UPMC Physician Resources

Pitt Researchers Find New Way to Classify Post-Cardiac Arrest Patients

Pitt Researchers Find New Way to Classify Post-Cardiac Arrest Patients, Improving Ability to Predict Outcomes

PITTSBURGH, July 11, 2011 – A new method for scoring the severity of illness for patients after cardiac arrest may help to predict their outcomes, according to researchers at the University of Pittsburgh School of Medicine. Most importantly, their findings, published in the early online version of Resuscitation, also show that none of the severity categories rules out the potential for a patient’s recovery.

“Traditionally, we have used historical or event-related information, such as initial cardiac rhythm or whether someone witnessed the collapse, to categorize these patients upon arrival at the hospital,” said Jon C. Rittenberger, M.D., lead author and assistant professor of emergency medicine. “Unfortunately, more than 10 percent of the time, such information is unavailable, which limits our ability to tailor therapies, counsel families about prognosis or select patients for clinical trials.”   

Cardiac arrest is the most common cause of death in North America, resulting in approximately 350,000 deaths each year.

The researchers looked at retrospective data for more than 450 post-cardiac arrest patients treated at UPMC Presbyterian between January 2005 and December 2009. Both in-hospital and out-of-hospital cardiac arrests were included. In 2007, the hospital implemented a multi-disciplinary post-cardiac arrest care plan, including therapeutic hypothermia, or cooling of patients to minimize brain damage.

Four distinct categories of illness severity were identified based on a combination of neurological and cardiopulmonary dysfunction during the first few hours after restoration of a patient’s spontaneous circulation. The researchers looked at rates of survival, neurologic outcomes and development of multiple organ failure for patients in each category, and found wide variations among the groups.

“Now, objective data available to the clinician at the bedside during initial evaluation may provide a better way of predicting outcomes and guiding the decisions of families and clinicians. We found that the category of illness severity had a stronger association with survival and good outcomes than did such historically used factors as initial rhythm of arrest or where it happened,” said Dr. Rittenberger.  “Our results indicate that illness severity should be carefully measured and accounted for in future studies of therapies for these patients.”

Co-authors of the study include Samuel A. Tisherman, M.D., Margo B. Holm, Ph.D., Francis X. Guyette, M.D., M.P.H., and Clifton W. Callaway, M.D., Ph.D., all of the University of Pittsburgh.

The research was supported by a grant from the National Center for Research Resources. Dr. Rittenberger is also supported by an unrestricted grant from the National Association of EMS Physicians/Zoll EMS Resuscitation Research Fellowship.

UPMC Palliative Care Program Recognized With Circle of Life Honor

PITTSBURGH, July 11, 2011 UPMC today was recognized for its innovative program that improves the care of patients near the end of life or with life-threatening conditions with a Circle of Life Citation of Honor from the American Hospital Association (AHA). The Circle of Life Award celebrates programs across the nation that have made great strides in palliative and end-of-life care.

A team of health care professionals work together as part of UPMC’s palliative care program to provide comfort to patients near the end of life. The program integrates family support with inpatient, outpatient and home care. 

“It’s a great honor for UPMC’s palliative care program to be honored with this citation,” said Robert Arnold, M.D., chief medical officer, UPMC Palliative and Supportive Institute. “Our goal is to help people with serious illness maintain the best quality of life possible, whether it be through managing pain, providing support to their families or facilitating conversations about the kind of care they expect.”

UPMC was selected by leaders in medicine, nursing, social work, ethics and health administration. The committee focused on innovative programs that respect patient goals and preferences, provide comprehensive care, acknowledge and address the family or caregivers’ concerns and needs, and build systems and mechanisms of support to continue the program for future patients and caregivers.

This is the 12th year for the Circle of Life Award. The 2011 awards are supported, in part, by the California HealthCare Foundation and the Archstone Foundation, based in Oakland, Calif. Major sponsors are the American Hospital Association, the Catholic Health Association, National Consensus Project for Quality Palliative Care and the National Hospice and Palliative Care Organization and the National Hospice Foundation. The American Academy of Hospice and Palliative Medicine and the National Association of Social Workers are Circle of Life co-sponsors. The Circle of Life Award is a program administered by the Health Research & Educational Trust.

“A patient needing palliative or end-of-life care faces difficult challenges that must be addressed with skill and unique expertise,” said AHA president and CEO, Rich Umbdenstock. “These winners exemplify what the health care field is striving for: compassionate care for patients and families at all times. These innovative programs serve as guiding lights for others on this path.”

For more information on the Circle of Life Award, visit www.aha.org/circleoflife.

UPMC is Only Health System Named ‘Most Wired’ for 13 Consecutive Years

PITTSBURGH, July 11, 2011 – For the 13th consecutive year, UPMC has been named one of the 100 “Most Wired” health systems in the country, the only organization to earn that distinction, according to Hospitals & Health Networks, the journal of the American Hospital Association (AHA).

UPMC also is one of the winners of the 2011 Most Wired Innovator Awards for its development of eVisits, a Web-based system for providing secure “electronic housecalls” to patients. This pioneering approach to health care is available to patients of most UPMC primary care physicians and provides a safe, convenient and cost-effective alternative to in-person visits or phone calls for more than 20 conditions. eVisits, using physician-created, structured questionnaires, are integrated into UPMC’s extensive electronic medical records (EMRs) to ensure continuity of patient care.

The awards will be presented at the 2011 Health Forum and AHA Leadership Summit in San Diego, July 17 to 19.

“UPMC is a long-time leader in adopting, developing and commercializing smart technology that improves care for patients. We are honored to be consistently recognized for these achievements by Hospitals & Health Networks and proud of the dedicated team of clinicians and technologists at UPMC who have made this possible,” said Daniel Drawbaugh, chief information officer of UPMC.

The 13th annual Most Wired Survey and Benchmarking Study included more than 1,300 hospitals and health systems across the country and measured the use of technology in clinical quality and safety, business and administrative functions, and ambulatory and community services.

Over the past five years, UPMC has invested more than $1.3 billion in technology to support clinical excellence and administrative efficiency as it creates new models of accountable care. UPMC is one of the nation’s earliest and most sophisticated users of EMRs. Children’s Hospital of Pittsburgh of UPMC in 2009 was the first pediatric facility in the nation to achieve HIMSS Stage 7 status for its virtually paperless environment and the most comprehensive use of EMRs, while seven other UPMC hospitals are Stage 6, as measured by HIMSS Analytics, a subsidiary of the Healthcare Information and Management Systems Society.

Last year, UPMC ranked fifth in the InformationWeek500, a list of the nation’s top technology innovators across all industries, and also was honored with the Healthcare Innovation Award for creating a system that allows radiologists and physicians to access imaging studies from across UPMC to better care for patients.

UPMC Opens New Specialty Clinic for Smokers, Offers Early Screenings That Could Save Lives

PITTSBURGH, July 7, 2011 – UPMC has established a new specialty clinic that will offer early lung cancer screening using low-dose helical CT scanning, a technique that was proven in a national trial to reduce deaths because tumors were detected early when treatment is more effective.

The Lung Nodule Clinic, located on the fourth floor of Falk Clinic in Oakland, is intended to screen current and former heavy smokers, said Christopher Faber, M.D., medical director of the UPMC Comprehensive Lung Center. Smoking remains the leading cause of lung cancer, the most common cancer in adults. 

“Patients will be evaluated to see if they are candidates for the screening test,” explained Dr. Faber. “If they are, they will participate in a one-hour, eight-person, group-educational session led by a nurse coordinator, followed by a low-dose helical CT scan.” 

A low-dose helical CT scan, also referred to as spiral CT, uses X-rays to obtain a multiple-image scan of the entire chest during a 7 to 15 second breath-hold. Patients will be strongly encouraged to quit smoking during the educational session, which will include smoking cessation information. Results of the CT scan will be sent to the patient and their primary care physician. 

This new fee-for-service clinic grew out of the findings of the National Cancer Institute’s National Lung Screening Trial, a randomized national trial that involved more than 53,000 current and former heavy smokers ages 55 to 74 and compared the effects of two screening procedures for lung cancer ― low-dose helical CT scans and standard chest X-ray ― on lung cancer mortality. The study found 20 percent fewer lung cancer deaths and a 7 percent reduction in overall mortality among the trial participants who were screened with low-dose helical CT. 

“The results of this study are very important, suggesting that many Americans who smoke should not only quit smoking, but also undergo lung cancer screening, both of which will reduce lung cancer mortality rates, said Mark Gladwin, M.D., chief, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine.

The lung screening program currently is not covered by insurance. The out-of-pocket fee of $200 includes the nurse coordinator-led class, CT scan and valet parking.

University of Pittsburgh Cancer Institute Again Earns Elite Comprehensive Cancer Center Status from National Cancer Institute

PITTSBURGH, July 7, 2011 – The National Cancer Institute (NCI) has renewed the University of Pittsburgh Cancer Institute’s (UPCI) status as a “Comprehensive Cancer Center,” the highest distinction it grants. With this designation comes national and international recognition that UPCI is a center of excellence in basic and clinical research, prevention and control programs, and population sciences, as well as a vital part of the region for cancer education and outreach.

“This renewal differentiates UPCI as a national leader in cancer research and care,” said Nancy E. Davidson, M.D., director of UPCI and UPMC Cancer Centers. “As one of only 40 centers in the country with this elite designation, our patients can be confident they receive the very best care possible, including superior patient education, access to the most up-to-date screening technologies and cutting-edge treatment options.”

In October, UPCI celebrated the successful renewal of its Cancer Center Support Grant from the NCI. The grant supports UPCI’s broad range of clinical, research and educational programs and its mission to lessen the burden of cancer for people throughout Western Pennsylvania and beyond. The grant renewal, a review of the quality of UPCI’s research and clinical care, was the first step in UPCI’s designation renewal. The second step evaluated UPCI’s programs in patient education, community service and community outreach.

“The renewal of our core grant was vital because it confirms the exceptional work happening inside the Cancer Institute,” said Dr. Davidson. “The renewal of our comprehensive status, however, is equally important because it recognizes our role in the community. An NCI-designated comprehensive cancer center should be an integral part of the fabric of the community, and our commitment to the community is as strong as our dedication to finding cures for this disease.”

Established in 1985, UPCI received its designation as an NCI-designated Comprehensive Cancer Center in 1989 and has retained this distinction since then.

Outpatient Treatment Proves Safe and Effective for Low-Risk Patients with Pulmonary Embolism in Multi-Center Trial

PITTSBURGH, June 23, 2011 Outpatient care for certain low-risk patients with pulmonary embolism (PE) can be safely and effectively used in place of inpatient care, according to a randomized, multi-center study in 19 emergency departments. The findings, published June 23 online in the Lancet, support current practice guidelines that are rarely followed by physicians.

“This is the most rigorous study to date to compare inpatient and outpatient care for a selected group of stable patients with pulmonary embolism,” said Donald M. Yealy, M.D., senior author of the study and chairman of the Department of Emergency Medicine at the University of Pittsburgh School of Medicine. “Our findings support a shift in clinical management of PE for a substantial portion of low-risk patients, which may reduce hospitalizations and costs.”

Pulmonary embolism is a blockage of the main artery of the lung or one of its branches. Most are due to pelvic and upper leg blood clots that grow in the vein before detaching and traveling to the lungs. The most common symptoms include unexplained shortness of breath or chest pain while breathing. On average, 650,000 PEs occur annually, and it is the third-leading cause of hospital death.

In the Outpatient Treatment of Pulmonary Embolism (OPTE) trial, researchers looked at more than 300 patients at 19 emergency departments in Switzerland, Belgium, France and the U.S. who had been randomly assigned to inpatient or outpatient care between February 2007 and June 2010. These patients were judged to have a low risk of death, based on a validated clinical prognostic model. Of those screened, 30 percent met the eligibility criteria, suggesting that a shift in the clinical management of such patients may have a broad effect.

Patients assigned to outpatient treatment received standardized teaching from a study nurse about self-injection with enoxaparin, an anti-coagulant, and were to be discharged from the emergency department within 24 hours. Patients assigned to inpatient treatment were admitted to the hospital and received the same enoxaparin regimen. In both groups, the study protocol recommended early initiation of oral anticoagulation medications and continuation for a minimum of 90 days.

Patient outcomes for outpatient care showed that it was as safe and effective as inpatient care. For instance, researchers found that one of 171 outpatients developed recurrent venous thromboembolism, or blood clots forming within the veins, within 90 days compared with none of 168 inpatients. One patient in each group died within 90 days. Two of the outpatients and no inpatients had major bleeding within 14 days.

Patient satisfaction regarding care exceeded 90 percent for both groups, and both had essentially the same numbers of hospital readmissions, emergency department visits and outpatient visits to a doctor’s office within 90 days. But researchers found that cost savings from reductions in hospital stays might be partially offset by an increased frequency in home-nursing visits.

“Our findings are consistent with previous non-randomized studies and systematic reviews that outpatient care of PE is associated with low rates of recurrent venous thromboembolism, major bleeding and death,” said Dr. Yealy. “Patients with PE prefer outpatient treatment, and these reassuring trial results should prompt physicians to consider such care more often for low-risk patients.”

Co-authors of the study include lead author Drahomir Aujesky, M.D., Bern University Hospital, Switzerland; Pierre-Marie Roy, M.D., LUNAM University and University of Angers, France; Franck Verschuren, M.D., University of Louvain, Belgium; Marc Righini, M.D., and Arnaud Perrier, M.D., University of Geneva, Switzerland; Joseph Osterwalder, M.D., Cantonal Hospital of St. Gallen, Switzerland; Michael Egloff, M.D., and Hans-Jűrg Beer, M.D., Cantonal Hospital of Baden, Switzerland; Bertrand Renaud, M.D., and Alfred N’gako, M.D., University Hospital Henri Mondor, France; Peter Verhamme, M.D., University of Leuven, Belgium; Michael J. Fine, M.D., VA Center for Health Equity Research and Promotion and Pitt School of Medicine; Roslyn A. Stone, Ph.D., and Nathan A. Pugh, B.S., University of Pittsburgh; Catherine Legall, M.D., University of Argenteuil, France;  Olivier Sanchez, M.D., Hôpital Européen Georges Pompidou, France; Jacques Cornuz, M.D., and Olivier Hugli, M.D., University of Lausanne, Switzerland.

The study was supported by grants from the Swiss National Science Foundation, the Programme Hospitalier de Recherche Clinique 2007, and the U.S. National Heart, Lung, and Blood Institute. Sanofi-Aventis provided free drug supply in the participating European centers.

Life Expectancy for Those With Type 1 Diabetes Improving, Pitt Study Shows

PITTSBURGH, June 24, 2011 – The life expectancy of people diagnosed with type 1 diabetes dramatically increased during the course of a 30-year, long-term prospective study, according to a University of Pittsburgh Graduate School of Public Health study being presented at the 71st Scientific Sessions of the American Diabetes Association.

The life expectancy for participants diagnosed with type 1 diabetes between 1965 and 1980 was 68.8 years – a 15-year improvement, compared to those diagnosed between 1950 and 1964, according to the study. Meanwhile, the life expectancy of the general U.S. population increased less than one year during the same time period.

“The estimated 15-year life expectancy improvement between the two groups persisted regardless of gender or pubertal status at diagnosis,” said Trevor J. Orchard, M.D., lead author of the study and  professor of epidemiology, pediatrics and medicine at the University of Pittsburgh.

The results, found in Abstract Number 0078-OR, are based on participants in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study, a long-term prospective study of childhood onset type 1 diabetes, which began in 1986. Participants in the study, who were an average age of 28 when entering the study and 44 at its completion, were diagnosed with type 1 diabetes between 1950 and 1980.

“Type 1 diabetes mortality rates have decreased over time, but formal life expectancy estimates for those diagnosed with type 1 diabetes in the United States are lacking,” Orchard said. “Therefore, we estimated the all-cause mortality experience and life expectancy of the EDC study cohort.”

The 30-year mortality of participants diagnosed with type 1 diabetes from 1965 to 1980 was 11.6 percent – a significant decline from the 35.6 percent 30-year mortality of those diagnosed between 1950 and 1964, according to the study. 

Previously known as juvenile diabetes, type 1 diabetes is usually diagnosed in children and young adults. In type 1 diabetes, the pancreas produces little or no insulin to properly control blood sugar levels. It is typically treated with insulin replacement therapy.

In addition to Dr. Orchard, other authors include Rachel G. Miller, M.S.; Aaron M. Secrest, Ph.D.; Ravi K. Sharma, Ph.D.; and Thomas J. Songer, Ph.D., all of the University of Pittsburgh. The study was funded by the National Institutes of Health.

The University of Pittsburgh Graduate School of Public Health (GSPH), founded in 1948 and now one of the top-ranked schools of public health in the United States, conducts research on public health and medical care that improves the lives of millions of people around the world. GSPH is a leader in devising new methods to prevent and treat cardiovascular diseases, HIV/AIDS, cancer and other important public health issues. For more information about GSPH, visit the school’s Web site at http://www.publichealth.pitt.edu.

Linda Siminerio of University of Pittsburgh Diabetes Institute Receives Outstanding Educator in Diabetes Award

PITTSBURGH, June 24, 2011 Linda M. Siminerio, R.N., Ph.D., C.D.E., executive director of the University of Pittsburgh Diabetes Institute, will receive the American Diabetes Association’s (ADA) prestigious Outstanding Educator in Diabetes Award at the association’s 71st Scientific Sessions in San Diego, June 24 to 28.

The award is presented to an individual who demonstrates significant contributions to the understanding of diabetes education, has spent many years of effort in the field, and has benefited recipients of education.

“Diabetes is a condition that requires the person to make informed daily decisions about food, activity and medication in response to blood glucose-monitoring results, all day, everyday. Self-management education provides the necessary foundation for quality self-care. With a diabetes epidemic and accountable care, it becomes critically important that people with diabetes become actively engaged in their self-care,” said Dr. Siminerio.

Dr. Siminerio, who also is associate professor in the School of Medicine and the School of Nursing at the University of Pittsburgh, has been a pioneer in the field of diabetes education. She was one of the first pediatric diabetes educators in the United States and has helped to establish 46 American Diabetes Association-recognized diabetes self-management programs throughout Pennsylvania. She has been a leader in the Pennsylvania Chronic Care Commission, whose efforts are aimed at improving services to people with diabetes. 

“This is the largest diabetes meeting in the world, and candidates for awards are submitted from around the world. Thus, the independent committee that selected Dr. Siminerio as Outstanding Educator rightfully regards her as one of the best diabetes educators,” said Andrew Stewart, M.D., chief, division of endocrinology and metabolism at the University of Pittsburgh School of Medicine, and chair of the scientific planning committee for this year’s ADA Meeting.

Dr. Siminerio is the author of numerous books and scientific publications in her field and is the author of the National Standards for Diabetes Education and the International Diabetes Standards and Curriculum.

She has served as senior vice president for the International Diabetes Federation (IDF) and served as chair of the IDF World Congress in 2009. She was the editor-in-chief of Diabetes Forecast, and a past president of Health Care and Education for the American Diabetes Association.

Nearly 26 million children and adults in the United States have diabetes. Diabetes contributes to the deaths of more than 231,000 Americans each year. The ADA estimates that the total cost of diagnosed diabetes in the United States is more than $174 billion. Published studies suggest that when additional costs for gestational diabetes, pre-diabetes and undiagnosed diabetes are included, the total diabetes-related costs in the United States could exceed $218 billion.

Director Named to the Adult Congenital Heart Disease Center at Children’s Hospital of Pittsburgh of UPMC and UPMC Heart and Vascular Institute

PITTSBURGH, June 22, 2011 Stephen Cook, M.D., has been named director of the Adult Congenital Heart Disease (ACHD) Center at Children’s Hospital of Pittsburgh of UPMC and UPMC Heart and Vascular Institute (HVI).

Dr. Cook comes to Children’s Hospital and the HVI from Nationwide Children’s Hospital in Columbus, Ohio, where he served as assistant professor of pediatrics and internal medicine and director of non-invasive imaging and research for the Adoloescent and Young Adult Congenital Heart Disease Program.

Dr. Cook brings to the center extensive experience in serving adolescents and adults with congenital heart disease as a board-certified physician in four specialties: adult and pediatric cardiology, internal medicine and pediatrics. He is an expert in the transition of care of patients with congenital heart disease from adolescence to adulthood. Other areas of expertise are non-invasive cardiac imaging, including echocardiography, cardiovascular magnetic resonance imaging, and cardiac computed tomography in adults with congenital heart disease.

“Because of advances in medical, transcatheter and surgical care, the survival rates and quality of life for patients with congenital heart disease have improved dramatically,” Dr. Cook said. “Our program provides the expertise, ongoing care and education needed by this complex group of patients who require lifelong follow-up.”

Dr. Cook also serves on many national committees to help define best practices for this unique population of heart patients. He is co-chair for the Adult Congenital Heart Association Research Committee and an active member of the Alliance for Adult Research in Congenital Cardiology, a multicenter collaboration to promote relationships between adult congenital heart disease programs, to support research efforts and to improve outcomes of adults with congenital heart disease.

“In his role as director of the Adult Congenital Heart Disease Center at both Children’s Hospital and the UPMC Heart and Vascular Institute, Dr. Cook will lead a team of specialists dedicated to providing the most advanced care for adults with congenital heart disease,” says Steven A. Webber, M.B.Ch.B., chief, Division of Pediatric Cardiology. “The Heart Center’s success rate for the care of children with congenital heart defects has led to an increase in the number of these patients reaching adulthood. Dr. Cook is exceptionally qualified to serve these patients and to help them lead healthy and active lives.”

For more information about Dr. Cook, the ACHD Center or Children’s Hospital of Pittsburgh of UPMC, please visit www.chp.edu/achd. Follow this hyperlink to download a high-res photo of Dr. Cook.

A successful heart transplant at UPMC allows patient to spend Father’s Day with his family

Pittsburgh, PA, June 17, 2011–As Father’s Day approaches, Tom Meshanko is preparing to spend the day with his family in Moraine State Park. He’ll take a boat onto the lake, fish, and spend time with his five grandchildren.

Meshanko counts himself lucky. The 69-year-old father of two said he doesn’t feel his age. That’s because his heart is 22 years old—literally.

A recipient of a heart transplant at UPMC Presbyterian, Meshanko celebrated the second anniversary of what he considers his “second chance” in life on June 13. The long-time Forest Hills resident and former council member said he struggled with heart problems for more than 20 years before the transplant; his own father died of a heart attack shortly after Meshanko and his wife Donna were married.

Read full article:  http://foresthills-regentsquare.patch.com/articles/fatherhood-take-two


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