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Archive for April, 2017

Cardiac Anesthesiologists Expand Surgery Options for Cardiac Patients

Cardiac patients who need other types of surgical procedures are often denied surgery due to the risks and complexity of their cases. But that is no longer the case at Nebraska Medicine.

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Sasha Shillcutt, MD

Cardiac anesthesiologists have specialized training in monitoring the function of the heart during surgery using advanced cardiac monitoring tools called transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE). This tool allows them to measure the function of the heart and gives them direct visualization of the chambers of the heart, its valves and the major connecting vessels and veins that supply blood to the heart. While many large medical centers have a cardiac anesthesiology program that provides monitoring of patients during cardiac surgery, few in the country have echo-trained anesthesiologists who also monitor cardiac patients during non-cardiac related procedures.

“The use of echo in non-cardiac cases is a new phenomenon that is state-of-the-art,” says Sasha Shillcutt, MD, cardiac anesthesiologist at Nebraska Medicine and Director of Perioperative Echocardiography, at the University of Nebraska Medical Center (UNMC). “This is a very unique service that no one else offers in the state and fulfills a critical need for the safety of these patients. Without our expertise in TEE, most non-cardiac surgeons would otherwise not perform surgery on these types of patients simply because it is too risky.”

The Perioperative Echocardiography Consult Service includes a team of 10 cardiac anesthesiologists who are trained in advanced TEE and TTE and eight other anesthesiologists who are trained in basic echocardiography and use their skills in trauma patients, liver transplants, vascular surgery and critical care medicine. Under Dr. Shillcutt, the department also leads a national perioperative echocardiography training program that prepares physicians across the country in basic and advanced perioperative echocardiography. It is one of a few training programs in the country.

Adult Congenital Heart Disease Conference

Friday, July 29 | 7:30 a.m. – 3 p.m.

Physicians, nurse practitioners, physician assistants, and nurses are invited to attend “Accepting the Challenge: Multidisciplinary Care of the ACHD Patient”.

For more information and to register go to unmc.edu/cce/achd

“Surgery is a very stressful event on the body,” explains Dr. Shillcutt. “When you take someone into surgery who already has had heart-related complications, the stress on the heart and potential risks are much more significant. All of our training is focused on getting the patient through surgery and out of the hospital without having a major cardiac event.”

The risk of having a cardiac event after surgery for patients with prior heart disease increases to 10 to 25 percent, notes Shillcutt. “We have been using echocardiography during open-heart surgery for years,” she says. “Using it in patients with heart disease undergoing major non-cardiac surgery only makes sense to improve outcomes. We have diagnosed blood clots, heart failure and holes in the heart during non-cardiac surgery. These are patients that might not have made it through surgery had we not had the technology and experience to detect these problems.”

The care in the operating room is backed by a team of critical care physicians, the state’s only certified heart failure team, cardiologists and other specialists who are trained to provide follow-up intensive care after surgery. “It’s an excellent example of a multi-specialty group of doctors working together to provide the best care for each patient,” says Dr. Shillcutt.

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Sasha Shillcutt, MD is an inspiring and remarkable example of the caliber of specialists and researchers working tirelessly to help provide better Cardiac patient care.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Training Exercise for Highly Infectious Patient Transport

U.S. State Department Training Exercise Involved 5 Aircraft and 11 Mock Patients

4-18 State Dept Drill airport plane

In the April 12 drill, one mock patient is seen arriving in a Gulfstream jet operated by Phoenix Air for the U.S. State Department.

The Nebraska Biocontainment Unit was one of five treatment centers that received patients during a practice drill organized by the U.S. State Department. During “Operation Tranquil Shift,” a total of 11 American citizens suspected of having or having been exposed to a simulated highly infectious disease were transported from Africa to the United States for treatment.

Three mock-patients arrived from Africa at Eppley Airfield the morning of April 12. Two patients arrived separately in one of two Gulfstream jets operated by Phoenix Air for the U.S. State Department. A third patient didn’t make the trip from Africa, but was also transported to the Biocontainment Unit.

A total of four aircraft (the two Gulfstreams which came to Omaha and two 747s) departed Atlanta, Georgia, and traveled to Freetown, Sierra Leone. Once patients were retrieved, all aircraft landed at the Washington-Dulles Airport to clear customs before continuing on to the five receiving facilities across the country, including Bellevue Hospital Center in Manhattan, New York, Johns Hopkins University Hospital in Baltimore, Maryland, the University of Minnesota Medical Center in Minneapolis, Minnesota, Denver Health Medical Center in Denver, Colorado, and Nebraska Medicine – Nebraska Medical Center. Once patients were transferred to ground ambulance teams, the aircraft departed for the next receiving facility or returned to Georgia for decontamination.  The scope of this exercise is unprecedented and a testament to the lessons learned and changes made in the aftermath of the Ebola outbreak.

The mock patient was transport to the Biocontainment Unit at the Nebraska Medical Center.

The mock patient was transported to the Biocontainment Unit at the Nebraska Medical Center.

“This was the next logical step in planning and preparing to transport a large number of patients with a highly infectious disease,” says Shelly Schwedhelm, executive director of Emergency Preparedness and Infection Prevention. “In November of 2016, we successfully transported three patients to the Nebraska Biocontainment Unit on one 747. We’re applying what we learned during the November drill to make even further improvements during this larger national exercise.”

The University of Nebraska National Strategic Research Institute (NSRI) works closely with the U.S. State Department to facilitate these transport exercises. “NSRI has assisted the State Department to develop the scenarios and develop a process for improving the transport and patient care process during transit.” says Eric Van Gieson, chief technology officer for NSRI.

“This exercise was a tremendous example of the power of collaboration,” says Christopher J. Kratochvil, MD, UNMC associate vice chancellor for clinical research, and vice president for research at Nebraska Medicine. “The coordinated efforts by numerous federal agencies and local partners allowed us all the opportunity to successfully test procedures in a very realistic setting. The lessons learned will significantly help prepare us for future international and domestic outbreaks.”

Two members of the NSRI team were observers onboard the aircraft coming to Omaha and spoke to the media at Eppley Airfield. The NSRI is one of 13 Department of Defense (DoD) authorized University Affiliated Research Centers in the nation. Established in 2012, NSRI is a long-term, strategic partner of its (DoD) sponsor, the U.S. Strategic Command (USSTRATCOM).

Along with the agencies previously mentioned, the U.S. Department of Health and Human Services, Douglas County 911, Douglas County Emergency Management, Omaha Fire Department, Omaha Airport Authority, Douglas County Health Department and the Nebraska Department of Health and Human Services all took part in the drill.

Watch the drill unfold in this video.

 

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Our medical faculty and staff are inspiring and remarkable examples of the caliber of specialists and researchers working tirelessly to help provide emergency preparedness.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Patient Pays it Forward

 •Mike holding his new grandchild after receiving a double lung transplant at Nebraska Medicine

Mike Wohlhutter is seen holding his new grandchild after receiving a double lung transplant at Nebraska Medicine.

After receiving a double lung transplant at Nebraska Medicine, Mike Wohlhutter of Harlan, Iowa, is paying it forward.

“This whole deal is just awesome,” says Wohlhutter. “There are no words to describe how grateful I am.”

For years, Wohlhutter struggled with chronic obstructive pulmonary disease (COPD) — which made it hard to breathe. His work as a diesel mechanic only made things worse. In August 2016, Wohlhutter received a double lung transplant.

“The medical professionals at Nebraska Medicine walked me through a lot of tough times,” he explains. “I can’t thank them enough for what they’ve done.”

One month after his transplant, Wohlhutter’s family and friends held a poker run to help cover some of his medical expenses. With money left over, Wohlhutter wanted to donate $1,500 to each of the two other lung transplants patients. On March 18, Wohlhutter presented the checks to Bobbi Heffelfinger, nurse transplant coordinator. But this donation won’t be his last. Wohlhutter’s family is planning to host another poker run in September, with proceeds going to help Nebraska Medicine lung transplant patients.

To learn more, watch this story from KETV.

Mike (patient) giving two $1,500 checks to Bobbi Heffelfinger, nurse transplant coordinator at Nebraska Medicine – the checks will be given to two other patients who are currently waiting for a lung transplant 

Mike Wohlhutter (center) gave two $1,500 checks to Bobbi Heffelfinger, nurse transplant coordinator (right, with glasses). The checks will be given to two other patients who are currently waiting for a lung transplant.

Scientists Achieve Research Milestone with Parkinson’s Disease

The three key people on the phase I clinical trial were (left-right) Howard Gendelman, MD, Pamela Santamaria, MD, and R. Lee Mosley, PhD.

The three key people on the phase I clinical trial were (left-right) Howard Gendelman, MD, Pamela Santamaria, MD, and R. Lee Mosley, PhD.

In an early phase human clinical trial, researchers at UNMC tested a drug that transforms the immune system for diagnostic and therapeutic gain in Parkinson’s disease (PD).

The medicine was proven safe and generally well tolerated. Side effects were minimal, but included skin irritation, bone pain and an allergic reaction. Preliminary evidence of improvement in motor skills was observed and recorded in several of the treated patients, but validation will require larger patient enrollments.

PD ravages nearly 1 million Americans and generates direct and indirect costs of nearly $25 billion per year in the U.S. alone.

About the Study

To conduct the phase 1 clinical study, scientists partnered with 14 academic and community-based physicians and neuroscientists with extensive expertise in neurophysiology, bioimaging, clinical trials execution and movement disorders. The research was conducted in basic science laboratories at UNMC and Scripps Research Institute in La Jolla, California. The study subjects were seen at Nebraska Medicine.

Clinical support was overseen at UNMC by Pamela Santamaria, MD, a Nebraska Medicine neurologist and founder of Neurology Consultants of Nebraska; Danish Bhatti, MD, assistant professor in the Department of Neurological Sciences; and by David Standaert, MD, PhD, professor and chair of neurology and director of the Division of Movement Disorders at the University of Alabama at Birmingham.

Using a blinded clinical study approach for investigation, the patients, their caregivers and their physicians could not tell whether the drug or a placebo was being administered.

For more information on the study, call 402.559.6941.

The findings — which appeared March 24 in the journal npj Parkinson’s Disease — mark a milestone for PD research. At the heart of the discovery was the immune transformation of disease-inciting circulating white blood cells (called effector T-cells or Teff) to cells that protect and defend against brain injury (called regulatory T cells or Treg). The drug changed neurodestructive Teff into functional neuroprotective Tregs.

The research team was headed by two UNMC scientists, Howard Gendelman, MD, professor and chair of the Department of Pharmacology and Experimental Neuroscience, and R. Lee Mosley, PhD, pharmacology and experimental neuroscience professor and head of the Movement Disorders Research Laboratory. The discovery results from more than two decades of laboratory and animal investigation.

The idea was conceived in cell studies then validated in animals. During each step, immune transformation was realized with the drug granulocyte macrophage colony stimulating factor (also known as Sargramostim® Sanofi-Genzyme Pharmaceuticals).

Importantly, such drug-induced transformation has not only been successful for PD but also holds promise for a range of neurodegenerative disorders that include Alzheimer’s disease, stroke and amyotrophic lateral sclerosis.

The drug was found to produce significant and encouraging changes in the production of Treg cells in the blood of patients. These same changes did not take place in patients who received the placebo. Initial clinical observations proved encouraging and varied in intensity between patients, Dr. Gendelman says.

During the trial, physiological brain improvements were seen in specific motor areas of the brain for those patients receiving Sargramostim. This was recorded through the use of magnetoencephalography by a research team headed by Tony Wilson, PhD, associate professor and vice chair, basic/translational research for UNMC and director of the Magnetoencephalography Laboratory in the Department of Neurological Sciences.

Blood metabolites known to increase the number of neuroprotective Treg cells were observed in parallel studies on the same blood samples used to record the immune biomarkers. These biochemical studies were performed at the Scripps Research Institute by Gary Siuzdak, PhD, professor and director, Scripps Center for Metabolomics and Mass Spectrometry.

Doses of L-DOPA and other dopamine-sparing drugs used to treat PD were continued to all study subjects throughout the study.

“To our knowledge, this study represents the first time immune transformation was performed on any patient with neurodegenerative disease,” Dr. Mosley states.

Dr. Gendelman says the next step will be a broader study that will include larger patient numbers. This is being planned in the next one to two years, after the manufacture of an oral medicine.

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Howard Gendelman, MD, Pamela Santamaria, MD, and R. Lee Mosley, PhD are inspiring and remarkable examples of the caliber of specialists and researchers working tirelessly to help provide better Parkinson’s disease treatment.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

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