The Scope – Spring 2016
The New York Times recently highlighted Avedis Donabedian, a University of Michigan professor, who helped start the field of quality measurement. He developed a famous quality triad, which proposes that quality can be measured by looking at outcomes (how the subjects fared), processes (what was done) and structures (how the work was organized). These are all important issues …
However, shortly before he died, he was asked to summarize his view of quality. “The secret of quality is love,” he said. I think he was on to something crucial.
Unless we care, unless we love what we do, and more important, love the patient in front of us, we will not improve the quality and safety of our patients. My father has chronic myeloid leukemia, or CML, and I care deeply what his white blood cell count is, and how his splenomegaly feels. Perhaps the best way to care for our patients is to realize that each of them has a son or daughter, mother or father who cares for them like I do my father. When you take care of my father, you are taking care of me. If we can ex tend that six degrees, we can truly care for each other, and caring for each other is the foundation of caring for our patients. Studies have shown that soldiers fight in hopeless situations not so much for their country as for the friend next to them.
For so many of our patients we are the place of last resort, we are their only hope, we are truly hope for the hopeless. I can only give them love and hope when I know that my dad is being cared for by someone who cares about him, and thus by ex tension, cares about me.
This is so difficult to do when you feel that someone is not caring for you or for your loved one. It is so easy to hold back and be guarded, to not go that extra step, to not care, because you are afraid that you or your family will not be cared for. So, in away, the enemy of quality is fear. We are afraid we will be hurt, and so we sometimes give only half our hearts, do half measures and provide halfway care, protecting ourselves from that hurt. We do only what is reimbursed; we trade our
care, expecting to get something in return.
I think that Donabedian has the key to breaking through the transactional nature of current medical care nationally. If I can care for each patient as if he or she were my friend’s daughter or father, mother or son, as if he were my own father with CML, then I approach quality not like it is a number, but like it is a person, a person I love. If I work for a number we have defined as quality, then sooner or later, I may decrease attention on other things just as important to reach that number, even subconsciously. If I work for the person, then everything becomes important, not just that given number. Indeed, we become creative, we generate new ideas, we want to see everything get better, because six degrees away, it affects our loved ones.
Pancreatic Disease Grant Awarded to UF Health Researchers
UF Health researchers have received a five-year, $2 million grant to study the link between pancreatitis, pancreatic cancer and diabetes. They will be part of a nationwide group called the Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer, administered by the National Cancer Institute and the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases.
“Having longstanding diabetes is a risk factor for pancreatitis and cancer,” said Christopher Forsmark, MD, principal investigator of the grant at UF and a professor of medicine and chief of the division of gastroenterology, hepatology and nutrition. “Chronic pancreatitis is also a risk factor for pancreatic cancer and can cause diabetes.”
He will focus on the study of pancreatitis while fellow researchers Steven Hughes, MD, an associate professor of surgery and chief of the division of general surgery, will study pancreatic cancer and Kenneth Cusi, MD, a professor of medicine and chief of the division of endocrinology, diabetes and metabolism, will focus on diabetes.
The grant establishes a clinical center at UF that will enable the three researchers to focus more time on each disease. UF’s clinical center is one of only 15 such centers across the country.
Transforming Technology and Innovation in Transplantation
There is a critical shortage of organs available for transplantation, and this gap between available donor organs and patients on the wait list continues to widen. UF Health’s expertise and dedication to patient care, education and research provide the UF Health Shands Transplant Center and its patients with leading technology and the best possible patient outcomes.
EXTRACORPOREAL MEMBRANE OXYGENATION
Extracorporeal membrane oxygenation, or ECMO, is a mechanical circulatory system that temporarily takes over the function of the lungs in patients with acute respiratory failure. It can also provide cardiac support until the patient recovers or is able to receive further treatment. ECMO is used both in adult and pediatric patients, including neonatal patient cases. The ECMO machine is similar to the heart-lung bypass machine used in open-heart surgery. It pumps and oxygenates a patient’s blood outside the body, allowing the lungs, and sometimes the heart, to rest. When connected to an ECMO device, blood flows through tubing to an artificial lung in the machine that adds oxygen and takes out carbon dioxide; then the blood is warmed to body temperature and pumped back into the body.
ECMO is beneficial in patient care in the following scenarios:
- As a bridge to recovery from lung failure.
- As a bridge to further treatment, when doctors want to assess the state of other organs before performing surgery.
- As a bridge for patients awaiting cardiothoracic transplant.
FOR MORE INFORMATION OR TO REFER A PATIENT, CALL 352.246.8086.
XVIVO LUNG PERFUSION SYSTEM
Transplant Program is testing a new approach that could improve the viability of many donated lungs, allowing more of them to be used and shortening the time patients have to wait for transplantation. Currently, only around 20 percent of lungs offered from deceased donors are used, while 80 percent of the remaining donor lungs are rejected by the transplant centers, primarily due to poor organ function.
The UF Health Shands Transplant Center is one of 15 sites nationwide participating in a study to continue evaluating the XVIVO Lung Perfusion System, also known as XPS. This system allows donor lungs to essentially be kept alive and potentially improved to become eligible for transplant. Some of the lungs may have reversible problems, such as pulmonary edema or impaired gas exchange, which, if addressed, make them excellent organs for successful transplantation.
Using the XVIVO Lung Perfusion System, UF Health lung transplant surgeons will bring lungs identified for perfusion back to Gainesville and attach them to the XVIVO machine, which keeps them alive and functioning under normal body temperature. If consistent improvement is observed during careful periodic assessments over a four-hour period, studies have shown that these lungs can be safely transplanted.
FOR MORE INFORMATION, VISIT UFHEALTH.ORG/TRANSPLANT-CENTER OR CALL 352.265.0130.
Comprehensive Heart Care for Athletes At All Levels
The newly formed UF Health Sports and Exercise Cardiology aims to maximize the performance of individual athletes, allowing them to reach their goals while at the same time maximizing safety by systematically evaluating for potential cardiac disease.
The dedicated team offers a multidisciplinary approach to comprehensively evaluate and manage cardiac illnesses in adult athletes who are at risk for, have been diagnosed with or are recovering from cardiovascular disease. They work with the full range of athletes, including sports enthusiasts, competitive, elite and masters athletes at the high school, college, professional and recreational levels.
Services offered to patients include:
- Preparticipation athlete cardiovascular screening
- Evaluation of symptoms such as shortness of breath during training or competition, chest pain, passing out or fainting, or palpitations
- Evaluation of an unexplained deterioration in performance
- Clearance to return to play after an event or treatment
- Risk factors or family history of cardiovascular disease or sudden cardiac disease
- Establishing preventive cardiac care
- Comprehensive cardiovascular screening
UF Health Recognized by U.S. News & World Report’s: 2015-2016 Best Hospitals Rankings
University of Florida Health Shands Hospital has been recognized among the nation’s best hospitals in seven adult medical specialties, according to U.S. News & World Report’s 2015-16 Best Hospitals rankings released July 21, 2015. U.S. News & World Report evaluated nearly 5,000 hospitals across the country to determine rankings in 16 adult medical specialties. Only 3 percent of these hospitals earned top 50 rankings in at least one specialty.
The seven adult medical programs at UF Health Shands Hospital ranked among the top 50 in each specialty nationally include nephrology (tied for 13th), diabetes and endocrinology (28th), pulmonology (29th), urology (37th), neurology and neurosurgery (40th), cardiology and heart surgery (tied for 42nd) and cancer (46th).
UF Health Shands Hospital was the highest ranked in the state in adult nephrology and pulmonology. In addition to being ranked among the nation’s top 50 hospitals in seven specialties, UF Health Shands Hospital also was listed as “high performing”
in five additional specialties: gastroenterology and GI surgery, geriatrics, gynecology, orthopaedics, and ear, nose and throat.
An internationally known expert in blood cancers, Jonathan D. Licht, MD, comes to UF Health from Northwestern University in Chicago and brings a $2 million research portfolio that includes funding from the National Institutes of Health, the National Cancer Institute and national foundations, such as the Leukemia and Lymphoma Society. His laboratory studies aberrant gene regulation as a cause of blood cancers and is developing treatment strategies to reverse abnormal, cancer-causing gene functions.
Dr. Licht previously served as the associate director for clinical sciences at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, holding appointments in the Northwestern University Feinberg School of Medicine as the Johanna Dobe Professor of Hematology/Oncology, chief of the division of hematology/oncology and professor of biochemistry and molecular genetics.
“Being director of the UF Health Cancer Center is an extraordinary opportunity,” said Licht. “The center has an outstanding reputation and already possesses the foundational strengths necessary to support the two benchmarks of excellence I believe are crucial to the center’s role as a cancer leader in the state and nation.”
Building a Better Future For Our Community
In 2018, UF Health will open the new UF Health Heart & Vascular Hospital and the UF Health Neuromedicine Hospital in Gainesville. These hospitals will feature the latest innovations in medical technology and hospital design, giving rise to the Southeast’s most advanced home for care of patients with heart, vascular and neurological illnesses. The UF Health Heart & Vascular Hospital will occupy the south tower of the building and will include 120 beds.
Key features patients can expect:
- Design characteristics that improve patient safety and health care, including improved navigation and wayfinding.
- Cardiovascular specialists consolidated in one location to improve care and speed recovery time.
- Conveniently located and centralized cardiology and cardiovascular surgery offices for pre- and postoperative appointments.
- 48 cardiovascular and vascular medicine/surgical care patient rooms and 72 ICU patient rooms – all private to enhance privacy and recovery.
- 20 heart and vascular exam rooms.
- Heart Station with four vascular rooms, six echocardiogram rooms, two TEE rooms, three treadmill rooms and one EKG/Holter room.
- Two cath labs, three EP labs, one TEE/cardioversion procedure room.
- Five heart and vascular general ORs and three heart and vascular hybrid ORs, featuring flexible diagnostic and surgical set-ups.
A research team at University of Florida Health has been approved for a $15.48 million research funding award by the Patient-Centered Outcomes Research Institute, or PCORI, to study the effectiveness of three medications used to treat hepatitis C.
The five-year, randomized clinical trial will be led at UF by David R. Nelson, M.D., director of the UF Clinical and Translational Science Institute and a professor of medicine in the department of medicine.
The trial’s main goal will be to compare the recently approved oral medications to determine if one of them is more effective at curing hepatitis C, Nelson said. Researchers also hope to learn more about the drugs’ side effects and whether they work equally well in real-world conditions when used by a diverse group of patients
that includes minorities and people with other medical conditions.
“There is not a single study in the world right now that has compared any of these all-oral therapies against each other. These drugs are already in use, so we want to understand their safety and effectiveness and how they’re working in diverse populations,” Nelson said.