU and RAA initiative, known as the Advanced Resuscitation Cooling Therapeutics and Intensive Care Center, or ARCTIC, is the most comprehensive program of its kind in the United States, and its strategy resulted in an almost two-fold improvement in the return of spontaneous circulation, from 25 percent in 2001 using conventional treatments to 46 percent in 2008. In turn, the survival rate to hospital discharge improved from 9.7 percent in 2003 to 17.9 percent at the end of 2008. The national average is less than 7 percent.

ARCTIC has two goals: to restart the heart as quickly as possible following onset of cardiac arrest, and to protect the brain by starting cooling as early as possible and bringing resuscitated patients to a single specialized post-resuscitation facility. Between 2001 and 2008, the team evaluated 1,598 cases of adult, out-of-hospital cardiac arrest events in Richmond, Va., and concluded that a building block strategy comprised of a unique combination of mechanical chest compressions, airway management, drugs that restart the heart, and cold saline given during resuscitation prior to the return of spontaneous circulation, sequentially improved patient outcomes.

"What we now know is that we have to protect the brain and vital organs during resuscitation and after the heart is restarted and this has led to a totally new strategy for how we treat cardiac arrest patients," said Joseph P. Ornato, M.D., chair in the Department of Emergency Medicineat the VCU School of Medicine and operational medical director of the Richmond Ambulance Authority.

"Richmond Ambulance Authority paramedics are the first in the country to initiate the cooling process during resuscitation. RAA's treatment strategy includes using a combination of drugs given early to support circulation and restart the heart, and performing high quality CPR using a mechanical device - available in all RAA ambulances - that squeezes the chest to achieve better blood pressure and oxygen delivery than that achieved with just standard CPR," he said.

"The Richmond Ambulance - VCU Medical Center partnership is so successful because it provides a continuum of care for the cardiac arrest patient from the time the 911 call is received until the patient walks out of the hospital. We are constantly sharing and assessing detailed data to improve the clinical and operational process, and the dramatic increase in our survival rate reflects this," said Chip Decker, chief executive officer of the Richmond Ambulance Authority.

Decker continued, "The EMS system in the city of Richmond is a team approach between the Richmond Ambulance Authority and Richmond Fire Department, with Fire as first responder, and it works extremely well. Our rapid response times, combined with leading-edge clinical protocols like the cooling process implemented under Dr. Ornato's guidance, have enabled us to deliver a more viable patient to VCU."

VCU Medical Center is continuously staffed with a team of specially trained physicians and nurses experienced in post-resuscitation care who continue the rapid cooling process by placing a high-tech plastic coil into a large vein soon after arrival at the emergency department. Patients are treated by specially trained coronary care unit nurses and physicians who administer complex "goal-directed" treatment protocols and maintain the patient's body temperature at 93° F for at least 24 hours, following which the patient is gradually rewarmed in a computer-controlled sequence.

In previous work, researchers have found that patients who undergo controlled hypothermia using simple techniques such as cooling blankets and ice packs, have a better chance of brain recovery and survival following cardiac arrest than those whose body temperature is not lowered. However, such techniques are crude and often result in large temperature swings. The catheter technique used at VCU allows precise control of the cooling and rewarming process in an attempt to minimize brain injury following the cardiac arrest. The comprehensive ARCTIC approach is showing greater benefit than that which was seen using just conventional resuscitation and simple cooling techniques alone.

"One of the novel things about VCU's ARCTIC program is that we have been able to seamlessly incorporate the care of the cardiac arrest patient from the time they arrest in their home to the time they return home with good neurologic survival," said Mary Ann Peberdy, M.D., Professor of Medicine and Emergency Medicine in the Division of Cardiology at the VCU School of Medicine.

"We have been able to develop a partnership with our EMS system as well as our referring hospitals and initiate therapies that are unparalleled in the country. The care that this multidisciplinary team provides gives patients better outcomes than we have seen with traditional cooling alone," she said.

The team presented their findings on Nov. 14 and 15 during the Resuscitation Science Symposium at the American Heart Association Meeting in Orlando, Fla.

In a second study of 181 consecutive, out-of-hospital cardiac arrest patients who were successfully resuscitated in the field and brought to VCU from various EMS agencies or other hospitals throughout Central Virginia between 2001 and 2009, the study showed survival to hospital discharge was 19% in 2001-3 when standard post-resuscitation care was provided. It increased to 38% in 2004-7 when simple cooling techniques were added, but further improved to 49% in 2008-9 using the full ARCTIC strategy.

Additionally, patients whose cardiac arrest was caused by the abnormal rhythm, ventricular fibrillation (VF), now have a 72% chance of surviving to hospital discharge if treated in the ARCTIC program. The aggressive ARCTIC treatment also improved the neurological outcomes for VF patients over simple cooling alone.

Additional Background

Cardiac arrest is a condition in which the heart suddenly stops beating, most commonly due to a rhythm disturbance known as ventricular fibrillation (VF). Within 10-20 seconds, the brain and other vital organs are deprived of oxygen, and the victim collapses to the ground unconscious and pulseless. Delivering an electrical shock to the heart promptly with a defibrillator can often start it beating again, but a defibrillator is not often available immediately. Cardiopulmonary resuscitation (CPR) can provide life sustaining blood flow and oxygen delivery to vital organs until trained rescuers can arrive and administer standard resuscitation techniques such as defibrillation, drug therapy, and other treatments. Unfortunately, survival from out-of-hospital cardiac arrest averages only 6-7%, claiming the lives of approximately 350,000 Americans each year using standard techniques. In many communities, paramedics can initially resuscitate cardiac arrest victims, but the majority will never regain consciousness and die due to brain injury.

It has long been thought that the brain can only survive without blood and oxygen for 4-6 minutes before irreversible damage occurs. That is now known to be incorrect. Brain cells begin to show signs of abnormal function soon after they are deprived of oxygen, but recent studies show that permanent damage begins after the heart restarts and oxygen returns to the brain. The cells try to consume the oxygen, but their injured machinery converts the oxygen into poisonous chemicals called "free radicals" which kill the cells. Cooling the brain as quickly as possible, ideally before the heart even restarts, slows its metabolism so it can't generate a large quantity of "free radicals". Maintaining precise temperature control for 24 hours and rewarming gradually using the catheter device is designed to prevent large swings in the body temperature which can result in a surge of metabolism and "free radical" production.

See VCU News Release.

Virginia Commonwealth University announced today that it has received a $100,000 Grand Challenges Explorations grant from the Bill & Melinda Gates Foundation.

The grant will support an innovative global health research project conducted by Luiz Shozo Ozaki, Ph.D., associate professor in VCU Life Sciences' Center for the Study of Biological Complexity. The project is called "Bacterial viruses as tool for blocking transmission of the malaria parasite."

Ozaki's project is one of 76 grants announced late Tuesday by the Gates Foundation in the third funding round of Grand Challenges Explorations, an initiative to help scientists around the world explore bold and largely unproven ways to improve health in developing countries. The grants were provided to scientists in 16 countries on five continents.

To receive funding, Ozaki showed in a two-page application how his idea falls outside current scientific paradigms and might lead to significant advances in global health. The initiative is highly competitive, receiving almost 3,000 proposals in this round.

"The winners of these grants show the bold thinking we need to tackle some of the world's greatest health challenges," said Dr. Tachi Yamada, president of the Gates foundation's Global Health Program. "I'm excited about their ideas and look forward to seeing some of these exploratory projects turn into life-saving breakthroughs."

Ozaki and Gail Christie, Ph.D., a professor in the Department of Microbiology and Immunology, will genetically engineer bacterial viruses (phages) to express inhibitors of the malaria parasite in the mosquito gut upon phage infection of gut bacteria, and test the engineered phages as a biological tool for controlling the transmission of the disease.

"The award is important in that it will enable us to contribute one more gun for the arsenal to combat malaria, which at this moment is tiny," Ozaki said. "This tool will be first tested with malaria and if efficient, it will be adapted to other diseases that are transmitted through an invertebrate vector such as Lyme disease transmitted by ticks, leishmaniasis transmitted by sand flies, filariosis transmitted by mosquitoes, babesiosis transmitted by ticks, just to name a few."

Gregory Buck, Ph.D., director of VCU's Center for the Study of Biological Complexity, said it is clear that "novel strategies, like those encouraged by the Gates Foundation and proposed by Doctors Ozaki and Christie, are required to combat the disease. This award by the Gates Foundation to VCU adds further recognition to the university as a center of excellence in the study of important infectious diseases."

About Grand Challenges Explorations

Grand Challenges Explorations is a five-year, $100 million initiative of the Gates Foundation to promote innovation in global health. The program uses an agile, streamlined grant process - applications are limited to two pages, and preliminary data are not required. Proposals are reviewed and selected by a committee of foundation staff and external experts, and grant decisions are made within approximately three months of the close of the funding round.

Applications for the current round of Grand Challenges Explorations are being accepted through November 2, 2009. Grant application instructions, including the list of topics for which proposals are currently being accepted, are available at http://www.grandchallenges.org/explorations.

See VCU News Release.

Virginia Commonwealth University Health Sciences has named Quincy Byrdsong as the new Executive Director of Research Administration for VCU Health Sciences and VCU Health System.

As the executive director, Byrdsong will lead the efforts on the MCV Campus to strengthen research administration and increase compliance with federal and industry research standards. He will also assist other University leadership in identifying best practices for research administration and customizing research administration educational programs for faculty and staff on the MCV Campus.

"We are extremely pleased that Mr. Byrdsong is joining VCU Health Sciences," said Alan D. Johns, assistant vice president for Health Sciences - Financial and Administrative Affairs. "His expertise in research administration and leadership in the profession will serve to be a tremendous asset to the MCV Campus as we continue to expand our research agenda."

Byrdsong, who was selected based on his extensive qualifications in research administration and clinical trials management, will work with Johns and others to develop the infrastructure needed to support Health Sciences' growing and increasingly complex research programs. Byrdsong will also work closely with VCU's School of Medicine as they continue implementing their research strategic plan.

Most recently, Byrdsong served as the administrative program director for clinical and translational research for the School of Medicine and chair of the Institutional Review Board at Meharry Medical College in Nashville, Tenn. He has served in several capacities in academic medical centers including director of the Meharry Institutional Review Board, department administrator for neurology and fiscal officer for the Meharry Center for Women's Health Research. Additionally, he served as a research services consultant for Vanderbilt University Medical Center.

Byrdsong earned both his bachelor's and master's degrees at Middle Tennessee State University, and he is currently working towards a doctorate of education at Tennessee State University.

See VCU News release.

Students at Cosby High School in Midlothian have a particularly interesting - and potentially rewarding - opportunity in the school's Health Science Specialty Center.

Since Cosby's center was established in September 2007, its teachers and administrators have worked closely with VCU faculty to offer programs for students who want to prepare for and pursue careers in the health-care industry. The School of Pharmacy's representative is Thomas Reinders, associate dean for admissions and student services.

Beginning in the spring of 2008, each of the MCV Campus schools have offered modules as part of a course coordinated by Seth Leibowitz, director of pre-health sciences advising for VCU University College, and Donna Jackson, director of outreach for the School of Medicine. The course includes in-class exercises, lectures and lab experiences for the high-school students.

Reinders says the pharmacy module consists of didactic and experiential approaches to educating students about the role of pharmacists in healh care.

During the spring 2009 module, Ron Ballentine, associate professor of pharmacy and assistant director of admissions and student services, and Tyler Stevens, assistant professor of pharmacy, served as lecturers. The session was followed by special laboratory exercises in the R. Blackwell Smith Jr. Building. Trish Horning, instructor of pharmacy; Donna Francioni-Proffitt, assistant professor of pharmacy; and about 15 SOP students assisted Stevens and Ballentine.

When the center opened, Cosby Principal Brenda Mayo noted that the opportunities to visit local health-science facilities and to work with college students and health professionals in a "real-world environment" would be the program's most important components.

Every Chesterfield County high school has a specialty center; the topics range from the arts to technology.

Read the article from the School of Pharmacy.