Archive for the ‘Articles’ Category

Watchman Procedure

In January 2018, Nebraska Medicine became the first health care system in Omaha to implant the WATCHMAN™ left atrial appendage occlusion device. This device is designed to lower your risk of stroke due to atrial fibrillation (afib) while at the same time allowing you to stop blood thinners. Clinical trials have shown this implant to be a safe alternative to the blood thinner warfarin (also known as Coumadin) with comparable stroke-risk reduction.

Watchman01-17-2018.jpg
The WATCHMAN™ device pictured above is about the size of a quarter.

Atrial fibrillation — irregular quivering of the upper chamber of the heart — affects more than 5 million Americans and is responsible for 15 to 20 percent of all strokes nationwide. The average person with afib is five times more likely to have a stroke than someone with a regular heartbeat. Afib leads to a decrease in the pumping capacity of the upper chambers of the heart. This results in decreased blood movement and encourages blood clots to form in a blind pouch connected to the left upper chamber, called the left atrial appendage. A blood clot could escape from this area and travel to another part of the body. When this part of the body is the brain, it can results in a stroke.

Medicines like warfarin that thin the blood to prevent clots have, until now, been the standard way to reduce the risk of stroke. However, these medications are not suitable for many patients due to bleeding risks, medication interactions, and other adverse reactions.

If you have a reason to seek an alternative to blood thinners, such as a history of bleeding or a lifestyle, occupation or condition that puts you at risk for bleeding, WATCHMAN™ may be right for you.

Why have this procedure done at Nebraska Medicine?

First in Omaha

We were the first in Omaha to offer the procedure, and we’re the only program in the state to offer a comprehensive team dedicated to treating atrial fibrillation.

Potential Permanent Solution

WATCHMAN™ is a permanent implant that provides an alternative to the lifelong use of blood thinners, while lowering your stroke due to afib risk. The device is about the size of a quarter and made from nitinol, a very light and compact material commonly used in many other medical implants.

Short Procedure Done Under General Anesthetic

We implant the WATCHMAN™ device through a vein in the leg using a minimally invasive catheter to reach the heart.  The procedure only takes about an hour and is guided by transesophageal echocardiography (TEE ultrasound).  A one-night hospital stay is typical.  The procedure is performed by Dr. Andrew Goldsweig and Dr. Jessica Delaney.

Medicare and many insurance companies now cover this device, which is approved by the FDA. Watch this video by Boston Scientific, manufacturer of the WATCHMAN™ device, to understand the procedure in more detail and to see statistics on its successful outcomes.

Normally, you’ll have to take blood thinners for about 45 days after the procedure. During this time, heart tissue will grow over the implant to form a barrier against blood clots. We’ll monitor this process by taking TEE ultrasound pictures of your heart to see when you can stop taking blood thinners.  Most patients will also need to take a medicine called clopidogrel (also known as Plavix®) for a few months and aspirin on an ongoing basis.

Our Team Offers a Wide Variety of Ways to Assist You

If this procedure is not the right fit for you, we offer a wide variety of other ways to help you with cardiac arrhythmias, of which afib is the most common.

See a list of insurance companies we accept.

The information contained on this page is for information purposes only. For specific questions regarding your medical condition or treatment, please consult with your doctor directly.

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

Fred & Pamela Buffett Cancer Center Marks One Year

Today marks the one-year anniversary of the opening of the Fred & Pamela Buffett Cancer Center. Director Ken Cowan, MD, PhD, called it “an incredibly successful year and the beginning of a very exciting future.”

UNMC Chancellor Jeffrey P. Gold, MD, says the impact of the cancer center has exceeded all expectations.

“The Fred & Pamela Buffett Cancer Center has shown in its first year the breadth and depth of its efforts in the battle against cancer, through its state-of-the-art patient care, by providing a base for cutting-edge cancer research, and through its education of the next generation of cancer-fighting health professionals,” Dr. Gold says. “We are incredibly grateful for the public-private partnership with our community that made the cancer center possible and are so proud of the work that has been done here. We expect even greater achievements in the future.”

“Nebraska Medicine and UNMC share a mission to lead the world,” says Dan DeBehnke, MD, MBA, CEO of Nebraska Medicine. “The Fred & Pamela Buffett Cancer Center is a beautiful example of that partnership and mission. We’ve done some extraordinary things in the past year thanks to a dedicated team. This first year lays a foundation for all the years to come. We are just getting started.”

“This center shows what is possible when we focus on what is important and are determined to do it right and at the highest level,” says Sarah Thayer, MD, PhD, physician in chief at the cancer center. “And we will keep reaching for new breakthroughs.”

Feedback from patients, faculty and staff has been “incredibly positive,” Dr. Cowan says.

“Everybody is excited about working closer together to advance the opportunities to develop new therapies and treatments for patients and to make them available sooner,” he says. “And for patients — in terms of the ease of being able to see all of their oncology providers and all the services they need in one environment — it has been very successful.”

“When we look at where we were a year ago and the patient experience we can provide today it is transformational,” says Theresa Franco, vice president of Nebraska Medicine cancer services. “What the cancer team has dreamed, designed, and committed to our patients has come to life.”

Educationally, Dr. Cowan says, the center has been transformational in allowing graduate students in the PhD programs to learn more about clinical challenges while clinical trainees, residents and fellows learn more about cutting-edge cancer research.

“Our ability to put everybody together means literally everybody can learn from each other, from the earliest part of their education,” he says.

Dr. Cowan spoke for the medical center leaders when he praised the supporters of the Fred & Pamela Buffett Cancer Center.

“I want to say thank you to our state, city and county, who supported the vision of the cancer center early on, and to the many philanthropic donors and foundations and businesses that supported the vision and provided support for the building of the cancer center to make this the largest public-private partnership in the history of the state of Nebraska,” he says. “And I’d like to thank all of our patients, our staff and faculty and students.”

 

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

Top Performer in Treatment of Heart Attack Patients

Nebraska Medical Center Among Nation’s Best When it Comes to Recognizing and Treating a Heart Attack

Nebraska Medical Center has received the American College of Cardiology’s National Cardiovascular Data Registry ACTION Registry Silver Performance Achievement Award for 2018. Nebraska Medical Center is one of only 95 hospitals nationwide to receive the honor.

“This national award by the American College of Cardiology recognizes the commitment and dedication of the personnel at Nebraska Medical Center to provide the highest level of patient care,” says Edward O’Leary, MD, Chest Pain Center medical director. “It is truly inspiring and amazing to watch all the teams come together for the care of these patients.”

To receive the ACTION Registry Silver Performance Achievement Award, Nebraska Medical Center has demonstrated sustained achievement in the ACTION Registry for four consecutive quarters and has performed at the top level of standards for specific performance measures. Full participation in the registry engages hospitals in a robust quality improvement process using data to drive improvements in adherence to guideline recommendations and overall quality of care provided to heart attack patients.

Participating in the ACTION registry has allowed Nebraska Medical Center to benchmark its performance and optimize care delivery for its heart attack patients.

“Our performance throughout 2017 demonstrates a consistent approach to guideline-directed therapy and adhering to national standards,” says Melissa Lederer, Heart and Vascular Chest Pain Center coordinator. “Internal improvement efforts hinged on using our ACTION registry results to evaluate outcomes and our ability to provide safe, effective care. Our Chest Pain Center team has done a tremendous amount of work to establish an evidenced-based regional system of care through strong collaboration with our Emergency Medical Services and our community-hospital providers. We’re proud of all of the work that has been done to improve processes for this patient population.”

 

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

Nebraska Medicine – Bellevue Earns Chest Pain Center Accreditation

accreditation.jpg

Hospitals that have earned ACC Chest Pain Center with Primary PCI Accreditation have proven exceptional competency in treating patients with heart attack symptoms and have a primary PCI available 24/7 every day of the year.

Nebraska Medicine – Bellevue has earned full accreditation as a Chest Pain Center with Primary PCI (percutaneous coronary intervention) from the American College of Cardiology (ACC). This is the first time the hospital has achieved this level of accreditation. It was awarded based on rigorous on-site evaluation of the staff’s ability to evaluate, diagnose and treat patients who may be experiencing a heart attack.

PCI is also known as a coronary angioplasty. It is a non-surgical procedure that opens narrowed or blocked coronary arteries with a balloon to relieve symptoms of heart disease or reduce heart damage during or after a heart attack.

Hospitals that have earned ACC Chest Pain Center with Primary PCI Accreditation have proven exceptional competency in treating patients with heart attack symptoms and have a primary PCI available 24/7 every day of the year.

“Nebraska Medicine – Bellevue has demonstrated its commitment to providing excellent heart care,” says Phillip D. Levy, MD, chair of the ACC Accreditation Management Board. “ACC Accreditation Services is proud to award Bellevue with this accreditation.”

Bellevue.jpg
Nebraska Medicine – Bellevue has earned full accreditation as a Chest Pain Center with Primary PCI (percutaneous coronary intervention) from the American College of Cardiology (ACC).

“To be upgraded to a Chest Pain Center with PCI, it takes a collaborative effort from the entire team,” says Nicole Keil, clinical program coordinator, Chest Pain/Stroke at Bellevue. “This is a huge achievement for Bellevue Medical Center and it shows our continued commitment to improving STEMI patient care in our community.  I am very proud of our Chest Pain Center team and their continued dedication to providing Serious Medicine. Extraordinary Care.”

“We are proud of the achievement of an accredited Chest Pain Center with Primary PCI by the American College of Cardiology,” says Matt Pospisil, vice president of Bellevue and Perioperative Services. “This achievement is a validation of the excellent care delivered by the team and wouldn’t be possible without collaboration among multiple departments across the system.”

According to the Centers for Disease Control and Prevention (CDC), more than 730,000 Americans suffer a heart attack each year. The most common symptom of a heart attack for both men and women is chest pain or discomfort. However, women are more likely to have atypical symptoms. Other heart attack symptoms include, but are not limited to, tingling or discomfort in one or both arms, back, shoulder, neck or jaw, shortness of breath, cold sweat, unusual tiredness, heartburn-like feeling, nausea or vomiting, sudden dizziness and fainting.

Dr. Potter Receives American Geriatric Society Honor

Jane Potter, MD, chief in the Division of Geriatrics at the University of Nebraska Medical Center (UNMC) and geriatrics physician at Nebraska Medicine

Jane Potter, MD, Division of Geriatrics chief at the University of Nebraska Medical Center (UNMC) and geriatrics physician at Nebraska Medicine, is the recipient of the 2018 American Geriatric Society’s (AGS) Dennis W. Jahnigen Award that celebrates work to train more health professionals in the care we all need as we age.

“Over the past 35 years, Dr. Potter’s tireless work has advanced education for thousands of health professionals,” says Ellen Flaherty, PhD, board chair. “It would be difficult to locate a geriatrics clinician trained in the last two decades whose education has not been shaped in some way by Dr. Potter’s influence.”

A dynamic force driving geriatrics education, Dr. Potter has not only led medical education at UNMC but has expanded the scope of her work to lead national efforts aimed at increasing the prestige and prominence of the geriatrics workforce. Dr. Potter is a co-principal investigator for the AGS’s Geriatrics Workforce Enhancement Program (GWEP) Coordinating Center – a strategic resource supported by The John A. Hartford Foundation for 44 organizations in 29 states working through the only federal program focused on increasing the number of doctors, nurses, social workers, and other health care professionals trained to care for America’s older adult population.

Across her career, Dr. Potter has led several other impactful education programs through the Donald W. Reynolds Foundation and the Health Resources & Services Administration (HRSA, which also operates the GWEP), including the Geriatric Medicine and Geriatric Dentistry Fellowship Program and the Nebraska Geriatric Education Center. Dr. Potter is a past AGS president and board chair and deputy director for the AGS Geriatrics-for-Specialists Initiative.

Nebraska Medical Center Named To 100 Great Hospitals List

List Features Biggest Names in American Health Care

Becker’s Hospital Review is out with its 2018 edition of “100 Great Hospitals in America,” a compilation of some of the most prominent, forward-thinking and focused health care facilities in the nation. For the fifth straight year, Becker’s named Nebraska Medicine – Nebraska Medical Center to the prestigious list.

Hospitals included on the list are recognized nationally for excellence in clinical care, patient outcomes and staff and physician satisfaction. These institutions are industry leaders that have achieved advanced accreditation and certification in several specialties. The list also includes industry innovators that have sparked trends in health care technology, hospital management and patient satisfaction. A version of this list has been published each year since 2011.

“It really does mean a lot for us to be included on this list,” says CEO Dan DeBehnke, MD, MBA. “We have thousands of people working to provide Serious Medicine and Extraordinary Care to each of our patients every day. It’s rewarding to see that the work we’re doing here places us among the elite institutions that are the most recognized names in the industry.”

To develop the list, Becker’s Hospital Review’s editorial team conducted research and evaluated reputable hospital ranking sources, such as U.S. News & World Report, Truven Health Analytics, Centers for Medicare and Medicaid (CMS) star ratings, Leapfrog grades and several other resources. The final result is a group of 100 hospitals that are leaders in their region, their state and the nation in terms of high-quality patient care.

No Matter the Language, Transplant Nurse Communicates Extraordinary Care to Patients

IMG_5840.jpg
Nurse transplant coordinator Cindy Vandersnick, RN, BSN, looks over Nar Monger’s medications during a visit to Nebraska Medicine – Nebraska Medical Center. 

Nar Monger grew up in Bhutan and spent time in a refugee camp in Nepal before moving to the United States in 2015. His native language is Nepali.

He was diagnosed with end-stage liver disease (ESLD) at an outside hospital and was transferred to Nebraska Medicine in May 2017 for a liver transplant evaluation. Following his evaluation, Nar was placed on the transplant waiting list due to cryptogenic cirrhosis.

IMG_5823.jpg
After Nar received his liver transplant, he spent some time recovering at Madonna Rehabilitation Hospitals – Omaha Campus. Nar and his family were overwhelmed with the idea of returning home, so Cindy arranged to spend a weeknight at Madonna going over his post-transplant education materials. 

In January, Nar received his liver transplant and did well following the surgery. However, we felt Nar needed ongoing nutritional support and strengthening before returning home with his wife and grown children.

Once a week, a nurse coordinator with the liver team goes to Madonna Rehabilitation Hospitals – Omaha Campus to see our patients who are continuing their care post-transplant. That’s where I met Nar and his wife, Bissnu.

On the first visit, it’s important to not only see how the patient is progressing in their rehabilitation, but also access their knowledge of post-transplant care. Each patient is given a post-transplant education binder that is reviewed with them and their care partner(s) prior to discharge from the hospital. For Nar and his family, this education was done with the assistance of the certified language line through Nebraska Medicine.

During my first visit with Nar, I noted that he and his wife were very anxious and overwhelmed with the idea of returning home. They had many questions regarding things that had been reviewed with them during their hospital stay, so I felt the best thing to do was to review it again and have the entire family come.

I was able to set up a time that worked for his wife and all three children during a weekday evening. I arranged for the Nepali interpreter to be on speakerphone in his room at Madonna, and took extra copies of the discharge teaching materials. We reviewed it together again and again until they were comfortable with the information.

I also took a map of the Nebraska Medicine – Nebraska Medical Center campus, circled areas and highlighted routes from where to park, to clinic appointments and the diagnostic center. On his first post-transplant clinic appointment, I made sure I was there to answer any questions and provide consistency in his teaching and care. We would spend an hour together each visit reviewing medications (color-coded to help with the language barrier) and other post-transplant care. We became very familiar with each other and were able to establish a relationship of comfort and trust.

Nar has done incredibly well post-transplant with the support of his great family, his wonderful home healthcare nurse and the team at Nebraska Medicine. No matter the language, it’s our goal to communicate and provide extraordinary care to patients.

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

New Technology Deploys in Laboratories

Achievements Spotlighted to Celebrate Laboratory Professionals Week

It’s been a busy year for our laboratory professionals. They’re a critical piece of the “Serious Medicine” we provide, as so much of our treatment decisions rely on the information our laboratories provide.

The Sysmex automated Hematology line can process 300 CBCP samples per hour.

One significant advancement was made last year, when the Core Lab was able to expand a crucial offering for patients who may be bleeding internally.

It’s called viscoelastometry (or TEG) and for years, we offered this testing outside the ORs at Nebraska Medical Center. But there were many barriers to utilizing the equipment, including time-intensive set up and that physicians had to leave the OR to review the test results on a paper report.

As Nebraska Medical Center worked to earn its Level 1 trauma designation, leaders knew in order to achieve this, TEG testing must be offered 24/7 and at many locations, not just outside the OR.

If a patient is bleeding, physicians are able to treat it by giving the patient one of four blood products:  plasma, red blood cells, platelets or cryoprecipitate.

“There are many different reasons that would cause a patient to bleed,” says Pathologist  Scott Koepsell, MD, PhD. “Before this technology, a physician would have to make an educated guess as to what blood product would stop the bleeding. This technology allows a physician to view the test results in real time, to understand exactly what blood product the patient needs.”

Medical Laboratory Scientists Trish Hansen, Jane Larson, and Jessica Price at the REMI command center.

Dr. Koepsell says not only does this protect the patient from potential harm by giving them a blood product they don’t need, it also conserves the blood products our community donates, which is a precious resource.

After the lab receives a sample of the patient’s blood through the pneumatic tube, they have a two-hour window to test the blood, and the test runs for 60 minutes.

“This test takes priority over everything else,” says Valerie Henry, lead medical lab scientist, Core Lab. “As the test is running, it generates pieces of data every five minutes. This is meaningful information a physician can see where they may be – the OR, a trauma bay, or the ICU.”

Our specialists, like cardiologists and neurologists, who have patients using stents can also use TEG to determine how well the blood-thinning medication is working.

“Before, the only way doctors knew a medication was not working is if the patient suffered a serious adverse event, like a stroke,” says Dr. Koepsell. “Now, they can see right away if a patient is not responding to a medication and to make adjustments to keep the stent open.”

Another example of improved patient safety involves patients who are on bypass.

“Before a patient could go to the OR, they had to wait days for their blood thinners to wear off,” he says. “This technology can pinpoint exactly when it’s safe to take the patient to the OR.”

We have four TEGs, which can run two tests at a time, that are always running.

Medical Laboratory Scientists Erin Koziel and Gina Le in the differential area.

Three went live May 2017 and the fourth went live in August 2017.

To validate the TEG, Henry drew samples of her colleagues’ blood and sent samples through the pneumatic tube system, while walking additional samples to the Core Lab.

“We needed to know if the pneumatic tube would compromise the blood,” Henry says. “Fortunately, it did not.”

The feedback from lab scientists and physicians has been very positive.

“The first month we conducted 50 tests, the following month, we performed approximately 200 tests,” says Henry. “It demonstrates how fast the news of this valuable testing spread among our physicians.”

Research also shows the added safety measures this technology provides reduces the average patient length of stay by three to four days.

Another cool new testing technique will go live this summer in the Microbiology Laboratory. It’s called matrix assisted laser desorption/ionization (MALDI) and it’s designed to identify bacteria incredibly fast.

Currently, if a culture is sent to Microbiology to identify a possible bacterial infection, the lab technologists will wait for the bacteria to grow and then analyze and identify it.

“Depending on the culture, it could take hours, even weeks to identify the bacteria,” says Dr. Koepsell.

Chastity West, lead medical laboratory scientist, seen reviewing data from MALDI, has been working with Caitlin Murphy, PhD, assistant medical director, to validate the instrument.

With MALDI, the turnaround time will be reduced to minutes.

Dr. Koepsell describes the new technology as “using a laser to blow up bacteria to identify it.”

“Every bacteria blows up differently,” he adds.

MALDI features an FDA-approved instrument panel with different methods to identify a variety of bacteria.

“This will give physicians a much better idea of what antibiotic can be used to treat the bacteria,” says Amy Crismon, Laboratory manager.

This also supports our mission of antibiotic stewardship and protects the patient from unneeded antibiotic treatment.

“We’ve wanted this for years,” adds Crismon, “We’re pretty darn excited.”

The Microbiology Lab will complete the MALDI validation very soon and then conduct training and competencies in May.

 

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

Cancer Research Accelerates New Therapies

Lin-Hollingsworth-Batra-2018-04-03.jpg
From left to right; Chi Lin, MD, PhD, radiation oncologist, Michael Hollingsworth, PhD, researcher and Surinder Batra, PhD, researcher

One of the differentiators of the Fred & Pamela Buffett Cancer Center is the integration of scientists and clinicians, which allows them to collaborate in the evaluation of our cancer patients to design new treatments.

One example of this bench-to-bedside research coming to fruition can be seen through the collaboration of Chi Lin, MD, PhD, a radiation oncologist and researcher Surinder Batra, PhD, associate director for education and training at the Fred & Pamela Buffett Cancer Center. Through Dr. Batra’s basic science research lab, a pathway was discovered in which cholesterol is converted into other compounds in pancreatic cells that contributes to radiation therapy resistance. Dr. Batra’s lab then found another drug that is effective in inhibiting this cholesterol synthesis pathway, thereby increasing radiosensitivity in tumor cells.

This laboratory discovery is now available to patients through a clinical trial that combines chemotherapy with this drug to sensitize pancreatic tumors to radiation. “This is very important because current protocols for radiation therapy are very limited in their effectiveness on pancreatic tumors,” says Michael Hollingsworth, PhD, associate director for Basic Research at the Fred & Pamela Buffett Cancer Center.

“While pancreatic cancer is still extremely difficult to treat, we are making huge progress in understanding the disease,” says Dr. Hollingsworth.

 

“Our goal is to turn these discoveries into improved diagnostics, new therapies and other ways to improve survival and quality of life for these patients.”

 

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

 

Nebraska Medicine Receives Nebraska’s Safest Companies Award

The National Safety Council, Nebraska (NSCN) recently awarded Nebraska Medicine with its “Nebraska’s Safest Companies” award. It will be presented on Wednesday, May 9, as part of the NSCN’s 35th annual Celebration of Safety event. NSCN is a private, nonprofit organization that partners with businesses, schools, law enforcement, firefighters, hospitals and Nebraska communities to provide education and training focused on keeping Nebraskans safe.

The award signifies our exemplary safety record, which is better than the national average when compared to the rest of our industry and recognizes comprehensive safety programs that our organization has implemented.

“The Celebration of Safety honors organizations that have achieved excellence in safety this past year and we are proud to recognize their achievements in providing a safer Nebraska for their employees and their families,” says Eric Koeppe, president and CEO, National Safety Council, Nebraska.

“At Nebraska Medicine, we are focused on being the safest place possible — for patients, their families and our employees,” says CEO Dan DeBehnke, MD, MBA. “The recent Shout Out for Safety initiative, in which we address safety concerns on a daily basis, is one example of our commitment to improving safety. The upcoming Zero Harms Tools training for all colleagues is the next step on our journey to safety and high reliability. “

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

Loading