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Building the Relationship between Geisel School of Medicine and Dartmouth-Hitchcock

Building the Relationship between Geisel School of Medicine and Dartmouth-Hitchcock

On Thursday, November 30, Duane Compton, PhD, Dean of the Geisel School of Medicine, and Joanne Conroy, MD, CEO and President of Dartmouth-Hitchcock, hosted an event convening teams representing Neurosciences, Cancer Care, The Dartmouth Institute (TDI), Cardiovascular Care, and Children’s Health. These teams participated in brainstorming to identify links within new research opportunities, clinical care, implementation science and education in an integrated way.

Below are examples of the ideas each team shared during the event:

Cancer Care

(led by Steve Leach, MD, Medical Director for Norris Cotton Cancer Center):

Developing the Cures We Discover: The Dartmouth Drug Development Network (D3N):

Over the years, Norris Cotton Cancer Center (NCCC) scientists have discovered hosts of new therapeutic strategies, drug targets and associated new cancer drugs. Two of the drugs currently revolutionizing cancer care were literally invented here at NCCC. Drug and device discoveries by Geisel and D-H researchers have spawned a host of successful biotech and pharmaceutical startup companies, including Medarex, Celdara, Immunext, Adimab, and DoseOptics. The Cancer group proposed a major investment in a new Dartmouth Drug Development Network (D3N) that would position D-H and Geisel as a preferred partner for both local and global biotech in the early clinical evaluation of new drugs and devices. 

Dartmouth Center for Immuno-oncology (DCI):

Through the discovery of antibodies that can bypass self-imposed "checkpoints" on immune responses, our scientists first unleashed the full power of patients' individual T cells in combating cancer. This "cure from within," relying on each patient's internal immune system, has revolutionized the treatment of lung cancer, ovarian cancer, kidney cancer and melanoma, and promises to offer similar benefit for other tumor types. NCCC scientists are now leading the way in characterizing new "second generation" immune checkpoint inhibitors. 

We are also clarifying the unique role played by so-called "memory T cells" in cancer immunology, capitalizing on the unique ability of the immune system to provide lifelong immunity and protection against relapse based on the immune system's capability for long-term memory. Our scientists are also leading the way in the development of CAR-T (chimeric antigen receptors) cell technology, in which a patient’s own immune cells are removed from the body, genetically engineered for enhanced tumor destruction and re-infused to the patient in a manner that provides long-term cancer control. The investment in a new Center for Immuno-oncology would support accessible facilities at D-H for advancing CAR-T cell therapy, allowing NCCC scientific and medical teams to continue their leadership in the further refinement and optimization of this lifesaving technology.

Neurosciences

(led by Jeff Cohen, MD, Chair of Neurology):

Dartmouth-Hitchcock Center for Brain Science:

Our ability to change the way networks in the brain function holds great promise not only for the treatment of epilepsy but the modulation of depression, memory, movement disorders, tracking drug effectiveness and addiction, among other behaviors. The neuroscience group developed a bold and ambitious plan for a Dartmouth-Hitchcock Center for Brain (and Mind) Science that would include clinical programs linking together neurosurgery, neurology and psychiatry (to include a neuro ICU), clinical and basic science labs, and a linked neuroscience graduate program. Within this large-scale project are three primary areas of focus: the creation of a neuro ICU, advancement in brain mapping and neuro-modulation, and furthering our clinical and translational research work in substance abuse.

Supporting the establishment of this proposed Center is the fact that we have a unique population—rural, tied to the area, high incidence rates of MS and PD, older and suffering from neurodegenerative diseases and dementia, and struggling with addiction (e.g., alcoholism, cannabis and opioid abuse) —that lends itself to being studied and followed over time. D-H has the potential to become a regional leader in clinical and translational neuroscience and nationally recognized for its neurology, neurosurgery and psychiatry research. By linking programs in clinical neuroscience, we can provide efficient one-stop care for patients—including those with memory disorders. What we need is to bolster our strong clinical foundation with PhDs, graduate students, technology, basic science and animal research to flesh out our existing strengths.

The Center for Brain Science would be a systems neuroscience lab that studies human brain electrophysiology, cognition, imaging and histopathology in patients. It would have imaging and OR (operating room) space, inpatient and ICU (intensive care unit) beds, outpatient clinics and research labs. The overall goal of the work would be to facilitate the optimization of brain modulation therapies and the discovery of novel neurobiological targets, by filling gaps in our understanding of human brain function that are critical for helping our patients. A primary goal in neuroscience research is to understand how the brain controls behavior under normal physiological conditions and how its dysfunction causes abnormalities in diseases. This requires precise spatiotemporal manipulation of brain activity in behaving animals. Many brain modulation tools have been developed for this purpose. These brain modulation tools have greatly helped to advance our knowledge about brain function. The Center for Brain Science would bridge our research understanding of targets in animal models and translate them to human trials.

The Dartmouth Institute of Health Policy and Clinical Practice

(led by Elliott Fisher, MD, MPH, Director of TDI):

Based on the work that has already been done by TDI, the goal is to have a sharp focus on working as partners to create a learning health system within high-priority areas—at front lines of care—as a model to be spread within D-H and to other health care systems through the following strategies:

  • Patient-Centered Integrated Practice Units—specialty specific and primary care
  • Co-design (user centered design) with patients and clinical teams
  • Built on co-production model
    • Best possible measures of health—risk, function, quality of life, costs
    • Goals brought to forefront at every patient visit
  • Learning system that supports:
    • Bringing best evidence to point of care
    • Comparative effectiveness research
    • Systems research—how teams, organizational units and system work
    • Implementation science—foundation for how to spread and scale

Cardiovascular

(led by Mark Creager, MD, Medical Director for Heart & Vascular Center):

Establish a Heart & Vascular Center for Community Education and Wellness

This new center would be the public face of the Heart & Vascular Center, a place for community engagement and a portal for patients. The center would provide public and patient-oriented cardiovascular programs across the “lifespan,” in healthy lifestyle, prevention, screening, patient navigation, shared decision making and end-of-life transition to palliative care.

Create a Center for Cardiovascular Device Development and Outcomes

This center would focus on device innovation, testing and evaluation, surveillance, and outcomes:

  • It will leverage the expertise we already have in device development, the conduct of clinical trials and in outcomes assessment.
  • The Center will integrate multiple databases to survey outcomes of different devices, disseminate information and inform patient decision-making.

Other Cardiovascular Research Opportunities include:

  • Program in Regenerative Therapies for Limb Salvage
    Bench-to-bedside research to develop gene and cell-based therapies for treatment of limb ischemia (insufficient blood supply to the legs).
  • Genomics, Biomarkers and Cardiovascular Outcomes
    Inter-institutional research program incorporating bioinformatics to identify genomic, proteomic, and other biomarkers to assess risk of cardiovascular events and develop targeted treatment strategies to improve cardiovascular outcomes.

Cardiovascular Training and Educational Opportunities

  • Fund young clinician scientists interested in developing skills in translational or outcomes research to pursue a Master’s degree at TDI or elsewhere.
  • Create a nurse practitioner program.

Children’s Health

(led by Keith Loud, MD, MSc, Medical Director for the Children’s Hospital at Dartmouth-Hitchcock and Chair of Pediatrics):

The goal is to build upon the strengths already in place at CHaD—rigor in small, collaborative world-class academic community; academic departmental home to C. Everett Koop Institute and its expertise on media influences on youth behavior; leading Children’s Environmental Health Center (NIH ECHO Grant) & NH Birth Cohort; new Dartmouth Regional Pediatric Clinical Research Unit (NIH IDeA States Network); and deep connections with TDI. Building on these strengths, CHaD research initiatives have unique opportunity to innovate in children’s health in rural settings while reaching urban centers in our southern region and disseminating for national impact. Some of the promising potential initiatives include:

  • Creating a Child Health Research Institute to share core resources and leverage the strengths of the Children’s Environmental Health Center, preventative regulatory science at the Koop Institute, and Pediatric Delivery Science and Health Services Research at TDI. CHaD Clinical Research Unit would bring pediatric expertise to broader D-H investigations in: Cystic Fibrosis, Irritable Bowel Disease, Obesity (weight and wellness), and the new initiatives identified in Cancer, Heart and Vascular and Neurosciences.
  • Lead high-value pediatric health initiative to modify expectations and behaviors of health care consumers from an early age, and to disseminate current innovations, such as care for newborns with the Neonatal Abstinence Syndrome, late pre-term newborn care, and new onset diabetes.
  • Enhance CHaD education and training programs to amplify these initiatives throughout their careers across the country and the world:
    • Fund stipend to allow local/regional pediatricians to engage in direct teaching in the ambulatory setting so learners may be more consistently exposed to the principles of prevention and high value care delivery here.
    • Endow Master’s degree training for: select pediatric residents (one year), and a Child Health Research Institute fellow (physician, nursing, other allied health professionals).
    • Support Koop Institute action-based learning in public policy advocacy to prevent the non-communicable diseases of consumption, bridging researchers, students at Dartmouth, Geisel, TDI, Tuck and residents at DHMC.
Photo at top, from left: Graduate student Rachel Borg, BS, Patricia Pioli, PhD, and graduate student Rajan Bhandari, BA.

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