A national expert on child development will speak at the Center on Human Development and Disability (CHDD) on Thursday, Feb. 24. Dr. Robert H. Bradley, professor at the Center for Applied Studies in Education, University of Arkansas at Little Rock, will discuss “New Avenues for Preventing Behavior Problems in Young Children” in a public lecture from 3:30 to 5 p.m. in the CHDD auditorium, CD-150. The lecture is open to everyone.

Bradley is an expert in a wide array of topics related to children, including cross-cultural considerations of home environments, family influences on children with disabilities and typically developing children, and ecological factors affecting child health and development. He is chair of the Biobehavioral and Behavioral Research Committee of the National Institute of Child Health and Human Development (NICHD) and a member of the Advisory Committee for the Maternal Lifestyles Study of the National Institute on Drug Abuse (NIDA).

His research interests include relationships between children’s experiences in their family environments and various aspects of their well-being—social, cognitive, emotional, health and growth; measures of parenting and the child’s physical environment; impact of socioeconomic status on well-being; early education programs for high-risk children and families; early intervention for children with disabilities and chronic medical problems; child care; fathering; and cultural and cross-cultural issues pertaining to parenting and child well-being.

“When the topic of bad behavior in children arises,” says Bradley, “advice often focuses on what parents should do—engage in positive forms of parenting such as being sensitive and providing appropriate structure and demands—or not do —engage in negative forms of parenting such as spanking or being inconsistent or indifferent. But children build capacities for self-regulation and self-control from the totality of their experience. Self-control is a set of interrelated functions that help a child adapt to the environment. Control doesn’t involve just putting on the brakes, but applying energy toward a variety of goals. A diverse array of opportunities for productive activity increases the likelihood that a child will learn how to avoid circumstances that lead to inappropriate behavior and engage in activities that produce positive emotional/mood states.”

Bradley’s visit to the UW is sponsored by CHDD’s Research Emphasis Area on Ecological Factors. For more information, contact Dr. Susan Spieker at spieker@u.washington.edu or 206-543-8453.

To inaugurate the new Fragile X Research Center at the Center on Human Development and Disability (CHDD), two internationally known experts on fragile X syndrome will visit the UW next week to give lectures and hold a series of meetings with fragile X researchers and clinicians. Their visits are being coordinated by Dr. Charles Laird, UW professor of biology, director of the Fragile X Research Center and coordinator of CHDD’s Research Emphasis Area on Fragile X Syndrome.

Dr. Randi Hagerman, professor of pediatrics and medical director of the MIND Institute at the University of California at Davis, will discuss “Neurodevelopment and Neurodegeneration: Two Faces of the Fragile X Gene, FMR1,” focusing on fragile X syndrome in children and the newly identified fragile X-associated tremor/ataxia syndrome, or FXTAS, in older adults. She will speak at 12:30 p.m. Tuesday, March 16, in room CD-150 at CHDD.

Her husband, Dr. Paul Hagerman, professor of biological chemistry at UC Davis School of Medicine, will discuss “The Fragile X Gene: Distinct Molecular and Neuropathologic Mechanisms Give Rise to Two Separate Syndromes,” at 4:30 p.m. on Monday, March 15, in room K-069 of the Health Sciences Center. His lecture is sponsored by the UW Department of Pathology.

Last fall, CHDD was awarded a five-year $5.86 million grant from the National Institute of Child Health and Human Development to establish the Fragile X Research Center.

Fragile X syndrome is the most common inherited cause of mental retardation, affecting an estimated one in 4,000-6,000 males and about half as many females. Physical features are variable, but can include enlarged ears, a long face, connective tissue problems and skeletal problems. Some males exhibit speech disturbances, hand biting or hand flapping, and autistic behaviors. About one in 260 females is an unaffected carrier of the mutation in the FMR1 gene, located on the long arm of the X chromosome. Under normal conditions the gene produces a protein that maintains proper functioning of nerve cells in the brain. The mutated gene causes a particular segment of DNA to repeat too many times, in what is called a CGG repeat, because it contains the same DNA building blocks—cytosine, guanine and guanine—in the same repetitive order.

While the focus of the Fragile X Research Center is on fragile X syndrome, the Hagermans will also discuss their research into FXTAS, which they published Jan. 28 in the Journal of the American Medical Association. They state that a significant number of adults with progressive tremors, balance problems and dementia are misdiagnosed with Parkinson’s disease, senile dementia or Alzheimer’s disease, when their condition could be accurately identified as FXTAS with a standard DNA blood test.

“Fragile X syndrome and FXTAS are two completely separate syndromes, the former a developmental disorder of childhood and the latter a neurodegenerative disorder in older adults,” said Paul Hagerman. “They are caused by trinucleotide repeat expansions of the same FMR1 gene, but they arise by completely separate molecular mechanisms and affect separate groups of individuals.”

During their visit, the Hagermans will also hold meetings with members of CHDD’s Research Emphasis Area (REA) on Fragile X Syndrome, joined by faculty drawn from CHDD’s REA on Neurodegenerative Disorders. Through collaborations among investigators from both groups, CHDD is in a unique position to help fully understand these neurodevelopmental and neurodegenerative disorders. Close collaborative projects with the Hagermans on this and related efforts are in the planning stages.

For information on Randi Hagerman’s lecture, contact Laurie McHale at 543-4037 or lmchale@u.washington.edu. For information on Paul Hagerman’s lecture, contact Steve Berard at 543-0269 or sberard@u.washington.edu.

To inaugurate the new Fragile X Research Center at the Center on Human Development and Disability (CHDD), two internationally known experts on fragile X syndrome will visit the UW next week to give lectures and hold a series of meetings with fragile X researchers and clinicians. Their visits are being coordinated by Dr. Charles Laird, UW professor of biology, director of the Fragile X Research Center and coordinator of CHDD’s Research Emphasis Area on Fragile X Syndrome.

Dr. Randi Hagerman, professor of pediatrics and medical director of the MIND Institute at the University of California at Davis, will discuss “Neurodevelopment and Neurodegeneration: Two Faces of the Fragile X Gene, FMR1,” focusing on fragile X syndrome in children and the newly identified fragile X-associated tremor/ataxia syndrome, or FXTAS, in older adults. She will speak at 12:30 p.m. Tuesday, March 16, in room CD-150 at CHDD.

Her husband, Dr. Paul Hagerman, professor of biological chemistry at UC Davis School of Medicine, will discuss “The Fragile X Gene: Distinct Molecular and Neuropathologic Mechanisms Give Rise to Two Separate Syndromes,” at 4:30 p.m. on Monday, March 15, in room K-069 of the Health Sciences Center. His lecture is sponsored by the UW Department of Pathology.

Last fall, CHDD was awarded a five-year $5.86 million grant from the National Institute of Child Health and Human Development to establish the Fragile X Research Center.

Fragile X syndrome is the most common inherited cause of mental retardation, affecting an estimated one in 4,000-6,000 males and about half as many females. Physical features are variable, but can include enlarged ears, a long face, connective tissue problems and skeletal problems. Some males exhibit speech disturbances, hand biting or hand flapping, and autistic behaviors. About one in 260 females is an unaffected carrier of the mutation in the FMR1 gene, located on the long arm of the X chromosome. Under normal conditions the gene produces a protein that maintains proper functioning of nerve cells in the brain. The mutated gene causes a particular segment of DNA to repeat too many times, in what is called a CGG repeat, because it contains the same DNA building blocks—cytosine, guanine and guanine—in the same repetitive order.

While the focus of the Fragile X Research Center is on fragile X syndrome, the Hagermans will also discuss their research into FXTAS, which they published Jan. 28 in the Journal of the American Medical Association. They state that a significant number of adults with progressive tremors, balance problems and dementia are misdiagnosed with Parkinson’s disease, senile dementia or Alzheimer’s disease, when their condition could be accurately identified as FXTAS with a standard DNA blood test.

“Fragile X syndrome and FXTAS are two completely separate syndromes, the former a developmental disorder of childhood and the latter a neurodegenerative disorder in older adults,” said Paul Hagerman. “They are caused by trinucleotide repeat expansions of the same FMR1 gene, but they arise by completely separate molecular mechanisms and affect separate groups of individuals.”

During their visit, the Hagermans will also hold meetings with members of CHDD’s Research Emphasis Area (REA) on Fragile X Syndrome, joined by faculty drawn from CHDD’s REA on Neurodegenerative Disorders. Through collaborations among investigators from both groups, CHDD is in a unique position to help fully understand these neurodevelopmental and neurodegenerative disorders. Close collaborative projects with the Hagermans on this and related efforts are in the planning stages.

For information on Randi Hagerman’s lecture, contact Laurie McHale at 543-4037 or lmchale@u.washington.edu. For information on Paul Hagerman’s lecture, contact Steve Berard at 543-0269 or sberard@u.washington.edu.

The UW has received an award of $5.86 million for a research center to study fragile-X syndrome, the most common inherited cause of mental retardation. The five-year award, from the National Institute of Child Health and Human Development at the National Institutes of Health, will be administered by the UW Center on Human Development and Disability (CHDD).

Affecting an estimated one in 4,000 to 6,000 males and about half as many females in all ethnic groups, fragile-X syndrome is second only to Down syndrome as a cause of cognitive disability. About one in 100 to 600 females is an unaffected carrier of the mutation in a gene called FMR1. This gene, which was identified in 1991, is located on the long arm of the X chromosome.

Since females have two X chromosomes and hence two copies of FMR1, females with the fragile-X mutation usually also have a normally functioning copy of the gene. This normal copy of the gene can partially compensate for the mutant one. Males have only one X chromosome, and therefore usually have more severe symptoms than girls when they carry a fragile-X mutation. Physical features can include enlarged ears, a long face, connective tissue problems and skeletal problems. Some males exhibit speech disturbances, hand biting or hand flapping, and autistic behaviors. Because of the variability in symptoms, the diagnosis of fragile-X syndrome is often delayed.

Lead researchers are Dr. Charles Laird, UW professor of biology and director of the Fragile X Research Center; Dr. R. Scott Hansen, UW research assistant professor of medical genetics; Dr. Stephen Tapscott, member of the Fred Hutchinson Cancer Research Center and UW associate professor of neurology, and Dr. Randi Hagerman, director of the MIND Institute at the University of California at Davis. She is a co-director of the grant and will direct patient recruitment and evaluation.

Laird emphasizes the interdisciplinary nature of the project. “CHDD has an outstanding record of bringing together faculty from different units, in this case the UW College of Arts and Sciences and the UW School of Medicine, the Hutchinson Cancer Research Center, and the University of California. This coalescence of interested groups and approaches is crucial to understanding the biology of this astonishingly complex genetic disease. We also expect that fragile-X research will provide new insights into normal cellular processes. For example, our work on fragile X has made us re-think our understanding of the process of cell division.”

• Hansen’s lab in the UW Division of Medical Genetics will focus on the timing of DNA replication during the cell cycle, including the disruption of replication and its consequences in fragile-X syndrome.

• Tapscott and colleagues at the Hutchinson Center will look at the effect of the mutation on the organization of the chromosome, its chromatin structure.

• Laird’s lab in the UW Department of Biology will examine mosaicism, in which different cells of an individual with fragile-X syndrome may contain different forms of the mutation. Mosaicism is observed in 15 to 20 percent of fragile-X patients.

• Hagerman and colleagues at UC Davis will manage the patient recruitment and evaluation core. This core will interface with the three Seattle projects and CHDD core facilities as correlations between molecular characteristics and clinical manifestations are sought. Initially, about 50 patients will be enrolled in the study.

Fragile-X syndrome involves a type of genetic mutation called a trinucleotide repeat expansion, in which a specific combination of the building blocks of DNA—in this case the nucleotides CGG—repeat themselves over and over beyond a normal threshold. The number of repeats appears to influence the severity of the disease. Fragile X also involves inappropriate methylation of DNA. Normally, DNA methylation is a process by which a methyl group—one carbon and three hydrogen atoms—is added to one of the nucleotides in DNA, which can shut down the activity of a nearby gene. In most cases this shutdown is needed for normal function, as in the inactivation of genes on the second, mostly inactive, X chromosome in females. In fragile-X syndrome, however, there is excess, or hypermethylation, of the FMR1 gene. This hypermethylation leads to abnormal silencing of FMR1, resulting in decreased or absent FMR1 protein that is needed for normal cognitive function.

The ����Ӱ�Ӵ�ý has been awarded a $3.5 million federal grant to establish a National Center on Accessible Information Technology in Education, to be known as AccessIT. The five-year renewable grant, awarded on a competitive basis, comes from the

The award will be administered by co-principal investigators Dr. Kurt L. Johnson, associate professor of rehabilitation medicine and director of the at the UW’s , and Dr. Sheryl Burgstahler, an assistant director of and director of the UW’s (Disabilities, Opportunities, Internetworking, and Technology). Dagmar Amtmann of CTDS is the assistant director.

“The explosion of information technology has been a double-edged sword,” says Johnson. “We now have a wealth of options for acquiring information, but if information technology is not universally accessible, it may shut out people with disabilities.”

The Center for Technology and Disability Studies provides training and research on assistive technology for people with disabilities throughout the Pacific Northwest. The DO-IT program offers college and career preparation to students with disabilities as well as training to employers and educators. Although the two programs have collaborated on smaller projects, AccessIT will give them, together, a much expanded mission.

“Its purpose is to coordinate a nationwide effort to assist educational and governmental institutions to make education-based information technology accessible to all students and employees, including those with disabilities,” says Burgstahler. “Educational-based information technology is any technology used by students and employees in educational settings, including computers, software, web pages, telecommunications, fax machines, copiers, printers, kiosks, and other equipment.”

“As far as we have come with advances in computing, Internet access, telecommunications and other forms of information technology,” said Johnson, “these advances are not available to everyone, particularly people with disabilities who may be unable to read or see displayed information, hear or respond to spoken prompts, or use such devices as a keyboard or computer mouse.”

The new center’s focus will be broad, extending from K-12 schools through universities and other post-secondary educational institutions. AccessIT will provide training and technical assistance, working primarily through the national network of 10 NIDRR-funded , established in response to mandates of the Americans with Disabilities Act.

AccessIT’s audience will include policymakers, teachers, special education teachers, computer lab staff, library staff, students and employees with disabilities, as well as their families and advocates.

“A coordinated nationwide effort is needed to assist educational and governmental institutions in reaching the goal of making information technology accessible to everyone,” said Burgstahler. “Our new center is a giant step toward achieving this goal.”

“This grant is the culmination of at least a decade of effort at the UW to make information technology accessible and the recognition of the considerable expertise that exists at the UW in the area of making information technology accessible to all,” said Johnson.

In addition to the two UW centers, partners in AccessIT are Equal Access to Software and Information, the Washington Education Association, and Microsoft Corporation.

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For more information contact Dr. Kurt Johnson at (206) 543-3677, Dr. Sheryl Burgstahler at (206) 543-0622, and Dagmar Amtmann at (206) 543-4741.

A free public forum on pediatric epilepsy will be sponsored by the ����Ӱ�Ӵ�ý Pediatric Epilepsy Research Center.

It takes place from 4 to 7 p.m. on Tuesday, April 4, at the UW’s Center for Urban Horticulture, 3501 N.E. 41st, Seattle. Parents of children with epilepsy are especially invited to attend.

The featured speaker is Dr. Gregory L. Holmes, professor of neurology and director of clinical neurophysiology at Harvard Children’s Hospital in Boston. A leader in the study of how seizures affect the immature organism, he has developed a number of models to analyze factors that may lead to seizures, and has studied the effects of repeated early seizures on brain structure and function, as well as on behavioral and cognitive capabilities.

The forum schedule includes the following:

3 p.m. Registration, reception and exhibits

4 p.m. What is Pediatric Epilepsy?
Holmes

4:30 p.m. Insights into Pediatric Epilepsy and its Treatments
Dr. John Rho, assistant professor of neurology and pediatrics, and Children’s Hospital and Regional Medical Center

5 p.m. Key Problems in Pediatric Epilepsy: What Research is Being Done?
Dr. Philip Schwartzkroin, professor of neurological surgery, UW

5:30 p.m. Workshop 1: Alternative Medical Approaches
Dr. Marcio Sotero, Kathy Adamski and Renee Williams, Children’s

Workshop 2: Psychosocial Issues in Childhood Epilepsy
Dr. Molly Warner, Dr. Hillary Shurtleff, Tim Humes and Patti Murphy, Children’s

Workshop 3: New Anticonvulsant Medications
Rho, Dr. Joseph Pinter and Dr. John Kuratani, UW Department of Neurology and Children’s

Workshop 4: Pediatric Epilepsy Research Center (PERC): Who We Are, What We Do
Schwartzkroin; Linda Jaech and Rhoda Altom, parents and co-chairs, PERC External Relations Board; Shari Ireton, program assistant

7 p.m. Reception

For more information, call (206) 221-5364 or email perc@u.washington.edu

PEDIATRIC EPILEPSY RESEARCH CENTER

The UW Pediatric Epilepsy Research Center (PERC) was established through joint efforts of the UW School of Medicine and parents of children with epilepsy. It draws on multidisciplinary expertise in neurosciences at the UW and Children’s Hospital and Regional Medical Center. Its goal is to advance the understanding and treatment of pediatric epilepsies through basic laboratory and clinical research.

Dr. Philip Schwartzkroin, professor of neurology and biophysics, is PERC’s director for research; he is a past president of the American Epilepsy Society. Dr. Jong Rho, assistant professor of neurology and pediatrics and a clinician at Children’s, is co-director for translational research. Dr. Richard Winn, chair of neurosurgery, and Dr. Bruce Ransom, chair of neurology, serve as co-chairs of PERC’s advisory board.

The cornerstone of the center is development of major interdiscplinary research studies. With PERC support, scientists from several departments are investigating the mechanisms by which the keogenic diet — a high-fat/low-carbohydrate diet — reduces frequency of seizures in some children with medically intractable epilepsy. In addition, PERC has awarded four grants for pilot projects to UW researchers studying other issues important for understanding epilepsy in the immature brain.

FACTS ON EPILEPSY

Epilepsy is a disorder consisting of chronically recurring seizures: sudden and unpredictable alterations of brain function associated with aberrant electrical activity. Seizures can result in uncontrollable movements, changes in memory, alterations in thinking and reasoning, and/or changes in consciousness.

Epilepsy can be triggered by a blow to the head, a brain tumor, stroke or infection. Genetics undoubtedly play a role in who develops epilepsy. For most people with epilepsy, however, the cause is unknown.

Approximately one out of 100 people suffers from epilepsy. The first signs are usually seen in childhood or adolescence.

Available medications provide significant seizure relief for 50 to 70 percent of people with epilepsy. However, many drugs have significant undesirable side effects. Surgery can help only a small fraction of individuals with medically intractable seizures. Basic research is the best hope for developing new and better approaches to prevent, treat, and cure epilepsy.

It’s been three years since the ����Ӱ�Ӵ�ý’s last Health Sciences Open House, and this year’s free two-day event promises an array of new exhibits that will intrigue adults and young people alike.

Around the theme of “Step into the Future,” the UW Health Sciences Open House 2000 will highlight the latest advances in medical research, patient care and teaching, as well as offer information on exciting careers in health care.

The Open House takes place from 9 a.m. to 6 p.m. on Friday, April 7, and from 10 a.m. to 5 p.m. on Saturday, April 8. It includes 85 exhibits located throughout the public areas of UW Medical Center and the adjoining Warren G. Magnuson Health Sciences Center, at 1959 N.E. Pacific, Seattle. The complex is located just west of Husky Stadium.

High school student groups will comprise most of the visitors on Friday morning; the public is encouraged to attend on Friday afternoon and all day Saturday. More information is available at or by calling (206) 543-4767.

Many of the 85 exhibits will feature computer-based, high-tech and interactive presentations. Examples include:
o A virtual reality helmet that allows the wearer to enter a virtual environment, being investigated as a means of pain control for burn patients.
o Surgical innerspace, a demonstration of the tools used in minimally invasive surgery
o Computer-controlled mannequin to provide training in anesthesia
o Innovative treatment for heart failure: advanced technology that helps patients remain active while awaiting a heart transplant
o Brain Power, a group of interactive exhibits that illustrate the workings of the brain
o Genetic abnormalities viewed through the microscope; seeing the difference between males and females by looking at their cells
o Diagnostic imaging: the various tools available to the radiologist, including mammography, MRI, ultrasound and CT scan
o Protecting your head, protecting your heart: information on gun safety and bicycle helmet safety
o Airlift Northwest: information on emergency air ambulance service in Washington, Alaska, Montana, Idaho and western Canada
o Wellness Center, sponsored by the School of Pharmacy, offers body-fat measurements, blood pressure checks, cholesterol checks, bone density checks and information on immunizations and herbal products.
o Tours of UW Medical Center’s extensive art collection will be offered, at 10 a.m., noon and 2 p.m. on Friday, and 10:00 a.m. and noon Saturday.

The Open House highlights the work of one of the nation’s top health sciences complexes and related agencies:
o The UW receives the most federal funding for medical research of any public university in the country;
o The UW School of Medicine is ranked number one in the country in training of primary-care physicians and is ranked number 11 in research;
o The UW School of Nursing is ranked number one in the country;
o UW Medical Center has regularly been ranked among the top 10 medical centers in the country and was the first institution awarded the status of Magnet Hospital by a top nursing organization;
o Harborview Medical Center, operated by the UW, is the region’s only level-1 trauma center, serving a four state region. It has one of the largest burn centers in the country.

, ����Ӱ�Ӵ�ý professor of medicine and genetics, will give the third and last in this year’s series of free public lectures sponsored by the newly created ����Ӱ�Ӵ�ý Science Forum.

Her lecture, “Genomic Views of Human History,” will be held at 7:30 pm. Tuesday, March 14, in Kane Hall room 130 on the UW campus. The talks are accessible to people with a high school science background, and are designed to share exciting frontier research at the UW and show how it fits into the big picture of scientific knowledge.

King, whose lab mapped the gene for BRCA1, a gene implicated in breast and ovarian cancer, is an engaging speaker who addresses lay and scientific audiences around the world. She moved her lab to the UW from the University of California at Berkeley in 1995.

In addition to breast cancer genetics, her lab is seeking the genetic basis of a number of other diseases. She is also involved in human rights work, doing DNA identifications of victims of human rights violations in South America, Africa and Eastern Europe.

She is the author, with Kelly Owens, of a Viewpoint article in the journal Science (Oct. 15, 1999). She states that new tools of genomic analysis are being used to shed light on historical puzzles. Migrations of ancient peoples, the effects of geographic boundaries on human movements, origins of ethnic groups, and racial differences are now the focus of integrated analysis by historians, anthropologists and geneticists.

“When people move, they take their genes along and pass them on to their descendants in their new homes,” she states. “Thus, every present-day population retains clues to its ancient roots. Common ancestries can be confirmed and human migrations traced by comparing DNA sequences of present-day populations.”

In addition to the public lectures, the new UW Science Forum is aimed at bringing together faculty and graduate students once a month to discuss topics in a wide range of scientific disciplines.

Earlier lectures were given by Dr. Bruce Margon, professor of astronomy, and Dr. John Delaney, professor of oceanography. These lectures, and that of King, are being videotaped for later broadcast on UWTV. The schedule of cable broadcasts is at www.washington.edu/uwtv/sciforum/

“Ears, Hearing and Beyond” is the subject of a free public conference on hearing loss, to be held from 9 a.m. to 4 p.m. on Saturday, March 11, in the HUB Auditorium on the ����Ӱ�Ӵ�ý campus.

“The conference is for everyone interested in learning more about the ear, prevention of hearing loss, strategies for coping with hearing loss, hearing aids, assistive listening devices, cochlear implants, and what’s new in current research,” said Dr. George A. Gates, UW professor and director of the UW’s . The center sponsors the annual conference with the Lions District 19B Hearing Conservation Foundation and the Lions Sight and Hearing Foundation.

An FM hearing system will be available in the auditorium, and presentations will be accompanied by real-time captioning. Those attending will receive written summaries of all talks.

The exhibit room will be open all day with approximately 20 exhibitors, including hearing aid, cochlear implant and assistive listening device manufacturers.

For more information, call (206) 616-4105 or visit the .

The program includes:

o Overview of the Ear, and Hearing and Auditory Disorders, with Dr. George A. Gates, director, Virginia Merrill Bloedel Hearing Research Center; otologist and professor of otolaryngology-head and neck surgery

o Effects of Hearing Loss, with John Jaco, executive director of Self-Help for Hard of Hearing People (SHHH)

o What’s New in Hearing Aids, with Dr. Tom S. Rees, audiologist and associate professor of otolaryngology-head and neck surgery

o The Effectiveness of Hearing Aids: Which Features Are Worth the Price? with Dr. Bevan Yueh, assistant professor of otolaryngology-head and neck surgery

o Early Detection, Diagnosis and Intervention of Hearing Loss in Washington State: A Public-Private Partnership, with Dr. Susan J. Norton, director, Research and clinical audiology, Children’s Hospital & Regional Medical Center; UW associate professor of otolaryngology-head and neck surgery

o Implantable Listening Devices, with Gates

o Inherited Hearing Loss: A New Study, with Dr. Bruce L Tempel, assistant professor otolaryngology-head and neck surgery, and Dr. Valerie Street, senior postdoctoral fellow, otolaryngology-head and neck surgery

o Vertigo and Dizziness: What’s the Difference? with Dr. Larry G. Duckert, otologist and professor of otolaryngology-head and neck surgery

o Balance and Vision, with Dr. James O. Phillips, assistant professor of otolaryngology-head and neck surgery

o Assistive Listening Devices: What’s New? with Pam Hurst, community education coordinator, Hearing, Speech and Deafness Center.

Patients filling a prescription usually can rely on their pharmacist to warn of possible negative side effects caused by interactions with other prescriptions and over-the-counter medications that they may be taking.

But two top national experts on drug interactions from the believe the health-care provider actually writing the prescription should be the first line of defense against such interactions.

Accordingly, Drs. Philip D. Hansten and John R. Horn, both professors of pharmacy, have published a pocket guide for health-care practitioners, called The Top 100 Drug Interactions: A Guide to Patient Management.

The guide is designed to be kept close at hand and consulted frequently. It is a condensed version of the authors’ major publication, Drug Interactions Analysis and Management.

It lists the three classes of drug interactions most likely to result in negative side effects. For Class 1 interactions, prescribers are advised to avoid the drug combination entirely; for Class 2, to use only if the benefit outweighs the risk; and Class 3, to assess the risk and take action if necessary.

The guide lists approximately 600 drug interactions and gives options for alternative, non-interacting drugs that practitioners can offer their patients as substitutes. A table lists 150 common drugs with the enzyme responsible for metabolizing each drug. By using the table, the practitioner may be able to predict potential drug interactions that have not yet been reported.

The authors say the guide doesn’t list every interaction, but it does include the most frequent and most dangerous ones. It lists some foods and beverages (such as grapefruit and alcohol) that interact with some medications, and includes both prescribed and over-the-counter medications.

“Our position is that drug interactions are almost 100 percent preventable,” said Hansten. “These interactions are predictable.”

For example, if a patient is taking either Zocor or Mevacor, both “statin” drugs used to lower cholesterol, the guide tells the health care provider to be cautious about prescribing the antibiotics erythromycin or Biaxin. Interactions could range from muscle pain and muscle damage, to pancreatitis and acute kidney failure in rare cases. The guide suggests alternative antibiotics that don’t interact in the same way with the cholesterol drugs, as well as other statin drugs that don’t interact with those antibiotics. As another alternative, it suggests the patient be temporarily taken off the cholesterol medication if the antibiotic therapy is short-term. The statin-antibiotic example is listed as a Class 2 interaction: the combination should be used only if the benefit outweighs the risk.

While the doctor should be the first line of defense, the authors caution that patients must be aware of all the medications, prescribed and over-the-counter, that they are taking. “We’re trying to get this data through to the users,” said Horn. “The patient is the only one who knows what drugs he or she is taking.”

“It’s a particular problem with the elderly, who may be taking a number of medications,” said Hansten. “The patient who’s taking five or more drugs can assume some interactions may be occurring. An estimated 15 percent of elderly patients are experiencing adverse effects.”

The American Hospital Association, notes Hansten, has introduced a major new initiative to reduce drug errors, in the wake of the Institute of Medicine’s report on medical mistakes in hospitals. “A guide like ours can help in that effort,” he said.

“Drug interactions are a very important focus for the School of Pharmacy,” said Horn, “from the basic science to clinical applications and public health. Three-quarters of our faculty are working in some way in the area of drug interactions.”

The pocket guide grew out of a handout that Hansten and Horn made for their pharmacy students.

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For more information contact Dr. Philip Hansten at (206) 543-2579 or Dr. John Horn at (206) 543-1413.