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Archive for September, 2016

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.

What’s Life Like After Lung Transplantation?

Aleem Siddique, MD

Aleem Siddique, MD

Lung transplantation is a life-changing event. Before transplantation, the lung transplant recipient will have been very limited in his/her day-to-day activities because of severe lung disease. They might have required assistance for even the simplest of tasks, such as having a shower or changing clothes. That degree of limitation leads to significant de-conditioning, hence, after recovering from the transplant surgery, the recipient will begin a process of rehabilitation.

Over time, most lung transplant recipients will experience significant improvements in their functionality and correspondingly will describe significantly better quality of life. They will find it easier to breathe and most patients will no longer require oxygen therapy. The impact of this is difficult to describe or quantify, simply put, breathing itself had become an enormous burden and that strain is lifted.

Lung transplantation is not without it’s own burdens. Principal amongst these is the constant need for immuno-suppression medication to prevent rejection of the transplanted lung(s) by the recipient’s immune system. Conversely, the possibility of acquiring an infection goes hand-in-hand with use of immuno-suppression medications. Therefore close monitoring is required to prevent and treat both rejection and infection, this means that the transplant team is always close at hand. For many patients, the transplant team becomes like family.

Despite some difficulties, most lung transplant recipients report being highly satisfied with the transplant outcome, and that, if they had to make the decision again, they would still choose to have a lung transplant.

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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