Archive for the ‘Medical Professionals’ Category

A Rising Star in the Wild West – Neurology @ Nebraska Medicine

U.S. News and World Reports recently ranked Nebraska Medicine as one of the best hospitals in the country for its expertise in six adult specialties: cancer care, gastroenterology and GI surgery, nephrology, neurology and neurosurgery, pulmonology and urology. This is the best performance for the hospital in terms of national recognition in these rankings.

In a series of blog posts, the experts from each nationally-ranked department will highlight what makes Nebraska Medicine a leader in providing care to its patients.

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We’re delighted with the news – that US News & World Report has given our division a #31 ranking among the best hospitals in America. It means our neurology and neurosurgery division is in very good company.

Some people might be surprised. They don’t expect to find excellent neurological care here in Nebraska. They think of institutions on the east coast—the famous hospitals with long histories.

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Matthew Rizzo, MD Chief of Neurology and Neurosurgery

Well, it’s no surprise to those of us who chose Nebraska Medical Center for our medical practice. We recognize the top-notch individuals in this group. I like Nebraska and the Wild West mentality. The people here have a can-do attitude. We know that Nebraska Medicine is a rising star. The Department of Neurological Sciences and our partners in neurosciences make up an equally premier service on the rise—a very broad, comprehensive program involving mind, body and health.

Let me tell you about our neuroscience specialists — trained in neurology, neurosurgery, psychiatry, psychology, anesthesia and pain/palliative treatment. They treat the full range of neurological conditions—tumors of the brain or spine, epilepsy, Alzheimer’s or dementia, stroke, psychiatric disorders, multiple sclerosis, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), spinal disorders, traumatic brain injury, degenerated or herniated disks, pain syndromes, vascular malformations and aneurysms.

In collaboration with our pediatrics colleagues at the Monroe Meyer Institute, we also treat children with autism and attention deficit disorders. And, we treat both adults and children with neurological problems related to diabetes and cancer.

Many, many people are affected by neurologic conditions for decades. These chronic conditions can be very debilitating. That’s why Nebraska Medicine stays on top of the latest treatments—and why we conduct ongoing research to uncover the best treatments. We aspire to be the best neurological service in Omaha, in the Heartland and in the world.

These specialty clinics are crown jewels in our neurology division:

Movement disorders clinic

Midwesterners don’t brag much, but maybe we should. In Neurology, we’ve brought on board many top experts, including Diego Torres-Russotto, MD, a specialist in movement disorders. Dyskinesia, for example, is characterized by a slight tremor or involuntary muscle movements. This is a symptom for several medical conditions, and requires a specialist to determine the cause. Dr. Torres-Russotto is an expert at this type of complex diagnosis and outlining the best treatment.

He is also a specialist in diagnosing orthostatic tremor, a neurological condition that involves the legs and trunk. Very few doctors recognize the symptoms or know how to treat this condition. With Dr. Torres, you’re in very good hands.

If you’ve got a tremor that is affecting your everyday life, it’s important to see a specialist who can recognize the subtlest clues—and who can make a correct diagnosis. That’s the only way to assure you’ll get the best treatment.

For example, we’ve found that Botulinum toxin is a very successful treatment for severe intractable tremors and a variety of neurological conditions—blepharospasm, cervical dystonia, writer’s cramp, spasticity, hemi-facial spasm and cerebral palsy. Many of these conditions are otherwise incapacitating.

While people didn’t know what to think about Botox a few years ago, we’ve found it to be an excellent treatment with very minor side effects. Botox is just one treatment we can offer our patients—to give them relief from debilitating problems.

Epilepsy clinic

We also have great expertise in treating epilepsy—including the really complex, difficult cases that require surgery. Deepak Madhavan, MD, is our epilepsy specialist, and he gives hope every day to patients whose lives are paralyzed by this disorder. He knows the difficulties that epilepsy causes—and he presents patients with medical and surgical treatments that can bring real relief.

In just a few years, the science and treatment of epilepsy has advanced tremendously—and patients can actually live seizure-free. That’s right, your hope is now more than a dream. We now have sophisticated diagnostic tools such as magnetoencephalography (MEG) under the expert guidance of Dr. Tony Wilson, PhD., to localize epilepsy in the brain. That allows us to determine the best treatment.

In Dr. Madhavan’s very capable hands, you can get on with your life, your work, your education with the security knowing that your seizures are under control.

Memory disorders clinic

Certainly, Alzheimer’s is a memory disorder we see every single day. Researchers say that if we live long enough, most of us are likely to develop dementia and Alzheimer’s, Parkinson’s disease or a related condition.

Many people come to us when they’re concerned about a family member. They see signs of a faltering memory, and they’re not quite sure whether to be concerned or not. We invite them to come in, and we provide the appropriate evaluation tests.

We can rule out treatable conditions that look like Alzheimer’s but really aren’t. Even hearing loss can make someone seem as if his or her thinking is impaired.

There may be a thyroid or sleep problem, or depression, which also affect memory and decision-making. Older people are often taking one or three or five medications – all prescribed by a well-intentioned doctor — but when taken together, memory can be affected.

In fact, prescription medicine for sleep problems or heart disease may cause slower thinking—making it look as if something is wrong. It may just be a too-high dosage, or it may be the patient needs a different pill.

After they are diagnosed, our patients receive the medications that help control symptoms. They also can enter a rehabilitation program for stroke or traumatic brain injury. Very often, we link patients with community resources and support groups. Also, our patients can participate in clinical trials and have access to new drugs long before they are widely available.

Our psychology and neuropsychology experts, under David Cates, PhD, are top-notch in diagnosing disease—which helps us begin early treatment, then gauge disease activity and improvement over time. Our goal is to help people age successfully at home, with healthy minds and brains, as long as possible.

Telemedicine and telehealth

This corner of the world — Nebraska and our nearest neighbors in the northern Great Plains — is a wide-open space. Many patients live in remote areas interspersed with small pockets of urban development. It’s a burden for them to drive to our clinic; they have to spend a lot of windshield time just to get to the doctor’s waiting room.

That’s why we’ve started a telemedicine program for stroke, Parkinson’s disease and multiple sclerosis (MS) patients. With high-speed internet and excellent technology, these patients can work with their local doctors—with the aid of consultations from our experts here in Omaha.

In fact, we have some specialists driving to these remote clinics—or even making house calls. Our patients love this personalized service. The specialists really enjoy doing this; it feels like you’re doing the right thing for your patients.

Many of these people wouldn’t get the medical treatment they need if we didn’t offer these telemedicine services.

The future for neurology services

We’ve very excited about the strength of our Neurology program and all our Neurosciences services—and about the opportunities that lie ahead. We continue to bring in specialists from the top institutions as well as the best technology, and foresee strong opportunities to improve.

We want to serve Omaha—as well as our neighbors throughout Nebraska, Kansas, the Dakotas, western Iowa and northern Missouri. We want to reach out across the country and around the world to connect with patients. We can offer them the best-quality neurology care available, while conducting premier research—and while training the next generation of healthcare experts to carry on.

Thanks, US News & World Report, for the great ranking—which we plan on surpassing in short order.

World-Class Digestive and Liver Care – Close to Home

Gastroenterology
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USNews-Badges-SmallerU.S. News and World Reports recently ranked Nebraska Medicine as one of the best hospitals in the country for its expertise in six adult specialties: cancer care, gastroenterology and GI surgery, nephrology, neurology and neurosurgery, pulmonology and urology. This is the best performance for the hospital in terms of national recognition in these rankings.

In a series of blog posts, the experts from each nationally-ranked department will highlight what makes Nebraska Medicine a leader in providing care to its patients.

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Mark Mailliard, MD | Chief of Gastroenterology and GI Surgery
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Alan Langnas, MD |  Chief of Transplant Surgery
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Jon Thompson, MD |  Colon and Rectal Surgery

We’re ranked as the 29th best hospital in the country for Gastroenterology (GI) and GI Surgery, according to this year’s U.S. News & World Report’s Best Hospitals in America report.

That’s excellent news!

If you’ve been diagnosed with a digestive or liver disorder, it’s important to know you’re seeing the “best of the best” when you come to our clinic. Our specialists diagnose and treat all GI problems—including inflammatory bowel disease, pancreatic disease, cancer of the GI tract and motility disorders.

We have special expertise with the most complex disorders—intestinal failure, pancreatic disorders, chronic liver disease, cirrhosis complications, liver tumors and viral hepatitis, especially hepatitis C.

When we added specialized endoscopy to our liver service, we brought a level of care unique to this region. Endoscopy of liver bile ducts and liver transplant are mainstays in our referrals.

Our colleagues around the world tell us they would send family members to Omaha if they needed a liver transplant. We heartily agree!

A revolutionary new therapy

We have another gem in our practice—an innovative therapy drawing international attention. Perhaps you’ve heard about it in the news. It may sound “different”—but it’s been tremendously successful in helping very sick patients.

Fecal microbiota transplantation therapy is proving to be an excellent treatment for patients who are fighting a bad intestinal bug–Clostridium difficile, or C. diff. Alex Hewlett, DO, is leading the  team to provide this novel therapy.

Here’s how the problem develops—and how fecal therapy works:

When patients are prescribed antibiotics too often, the drugs can wipe out the beneficial bacteria in the gut. That leaves the intestine vulnerable to attack by C. diff bacteria, which invade the intestine. Patients get very sick, with bloody diarrhea and dehydration. The colon can be damaged; some patients have died.

In many cases, C. diff can be controlled with antibiotics, but at times that fails. Fecal therapy is the only treatment that has been shown to work for 88 percent of patients treated.

What exactly is fecal therapy? It involves taking a watered-down stool from a healthy person (often a relative) and transferring it into the patient’s digestive tract via a tube down the mouth or nose, or into the colon. This “new” healthy bacteria helps to repopulate the digestive tract to combat the C. diff overgrowth.

With fecal therapy, these very sick patients have a chance to get well. The results can be very dramatic—even life-saving. In medicine, we view it as another way for the body to naturally heal itself.

Our international reputation

These complex digestive and liver problems require a robust, comprehensive team with the best medical, nursing, diagnostic, surgical and therapeutic resources—which many hospitals simply don’t have.

For patients who need this level of diagnostics and treatment, we serve as a referral and second-opinion hospital. Physicians need a destination for their sickest patients—and that’s where we excel.

Nebraska Medicine is known nationally and internationally for our work. Patients come here from all over the U.S. –North Carolina, New York City, California—even as far away as the Middle East. We offer a language translation service for those patients, to help them feel comfortable in their interactions here.

Patients like coming to Omaha because of our world-class medical care—and because Omaha isn’t such a big city. They’ve heard it’s easy to get around. They’re right!

Caring for the sickest patients

Referring physicians need a clinic like ours to treat their sickest patients. We’re equipped to do that. But we know that medicine is far more than medical services and technology. We understand the stress our patients are feeling.

Every patient comes to us after receiving bad news from their local physician. They know it’s a potentially life-threatening medical problem. We do our best to allay their fears, address their concerns and provide reassurance and hope.

We want our patients to feel like we’ve wrapped a warm blanket around them. We want them to feel safe, warm and looked after during this very critical time in their lives.

We have a comprehensive team—a nurse coordinator, nurse practitioner, surgeon, physician, social workers, physical therapists, pharmacists – all focused on their care.

This team approach provides great continuity of care. From clinic to hospital to outpatient care to home—we make sure the patient’s care is seamlessly connected. We make sure each patient feels secure, and in expert hands, while facing critical health problems.

With world-class surgeons and physicians—and the best care possible—we give patients the best outcome possible. This is the mission we embrace every single day.

UNMC/Nebraska Medicine named national Ebola training, education center

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UNMC/Nebraska Medicine, in collaboration with Emory University in Atlanta and Bellevue Hospital Center in New York City, have been awarded a $12 million grant by the U.S. Department of Health and Human Services (HHS) to establish and co-lead the nation’s National Ebola Training and Education Center (NETEC).

The three institutions will partner with the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Centers for Disease Control and Prevention (CDC) to support the training of health care providers and facilities on strategies to manage Ebola and other emerging infectious diseases.

UNMC and its primary clinical partner, Nebraska Medicine, will receive $5.1 million of the $12 million federal grant – the largest share of the three collaborating institutions.

Regional Ebola treatment center 

UNMC/Nebraska Medicine is one of nine regional Ebola treatment centers recently named by HHS as part of a national network of 55 Ebola treatment centers with enhanced capabilities to treat patients with confirmed Ebola or other highly infectious diseases.

Ebola treatment centers are staffed, equipped and have been assessed to have current capabilities, training and resources to provide the complex treatment necessary to care for a person with Ebola while minimizing risk to health care workers.

“We are pleased to receive this designation as a national leader in the world’s fight against Ebola and other infectious diseases,” said Jeffrey P. Gold, M.D., UNMC chancellor and board chairman for UNMC’s clinical partner, Nebraska Medicine. “Our campus is in this position because we have selfless, talented individuals who prepared for a decade to care for the sickest of patients in our biocontainment unit. They did so valiantly over several months in 2014, and they also have shared their expertise to train countless others from around the world in preparation for the next highly infectious disease outbreak.

“I also want to thank our state’s congressional delegation for their support and work in helping us receive this significant designation.”

During the Ebola outbreak of 2014, UNMC/Nebraska Medicine was recognized as a national asset and referred to as the “gold standard” for treatment and development of safety protocols to handle Ebola and highly infectious diseases.

UNMC/Nebraska Medicine has the largest operational biocontainment unit in the nation.

UNMC/Nebraska Medicine and Emory University have worked with the CDC since December to train more than 460 health care workers from 87 health care systems, including 37 designated Ebola treatment centers, on all aspects of infection control and patient care for individuals with Ebola.

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Philip Smith, M.D., medical director of the Nebraska Biocontainment Unit at Nebraska Medicine and professor, UNMC College of Public Health, is principal investigator of the UNMC/Nebraska Medicine grant from HHS.

UNMC and Emory are offering additional training opportunities this summer for up to 400 staff from Ebola assessment hospitals.
The new National Ebola Training and Education Center will expand on the success of this initial work and offer state health departments and health care facilities additional access to the clinical expertise and training capabilities offered by these institutions.

“The national center contributes to our nation’s health security by developing and teaching evidence-based practices of experienced providers and health care institutions in caring for patients with Ebola and other serious infectious diseases,” said Nicole Lurie, M.D., assistant secretary for preparedness and response for HHS. “While this training starts with Ebola, it also will help the health care community deal with other serious infectious diseases in the future.”

CDC Director Tom Frieden, M.D., said the ongoing Ebola epidemic in West Africa is proof “that a threat anywhere can be a threat everywhere; the United States must continue to prepare.

“Hospitals are often the first place where a new disease threat is recognized. This new center will help our hospitals and health care workers prepare to handle new threats and safely care for patients.”

Hyperbaric Oxygen Therapy Can Reverse Radiation Induced Vascular Injury

Hyperbaric oxygen therapy (HBO) has become an important treatment to reduce the uncommon but serious, late affects of radiation therapy.

“About one in 20 people will experience the late affects of radiation therapy and experience microvascular loss in that area,” says Jeffrey Cooper, MD, emergency specialist and medical director of the Hyperbaric Medicine Center at Nebraska Medicine. “We typically see an 80 to 85 percent success rate depending on the condition and how soon we see the patient. The longer the problem goes on before we treat the patient, the more difficult it is to treat the tissue.”

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Jeffrey Cooper, MD
HBO, which has been available at Nebraska Medicine since the mid-1980s, involves breathing 100 percent oxygen in a sealed chamber under pressure to treat a variety of disorders, including carbon monoxide intoxication, decompression sickness, diabetic wounds, air emboli and life-threatening processes including gas gangrene and other necrotizing infections.

By delivering oxygen at two to three times normal atmospheric pressure, the therapy works by forcing more oxygen into areas that aren’t getting adequate amounts due to tissue damage or swelling. This increases the oxygen concentration in the blood and body tissues, which promotes healing. It also helps revive the immune system and helps the antibiotics work more effectively.

HBO treats the delayed side effects of radiation therapy by reversing the radiation-induced vascular injury to affected bone and soft tissues. During radiation, many of the smallest of blood vessels may be damaged or destroyed, which then limits the access of ingredients necessary for healing such as oxygen, antibiotics, nutrition, vitamins and growth factors.

One study showed that when hemorrhagic cystitis was treated within the first six months, the success rate was nearly 100 percent, says Dr. Cooper. The success rate for patients who were treated after six months dropped to 66 percent.

“Necrosis tends to be progressive and many tissues won’t heal even with surgical intervention,” he says. “The key is to reverse the necrotic process so the body can start to heal itself again. If we see the patient early enough, we can sometimes reverse the process without surgery. While some patients may still need surgical intervention, the patient will likely require less aggressive surgery and it will be more successful.”

Treatment for osteoradionecrosis typically requires 30 to 40 two-hour daily treatments, notes Dr. Cooper. An additional 10 treatments may be required after surgical interventions.

Head and neck cancers are some of the most common cancers that lead to osteoradionecrosis. Other common cancers in which treatment can lead to radiation injury include bladder, bowel, jaw and skin cancers.

HBO has also become an important therapy in treating hard-to-heal diabetic wounds, anemia, and problem flaps or grafts from plastic surgery. Head and neck surgeons at Nebraska Medicine have also seen success in promoting healing for various soft tissue and bone restorative and reconstructive procedures.

Nebraska Medicine is the only hospital with a 24/7 Hyperbaric Oxygen Unit that can treat acute and critically ill patients in the area. Acute cases include patients with gas gangrene, necrotizing fasciitis, carbon monoxide poisoning, crush injuries to the limbs and those suffering from diving accidents. The unit now houses four monoplace (one person) chambers in total.

“HBO is an adjunctive treatment that can change a person’s odds,” says Dr. Cooper. “It is most often used in combination with antibiotics and surgery, and if we see the patient early enough, it can stack the deck in a person’s favor. We’re seeing a marked reduction in morbidity and mortality in patients whom we treat. We’re seeing fewer complications and in some cases, it can mean the difference between an amputation and saving a limb. The key to its success is getting the patient to us before things get out of control. HBO can salvage at risk tissue, but it can’t recover lost tissue.”

New Lung Transplant Program Expected to Begin Early Summer

Providers anticipate 10 lung transplants in the first year, increasing to 35 to 40 by the third year.

One of the biggest supporters of the new lung transplant program is Heather Strah, MD. As director of Lung Transplantation, she plays an integral role in the planning process.

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Heather Strah, MD
“There is definitely a need for a lung transplant program in this area,” says Heather Strah, MD, director of Lung Transplantation at Nebraska Medicine. “The nearest programs are almost 400 miles away. This creates quite a burden on the patient and family who must relocate for three months or more during the transplant process. Some patients are turned down because they are not able to relocate.”

Dr. Strah completed medical school at the University of Iowa Carver College of Medicine in Iowa City, an internal medicine residency at the University of Pittsburgh Medical Center and a pulmonary and critical care medicine fellowship at Washington University School of Medicine-Barnes Jewish Hospital. She also completed a post-doctoral research fellowship at Washington University School of Medicine in immunology. Washington University has one of the oldest lung transplant programs in the country and performs nearly 60 lung transplants annually.

Other members of the lung transplant team thoracic and cardiac surgeons Michael Moulton, MD, and Aleem Siddique, MD.

 

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Approximately 1,800 transplants are done in the United States each year. Thirty-five percent of these patients have end-stage chronic obstructive pulmonary disease (COPD), 15 percent have cystic fibrosis and 30 percent have interstitial lung disease or idiopathic pulmonary fibrosis. The remaining 20 percent have other conditions such as pulmonary hypertension or sarcoidosis.

Each patient must go through a thorough evaluation and screening process to make sure he or she is a good candidate. Lung transplants are generally reserved for individuals whose lung disease is in the most advanced stages and they are likely to die of their lung disease within one to two years despite maximal medical therapies, notes Dr. Strah. Good transplant candidates are in generally good health, other than their lung disease, and have a good support system.

Lung transplants are usually performed on patients between the ages of 16 to 65. Younger patients typically fare the best, says Dr. Strah. Survival for the first year is 80 percent. Five years out, half of patients will have died due to complications related to the transplant.

“For those who have good outcomes, a lung transplant can be a life-changing experience,” she says. “I have seen patients who have been living 20 years or more with their transplant.”

Dr. Strah stresses the need to refer potential candidates early on. About half the people on the waiting list receive a transplant within a year.

“There is no such thing as a referral that is too early,” notes Dr. Strah, “but there are definitely referrals that come too late. The lung is a fragile organ and it can take a long time to find a suitable donor so early referral is best.”

To contact Dr. Strah or request a referral, please call the clinic at (402) 559-4015.

Letter from the Director | Fred & Pamela Buffett Cancer Center

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Today we stand at the forefront of a revolutionary period for cancer research and patient care. For the very first time in history, we have the opportunity to uncover the mystery of cancer. These new findings promise to unlock our understanding of this deadly disease and forever change the way we administer treatment. Very soon, we will no longer treat cancer types but instead, personalize treatment by targeting specific gene mutations.

The Fred & Pamela Buffett Cancer Center is poised to take the lead in this effort – on a regional, national and international front. But to get there, we need to work together.

The culture of the new cancer center is defined by the idea that unplanned collaboration sparks discovery. The kind of magic where the stars align and everything falls into place.

Breakthroughs.

We are establishing a commitment to collaboration where the world’s best doctors and researchers ask questions, share ideas and find answers that profoundly improve patient outcomes. Here, science and medicine will align in new and uncharted ways.

Every square inch of the Fred & Pamela Buffett Cancer Center has been designed with this philosophy in mind. The physical layout will foster a new way of “doing” cancer research and care by breaking down the divisions and silos that have separated scientists and clinicians in the past.

The new Fred & Pamela Buffett Cancer Center wants to be something different, something out of the ordinary. Extraordinary patient care and scientific advancements will take place together, creating a synergistic precision that represents the future of medical care. Science and medicine will share not just a common space, but also a common goal.

For too long, the approach to treating cancer has been indiscriminate and lacking in precision. To kill the bad required physicians to also kill the good. It’s part of the reason cancer is so scary. Not just the disease itself, but because the treatments available cause significant damage and debilitation. Today we have the opportunity to discard the “one size fits all” treatments and develop and employ targeted, less toxic, more humane therapies.

The Fred & Pamela Buffett Cancer Center will bring together elements that aren’t commonly associated with cancer care, including music and fine art, meditation and yoga. Our team will aggressively work to cure disease of the body while recognizing the human mind and spirit play an integral role in the healing process. This integrated approach to medicine will help patients and their families deal with the challenges associated with cancer in an atmosphere that breeds hope, optimism and resilience.

The heroism found in each patient is the foundation from which we will build this great new center.

This is how I know we will succeed.

Because it’s personal.

 

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Kenneth H. Cowan, MD, PhD

Director, Fred & Pamela Buffett Cancer Center

Russian researchers/physicians learn about UNMC

by Tom O’Connor, UNMC public relations

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Members of the Russian delegation included (left-right) Ludmila Annable (translator), Aleksandr Khilkov (facilitator), Danielle Dohrmann, director of program development, international health and medical education and one of the UNMC hosts of the group, Kira Ageyeva, Dmitriy Kolpakov, Ward Chambers, M.D., executive director, international health and medical education and one of the UNMC hosts of the group, Dmitriy Kireyev, Anastasiya Pokrovskaya, Georgiy Yefimov, Maria Cochran (translator), and Konstantin Mironov.

A group of six Russian researchers/physicians spent three days at UNMC this week as part of the Open World Program, one of the most effective U.S. exchange programs for countries of the post-Soviet era.

“I think it was a very worthwhile visit,” said Ward Chambers, M.D., executive director, international health and medical education for the UNMC College of Public Health and one of the UNMC hosts for the group. “Russian scientists are just like scientists all over the world. When you’re dealing with other scientists, the politics between the two countries doesn’t matter. They are far more interested in knowledge than politics.”

The Russian delegation met with more than 20 UNMC administrators and faculty between Monday and Wednesday, including UNMC Chancellor Jeffrey P. Gold, M.D. They gained exposure to a variety of different areas, including organ transplantation, nanomedicine, HIV research, DNA sequencing, and human genetics.

“They were particularly interested in our HIV research, as infectious diseases and HIV are the focus of much of their work,” Dr. Chambers said. “It also was nice that some of our researchers were able to speak Russian with them.”

The Open World Leadership Center administers the Open World program. Begun as a pilot program in 1999 and established as a permanent agency in late 2000, the center conducts the first and only international exchange agency in the U.S. legislative branch.

It has enabled more than 17,000 current and future leaders from Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Ukraine, Tajikistan, and Turkmenistan to meaningfully engage and interact with members of Congress, Congressional staff, and thousands of other Americans, many of whom are the delegates’ direct professional counterparts.

The Open World program focuses both on assisting Congress in its oversight responsibilities and on conducting exchanges that establish lasting professional relationships between the up-and-coming leaders of Open World countries and Americans dedicated to showcasing U.S. values and democratic institutions.

Open World delegations consist of committed leaders (average age 38) who experience in-depth programming in themes of interest to Congress and of transnational impact.

Former U.S. Sen. Ben Nelson was instrumental in bringing the exchange program to Nebraska, Dr. Chambers said. Because of this, the Russian visitors are known as Ben Nelson Fellows.

Two prominent Nebraska business leaders and longtime supporters of UNMC, Mike Yanney and Walter Scott, are members of the Open World Leadership Center Board of Trustees. Scott is chairman of the board, while Yanney is chairman emeritus. Rep. Jeff Fortenberry of Nebraska also is a member of the board.

Dr. Green’s research led to lymphoma breakthrough

by Kalani Simpson, UNMC public relations

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Michael Green, Ph.D., assistant professor in the Eppley Institute,
A new recruit to the Fred & Pamela Buffett Cancer Center begins his UNMC career on the heels of a major contribution to a breakthrough in Hodgkin’s lymphoma treatment.

Clinical trial results for the new therapy inspired by his research were detailed in a December 2014 edition of The New England Journal of Medicine.

Michael Green, Ph.D., assistant professor in the Eppley Institute, while a postdoc at Dana-Farber Cancer Institute in Boston in 2010, was first author on the discovery of a therapy target — a gene whose increased expression allowed cancer cells to evade being seen and eradicated by the immune system.

Expression of this gene may be why Hodgkin’s relapse rates can be as high as 25 percent.

“It’s a ligand on the tumor cell surface that binds to a receptor on the T-cell and tells them not to perform their normal function,” Dr. Green said. “Its natural role in biology is after an infection to try and bring down the immune response after the infection has been cleared. But it has been hijacked by these cancer cells so they can shut down an anti-tumor immune response.”

Thankfully, there was a potential neutralizing antibody already in clinical trials. So a study involving patients with relapsed or refractory lymphoma got to skip straight to Phase II, to “a pretty remarkable result,” Dr. Green said. The treatment was awarded breakthrough therapy (BT) designation by the FDA. Dr. Green had already left for Stanford University by the time the clinical trial started, but feels very satisfied with the end result.

“That’s why we do what we do,” he said. “Publications and grants are nice but this is the real reason behind our research.”

At Stanford, Dr. Green turned his attention to the as-yet incurable follicular lymphoma. And there is no better place to continue this research, he decided, than at UNMC, where Jim Armitage, M.D., and Julie Vose, M.D., head up a world-renowned lymphoma study group.

“That was imperative in coming here,” he said. “I’m doing a lot of next-generation sequencing and there’s a genomics core here. I do a lot of immunology and there’s a very good flow cytometry core here. And the biggest thing really is a massive bank of tumors here.”

And the relationship history with the patients who gave them.

Now, Dr. Green is studying a novel gene mutation which helps follicular lymphoma cells evade the immune system. “We have defined the mutation we want to target, so now we are trying to identify a specific therapy — it is a great example of ‘precision medicine.'”

New insights in lung cancer treatment

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APAR KISHOR GANTI, MD

In the past decade, we’ve come a long way in our knowledge of lung cancer. Until then, we had only a basic understanding of the tumor cells – and chemotherapy helped only a small percentage of patients.

We knew very little about lung cancer cells. We only knew about “small cell lung cancer” and “non-small cell lung cancer,” which basically was everything else. Today, from 10 to 15 percent of lung cancers are the small cell type.

We knew there were differences among these “non-small cell” cancers. But we didn’t have the tools to identify them, and we didn’t know how to treat them. Everyone got the same chemotherapy treatment, which was very effective in some cases – but not for many.

That changed when drug called Iressa was introduced in the U.S. This drug helped a small minority of patients – and they responded dramatically. Their tumors disappeared in a matter of weeks. Unbelievable!

This led to research to find out more about these patients. This also started a revolution in understanding different sub-types of non-small cell lung cancer. Today, using sophisticated tests, we can identify the main mutation causing lung cancer in a significant proportion of patients.

This research has led to targeted treatments we use today, with much greater success. New drugs have been developed to treat two of these lung cancer sub-types. These drugs primarily help people who have not been smokers – but have developed lung cancer from other toxic exposures, like radon.

Erlotinib, Afatinib, Pemetrexed, Crizotinib and Ceritinib are drugs that that we use today – to treat some of these specific types of lung cancer. Many of these drugs and others like these are still in clinical trials, to study their effectiveness. While we still don’t have all the answers, and still don’t have drug treatments that help everyone, we’ve come a very long way.

Several more medications are in clinical trials. We’re continually looking for more answers, trying to help many more lung cancer patients. But our progress in the past 10 years has given all lung cancer patients – and medical specialists like me – more hope.

At Nebraska Medicine, our service is designated by the National Cancer Center as a Lung Cancer Alliance Screening Center of Excellence. This reflects our team’s experience as well as our multidisciplinary program in managing patient care.

With this level of expertise, you will receive the treatment that specifically targets your lung cancer sub-type. We’ll stay with you every step of the way, making sure you’re getting excellent care.

Take heart that, when your cancer is caught at an early stage, you stand a very good chance of cure. The American Cancer Society reports that over 430,000 people alive today have been diagnosed with lung cancer at some point.

A Transplant’s Not the Only Alternative for Children With Intestinal Failure; Rehab is an Option for Most Patients

Mercer
DAVID F. MERCER, MD, PhD

Our intestinal transplant program has a worldwide reputation. We’ve performed more intestinal transplants here at The Nebraska Medical Center than any other single hospital in the world. We helped pioneer the procedure.

But whenever possible we prefer not to do it.

Rehab for our pediatric intestinal failure patients is so successful, we don’t need to transplant very often. Rehab has become our default – with transplant as a wonderful backup plan, but no longer the only option.

Our patients come from all over the country and around the world. Many times, parents have been told that an intestinal transplant is the only treatment for their child. But when they arrive, we start with what they have – whatever the child’s condition and function – and go from there. It’s better to build on whatever they have than to start over. The family goes from having no hope to realizing that, very likely, their child will be able to live and eat normally.

When a child comes to our program, the family needs to be here four to six weeks. That sounds like a long time at first. But once they arrive, the families are so relieved and comfortable, often they don’t want to leave. Regardless of when they return home, they are part of the program for life.

Here’s what usually happens. The first week is evaluation with testing every day, and we make a plan. Next is an inpatient stay for a surgical intervention. Then it’s outpatient care for the next few weeks, attending weekly clinics and communicating almost daily with our team as we work on improving function in the intestinal tract, finding a pathway that will work for them and carefully moving toward our goal of eating and drinking by mouth.

When I tell parents that we hope their baby will one day go to kindergarten, carry a lunchbox to school and eat just like other kids, it blows their minds. But that is the goal, and we see our patients reach it all the time. It takes time and a dedicated team of experts guiding the way, but we get there working together. The family has been told to expect the worst; we let them know to expect the best.

There are times when we meet a child and we decide that the risks of taking time to work on intestinal rehabilitation are too high – that perhaps there has been too much damage done prior to their arrival.  There are other times when, despite everything we do, we cannot make progress and the risks of being on TPN begin to mount. These are the times when we turn to transplant, and in these cases it is truly lifesaving.

Rehabilitation and transplantation aren’t competitors with each other, but rather they work together so the right thing can be done for a child at the right time. When we can, we always prefer rehab, because successful intestinal rehabilitation doesn’t just delay the need for a transplant – it eliminates it.  When that goal can’t be achieved, transplant moves in to provide lifesaving therapy.

With these two complementary tools, the child with intestinal failure has a great chance to live a full, productive life.

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