Internal and External Marketing

There are two areas in a practice that are targeted when marketing your practice. The first is internal; the second is external.

“Internal” deals with dissemination and promotion within your practice and to already-established patients. It includes things such as:

  • In-office patient referrals
  • Reactivation of old patients through letters and calls
  • Newsletters
  • Mailings to existing patients
  • Events, such as open houses and patient appreciation events
  • “Thank you” notes for referring patients
  • Welcome-to-the-practice letters

“External” deals with locating and reaching markets outside of your practice. It includes things such as:

  • Prospecting outside of the office for new patients
  • Advertising by using direct mail, yellow pages, etc.
  • Forming referral networks with other professionals
  • Having events and/or lectures for groups within the community

When starting out on a new marketing plan it is usually smartest, easiest and most cost effective to begin with internal marketing, as you have ready access to information about your current patients. Current patients are also more valuable because they are familiar with you and your practice.

Once you have an effective internal marketing program going, you can then look at what external marketing actions you want to do to potentially increase your stream of new patients.

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Search Engine Marketing –

Why Does SEO Matter More In a “Down Economy?’

By Lisa Thayer, GoldfishNetwork.com

The question on many business owners’ minds today is “How should I market my company given the current state of the economy?” The short answer is by placing your marketing dollars in client specific, targeted advertising campaigns that have a built in accountability for measuring results.

In uncertain times, a business owner’s first reaction may be to reduce their overall marketing and advertising budget as part of a “batten down the hatches” mentality. That reaction is prevalent among companies that have experienced some reduction in business lately whether due to “the economy” or for a multitude of other reasons. While that response may give your CFO temporary anxiety reduction, before you know it she’ll be pestering you about declining sales figures.

Now is the time to step back, take a deep breath and make decisive, informed business decisions and steadfastly refuse to respond emotionally to the nightly news. Review both online and offline marketing endeavors looking for those that produce the best return on investment.

Search engine marketing can often produce a better ROI than many offline marketing endeavors due to the fact that spending can be controlled, results can be measured and you can easily make incremental changes to adapt to conditions as they continue to fluctuate. Online marketing also works for you 24/7 without accruing additional payroll expense.

If you stay the course, you may even be able to spot new opportunities and actually capture a larger segment of your market as others react instead of methodically planning a marketing strategy.

The best way to achieve optimal results online is to first have a qualified search engine professional review your website. It doesn’t do you any good to spend money to drive thousands of people to your website if once they arrive on your site the visitors don’t have a compelling reason to do business with you.

When it comes to search engine optimization and marketing “one size does not fit all”.
A good SEO review should advise you in creating “calls to action”, help to solidify your unique selling proposition, present solutions to rectify any design or usability issues, and even identify areas of weakness in your competition.

Once the SEO review is complete, you will be able target your specific customers and therefore be able to maximize your efforts and reduce your ad spend.

Lisa Thayer is owner of GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients in 12 states across the United States. Lisa can be reached at (503) 783-0440 or by e-mail: Lisa@GoldfishNetwork.com

You can’t control the economy…

You can’t control the economy, but you can control your practice.

By: Ken DeRouchie

I have recently been interviewing doctors around the country regarding how the economy has been affecting their practice and what they have been doing to keep their practice financially viable. I have found that many of the doctors I’ve spoken to have simply shrugged their shoulders and accepted the down-turn in the economy. Many say there’s nothing they can do about the economy and, because of that, are producing less and making much less money. At the same time, most of them who feel this way have done little to nothing in terms of making any changes in the management of their practice to combat the exterior forces that are impeding the growth and solvency of their business.

This brings to mind an old saying: “If you always do what you’ve always done, you’ll always get what you’ve always gotten”. Simply put, if everything is changing around you and you don’t change and adapt with it, you will be unable to combat the external forces – very real forces – that are slowing or stopping your practice growth. It is imperative that if you want to continue growing in the economic environment that we are all experiencing, you must be able to adapt the management of your practice to the current state of your area, your local economy, the changing demographics of your area, etc. Most practice owners can grow in a booming economy. We’ve seen that during good economic times. But only those who have sound management skills, either inherently or through training, can adapt successfully to difficult times.

In August of 2007 I conducted a user poll on The Practice Solution Magazine’s web site in which 169 practice owners participated. The survey question was “The economy of the past 6 years has negatively affected my practice?”. 51% of the doctors answered :yes”.

I decided to follow this up with another user poll in November of 2007. 171 practice owners participated.

The topic of this was “When there are slow periods of the year, I …”.

46% of the doctors replied that [they] “live with it until it picks up again”

24% of the doctors replied that [they] “do extra marketing/promotion to make sure we don’t lose money”

16% of the doctors replied that [they] “schedule vacations at that time”

4% of the doctors replied that [they] “have a hard time making payroll”

11% of the doctors replied that [they] “wish there was something I could do to counter this”

You can see that only 24% of the doctors surveyed were actually doing something proactive to handle the slow periods! Obviously, you aren’t in a position to change the country’s economy, but you can , if you know how, make effective changes in your practice to combat slow periods.

Realize that the above surveys’ were conducted prior to the recent economic collapse. I therefore conducted a third survey in the last few months in which 71 practice owners took part. Since effective marketing of a practice is essential during poor economic periods, I decided to ask the question “On your new patient/client forms, when you ask the question “How did you find out about our practice”, what do you do with the answers?”

65% said [they] “Do Nothing”
1% said [they] “Enter it into a data base then nothing”
20% said [they] “Send a thank you card”
2% said [they] “Too busy to do anything with it.”
11% said [they] “Use this info for future marketing campaigns”

As you can see, only 11% were doing something useful with this vital data!

From these 3 surveys I conclude that:

  1. Many practices across the country are hurting from the effects of the economy.
  2. Most of them aren’t doing anything about it.
  3. When they are getting new patients in they don’t even bother to strengthen or further the actions that got those new patients in.
  4. The ultimate result of all of this is most practice owners that are completely the effect of the economic environment and not in control of their practice.

If this in any way sounds somewhat or a lot like what you are going through, read on. .

Things that you CAN control:

The following list includes links to articles written about specific areas in your practice that YOU DO have control over. If you are feeling a negative impact from the economy, I highly recommend that you hunker down and dig in. There’s a lot of ground to cover here but you will find this time well spent.. You do NOT just have to shrug your shoulders and “live with it”, you CAN take back control of your practice! These articles and others in this issue of Solutions can help you.

– Your appointment schedule – Cancellations/No-shows-rescheduled appointments

– Giving Great Service

– Marketing (internal and external)

– Staff efficiency

– Collections and Receivables

– Staff salaries and production bonuses

If you get in control over each of these areas in your practice you can very effectively “out create” the external forces that are negatively impacting your practice. If, however, you simply keep doing what you have always done and don’t change your operating basis, you will find yourself on a slippery slide with a crash at the end of the ride.

How to Survive Today’s Economic Time’s

by Shaw Millerman

Recently the President addressed the nation regarding the economic situation we are all experiencing in this country and around the world. It is very clear that we are now seeing the very obvious signs of a national recession, despite whatever spin may be put on it by the politicians from both sides of the aisle. We know now, because it is becoming very clear to diverse business owners everywhere, that the crisis is not just going to be limited to the finance sectors or the housing sectors. And we know that it is likely to get a lot worse before it gets any better and that it won’t be over for some time. The economic problems go deep and it could possibly be a decade before we’re able to fully recover. That’s a moderate time frame, not overly optimistic or the doomsday scenario that some would have us believe.

That’s what’s happening today.

We have worked with health care professionals for over 25 years and have gone through several periods of down economic times – some called them recessions, some called them “stagflation”, as well as a variety of other names. Whatever cute label one wants to attach to tough economic times, there is no fooling people with the fact that the economy in general, and their specific economic situation is far from ideal. And today, it is stated as being the worst economic situation since the Great Depression of the 1930′s.

What we have seen happen with stand alone health care professionals during a recessionary period such as this is that the doctor/owner “tightens up”. By this we mean that they usually get very worried, get “conservative” and reduce their promotion. They may start letting go of staff people and make do with fewer personnel. They often cut corners and consequently the quality of their service may begin to suffer. When the quality of service goes down patients become unhappy and start looking for another practice. They look for a practice that provides better service. Doctors who act in this manner will begin to lose some portion of their patient base. Thus it can make it a perfect time for doctors who don’t succumb to such thinking to capture more market share and increase their productivity.

Our clients generally thrive during recessions because they know what to do. They have learned how to manage their practice through objective means. They know how to effectively market without it costing an arm and a leg. We’ve been through three of these economic downturns/recessions and we’ve seen how our clients are able to take advantage of the situation rather than be the effect of it. In fact, as part of our surveying, we recently found out that, on average, our clients who are trained and skilled in practice management, have been increasing their productivity by 10% to 15% percent during those years the nation has been in recession. And this includes all socio-economic areas of the country. This type of growth is generally not true for the average practice owner.

Our clients thrive because they are able to prepare for down economic periods. They know how to closely monitor all of key areas of the practice and thus are in control of the practice. They know if they are understaffed or overstaffed, or if they have underutilized staff. Our clients have efficient systems that keep “busy work” off their desks. They don’t have a desk full of backlogged activities. They don’t give new projects to overloaded staff people. They make realistic plans based on objective data and don’t squabble with their spouses over finances. They hire, train, and monitor staff objectively and systematically and they have composed a business plan, marketing plan and financial plan they can refer back to and review and re-evaluate as necessary.

This is called running good control over your practice. And that doesn’t mean, as some people think, that it means not having fun at work or not having relaxed staff people or having people obsess constantly over profit instead of paying attention to people and service. It simply means that you know what is going on in your practice, that your staff know their jobs and work well as a team together and, because of that, you and your staff enjoy the work environment much more.

Objective systems are the component that allow staff people to remain calm and competent. When they know their jobs inside and out, it allows them to respond creatively to unique and unanticipated situations. It allows them to be calm and composed even when work backs up or the amount of office traffic could easily overwhelm them. Staff become accountable and self motivated because their work is measured by objective statistics. They are productive rather than just busy.

Prior to the current economic situation, we have seen a large percentage of practices and businesses supported and inflated by the bull markets. But this often was an artificial inflation, built on credit and people living outside their means. Now that credit is less available, it becomes obvious which offices have the infrastructure capable to handle the change. It isn’t enough to do the same old thing. Every income source must be maximized and must be maximized with the best interest of the patient in mind. Staff must be able to communicate the importance of delivering the highest quality of care without seeming to be solely motivated by profit.

Everyday we work with practice owners to put together plans and implement those plans. We do this so practice owners are able to grow and thrive in a sane manner, in economic uncertain times, and in a time frame that allows the creation of a stable infrastructure. Not only is this possible in these times but it is essential to your financial future.

To survive any activity, you must be trained and knowledgeable in that activity. You wouldn’t be an effective doctor if you weren’t adequately trained in your profession. The business environment is very tough right now. The fact is that your practice is a business and the better you are trained in the running of your business – i.e. practice management – the better you will be able to not only survive this economic crisis, but to actually be able to expand during these tough times.

Letter to the Editor – Sleep Medicine

Letter to the Editor
By David E Lawler, DDS, D. ABDSM
Bloomington, IN

Hello,

This week, I had the pleasure of being interviewed for an article in The Practice Solution Magazine by one of your research staff. As a result of this interview, I want to encourage you to step back and look at a different topic with a broader perspective.

You are a practice management magazine whose perspective should clearly be focused on that topic. However, there are opportunities in dentistry that are rarely looked at that, especially in these troubling economic times, should be more widely discussed.

The addition of sleep medicine to my practice of dentistry has been, not only the most rewarding professional thing that I have ever done, it has been a wonderful cushion in a time of economic down-turn. If the absence of pain, bleeding or swelling, a great deal of dental services are highly discretionary and can be delayed. However, people always need air and those people with sleep-breathing disorders have their air supply greatly reduced during the night as well as their quality of life during the day and their overall health. All they need is the proper information and a therapy that they can tolerate to accept treatment.

Last week I was asked to speak to the annual meeting of the Indiana Self-Insurers Association on the management of these sleep-breathing disorders with oral appliance therapy. This was a room full of people who are intimately aware of the cost of medical care. They were wide-eyed as I showed statistics showing the dramatic drop in medical costs associated with the proper management of these disorders. In addition, there were quite a few present that now know that the annoying sound coming from their bed partners as they sleep is the sound of these people fighting for their next breath.

Similarly, yesterday I spoke to a state-wide respiratory therapy conference at our local hospital on sleep-related breathing disorders like snoring, upper airway resistance syndrome and sleep apnea and their management with oral appliances. At the break following my discussion, I was surrounded by attendees at this conference who wanted to tell me that they now recognized in themselves or their spouses, the conditions that I had just talked about. These are people who are intimately and professionally familiar with the process of breathing but who were unaware of the many forms these disorders take that allow them to remain unrecognized. Similarly, there was a sizable number who knew they or a family member had a problem but were unaware that there was an alternative, patient friendly, therapy as a substitute to the traditional CPAP therapy that they could not tolerate.

These sleep-related breathing disorders are epidemic in our society, with as many as one in five adults having a sleep breathing problem significant enough to affect their health. Since these occur only during sleep, the vast percentage of people suffering from these disorders have no clue that they are affected. Occasionally a bed-partner will say something, but usually that is only to complain about the noise disturbing their own sleep. Even those people seeking regular medical care usually are undiagnosed, since only a very small number of physicians question their patients about sleep quality. Those people who are fortunate to get a diagnosis are routinely prescribed a therapy that as many as 50% refuse or fail within the first six months of use. Those who remain undiagnosed, or who are diagnosed and yet unmanaged because they cannot tolerate their prescribed therapy, go on to live shortened lives of diminished quality with medical expenses easily doubling those who are diagnosed and able to tolerate therapy.

Oral appliance therapy can offer life saving treatment to untold thousands of people if they only knew about it. Dentists would gladly add this therapy to their existing practice model if they knew how easy it was for them to recognize these problems in their existing patient base.

Sleep medicine is a very young field of medicine. Because of that, physicians are only now starting to connect the dots between these disorders and many of the problems that they commonly treat. What is necessary is more public recognition of these disorders and this is where I believe strongly you can play a role.

I was very impressed by the amount of time and the intensity in which researcher focused on his interview this week. I am fully convinced that he is more than qualified to develop this topic in order to give it the attention your readers deserve.

Thanks, in advance, for your consideration.

David E. Lawler DDS, D. ABDSM
Diplomate American Board of Dental Sleep Medicine
The Center for Sound Sleep
www.thecenterforsoundsleep.com
2909 Buick Cadillac Blvd.
Bloomington, IN 47401
812-339-4499
812-339-6013 fax
Better health through restful sleep

From the Editor

For starters, we wish to thank everyone reading our on-line magazine for the massive amount of help you provided in our continual surveying of practice owners. Our survey team was very busy last quarter calling all over the U.S. and Canada. The survey results were very interesting and helped us design the format for this issue of The Practice Solution Magazine.

Given the nature of today’s financial climate, it is not surprising that our survey team found that there is a great deal of attention on the ability of the practice to attract new patients and clients. Our surveys showed that 60% of the professionals we talked to do little or nothing to effectively market for new patients/clients. Therefore we have included in this issue several articles on marketing, with emphasis on internal marketing (rather than fancy and/or expensive advertising) and more specifically, doing effective marketing surveys to find out what your public needs and wants. Knowing the basics of marketing will help attract more new patients – something vital in these economic times.

We have also included a number of articles presenting viewpoints that we think are important for professionals to have during the economic slump we are all experiencing.

As always, we scoured the Internet newswires for profession specific articles that we thought might be of interest and use to our readers.

In the spirit of offering solutions to the everyday business of running a practice, I offer you the next issue of The Practice Solution Magazine.

Cory D. Radosevich
Managing Editor
The Practice Solution Magazine

Veterinary Medicine Contributes to New England Economy

Veterinary Medicine Contributes $3.3 Billion to New England Economy

Newswise – Veterinary medicine contributes $3.3 billion to the economies of New England-and the region faces a shortage of as many as 658 veterinarians by 2014, according to a study released today by the Cummings School of Veterinary Medicine at Tufts University.

The study-undertaken by the UMass Donahue Institute and commissioned by the Cummings School, the only veterinary school in the six-state New England Region-reveals that veterinarians and associated staff comprise over 20,000 jobs in the area. Moreover, for every 100 veterinary medical jobs in the region, an additional 59 jobs are created in related industries, the study indicates.

Clinical practice-providing medical services for household pets, farm and food animals, and exotic animals-represents the largest percentage ($1.1 billion, or 65 percent) of direct veterinary expenditures in New England, which total $1.72 billion. Scientific research and development-which require animal health and husbandry services to test new drugs and devices and better understand animal and human health-comprises the next-largest category, with a total of 23 percent of veterinary medicine spending and 14 percent of the industry’s total employment. Laboratory animal veterinarians are responsible for the welfare of as many as 2 million laboratory animals in New England.

The study also highlights a growing critical need for veterinarians in the region. According to Bureau of Labor Statistics (BLS) data, the study found that the region will have 1,036 vacancies for veterinarians by 2014, both through new job creation and retirement of an aging workforce. With an average of 60 percent of Cummings School graduates remaining in New England, trends suggest that 378 of the school’s graduates will enter the region’s workforce, leaving unfilled 658 new vacancies for veterinarians.

What’s more, the study suggests that the region faces a flood of retirements among food animal veterinarians. Over a quarter of the region’s more than 100 specialized food animal veterinarians will reach retirement age by 2014. With current levels of food animal graduates, the Cummings School will be positioned to replace only half of these vacancies. Overall, 43 percent of New England veterinarians are over age 50; by contrast, 56 percent of livestock veterinarians are over age 50. Until 2014, the study suggests, food animal veterinarians will retire at nearly twice the rate of their companion animal colleagues. With the critical role that food animal veterinarians play in protecting the nation’s food supply, this shortage is especially alarming.

“This study confirms the importance and economic impact of veterinary medicine in Massachusetts and New England,” said Deborah T. Kochevar, DVM, PhD, dean of the Cummings School of Veterinary Medicine at Tufts University. “Cummings School is proud to serve the citizens of this region by educating veterinary professionals, advancing biomedical research, and serving as a clinical and public health resource for animals and their owners.”

The study was supported by the Veterinary Medical Associations of Massachusetts, Connecticut, Maine, New Hampshire, Rhode Island and Vermont, the New England Veterinary Medical Association and InTown Veterinary Group. Hill’s Pet Nutrition, Inc., was the study’s lead industry sponsor.

“In order to best understand the health of the animals in New England, we need to understand the industry that cares for them,” said Dr. Christine Jenkins, Director of Academic Affairs at Hill’s Pet Nutrition, the study’s lead industry sponsor. “This study does just that-and we hope it sheds light on the growing need for veterinarians in the workforce to ensure the care and safety of animals in the region.”

The study also revealed interesting findings in each state of New England. Among them:

  • Massachusetts has New England’s biggest veterinary scientific research and development sector, with more than 5 percent of the state’s veterinarians specializing in this area. The state is the fifth-largest in the nation for research animals registered under the Animal Welfare Act and veterinarians support the work of a vital life sciences industry in the state. With 8,000 employees statewide and a total economic impact of $1.3 billion in 2006, veterinary medicine is an essential part of the state economy.
  • In Connecticut, $83 is pumped back into the state’s economy for every $100 spent by the veterinary industry, a multiplier of 1.83. For every 100 jobs in the industry, another 55 jobs in Connecticut are supported. Connecticut boasts a total veterinary economic impact of nearly $1 billion in 2006, the second largest in the region.
  • Maine has the nation’s sixth-highest rate of pet ownership, with 70 percent of households (376,000 homes) owning one or more pets. The veterinary industry represents an economic impact of more than $290 million in the state.
  • New Hampshire residents spend the second-most in the region on veterinary clinical services per capita, at $94. The state also ranks second in median wages for veterinarians, at $78,180. Every $100 of veterinary industry spending in the state supports another $74 of economic activity in the state.
  • In Rhode Island, veterinary medicine employs an estimated 1,110 people, including 189 veterinarians. The industry invests an estimated $81 million on payroll, operating expenses and capital projects, including over $69 million in veterinary clinical practice, $5 million in scientific R&D and $6 million in academia.
  • Vermont has both the highest rate of pet ownership in the region and the nation-74.5 percent-and the region’s highest per capita spending on veterinary clinical services ($97). Additionally, the state boasts the region’s highest rate of veterinary practice ownership (52 percent of clinical practice veterinarians are self-employed).

Several leaders from the biomedical industry in Massachusetts spoke out in support of the study’s findings. “In order for the biomedical and medical device fields to continue to thrive in Massachusetts, we must maintain a very high standard for ethics and care in our research divisions,” said Kevin O’Sullivan, President and CEO of Massachusetts Biomedical Initiatives. “As such, veterinarians are our greatest resource, and provide a crucial element for the growth of the biotech sector.”

“The economy of Massachusetts is intrinsically linked with the growth of the biotechnical, pharmaceutical, and medical device sectors-and without a ready supply of veterinarians to oversee the clinical trials for these industries, the growth would be stifled,” continued Thomas J. Sommer, President of MassMEDIC. “The Commonwealth has a great resource in the Cummings School of Veterinary Medicine-not just as a excellent training ground for the next generation of veterinarians, but also as an economic incubator for small biomedical start-ups. This study brings the contributions of the Cummings School and of veterinarians in general to light.”

“The Cummings School of Veterinary Medicine is an essential resource for the Massachusetts life sciences super cluster,” said Robert Coughlin, President of the Massachusetts Biotechnology Council. “The close proximity of this global leader in veterinary medicine is another reason why so many companies and institutions find Massachusetts the best place in the world to do business.”

About the Cummings School of Veterinary Medicine

Founded in 1978 in North Grafton, Mass., the Cummings School of Veterinary Medicine at Tufts University is internationally esteemed for academic programs that impact society and the practice of veterinary medicine; three hospitals that treat more than 28,000 animals each year; and groundbreaking research that benefits animal, public, and environmental health. The school has secured more than $23 million in NIH funding to build a level-3 Regional Biosafety Laboratory for work with infectious disease organisms, the anchor tenant of a life sciences industrial development known as Grafton Science Park.

© 2008 Newswise. All Rights Reserved.

NC State Offers Canine Bone Marrow Transplants

Newswise – Dogs suffering from lymphoma will be able to receive the same type of medical treatment as their human counterparts, as North Carolina State University becomes the first university in the nation to offer canine bone marrow transplants in a clinical setting.

Dr. Steven Suter, assistant professor of oncology in NC State’s College of Veterinary Medicine, received three leukophoresis machines donated by the Mayo Clinic in Rochester, Minn. Leukophoresis machines are designed to harvest healthy stem cells from cancer patients. The machines are used in conjunction with drug therapy to harvest stem cells that have left the patient’s bone marrow and entered the bloodstream. The harvested cancer-free cells are then reintroduced into the patient after total body radiation is used to kill residual cancer cells left in the body. This treatment is called peripheral blood stem cell transplantation.

The machines, once used for human patients, are suitable for canine use without modification, as bone marrow therapy protocols for people were originally developed using dogs.

“It’s not a new technology, it’s just a new application of an existing technology,” Suter says. “Doctors have been treating human patients with bone marrow transplantation for many years, and there have been canine patient transplants performed in a research setting for about 20 years, but it’s never been feasible as a standard therapy until now.”

Canine lymphoma is one of the most common types of cancer in dogs, but the survival rate with current treatments is extremely low. Peripheral blood stem cell transplantation, in conjunction with chemotherapy, has raised human survival rates considerably, and it is hoped that dogs will see the same benefits.

“We know that dogs who have received bone marrow transplants have a cure rate of at least 30 percent versus about 0 to 2 percent for dogs who don’t receive the transplants,” Suter adds. “The process itself is painless for dogs – the only thing they lose is a bit of body heat while the cells are being harvested.”

Contact Information

Tracey Peake, News Services, (919) 515-6142 or tracey_peake@ncsu.edu

© 2008 Newswise. All Rights Reserved.

Veterinary Researcher Studying Brain Tumors

Veterinary Researcher Studying Brain Tumors in People, Animals

Newswise – A veterinary neurologist on faculty in the Virginia-Maryland Regional College of Veterinary Medicine at Virginia Tech has been awarded funding from the Wake Forest University Translational Science Institute to study innovative approaches for treating brain tumors in dogs, cats, and humans.

Dr. John Rossmeisl, an assistant professor in the Department of Small Animal Clinical Sciences (DSACS), is working with Wake Forest University Medical Center researchers to develop better therapeutic approaches for managing very serious forms of brain tumors called gliomas.

Rossmeisl will work closely with a cluster of scientists and physicians at Wake Forest University and with VMRCVM veterinary pathologist Dr. John Robertson, director of the college’s Center for Comparative Oncology, on the project. The veterinary college is a participating institution on a major translational research initiative at Wake Forest University funded by the National Institutes of Health (NIH).

“Gliomas are an aggressive and deadly form of brain cancer that affects dogs and people,” said Rossmeisl, who is board certified in veterinary neurology by the American College of Veterinary Internal Medicine. “Because there are so many similarities between clinical signs and pathobiology, the dog has emerged as an excellent model for studying gliomas in humans.”

Every year about 120,000 new cases of primary and secondary brain cancer are diagnosed, according to the National Cancer Institute. Much less is known about the incidence of brain tumors in domestic animals, according to Rossmeisl. Clinical signs associated with brain tumors in both people and animals can include seizures, abnormal behaviors, weakness of the limbs, loss of balance, blindness and other problems.

Gliomas arise from glial cells, according to Rossmeisl, which play numerous supporting roles for neurons, brain cells that control thought, sensations and motion. Glial cells outnumber neurons by a factor of about ten to one in the brain, and they play an essential role in creating the architecture and structure of the brain and supporting its functions.

There are several different specific types of glial cells, but two that interest Rossmeisl and colleagues most are called astrocytes and oligodendrocytes. Oncogenic abnormalities associated with each of these can lead to cancers called astrocytomas and oligodendrocytomas, according to Rossmeisl.

The most common approaches for managing these tumors involve surgical excision, radiation therapy and chemotherapy. But conventional radiation and chemotherapy affect normal cells in addition to the cancerous cells they target, so perfecting approaches that exclusively target the molecular abnormalities present in each individual’s cancer cells and spare healthy cells is a major thrust in modern oncology.

To develop more precisely targeted systems for administering therapeutic agents to cancer cells, Rossmeisl and his colleagues are attempting to further establish the molecular similarity of human and canine gliomas.
Scientists know that when astrocytomas spontaneously arise in people, they over-express three proteins: interleukin 13 receptor alpha2 (IL-13R), which is a cancer testis tumor like agent; EphA2, a tyrosine kinase receptor; and fos-related antigen 1, an AP-1 transcription factor.

Rossmeisl and colleagues working in the college’s Center for Comparative Oncology have opened a clinical trial and are currently enrolling animals from around the region that have been positively diagnosed with a brain mass consistent with the appearance of a glioma on magnetic resonance imaging (MRI).

The researchers will be studying tissue samples from affected animals in search of these proteins that are not otherwise present in normal brain tissues. Identifying these proteins could further document the dog’s suitability as a model for studying pre-clinical human disease, according to Rossmeisl, and ultimately lead to the development of more precisely targeted methods for managing these tumors.

Another portion of the work is focused on the development of powerful new cancer treatments. Through a process known as convection enhanced delivery (CED), the researchers are removing the diseased tissues and testing the application of a proprietary experimental compound. This agent is used to “bathe” the margins of the area in which the tumor was removed and it has been designed in a way that it will only bind with receptors in tumor cells expressing abnormal proteins.

“Their potential value is tremendous to humans and dogs with cancer,” said Rossmeisl. These treatments may represent a significant advancement in prolonging survival in dogs and people with these highly aggressive cancers.”

The researchers will also be looking at improved processes for performing radiation therapy on brain tumors in dogs.

“Currently, the standard of care in veterinary radiotherapy is fractional radiotherapy delivered with a linear accelerator,” explained Rossmeisl. This form of radiation therapy is typically delivered with frequent administration of relatively small doses of radiation multiple days per week over several weeks. Though it can be fairly precisely targeted, it can affect tissues unrelated to the tumor.

The grant will enable the researchers to perfect protocols for treating canine patients with stereotactic radiosurgery – more commonly known as the “gamma knife.” The gamma knife uses a specialized head-frame to target an exactingly focused beam of killing radiation with pin-point accuracy on the tumor itself. As opposed to a traditional course of radiotherapy that can take weeks, the gamma knife can accomplish the task in one session lasting a few hours.

For more information regarding the Comparative Canine Glioma Trial (CCGT) study, view the CCGT General Information Form, or contact Luann-Mack Drinkard (clinical research technician) at lmackdr@vt.edu or by phone at (540) 231-4621, or the study co-director, Dr. John Rossmeisl at jrossmei@vt.edu.

The Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM) is a two-state, three-campus professional school operated by the land-grant universities of Virginia Tech in Blacksburg and the University of Maryland at College Park. Its flagship facilities, based at Virginia Tech, include the Veterinary Teaching Hospital, which treats more than 40,000 animals annually. Other campuses include the Marion duPont Scott Equine Medical Center in Leesburg, Va., and the Avrum Gudelsky Veterinary Center at College Park, home of the Center for Government and Corporate Veterinary Medicine. The VMRCVM annually enrolls approximately 500 Doctor of Veterinary Medicine and graduate students, is a leading biomedical and clinical research center, and provides professional continuing education services for veterinarians practicing throughout the two states. Virginia Tech, the most comprehensive university in Virginia, is dedicated to quality, innovation, and results to the commonwealth, the nation, and the world.

Contact Information
Jeffrey Douglas (540) 231-7911 jdouglas@vt.edu

© 2008 Newswise. All Rights Reserved.

“Lazy Eye” Treatment Shows Promise in Adults

Newswise – New evidence from a laboratory study and a pilot clinical trial confirms the promise of a simple treatment for amblyopia, or “lazy eye,” according to researchers from the U.S. and China.

The treatment was effective on 20-year-old subjects. Amblyopia was considered mostly irreversible after age eight.
Many amblyopes, especially in developing countries, are diagnosed too late for conventional treatment with an eye patch. The disorder affects about nine million people in the U.S. alone.

Results from the laboratory study will be published online the week of Mar. 3 in PNAS Early Edition.
Patients seeking treatment will need to wait for eye doctors to adopt the non-surgical procedure in their clinics, said Zhong-Lin Lu, the University of Southern California neuroscientist who led the research group.

“I would be very happy to have some clinicians use the procedure to treat patients. It will take some time for them to be convinced,” Lu said.

“We also have a lot of research to do to make the procedure better.”

In a pilot clinical trial at a Beijing hospital in 2007, 28 out of 30 patients showed dramatic gains after a 10-day course of treatment, Lu said.

“After training, they start to use both eyes. Some people got to 20/20. By clinical standards, they’re completely normal. They’re not amblyopes anymore.”

The gains averaged two to three lines on a standard eye chart. Previous studies by Lu’s group found that the improvement is long-lasting, with 90 percent of vision gain retained after at least a year.

“This is a brilliant study that addresses a very important issue,” said Dennis Levi, dean of optometry at the University of California, Berkeley. Levi was not involved in the study.

“The results have important implications for the treatment of amblyopia and possibly other clinical conditions.”

The PNAS study shows that the benefit of the training protocol – which involves a very simple visual task – goes far beyond the task itself. Amblyopes trained on just one task improved their overall vision, Lu said.

The improvement was much greater for amblyopes than for normal subjects, Lu added.

“For amblyopes, the neural wiring is messed up. Any improvement you can give to the system may have much larger impacts on the system than for normals,” he said.

The Lu group’s findings also have major theoretical implications. The assumption of incurability for amblyopia rested on the notion of “critical period”: that the visual system loses its plasticity and ability to change after a certain age.

The theory of critical period arose in part from experiments on the visual system of animals by David Hubel and Torsten Wiesel of Harvard Medical School, who shared the 1981 Nobel Prize in Medicine with Roger Sperry of Caltech.

“This is a challenge to the idea of critical period,” Lu said. “The system is much more plastic than the idea of critical period implies. The fact that we can drastically change people’s vision at age 20 says something.”

A critical period still exists for certain functions, Lu added, but it might be more limited than previously thought.

“Amblyopia is a great model to re-examine the notion of critical period,” Lu said.

The first study by Lu’s group on the plasticity of amblyopic brains was published in the journal Vision Research in 2006 and attracted wide media attention.

Since then, Lu has received hundreds of emails from adult amblyopes who had assumed they were beyond help.

Berkeley’s Levi cautioned that the clinical usefulness of perceptual learning, as Lu calls his treatment, remains a “sixty-four thousand dollar question.”

“It’s clear that perceptual learning in a lab setting is effective,” Levi said. “However, ultimately it needs to be adopted by clinicians and that will probably require multi-center clinical trials.”

Lu is collecting patients’ names for possible future clinical trials. He can be contacted at zhonglin@usc.edu.

The researchers are also working to develop a home-based treatment program.

For patients who can travel, the Chinese hospital that hosted the pilot trial may be able to provide treatment. Contact Dr. Lijuan Liu, Beijing Xiehe Hospital, at lijuan_l@yahoo.com.cn.

The other members of Lu’s group are Chang-Bing Huang and Yifeng Zhou of the Vision Research Lab at the University of Science and Technology of China, in Hefei, Anhui province (Huang is currently a postdoc in Lu’s lab at USC).

Funding for the research came from the Chinese National Natural Science Foundation and the U.S. National Eye Institute.

ABOUT AMBLYOPIA (from PNAS)

Amblyopia affects about 3 percent of the population and cannot be rectified with glasses. People with the disorder suffer a range of symptoms: poor vision in one eye, poor depth perception, difficulty seeing three-dimensional objects, and poor motion sensitivity.

Also known as lazy eye, the disorder is caused by poor transmission of images from the eye to the brain during early childhood, leading to abnormal brain development. Lazy eye is actually a misnomer because in many cases the structure of the eye is normal.

Source: University of Southern California Released: Wed 27-Feb-2008, 13:10 ET Embargo expired: Mon 03-Mar-2008, 17:00 ET

Contact Information

Contact: Carl Marziali, (213) 219-6347 marziali@usc.edu

© 2008 Newswise. All Rights Reserved.