Archive for the ‘Articles’ Category

New Procedure a First for Nebraska

A neck injury sent Scott Winter to the ED, only to discover he suffered from atrial fibrillation. His cardiologist, Shane Tsai, MD, recommended a new procedure that would prevent his heart from beating irregularly. Winter would be the first patient in the state to undergo this procedure, performed by HelenMari Merritt, DO.

Watch more in this video below.

Less-invasive Option for Thyroid Surgery

Estelle Chang, MD.

Estelle Chang, MD.

It’s a new option for patients who require thyroid surgery, one that’s much less invasive. Minimally-invasive robotic surgery is now offered at Nebraska Medicine for patients who need thyroidectomy, meet specific criteria, and desire a procedure that won’t leave a visible neck scar.

Estelle Chang, MD, an Otolaryngology Head and Neck surgeon, recently returned from a six month Advanced Robotic Head and Neck Endocrine Surgery fellowship at Yonsei Severance Hospital in Seoul, South Korea.  During her fellowship training, Dr. Chang also studied the latest, minimally invasive, thyroid and parathyroid surgery techniques. She also offers minimally invasive robotic surgeries for patients who need to have their submandibular gland, thyroglossal duct cyst and other non-cancerous lesions from neck removed.

“Traditionally, thyroidectomy has been performed using a 4 to 8 cm incision in the front of the neck which leaves a very visible scar,” says Dr. Chang. “Robotic thyroidectomy is the latest, minimally invasive surgical technique that is used to remove all or part of a thyroid gland without leaving a visible scar.”

Robotic surgery for thyroid disorders in the United States is currently offered at a few leading academic medical centers. It is considered to be a very safe procedure in the hands of an experienced robotic surgeon, says Dr. Chang. Robotic surgery can also be used to remove other benign masses of the neck, such as lipomas and thyroglossal duct cysts.

Lauritzen Outpatient Center Latest Openings

Nebraska Medicine and UNMC opened level one last week and level three yesterday of the Laurtizen Outpatient Center. By shifting outpatient services from main campus as well as adding complimentary support services for one-stop, patient-centered care, we are creating a better patient experience. Dedicated surface and garage parking for patients and their families offers a new convenience not historically found on the main campus. So far, the staff and physicians are embracing the new delivery of care.

“Having our clinic, X-ray and Physical Therapy in close proximity has made for a much more efficient flow of our patients through our facility and has improved our patients’ experience dramatically,” says Matthew Mormino, MD, orthopaedic surgeon and professor of Orthopaedic Surgery at UNMC.  11-23-lauritzen-shared-work-space

Also, new to the format of Lauritzen Outpatient Center are shared work spaces for physicians and staff that lead into patient rooms

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Services on level one include:

  • Orthopaedics Clinic
  • Physical and Occupational Therapy (PT/OT)
  • Outpatient Pharmacy
  • Radiology
  • Laboratory Services

Services on level three include:

  • Ear, Nose & Throat and Audiology
  • Oral & Maxillofacial Surgery
  • Oral Facial Prosthetics
  • Surgery-Urology

Lauritzen Outpatient Center, including the Fritch Surgery Center, has been opening services over the course of the last three weeks and will be fully operational by Nov. 30. The schedule is as follows:

  • Level one: Orthopaedics Clinic, PT/OT, Outpatient Pharmacy, Radiology, Laboratory Services and Coffee Shop – NOW OPEN
  • Level three: clinics including Ear, Nose & Throat and Audiology, Oral & Maxillofacial Surgery, Oral Facial Prosthetics and Surgery-Urology – NOW OPEN
  • Level four: Orthopaedics faculty and research as well as Telemedicine opening throughout November
  • Level two (Fritch Surgery Center): Pre/post op and outpatient surgery – Opening Nov. 30
    Note: University Tower ORs are now permanently closed

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.

Nebraska Medicine Earns Elite National Quality Award

Excellence Award from Vizient, Inc. for Quality Leadership Performance

Nebraska Medicine is honored to announce its recognition by Vizient, Inc., as a recipient of the 2016 Bernard A. Birnbaum, MD Quality Leadership Award. The award recognizes Nebraska Medicine’s performance among more than 100 academic medical centers participating in Vizient’s Quality and Accountability Study. Thirteen academic medical centers were recognized this year.  Nebraska Medicine is ranked tenth and is the only health system in the region to earn this recognition. The others are:

  • University of Utah Hospitals and Clinics
  • NYU Langone Medical Center
  • Mayo Clinic Hospital-Rochester
  • Froedtert Health-Froedtert Hospital
  • Rush University Medical Center
  • WVU Medicine West Virginia University Hospitals
  • Penn State Milton S. Hershey Medical Center
  • Cedars-Sinai Health System
  • Houston Methodist
  • Nebraska Medicine
  • The Ohio State University Wexner Health System
  • University of Michigan Hospitals and Health Centers
  • University of Vermont Medical Center

“This is truly a special honor for everyone at Nebraska Medicine,” said Dan DeBehnke, MD, MBA, CEO of Nebraska Medicine. “Achieving a Five Star ranking took a tremendous amount of dedication and work from many, many people here.”

This year, more than 100 academic medical centers and 124 community hospitals were included in the study, which reviewed performance data from a variety of sources, including Vizient’s Clinical Data Base, the core measures data base, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and the Centers for Disease Control and Prevention’s National Healthcare Safety Network.

“Nebraska Medicine is dedicated to providing our patients with the highest quality, safest, most efficient and compassionate care available,” said Michael Ash, MD, Chief Transformation Officer, “To achieve a top ten Vizient Quality Leadership rank, among our nation’s elite academic medical centers, is a reflection of our colleagues and their devotion to extraordinary patient care.”

Heart Failure Patient Becomes Mother

Sarah Hawthorne gave birth to her baby at the same hospital that evaluated her heart defect shortly after she was born.

Sarah Hawthorne gave birth to her baby at the same hospital that evaluated her heart defect shortly after she was born.

Sarah Hawthorne Writes About Her Experience with Our Partnership with Children’s Hospital & Medical Center

May 22, 2016, was a day that changed my life forever. I gave birth to a healthy, 7 pound 7 ounce baby boy at the Nebraska Medical Center. Thirty-one years earlier, I had been airlifted to that same hospital because I was born with a congenital heart defect. Little did my family know then, how much the pediatric and adult congenital heart cardiology teams would become a part of our family.

I was born in the small town of Minden in central Nebraska. The physician that delivered me could tell that something wasn’t quite right. He had me transported to a hospital in Kearney where they decided to airlift me to Omaha. It was there that I was diagnosed with transposition of the great arteries (TGA) – a serious but rare heart defect.

I had open-heart surgery eight months later, and now, as a parent, I am only somewhat able to imagine how incredibly hard that must have been for my parents. Thankfully, everything went well, and I was able to live a fairly normal life as an energetic, active child.

When I was 7-years-old, I went into congestive heart failure and was once again sent to Omaha. This time, at Children’s Hospital & Medical Center. I was given a pacemaker and began my journey with cardiologist John Kugler, MD. Since then, I have had two more pacemakers, several heart catheterizations and another open-heart surgery in 2015.

Sarah Hawthorne after her heart surgery when she was 7 years old.

Sarah Hawthorne after her heart surgery when she was 8 months old.

My pregnancy further added to my team. I was under the care of Nebraska Medicine cardiologist Shane Tsai, MD, and the maternal-fetal medicine specialists at the med center. I moved to Omaha for my last month of pregnancy to ensure that the delivery went smoothly.

On May 22, our baby boy was born healthy and without any heart problems that I could have possibly passed on. Since then, I have continued to see Dr. Tsai and the Adult Congenital Heart Disease (ACHD) team.

What the medical facts don’t illustrate, though, are the relationships that have formed over the years with our doctors and nurses at Children’s and Nebraska Medicine. It’s amazing how Dr. Kugler remembered so much about me even when he was only seeing me once a year.

Toward the end of my 20s and early 30s, I developed some arrhythmias that required more frequent appointments. The interest the doctors and nurses took in my life and family was unnecessary, and yet always made me feel loved and cared for.

Dr. Kugler and his nurse, Kris Houston, even drove three hours to attend my wedding, and when we had our baby at the med center, Kris came to the hospital to visit. As I transition to the ACHD team at Nebraska Medicine, I know those relationships will develop into trusting, caring, and loving relationships as well. This, to me, is what sets these two teams apart from everyone else. They are very knowledgeable about my heart condition and take great care of me medically – all while making me feel extremely important to them as a person.

On top of all of this, they helped me achieve something I only dreamt of for many years – becoming a mother.  And for that, I will be eternally grateful to the Pediatric and ACHD teams.

To learn more about the importance of the ACHD clinic at Nebraska Medicine and the unique relationship they have with Children’s, read this blog from Dr. Tsai.

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.

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