Archive for the ‘Medical Professionals’ Category

New Development in Breast Cancer Surgery

 

Today, women diagnosed with breast cancer have multiple surgical options to choose from.

Today, women diagnosed with breast cancer have multiple surgical options to choose from.

Today, women diagnosed with breast cancer have multiple surgical options to choose from. Historically, breast cancer surgery has been limited to removing the entire breast (mastectomy), or removing the lump (tumor) and preserving the breast. This is known as a lumpectomy, or breast conserving surgery. Advances in surgical techniques, as well as the need for improved breast cancer care, have resulted in the development of oncoplastic breast surgery.

Jessica Maxwell, MD

Jessica Maxwell, MD

What is oncoplastic breast surgery?

Oncoplastic surgery combines traditional lumpectomy with plastic surgery techniques. Once the tumor has been removed, the breast is reshaped in order to provide the most visually pleasing outcome. Reshaping the breast prevents contour deformities and allows for better cosmetic results. Removal of the tumor and reshaping of the breast are done during the same operation.

Is it safe?

Oncoplastic surgery does not compromise your cancer care. Safe treatment of breast cancer is always our number one priority. The goal is to remove the tumor with clear margins, the same as in traditional lumpectomy operations. Radiation treatment is generally recommended following oncoplastic breast surgery, just as in standard breast conserving surgery. Studies comparing traditional breast conservation and oncoplastic surgery have shown comparable outcomes. Oncoplastic surgery is equally safe from a cancer perspective.

There is a difference when we compare cosmetic outcomes and quality of life. Women who undergo oncoplastic surgery are more satisfied with the cosmetic appearance of their breasts. This can lead to improved quality of life through better self-confidence, self-esteem, and comfort with intimacy.

Oncoplastic surgery combines traditional lumpectomy with plastic surgery techniques.

Oncoplastic surgery combines traditional lumpectomy with plastic surgery techniques.

What are the possible complications?

As with traditional lumpectomy, complications are possible. These may include bleeding, infection, changes in breast and nipple sensation, wound healing issues, asymmetry, cosmetic dissatisfaction, and need for reoperation.

On occasion, a second operation is needed to treat the cancer. This may happen if the first surgery failed to remove all of the disease. This can happen in any breast cancer surgery, but can be challenging in oncoplastic surgery because the tissue has been rearranged. A larger surgery may be needed to remove the remaining cancer. This may include mastectomy. To avoid this, imaging studies such as mammogram, ultrasound, or MRI may be done before your surgery to fully assess the location and extent of the disease.

What about the opposite breast?

Oncoplastic surgery generally results in a smaller, rounder breast on the operative side. Radiation can further shrink or tighten the breast. To achieve symmetry, the opposite breast can be reshaped or reduced. Surgery on the opposite breast can be done at the time of the cancer surgery, or later on, once all of the breast cancer treatment has been completed.

Which patients are good candidates for oncoplastic breast surgery?

Oncoplastic surgery is ideal for women with moderate to large sized breasts who require a large volume of breast tissue removed. By reducing and reshaping the breasts, some symptoms of macromastia (large, heavy breasts) may be reduced. These include back, neck and shoulder pain, and recurrent rashes under the breast. Most women who have had previous breast surgery are still candidates for oncoplastic surgery.

Women with very small breasts and those who smoke heavily are not ideal candidates for oncoplastic surgery. Oncoplastic surgery is not recommended for women who require mastectomy to safely remove the entire tumor, or for women unable to undergo radiation treatment. Your breast surgeon can help determine if this approach is right for you.

Nebraska Medicine now offers oncoplastic surgery to appropriate candidates.

Nebraska Medicine now offers oncoplastic surgery to appropriate candidates.

What are my breast surgery options at Nebraska Medicine?

Nebraska Medicine now offers oncoplastic surgery to appropriate candidates, along with multiple other breast cancer surgery and reconstruction options. Remember – treating breast cancer is our main concern. You, along with your breast oncology team, will decide which option works best for you.

Dr. Vetro aims to improve treatment for cancer patients

Image with caption: Joseph Vetro, Ph.D.

Joseph Vetro, Ph.D.

Joseph Vetro, Ph.D., assistant professor of pharmaceutical sciences, wants his research to impact patients. Publication is great, yes. But what does it mean if it doesn’t eventually help people?

And Dr. Vetro believes that technology to effectively deliver RNA interference molecules (RNAi) can improve treatment for cancer patients. RNAi could be used to suppress gene expression in tumors that causes them to eventually become more resistant to chemotherapy. This could make chemotherapy more effective for people fighting cancer.

The tough part is getting therapeutic levels of RNAi into cancer tumors and metastases. Administered intravenously, RNAi levels end up undetectable, ineffectual.

Dr. Vetro had an idea to increase the potency of RNAi in tumors by forming polymer complexes with cholesterol-modified RNAi. He has preliminary evidence that this works.

But the stuff he’s working on in his lab needs to traverse many steps to get to clinical translation, to people. How does one do this? He needs someone else, a big company, to pick it up and take it the rest of the way, to the marketplace. And to do that? He needs to de-risk it, so it’s a good investment for these companies, by obtaining favorable Phase I clinical trial data. That makes it a better sell.

“You need to get industry to take a serious look at you,” Dr. Vetro said.

To start the process, Dr. Vetro and his wife formed a startup company, Actorius Pharmaceuticals, which recently was awarded National Institutes of Health (NIH) Small Business Technology Transfer (STTR) grant with UNMC collaborators Rakesh Singh, Ph.D.; Samuel Cohen, M.D., Ph.D.; Yazen Alnouti, Ph.D.; and Kenneth Cowan, M.D., Ph.D. They’re working to move the technology closer to a Phase I clinical trial in breast cancer patients.

To attract a company, they’re thinking like a company. They are working with a strategic business consultant and have obtained matching economic development funding from the state.

The ultimate end goal is to develop the technology for clinical use. How? “Sub-license the technology to a pharmaceutical company,” Dr. Vetro said.

It’s a strange thing to put so much work into something, to discover it, to nurture it, to have it be yours, only to give it away.

But isn’t that what we do?

“It’s like letting your kids go out into the world,” Dr. Vetro said.

It would be a big day to see the kids all grown up.

 

18 Years and Counting, Nebraska Medicine Wins Consumer Choice Award

11-14-consumer-choice-shieldIt’s once again evident folks in our region choose Nebraska Medicine over our competitors. For the 18th year, we’ve been awarded the National Research Corporation’s Consumer Choice Award, given annually to hospitals across the U.S. that health care consumers choose as having the highest quality and image.

The results for the 2016/2017 edition of the award were determined by consumer perceptions on multiple quality and image ratings collected from the company’s Market Insights Survey, the largest online consumer health care survey in the country. National Research surveys more than 300,000 households in the contiguous 48 states and the District of Columbia. The award is based on the hospital that possesses:

  1. Best overall quality
  2. Best overall image/reputation
  3. Best doctors
  4. Best nurses

“This award reflects the tradition of quality care at Nebraska Medicine,” says Dan DeBehnke, MD, MBA, CEO of Nebraska Medicine. “We will continue our quest for improvement, earning the confidence and trust of our patients and the communities we serve.”

Heart Program Receives National Attention

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Nebraska Medicine Named to Top 100 for Heart Programs

Becker’s Hospital Review named Nebraska Medicine to the 2016 edition of its list, “100 Hospitals and Health Systems with Great Heart Programs.”

The hospitals on this list lead the nation in cardiovascular health care. Many have pioneered ground-breaking procedures and are still pioneering breakthroughs today. All have received recognitions for top-of-the-line patient care.

To develop this list, the Becker’s Hospital Review editorial team examined several reputable ranking and award agencies, including U.S. News & World Report rankings for cardiology and heart surgery, Truven Health Analytics’ cardiovascular hospital rankings, CareChex rankings for cardiac care, Blue Distinction Centers for Cardiac Care, star ratings from the Society of Thoracic Surgeons, Healthgrades cardiology awards and Magnet designation. Hospitals included in this list have received marks of distinction from these organizations.

Surgical Robot Less Invasive, Allows Quicker Recovery

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Kolby Baber suffered from a rare digestive disorder that made it difficult, and sometimes impossible, for him to swallow. After trying several other treatments, Baber discovered Dmitry Oleynikov, MD. Dr. Oleynikov told Baber about a new surgical robot, the daVinci Xi, which would be the perfect way to fix his problem. The daVinci features two work stations for Dr. Oleynikov and one of his colleagues to work simultaneously on patients instead of one like the previous model. It also allows surgeons to work on a wider range of cases than they could previously.

See how Dr. Oleynikov used the first daVinci Xi in Omaha for the first time to make Baber’s problem disappear in this video.

New Technology Tapped to Teach Sepsis

Clinical Effectiveness Team Utilizes UNMC’s iEXCEL for Interactive Training

It’s an opportunity for our health care team to learn in a new way: utilizing state-of-the art technology. Our clinical educators are taking advantage of UNMC’s iEXCEL advanced visualization, experiential and learning hub to help our nurses learn about the origins of sepsis and its impact on the body’s organs.

The iEXCEL visualization hub inside the Sorrell Center features MultiTaction panels, often referred to as iWall, that generate an interactive display wall that can detect an unlimited number of fingers, hands and infrared pens to incorporate a level of experiential learning. The simulation and virtual reality training will enhance training of current and future health professionals.

Jessica Strickler, clinical educator for MICU and SICU and Sara Hooper, clinical educator for 8 Telemetry are one of the first to partner with Ben Stobbe, executive director for Clinical Simulation, iEXCEL, to use the technology for our staff training on sepsis.

“We met with Ben and three student workers and described what we wanted the education to look like,” says Strickler, who together with Hooper, researched much of the content of the education.

Micah Beachy, DO, Clinical Effectiveness medical director, provided his expertise on sepsis’ impact on the body’s organs. After four more meetings, the interactive training was ready to go.

This 30-60 minute iWall training, called “Sepsis iWall Education,” is encouraged for nurses, but not required. Nurses who complete it will receive one hour of CEU. To register for class time, log into Apollo. Classes are being offered before and after shifts. Review the training schedule here.

iEXCEL is the programmatic component of UNMC’s Global Center for Advanced Interprofessional Learning.

Jessica Strickler, clinical educator for MICU and SICU, is seen demonstrating the new sepsis education.

Jessica Strickler, clinical educator for MICU and SICU, is seen demonstrating the new sepsis education.

Breakthrough Treatment for Peripheral Artery Disease

We’re among the first in the United States to offer a new treatment recently cleared by the U.S. Food and Drug Administration (FDA) to provide relief for patients suffering from the painful symptoms of peripheral artery disease, or PAD – a condition caused by a build-up of plaque that blocks blood flow in the arteries of legs or feet.

The device, Avinger’s Pantheris™ lumivascular atherectomy system, is an innovative image-guided therapy that, for the first time ever, allows physicians to see and remove plaque simultaneously during atherectomy – a minimally invasive procedure that involves cutting plaque away from the artery and clearing it out to restore blood flow.

Because the Pantheris device incorporates real-time optical coherence tomography (OCT) imaging on a therapeutic catheter – like having a small camera on the tip of the device – physicians are able to remove this plaque more precisely than ever before, with less risk of damage to the artery walls which can result in aggressive scarring that greatly increases the risk of restenosis, or re-narrowing of the artery. In the past, physicians have had to rely solely on X-ray as well as touch and feel to guide their tools while they try to treat complicated arterial disease.

For patients, this safe and more-precise treatment may potentially reduce the need for follow-up procedures and stents.

“Peripheral artery disease greatly impacts quality of life, with patients experiencing cramping, numbness, discoloration and pain,” says vascular surgeon David Vogel, MD. “The Pantheris technology is on the front lines. Nebraska Medicine is the only hospital in the region using it. We’re helping lead the way.”

David Vogel, MD, is seen using this new device on a patient during atherectomy – a minimally invasive procedure that involves cutting plaque away from the artery and clearing it out to restore blood flow.

David Vogel, MD, is seen using this new device on a patient during an atherectomy – a minimally invasive procedure that involves cutting plaque away from the artery and clearing it out to restore blood flow.

Clinical results confirm that the technology is safe and effective: a 130-patient study showed a target lesion revascularization rate of just 8 percent, and not a single event of vessel perforation, clinically significant dissection or late aneurysm resulted from Pantheris. In addition, this radiation-free technology may help minimize radiation exposure to clinicians and patients by decreasing use of fluoroscopy.

KMTV recently featured one of our patients who underwent the procedure.

Peripheral artery disease affects nearly 20 million adults in the U.S. and over 200 million people globally. PAD is caused by a build-up of plaque in the arteries that blocks blood flow to the legs and feet. Often dismissed as normal signs of aging, symptoms of PAD include painful cramping, numbness or discoloration in the legs or feet. PAD can become so severe and difficult to address with traditional treatments that patients and physicians often resort to undergoing invasive bypass surgeries, which can result in even higher health risks and lengthy, painful recoveries. In severe cases, patients often face amputation, the worst-case scenario associated with PAD.

Atherectomy is a minimally invasive treatment for PAD in which a catheter-based device is used to remove plaque from a blood vessel. Lumivascular technology utilized in the Pantheris system allows physicians, for the first time ever, to see from inside the artery during a directional atherectomy procedure by using an imaging modality called optical coherence tomography, or OCT. In the past, physicians have had to rely solely on X-ray as well as touch and feel to guide their tools while they try to treat complicated arterial disease. With the lumivascular approach, physicians can more accurately navigate their devices and treat PAD lesions, thanks to the OCT images they see from inside the artery.

Multidisciplinary Breast Cancer Clinic Offers Comprehensive, Convenient and Personal Care

 

Conveniently located at 175th and Burke St., just west of the Village Pointe shopping center, the Multidisciplinary Breast Cancer Clinic offers easy access with care provided in an intimate and comfortable environment.

Conveniently located at 175th and Burke St., just west of the Village Pointe shopping center, the Multidisciplinary Breast Cancer Clinic offers easy access with care provided in an intimate and comfortable environment.

Today, there are numerous choices available for breast cancer treatment. The new Multidisciplinary Breast Cancer Clinic at Nebraska Medicine – Cancer Center at Village Pointe, provides a very personalized and comprehensive approach to breast cancer care based on a patient’s individual needs and wishes as well as the expertise and careful assessment of a team of breast cancer specialists.

“Patients benefit from getting not just one opinion, but a comprehensive plan developed by a multitude of breast cancer experts using the most recent studies,” says Sarah Thayer, MD, PhD, surgical oncologist at Nebraska Medicine and physician-in-chief of the Fred & Pamela Buffett Cancer Center. “This model allows for enhanced communication between providers and the patient to ensure her goals and individual needs are met.”

Conveniently located at 175th and Burke St., just west of the Village Pointe shopping center, the Multidisciplinary Breast Cancer Clinic offers easy access with care provided in an intimate and comfortable environment. Patients can receive an array of cancer services in one convenient location including:

  • Comprehensive care plan developed by a multidisciplinary team of experts
  • Consultative services or second options from cancer experts in medical oncology, surgical oncology, radiation oncology and plastic and reconstructive surgery
  • Infusion services within private infusion rooms
  • Radiation treatment center
  • Women Imaging Center with state of the art 3D-mammography and MRI capabilities
  • Amenities and supportive services including wig fittings, a free wig bank, prosthetic and bra fittings, yoga, massage therapy, skin care and make-up lessons specifically geared for people with or recovering from cancer

Multidisciplinary, Personalized Care Plan

Sarah Thayer, MD, PhD

Sarah Thayer, MD, PhD

The multidisciplinary team of experts includes medical oncologists, surgical oncologists, radiation oncologists, plastic and reconstructive surgeons, geneticists and social workers. The team helps each patient navigate through the many decisions available in breast cancer treatment including lumpectomy, mastectomy, chemotherapy, radiation therapy, targeted therapies and breast reconstructive surgery in a collaborative approach that is based on a woman’s personal choices.

“When a patient arrives for an appointment, they will see all of the specialists required for that visit in one setting and one appointment,” says Dr. Thayer. “Not only is this saving our patient’s time but it helps eliminate duplication of tests and services.”

Providing 3-D mammography for all patients is another benefit that will be provided at the clinic and is expected to be available by early summer. “Studies have shown that 3-D mammography when used with standard digital mammograms can bump up breast cancer detection rates and reduce callbacks,” says Dr. Thayer.

Patients will also be given the opportunity to participate in breast cancer clinical trials offered through the University of Nebraska Medical Center as part of their treatment program.

Personal Care Needs

A host of amenities and supportive services are also available to help address a patient’s physical, educational, emotional and spiritual needs providing a more complete and holistic approach to care and includes wig fittings, a free wig bank, prosthetic and bra fittings, yoga, massage therapy, skin care and make-up lessons specifically geared for people with or recovering from cancer.

“The Multidisciplinary Breast Cancer Clinic is designed to provide patients the most oncologically-sound plan in an environment that is more personal, private and positive,” notes Dr. Thayer.

Hope for Stroke Patients: Recent Treatment Advances Offer Better Chances for Recovery

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Stroke is a severely debilitating disease that can permanently change the lives of patients and their families. Everyone knows a family member or a friend whose life has been permanently changed by stroke. Stroke is a very common disease around the world. Every year more than 795,000 people in the United States will suffer a stroke and more than 130,000 will die as a consequence of stroke. In Nebraska, stroke is the fourth leading cause of death and more than 36,000 people live with stroke. Despite these frightening numbers there is hope for stroke patients.

Stroke prevention

The best way to prevent a stroke is to take care of  you health. More than 90% of strokes are the result of poorly controlled medical conditions. Avoid tobacco, control your weight, watch your diet, exercise and follow up regularly with your primary care physician. Work closely with your doctor to control your high blood pressure, diabetes, high cholesterol or heart disease. Just by reducing your blood pressure by 10 points you can decrease your chance of having a stroke by one-third. Controlling the other risk factors will decrease your chances even further.

Sudden signs of stroke: remember them easily with “FAST”

Stroke can present in many different ways: confusion, severe headache, dizziness, double vision, facial droop, difficulty swallowing, arm or leg numbness or weakness, sudden loss of balance, inability to speak and slurred speech all are symptoms of stroke. One easy way to remember the sudden signs of stroke is by using the F.A.S.T. acronym. F is for facial droop, A is for arm weakness, S is for speech difficulties and T is for time to call 9-1-1. If you think you or a loved one is having a stroke, the best course of action is to call 9-1-1. Patients who call 9-1-1 arrive faster to the nearest hospital capable of treating stroke and have better chances of receiving treatment.

FAST

Stroke types and treatments

There are two major types of strokes: ischemic and hemorrhagic. Ischemic strokes are by far the most common type in the United States and in Nebraska. An ischemic stroke is usually the result of a blockage in a blood vessel, whereas a hemorrhagic stroke is due to a blood vessel rupture. Treatment is different for each type; however rapid treatment is essential in both.

Since 1996, the only FDA approved treatment for acute ischemic stroke has been to administer alteplase. This is a medication that is given to patients with an ischemic stroke who arrive to the Hospital within 4 ½ hours from the onset of symptoms. Patients who receive this drug have a 33% increased chance of being independent or less disabled at three months after their stroke, when compared with people who did not receive the drug. In the last year there have been significant advances in the treatment of acute ischemic stroke. Five new studies show that patients who suffered a large stroke and were treated with new devices called stent retrievers – within 6 hours of onset, in an experienced stroke center – have a 33% to 71% percent chance of regaining independence or experiencing less disability at three months.

New, advanced treatment options available at Nebraska Medicine

Nebraska Medicine has the capacity to offer these novel treatments to stroke patients who qualify. To make these crucial advancements in stroke treatment available to more people in Nebraska and neighboring states we launched the Nebraska Medicine Tele Stroke Network. Tele Stroke brings stroke neurology expertise to the bedside of community hospitals. Working together, the neurologist and emergency department physician collaborate on the most appropriate treatment for the stroke patient. This program provides local and rural emergency rooms with 24- hour access to stroke neurology expertise and the advanced treatment options available at Nebraska Medicine.

Dr. Kalil is lead author on new pneumonia guidelines

By Stephanie Goldina, Infectious Diseases Society of America

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Andre Kalil, M.D.

ARLINGTON, Va. — Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) — which account for 20 to 25 percent of hospital-acquired infections — should be treated with shorter courses of antibiotics than they typically are, according to new guidelines released by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) and published in the journal Clinical Infectious Diseases. In addition, the Society of Critical Care Medicine (SCCM), the American College of Chest Physicians (CHEST), and the Society for Healthcare Epidemiology of America (SHEA) endorsed these guidelines.

At a glance

•Seven days of antibiotics are effective for most hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) infections, according to the new guidelines published by the Infectious Diseases Society of America and American Thoracic Society.
•The new guidelines also recommend that each hospital develop an antibiogram to determine which strains are causing infection and ensure the right antibiotics are used for treatment.
•HAP and VAP cause 20 to 25 percent of hospital-acquired infections, and these may be fatal 10 to 15 percent of the time.

The recommendation of seven or fewer days of antibiotics for most of these infections reflects a change from previous guidelines to ensure safe and effective treatment while limiting the development of antibiotic resistance.
Created by a multidisciplinary panel led by infectious diseases, pulmonary and critical care specialists, the new guidelines also recommend that each hospital develop an antibiogram, a regular analysis of the strains of bacteria causing pneumonia infections locally as well as which antibiotics effectively treat them.

When possible, the antibiogram should be specific to the hospital’s intensive care unit patients, according to the guidelines. Antibiograms should be updated regularly, and the most appropriate frequency should be determined by the institution, the guidelines note.

“Once clinicians are updated regularly on what bugs are causing VAP and HAP in their hospitals as well as their sensitivities to specific antibiotics, they can choose the most effective treatment,” said Andre Kalil, M.D., lead author of the guidelines, professor of medicine in the Division of Infectious Diseases and director of the Transplant Infectious Diseases Program at UNMC. “This helps individualize care, ensuring patients will be treated with the correct antibiotic as soon as possible.”

Published in 2005, the previous guidelines recommended different lengths of treatment time for antibiotic therapy based on the bacterium causing the infection.

The 2016 guidelines recommend seven days or fewer for all bacteria. Newer evidence suggests that the shorter course of treatment does not reduce the benefits of therapy, Dr. Kalil said. In addition, he said this can reduce antibiotic-related side effects, the risk of Clostridium difficile, a serious diarrheal infection, antibiotic resistance and costs. In some cases, such as when a patient doesn’t improve or worsens, longer treatment may be necessary.

Mechanical ventilators help patients breathe. They are used when a patient is having surgery with general anesthesia or for those who suffer from impaired lung function. One of every 10 patients on a ventilator gets VAP, which is fatal about 10 to 15 percent of the time.

VAP also increases: the amount of time patients remain on a ventilator — from 7.6 to 11.5 days on average — and length of hospital stay — from 11.5 to 13.1 days on average.

While HAP typically is a less severe infection than VAP, half of patients have serious complications, including respiratory failure, fluid in the lungs, septic shock and kidney failure.

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