UPMC Physician Resources

Rule change would aid some who await organs

Pittsburgh, PA,  September 12, 2011–A proposed change in the way intestinal organs are allocated could increase access to those organs for people awaiting transplantation, according to a UPMC surgeon who is leading efforts to change federal rules.

The proposal affects people who are waiting for a combined liver-intestine transplant, a type of procedure that has sharply declined in frequency since 2008.

Surgeons attribute the drop in the combined surgeries to a federal rule that requires livers to be offered to every patient on the national waiting list. Doing so pushes down the list about 70 adults nationwide who are waiting for a combined liver-intestine transplant during any given year.

UPMC Stroke Institute Receives National Recognition for Top Patient Care

PITTSBURGH, Sept. 6 – The UPMC Stroke Institute has received the American Heart Association/American Stroke Association’s Get With The Guidelines® Stroke Gold Plus Achievement Award. The award recognizes UPMC’s commitment to providing excellent care for stroke patients, according to evidence-based guidelines.

To receive the award, the UPMC Stroke Institute achieved  85 percent or higher adherence to all Get With The Guidelines-Stroke Achievement indicators for two or more consecutive 12-month intervals and achieved 75 percent or higher compliance with six of 10 Get With The Guidelines-Stroke Quality Measures.

Physicians at the UPMC Stroke Institute offer comprehensive stroke care to more than 1,500 patients annually and lead efforts to partner with area community hospitals to initiate acute stroke treatment. The availability of this service has resulted in more than 200 interventional treatments in the past year.

“With a stroke, time lost is brain lost, and the Get With The Guidelines–Stroke Gold Plus Achievement Award demonstrates UPMC’s commitment to being one of the top hospitals in the country for providing aggressive, proven stroke care,” said Tudor Jovin, M.D., director of the UPMC Stroke Institute.

In addition to the Get With The Guidelines-Stroke award, UPMC also has received the association’s Target: Stroke Honor Roll, for improving stroke care. Over the past quarter, at least 50 percent of eligible ischemic stroke patients have received intravenous rt-PA, a clot-busting agent, within 60 minutes of arriving at the hospital (known as “door-to-needle” time).

“The UPMC Stroke Institute is to be commended for its commitment to implementing standards of care and protocols for treating stroke patients,” said Lee H. Schwamm, M.D., chair of the Get With The Guidelines National Steering Committee and director of the TeleStroke and Acute Stroke Services at Massachusetts General Hospital in Boston. “The full implementation of acute care and secondary prevention recommendations and guidelines is a critical step in saving the lives and improving outcomes of stroke patients.”

Get With The Guidelines–Stroke uses the “teachable moment,” the time soon after a patient has had a stroke, when they are most likely to listen to and follow their health care professionals’ guidance. Studies demonstrate that patients who are taught how to manage their risk factors while still in the hospital reduce their risk of a second heart attack or stroke.

“The time is right for UPMC to be focused on improving the quality of stroke care by implementing Get With The Guidelines–Stroke,” said Lawrence Wechsler, M.D., chairman, University of Pittsburgh Department of Neurology. “Stroke incidence is decreasing, but the aging population will result in an increase in the number of strokes.”

According to the American Heart Association/American Stroke Association, stroke is the third-leading cause of death in the United States and a leading cause of serious, long-term disability. On average, someone suffers a stroke every 45 seconds; someone dies of a stroke every three minutes; and 795,000 people suffer a new or recurrent stroke each year.

Sudden Death of a Parent May Pose Mental Health Risks for Children

PITTSBURGH, Sept. 5 – In the first longitudinal study of its kind, researchers at the University of Pittsburgh School of Medicine have found that 40 percent of children bereaved by sudden parental death will require intervention to prevent prolonged grief reaction and possible depression. The results will be published in the September issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

“The death of a parent is consistently rated as one of the most stressful events a child can experience; however, little is known about the course of grief and its effects on children,” said Nadine M. Melhem, Ph.D., lead author of the study and assistant professor of psychiatry at Pitt. “With our research, we are hoping to gain greater understanding of grief reactions so that we can better design treatments to relieve the burden of grief in bereaved children.”

Building upon their prior findings, the researchers studied 182 children between ages 7 and 18 whose parent died from suicide, accident or sudden natural deaths. They found that more than half of the children were able to cope with their grief within one year of the loss of their parent. However, the course of grief was shown to be more difficult for some children, with 30 percent showing a more gradual easing of their symptoms and about 10 percent displaying high and prolonged grief for nearly three years after their parents died. Those children with prolonged grief reaction also showed increased incidents of depression.

The researchers previously noted increased rates of psychiatric disorders in the parents prior to their deaths, not only among those  who died from suicide but also those who died from accident and sudden natural death, suggesting a pre-existing vulnerability in their children that puts them at higher risk for adverse psychiatric outcomes following their deaths.

The research team also examined the well-being of the children’s surviving caregivers, as previous research has consistently shown that it is a significant predictor of the children’s overall well-being. They found that the combination of complicated grief in the surviving parent and in the child were particularly strong in predicting depression in children up to three years after the death.

“These findings have important clinical implications for intervention and prevention efforts,” noted Dr. Melhem. “We believe it is imperative to assess the surviving parent and intervene when appropriate to improve the outcome of parentally bereaved children. Treatment of prolonged grief in children may require interventions that are family focused, rather than individually focused. Preventive interventions should target not only the 10 percent of bereaved children with prolonged grief, but also the 30 percent with increased grief reactions as they also showed increased incidents of depression.”

Co-authors of the study include David A. Brent, M.D., Giovanna Porta, M.S., and Monica Walker Payne, M.A., all from the University of Pittsburgh Department of Psychiatry; and Wael Shamseddeen, M.D., from Rosalind Franklin University of Medicine and Sciences. 

This study was supported in part by funding provided by the National Institute of Mental Health and the American Foundation for Suicide Prevention.

Pitt’s John J. Reilly named Jack D. Myers Professor and Chair of Medicine

 PITTSBURGH, Sept. 2 John J. Reilly Jr., M.D., executive vice chair, Department of Medicine, has been named the Jack D. Myers Professor and Chair, Department of Medicine, University of Pittsburgh. Reilly replaces Steven Shapiro, M.D., who was named chief medical and scientific officer of UPMC last year.

Dr. Reilly came to Pitt in 2008 as a professor of medicine. He is a prolific researcher who has authored or co-authored more than 100 peer-reviewed research reports and co-authored chapters in two of the most well-known textbooks of internal medicine. His areas of interest include the genetic and environmental factors associated with chronic obstructive pulmonary disease (COPD) and the role of alveolar macrophage enzymes in emphysema, COPD and lung cancer.  

“John Reilly is truly an exceptional academic physician-scientist.  He also has proven himself to be an outstanding leader and administrator,” said Arthur S. Levine, M.D., senior vice chancellor for the health sciences and dean, School of Medicine, University of Pittsburgh. “The Department of Medicine, the School of Medicine, and the University are in very good hands indeed with John’s appointment.”

Dr. Reilly currently is the principal investigator on a National Institutes of Health grant entitled “The Emphysematous Microenvironment Promotes Lung Tumorigenesis and Progression” and is a co- investigator on several other grants including the recently funded Specialized Program of Research Excellence in Lung Cancer, which aims to improve detection and treatment of lung cancer and to understand the mechanisms of increased susceptibility of women to lung cancer.   

“I’m excited about this new opportunity and look forward to continuing my work here at the university as a researcher, faculty member and mentor,” Dr. Reilly said.

Dr. Reilly graduated from Harvard Medical School after earning an undergraduate degree in chemistry from Dartmouth College. He completed his residency in internal medicine at Brigham and Women’s Hospital and later completed a fellowship there in pulmonary and critical care medicine. In 2010, he completed Intermountain Healthcare’s Advanced Training Program in Healthcare Delivery Improvement. 

Dr. Reilly’s academic career started at Harvard, where he rose from instructor of medicine to associate professor of medicine. He also was an attending physician at the Brigham and Women’s Hospital, where he served in several roles: medical director of the Lung Transplant Program, the Center for Chest Diseases, and the Pulmonary Rehabilitation Program; director of the Bronchoscopy Service and the Pulmonary Function Laboratory; interim chief of the Division of Pulmonary and Critical Care Medicine; and vice chairman of Brigham’s Integrated Clinical Services.

Dr. Reilly is certified by the American Board of Internal Medicine and by that Board’s Pulmonary Subspecialty Board.  He also holds a Board Certificate of Competence in Critical Care, is a Fellow of the American College of Physicians, and is a past chair of the National Heart, Lung, and Blood Institute Clinical Trials Study Section.

Photos, Videos, and News Coverage of Landmark Reconstructive Surgeries

Based on groundbreaking research and experience in solid-organ transplants, the University of Pittsburgh Medical Center (UPMC) has begun a novel clinical study on human hand transplantation that seeks to reduce the use of immunosuppressive drugs and their damaging side effects for patients.

Find all of the press releases, video, photos, and news coverage here.

Daily Dose of Common Antibiotic Makes Acute COPD Episodes Less Frequent

PITTSBURGH, Aug. 26 – A multicenter team that includes researchers from the University of Pittsburgh School of Medicine has found that patients with chronic obstructive pulmonary disease (COPD) had fewer episodes of acute worsening of their lung disease and a better quality of life if they took a daily dose of a commonly used antibiotic. The findings are reported in this week’s New England Journal of Medicine.

Even patients who are treated with standard bronchodilator and steroid inhalers to control COPD symptoms commonly have one or more flare ups of the disease each year, which means more doctor and hospital visits, lost work days and reduced lung function, explained Frank Sciurba, M.D., associate professor of medicine, Pitt School of Medicine, and leader of the local arm of the study.

 “Several small studies suggested that antibiotics called macrolides can have immune-modulating and anti-inflammatory effects that led to fewer exacerbations of COPD,” he said. “Our large trial shows it is true, and provides a way to improve the quality of life for patients whose breathing has been terribly impaired by this progressive and deadly disease.”
For the study, which was conducted by the COPD Clinical Research Network and led by Richard K. Albert, M.D., of the University of Colorado Denver Health Sciences Center, more than 1,100 COPD patients from 17 sites in 12 academic centers participated in the trial. About half of them were randomly assigned to take the macrolide antibiotic azithromycin every day for a year, while the rest took a placebo daily for the same time period. The Pitt arm enrolled 91 participants.

The median time to first COPD exacerbation was 266 days in the azithromycin group and 174 days in the placebo group. Also, exacerbations occurred 27 percent less frequently in the azithromycin group. There was a slightly greater likelihood of hearing problems in the azithromycin group, which is a known risk of prolonged use of the antibiotic, and the presence of antibiotic-resistant organisms was detected in some patients, although the infection rate was not higher.

 “Acute exacerbations account for a significant part of COPD’s health burden,” said Susan B. Shurin, M.D., acting director of the National Heart, Lung and Blood Institute (NHLBI), part of the National Institutes of Health, which funded the trial. “These promising results with azithromycin may help us reduce that burden and improve the lives of patients at risk.”
More research needs to be done to assess the safety of using azithromycin in COPD patients for longer than a year, and it’s not clear what impact that might have on antibiotic resistance, said trial co-investigator John Reilly, M.D., professor of medicine, Pitt School of Medicine.

According to NHLBI, COPD affects over 12 million people in the United States and is now the third leading cause of death in the United States. There currently is no cure, though a combination of drugs and lifestyle changes can help manage the symptoms.

 “This work is representative of several very important contributions to understanding and treating this very difficult disease made by the Emphysema/COPD Research Center,” said Mark Gladwin, M.D., chief, Division of Pulmonary, Allergy and Critical Care Medicine, Pitt School of Medicine.
For more information about ongoing projects at the Emphysema/COPD Research Center, call 866 948-2673 (COPD).

Stamford Hospital Adopts SmartRoom® Technology to Provide Safer Care That’s Easier to Deliver

PITTSBURGH and STAMFORD, Conn., Aug. 18, 2011 – Stamford Hospital, a 305-bed teaching facility in Stamford, Conn., will soon be one of the first hospitals in the country to provide innovative technology from SmartRoom® in every room so that care is safer for patients and simpler to provide for clinicians. 

Launched three years ago at UPMC and jointly funded by IBM, the SmartRoom solution uses real-time location tracking devices and other technology to bring patient information from the electronic medical record (EMR) and other data sources to a flat-screen monitor at the patient’s bedside. The information, including problem lists, allergies, medications and lab results, is tailored to meet the needs of specific caregivers at a particular time, reducing the effort required to find and sort relevant information in the EMR.

The solution enables nurses and aides to easily document patient vital signs and completion of certain tasks through a touch screen monitor, thus ensuring that the medical record is updated as patient care is provided. SmartRoom also allows patients to identify doctors, nurses and other caregivers as they enter the room, where their names and roles are automatically displayed on a monitor visible to the patient. Patients also can see daily schedules for tests and other procedures, view educational videos and obtain email and photos from family and friends.  

“As a hospital with a long commitment to patient-centered care, Stamford is excited about the potential for SmartRoom technology to improve quality and safety for our patients, to more closely involve them as partners in their care, and to simplify documentation and other daily tasks for our caregivers,” said Brian Grissler, President and CEO of Stamford Hospital.

“SmartRoom’s solution will complement the investments that Stamford has already made in its EMR by bringing the right patient information to clinicians when and where they need it most, at the bedside,” said Michael Boroch, CEO of SmartRoom. “SmartRoom helps hospitals deliver care more reliably and makes the right way the easy way to provide patient care.”

As part of the contract, IBM will provide installation, systems integration, real-time location services (RTLS) design, and other services and software.

A wholly owned unit of UPMC, SmartRoom designed and tested its solutions at 20-hospital UPMC, one of the country’s leading academic medical centers and one of America’s “best hospitals” on the U.S. News & World Report honor roll. UPMC Montefiore is the first UPMC facility to deploy the technology hospital-wide and is expected to complete that effort by early next year.

For more information, visit www.smartroomsolutions.com.

UPMC Cancer Centers Announces New Associate Director of Adult Neuro-Oncology Program

PITTSBURGH, Aug. 17, 2011 – Jan Drappatz, M.D., a leading expert in brain cancer treatment and research, has been appointed associate director of UPMC Cancer Centers Adult Neuro-Oncology Program, and associate professor of neurology and medicine with the University of Pittsburgh School of Medicine.

Dr. Drappatz joined Pitt and UPMC Cancer Centers on Aug. 15 from Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, where he served on the faculty and as an attending physician in the departments of neurology and oncology.

“Jan’s clinical and translational research experience will play a pivotal role in developing a multidisciplinary treatment approach to patients with brain tumors and to those suffering from the neurological effects of their underlying cancer,” said Edward Chu, M.D., chief of the Division of Hematology/Oncology. 

Dr. Drappatz received his M.D. from the Johannes Gutenberg University School of Medicine.  He completed residency training in neurology at the Partners Neurology Residency Program at Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard Medical School, and completed his fellowship training in neuro-oncology at Dana-Farber.

Key Oncoprotein Found in Merkel Cell Carcinoma

PITTSBURGH, Aug. 15, 2011 – Researchers at the University of Pittsburgh Cancer Institute (UPCI) have identified the oncoprotein that allows a common and usually harmless virus to transform healthy cells into a rare but deadly skin cancer called Merkel Cell Carcinoma (MCC). Their findings, published today in the Journal of Clinical Investigation, could improve diagnosis for MCC and may help in understanding how other cancers arise.

Three years ago, Yuan Chang, M.D., and Patrick S. Moore, M.D., M.P.H., in the Cancer Virology Program at UPCI, discovered a new human cancer virus, called Merkel Cell polyomavirus (MCV), that causes most cases of MCC. But until now, it was not clear how the virus triggered cancer development.

To figure that out, lead author Masahiro Shuda, Ph.D., UPCI research associate, and the team systematically examined the viral proteins that might trigger cancer cell growth. After establishing human MCC cell lines, the scientists learned that knocking out a viral protein called “small tumor protein,” or sT, stopped the cancer cells from replicating. When they introduced sT into healthy cells in the lab, the cells took on the characteristics of cancer cells.

“This was a surprise because the viral sT proteins from other similar viruses that cause cancers in laboratory animals do not directly increase cancer activity in cells,” Dr. Shuda said. “Once we found this, we had to next understand the biological mechanisms that make MCV sT a cancer-causing protein, or oncoprotein.”

The MCV sT triggers a cellular process called “cap-dependent translation” that allows certain cellular oncoproteins to be made, Dr. Moore explained. Although the cancers caused by MCV are rare, the virus is important because it helps scientists pinpoint cell pathways that are key to more common cancers. These cancers also might activate cap-dependent translation through a DNA mutation rather than through a virus infection. 

In related studies recently published by the team in Emerging Infectious Diseases, MCV was shown to normally infect four out of five healthy adults, where it remains a silent resident in skin cells without causing any symptoms. Only when specific mutations occur in the DNA of the virus―for example, by ultraviolet light exposure―does it have potential to cause cancer. The researchers are now working to identify new agents to target MCC cancer cells that may be more active and less toxic.

MCV is the first virus in the family of polyomaviruses shown to cause human cancer, but six other polyomaviruses have recently been discovered as inapparent infections of people, and scientists are actively seeking to find out if they are additional, cancer-causing viruses as well. MCV is the second human cancer virus found by the Chang-Moore laboratory, which previously also discovered the virus causing Kaposi’s sarcoma – the most common cancer among AIDS patients.  

Other co-authors are Hyun Jin Kwun, Ph.D., and Huichen Fung, Ph.D., both of the Cancer Virology Program. The research was funded by the National Institutes of Health, the American Cancer Society and UPCI. Dr. Chang is an American Cancer Society Professor of pathology, and Dr.  Moore is an American Cancer Society Professor of microbiology and molecular genetics, Pitt School of Medicine.

Pitt Team Finds A Molecular Pathway That Can Lead to Inflammation in Asthma

PITTSBURGH, Aug. 8, 2011  Researchers at the University of Pittsburgh School of Medicine have identified a molecular pathway that helps explain how an enzyme elevated in asthma patients can lead to increased mucus production and inflammation that is characteristic of the lung condition. Their findings, reported online in this week’s Proceedings of the National Academy of Sciences, reveal unique interactions between biological molecules that could be targeted to develop new asthma treatments.

An enzyme called epithelial 15-lipoxygenase 1 (15LO1) metabolizes fatty acids to produce an eicosanoid known as 15 hydroxyeicosaetetranoic acid (15 HETE) and is elevated in the cells that line the lungs of asthma patients, explained Sally E. Wenzel, M.D., professor of medicine, Pitt School of Medicine, and director of the Asthma Institute at UPMC and Pitt School of Medicine. Her team showed in 2009 that the enzyme plays a role in mucus production.

“In this project, we found out 15 HETE is conjugated to a common phospholipid,” she said. “That complex, called 15HETE-PE, and 15LO1 behave as signaling molecules that appear to have a powerful influence on airway inflammation.”

By examining lung cells obtained by bronchoscopy from 65 people with asthma, the researchers found that both 15LO1 and 15HETE-PE displace an inhibitory protein called PEBP1 from its bond with another protein called Raf-1, which when freed can lead to activation of extracellular signal-regulated kinase(ERK). Activated ERK is commonly observed in the epithelial, or lung lining, cells in asthma, but until now the reason for that was not understood.

“This is an important study as it directly explores the important role of 15-lipoxygenase 1 in the airway epithelial cells of patients with asthma, which immediately establishes the relevance to human disease,” said Mark T. Gladwin, M.D., chief, Division of Pulmonary, Allergy and Critical Care Medicine, UPSOM.

Other experiments showed that knocking down 15LO1 decreased the dissociation of Raf-1 from PEBP1, which in turn reduced ERK activation. The pathway ultimately influences the production of factors involved in inflammation and mucus production.

“These results show us on both a molecular and mechanistic level and as mirrored by fresh cells from the patients themselves that the epithelial cells of people with asthma are very different from those that don’t have it,” Dr. Wenzel said. “It also gives us a potential treatment strategy: If we can prevent Raf-1 displacement, we might have a way of stopping the downstream consequences that lead to asthma.”

Co-authors include Jinming Zhao, Ph.D., Silvana Balzar, M.D., Claudette M. St. Croix, Ph.D., and John B. Trudeau, B.S., of UPSOM and the Asthma Institute; and Valerie B. O’Donnell Ph.D., of Cardiff University, United Kingdom. The study was funded by the National Institutes of Health and the American Heart Association.

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