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Archive for January, 2013

UNMC training helps Chinese physicians face health care reform

by Kalani Simpson, UNMC public relations

It seems we are in similar places. Like the U.S., China looks to enact some version of health care reform. It does so in part because, like the U.S., it faces a shortage of primary care providers in rural areas.

And so, nearly 20 physicians from China are in Omaha to take part in a family medicine “training camp” at UNMC.
 

 
-Chinese physicians conduct a simulated child birth in the Sorrell Center’s Clinical Skills Lab as part of a family medicine training camp underway this week at UNMC. 

These doctors already know medicine, said Jeff Harrison, M.D., professor and program director of the Department of Family Medicine, but here, they’ll learn how UNMC teaches physicians how to interact with patients in family medicine settings.

Rural exodus
Qing Yong Ma, M.D., Ph.D., is a surgeon and dean of education at Xi’an Jiaotong University. In China, after eight years of training, many physicians opt to practice in big cities, he said.

It is hoped that perhaps by offering an alternate five-year program, and government support, more might return to their hometowns to practice rural family medicine.

Mindset shift needed
But providers aren’t the only ones who need to change to enact reform. The Chinese countryside has an historic tradition of “barefoot doctors.” Many rural people have the mindset that city physicians are superior when it comes to modern, educated care. This leads to travel, back-ups, long waits.

New rural family practice docs must win the trust of their potential patients, Dr. Ma said.

A place to practice
They practice those skills here, thanks in part to Problem Based Learning exercises. Paul Paulman, M.D., assistant dean for clinical skills and quality in the UNMC College of Medicine, praised the doctors’ ingenuity: “You took over the teaching,” he said.

They are hoped to be the seeds in a project that would eventually train 10,000 doctors in family practice techniques.

How would you deal with that?

One role-playing exercise had a physician visit an angry “patient” who insisted she be given antibiotics. The young woman to portray the patient seemed a friendly, effervescent, girl-next-door type. How could she do angry?

But at “go,” she started to berate the doctor in a Chinese dialect. The assembled class roared with laughter and a spirited discussion soon followed. How would you handle that? What should have been done?

It was clear in any language: The adjustment to a new future in primary care won’t be easy, in either country. But at UNMC, both countries will do everything possible to be ready for anything that comes.

 

Relief From Decades of Pain – New Clinic at The Nebraska Medical Center Gives Patients New and Convenient Treatment Options

Clinic is the only one of its kind in the Midwest

Charlene Stehlik had accepted the pain as part of her life. For more than 20 years, the pain was a constant, daily fight.

“I had a bleeding ulcer 26 years ago,” Stehlik says. “I just figured it was part of that.”

She describes it as feeling morning sickness every hour of every day. It grew progressively worse. She says her gastroenterologist couldn’t understand why it kept getting worse. He sent her to The Nebraska Medical Center where she was diagnosed with chronic pancreatitis.

Patients with disorders like hers can now be treated by the team in the newly created Comprehensive Pancreatobiliary Disorders and Autologous Islet Cell Transplant Clinic.

“The impetus behind starting this clinic was making sure we could offer specialized care for these individuals,” explains Luciano Vargas, MD, surgeon at The Nebraska Medical Center. “These patients have complex problems and often they get left behind.” That’s how Stehlik felt. She couldn’t play with her five grandchildren. Some days were spent curled up writhing in pain. She knew nothing but constant pain.

After finding the source of her pain, she learned the treatment was something she never imagined: an autologous islet cell transplant.

“He said, ‘I think we can fix this,’” Stehlik remembers. “If it would give me back my life that’s what I wanted. That’s why we opted for it.”

Islet cells produce insulin from inside the pancreas. During a transplant, the patient’s pancreas is removed, and its islet cells are relocated.

“We are able to infuse those islet cells into the liver where they retain their function,” Dr. Vargas explains. “It is just housing the islet cells. The islet cells have just changed zip codes if you will. They were in the pancreas, now they’re sitting in the liver.”

Since her transplant, Stehlik has rediscovered “normal;” living pain-free in a way she had not done in more than 20 years.

“I no longer get up worrying about how I’m going to feel this morning,” she says. “I no longer wonder, ‘Can I have a cup of coffee or is it going to make me sick?’”

While the medical center’s clinic is new, the physicians behind it bring with them years of experience in a number of medical specialties.

“Not only do you have a surgeon involved, you have a pancreatic specialist from a GI standpoint, and you have an endocrinologist involved.” Dr. Vargas says. “We have consolidated these individuals into one place.”

In addition to the specialist physicians in the clinic, there is also a nurse case manager who works directly with each patient throughout his or her treatment.

“Prior to coming to this clinic, many patients they feel like they’re not being heard,” says Christina Sailors, RN, clinical nurse coordinator at the clinic. “They can’t go to school, they’re missing work, and sometimes they’re on disability. They’re really at the end of their rope when they contact us. So to give them hope is really exciting.”

Charlene Stehlik says she has found that hope and happiness.

“All the doctors here at the med center, all the nurses; I’ve told them so many times; thank you thank you thank you.”

 

Adult stem cell breakthrough builds on Nobel Prize winners’ work

by Chuck Brown, UNMC public relations
January 23, 2013

UNMC researchers have built on Nobel Prize-winning research to devise a new way to create powerful stem cells that could cure several conditions that cause blindness.

A team led by Iqbal Ahmad, Ph.D., professor of ophthalmology and visual sciences, can now turn adult limbal stem cells from the cornea into cells similar to powerfully-regenerative embryonic stem cells in animal models.

 

 
Iqbal Ahmad, Ph.D. 

These new cells can generate retinal progenitor cells that could potentially cure conditions such as glaucoma and age-related macular degeneration.

The work builds off that of Drs. John B. Gurdon and Shinya Yamanaka, who won this year’s Nobel Prize in science after they genetically altered adult stem cells into induced pluripotent stem cells (iPSC) — which mirror the qualities of embryonic stem cells.

“Whenever a breakthrough such as that is made, it becomes a rung on the ladder that leads to further development,” Dr. Ahmad said.

A different mechanism
Rather than use genetic manipulation, Dr. Ahmad’s team soaks the adult limbal stem cells in an enhanced tissue culture. The soak in the solution changes the molecular make-up of the limbal cells so they become iPSCs.

Dr. Ahmad’s team has transplanted its new IPSCs into the retinas of mice with experimental glaucoma. Early tests show that the cells have started to transform into retinal cells that degenerate in glaucoma. They have shown that these newly generated retinal cells make the neural connections needed to restore sight.

Research’s promise leads to support
Further tests will show if sight is restored, Dr. Ahmad said, but the work has shown enough promise to secure a $1.48 million, four-year R01 grant from the National Institutes of Health.

The newly created retinal cells also can be studied to see what genes are responsible for sight degeneration and what genes fight vision loss. This could lead to drugs that block the degenerative genes or bolster the genes that fight vision loss, Dr. Ahmad said.

“We’ve shown that changing the environment around these adult stem cells can change the cells themselves,” Dr. Ahmad said. “We now seek more efficient ways to create these transformative environments to cultivate these powerful cells that may offer hope to so many.”

 

Finest Cancer Care

Jenna Zeorian
September 20, 2012

 
 She typed the words “leading lymphoma treatment center” into the Google search box and pressed enter.

 

 It was September 2004 and Chris Pilcher-Huerter of Omaha, was now seeking treatment advice for her newly diagnosed Hodgkin’s lymphoma.

 The search results that appeared on her computer screen matched what she already knew — what everyone, including her family full of respected medical professionals, had told her. The best option was only a few miles from home— the University of Nebraska Medical Center.

 The home team

Pilcher-Huerter made an appointment with international lymphoma expert Julie Vose, M.D., chief of the UNMC Division of Oncology and Hematology and a 1984 UNMC graduate. Soon after, she met her medical team and began treatment.

 “I could’ve gone to one of the most well-known cancer centers in the country,” Pilcher-Huerter said. “But after my initial meeting with Dr. Vose, and the immediacy the team showed, I chose with confidence to stay right here at home.”

 Grateful volunteer

Now three years cancer-free, Pilcher- Huerter “strives to pay it back” to the place and the people that gave her life back. She is an active volunteer at UNMC where she serves in many capacities, including as a member of the Patient Family Advisory Council.

 It was through her work with the council that Pilcher-Huerter first became aware of the plans for a new cancer center on the UNMC and The Nebraska Medical Center campus in Omaha.

 Better for patients

The center, a $370 million project, will provide the entire scope of cancer treatment and therapy by a multi-disciplinary team, bringing together physicians, nurses, pharmacists, cancer researchers and others in an environment where research and patient care seamlessly integrate.

“From a patient’s point of view, going from one clinic to the next to the next can be very trying,” she said. “The whole idea of having physicians, scientists, clinics and treatment facilities in one place is going to be so much more convenient for patients, for loved ones, for family members. And to have that here in Nebraska is absolutely unbelievable.”

Better for discoveries and new treatments

Translational cancer medicine — taking research from bench to bedside — will increase dramatically.

“Laboratory researchers will literally be shoulder to shoulder with practicing physicians,” said Kenneth Cowan, M.D., Ph.D., director of the UNMC Eppley Cancer Center. “Their proximity will hasten the transfer of discoveries from the lab into new treatments that benefit patients.”

 Statewide impact

“Not that I plan on having cancer again,” she said with a laugh, “But this will elevate the superior care that’s right here in our backyard. And it’s going to impact all Nebraskans, not just the ones with cancer.”

 The center would create an estimated 1,200 highly skilled jobs and infuse $100 million into the state economy. And it will position UNMC and The Nebraska Medical Center to earn the National Cancer Institute’s top designation of Comprehensive Cancer Center.

 This achievement would place the medical center among the 40 best cancer centers in the country.

 

Indian partnership reaches milestone

by Chuck Brown, UNMC public relations
October 08, 2012

The number of Indian physicians who have done observership rotations at UNMC through a partnership with the state of Andhra Pradesh in India recently topped 100.

Since the 2010 launch of the partnership — likely the only one in the U.S. that pairs an academic health science center with an entire state in India — between two and seven Indian physicians have been present for rotations at UNMC every month.

 


 
A group of physicians from Andhra Pradesh, India, recently visited with UNMC Chancellor Harold M. Maurer, M.D., in recognition of the success of a partnership between the medical center and the Indian state that has allowed 100 physicians to come to Omaha for observerships. Pictured from left are: Cindy Mitchell, Vasu Reddy Challa, M.B.B.S, M.S., Udaya Kiran Sirasati, M.B.B.S., Madhusudana Bommasandra Aswatha Reddy, M.B.B.S, M.S., Vanam Bharath, M.B.B.S., Dr. Maurer, Ward Chambers, M.D., Chandra Are, M.D., Sai Charan Kauthara, M.B.B.S., and Anusha Reddy Akepati, M.B.B.S. 
“That we’ve been able to bring 100 physicians here to UNMC from India for rotations in such a short span of time is a significant feat,” said Chandra Are, M.D., associate professor in surgical oncology and program director of general surgery residency and the lead architect of the partnership between UNMC and India. “It shows our commitment to global health and our partners in India.”
Facets of the partnership
The Indian physicians, who typically are fellows or recent medical school graduates, spend one to two months at UNMC where they observe the practices of physicians in various fields.
On the other side of the partnership, UNMC has sent two surgical residents to work as surgeons in Andhra Pradesh, a state in southeastern India that is home to nearly 80 million people and more than 35 medical schools.
Unmatched experience
The general surgery residents — Paul Kolkman, M.D., who went to India in 2009; and Filipe Sobral, M.D., who was there this year — worked as full-time trainee surgeons in Andhra Pradesh.
“The sheer volume of cases that these two encountered alone made this experience invaluable for them,” Dr. Are said. “And that doesn’t even touch on the invaluable knowledge and perspectives they gained as they were immersed in a different culture as people and as professionals.”
Just the beginning
The clinical rotations and experiences are just some of the benefits the partnership could have for UNMC, said Dr. Are, who envisions rotations for UNMC students, physicians from other specialties and innumerable opportunities for research collaboration.
“Our commitment to this partnership has built tremendous goodwill in India and we have positioned ourselves to do some truly special things through this partnership,” he said.
For more information
UNMC faculty members willing to host Indian physicians for observations and all those who want to know more about the medical center’s partnership with Andhra Pradesh should contact Dr. Are at care@unmc.edu.

 

The Nebraska Medical Center Opens New Endoscopy Center

A little more than half of the people in Nebraska who should be getting colonoscopies actually do.

“There are things we know we can do something about early: prostate cancer, breast cancer, blood sugar control, and colon cancer,” said Grant Hutchins, MD, gastroenterologist at The Nebraska Medical Center. “These are things in which we know we can make a difference early and can prevent a lot of mortality down the road.”

Dr. Hutchins and Gary Volentine, MD will see patients at a new endoscopy center opening this week at Village Pointe Medical Center near 180th and West Dodge Road in Omaha. Both physicians will begin seeing patients Friday, Sept. 7.

The center’s opening comes at a time when there is a renewed push across Nebraska to educate people about the importance of colonoscopy screening and colon cancer prevention. Colonoscopy is very effective at finding polyps and pre-cancerous lesions in the colon.

“The cure rate for colon cancer is excellent – if it’s found early.” Dr. Hutchins said. “It’s the people who don’t get screened when they’re young or have symptoms that they ignore, that unfortunately present later with disease that has spread to a lot of places.”

Dr. Hutchins recommends most people begin regular screenings at age 50. He advises others, including African Americans and those with a family history of colorectal cancer to begin screening at age 40. If there is a family history of colorectal cancer, the first colonoscopy should be performed ten years before the age that a person’s first-degree relative (parent or sibling) was diagnosed.

Dr. Hutchins advises people to ask their family doctor when they should begin screenings and to tell their doctor about any colon cancer symptoms such as a change in bowel habits or blood in the stool.

“We know people aren’t exactly clamoring for colonoscopies,” Dr. Hutchins said. “But it’s not a painful procedure. It is uncomfortable, but it’s not painful. And it is very important and very effective. We hope this new center will give patients more options to have their screenings done closer to home.”

Patients often have questions about the need for colonoscopies and what it takes to prepare for the screening. Dr. Hutchins answers many of those questions in a short video posted on The Nebraska Medical Center’s YouTube channel.

 

Thanks and Giving: A Transplant Story

Twitter helped connect donor and recipient

Kansas pastor Mike Bronson knew for years that a kidney transplant might be necessary. In 2009, it became a reality. His doctors said he was in end stage renal disease and needed a transplant.

“Once news became public, I was overwhelmed with the number of people offering to donate a kidney, Bronson says.

Family members, friends and members of his church all wanted to help.

 

-Transplant recipient Mike Bronson serves as pastor at West Haven Baptist Church in Kansas

 

“Another man in my church went through the entire battery of tests. At the very end, he was disqualified due to a ‘minor’ heart problem. It turns out that heart problem became major. He had two successful surgeries since but the problem may not have been uncovered in time without his desire to donate.”

Bronson tweeted about his search for a donor. That’s how he re-connected with Tonya Blythe, whom he had baptized several years before.

“Mike was a pastor at my church in Jefferson City, MO, but he had moved away and we lost touch,” Blythe recalls. She was still following him on Twitter.  “By the time I became aware of his need, he’d been on the waiting list for a year.”

Blythe contacted Bronson and began the process of getting matched.

“I thought, ‘This won’t work,’” she said, “But I kept getting green lights.”

Blythe turned out to be a match, but there was one thing that still wasn’t right.

“We didn’t feel comfortable at our transplant center, so right before we were going to be approved for transplant, we started looking elsewhere,” Blythe said.
 
-Kidney donor Tonya Blythe says the transplant will teach her children the importance of giving selflessly

 

“I stumbled across The Nebraska Medical Center,” Bronson said. “I sent Sue Miller an email and our experience was tremendous. Sue gave my wife and me a tour and after speaking with Tonya and her husband Jon, we were convinced God was sending us to Omaha.”

“We went out on a limb and said, ‘Let’s go to Nebraska and start over,’” Blythe said.

As the donor, Blythe says she had no second thoughts when it came time to come to the medical center to give her former pastor one of her kidneys; especially when she learned it would not affect her ability to have another child.

“As it was happening, I had this overwhelming feeling of, ‘Why don’t more people do this?’” she said. “This is a legacy of giving. I want others to know that giving is important. I want my children to understand: this is who we are as a family.”

 

-Transplant recipient Mike Bronson stands with his family at his son’s recent wedding

 

Three years later, Bronson says he is still sometimes at a loss for words when he thinks about the gift he received.

“You would think that a pastor who writes sermons and Bible studies weekly would be able to express himself well, but I still struggle to express my gratitude with clarity,” he says. “I still cannot believe that she was willing to subject herself to numerous tests, pain, great inconvenience and surgery and to save my life.”

Kidney disease continues to challenge Bronson even after the transplant. Continued treatment here and in Kansas City has slowed the disease’s progress and he remains optimistic and thankful. Not only for his donor, but also for Sue Miller; transplant coordinators Lori Schmida and Kim McAnally as well as co-directors of the kidney transplant program Drs. Cliff Miles and Michael Morris.

 

-Kidney recipient Mike Bronson talks with his donor Tonya Blythe after the transplant at The Nebraska Medical Center in 2009

 

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