Author: yec14002

New Program Promises Speedy Evaluation for Cranial Nerve and Brainstem Disorders

UConn Health Center Outpatient Pavillion


UConn Health this winter established New England’s first Cranial Nerve and Brainstem Disorder Program, bringing together a multidisciplinary team of experts to streamline care for patients with such conditions.

Led by esteemed neurosurgeon Dr. Ketan R. Bulsara and ear, nose, and throat specialist Dr. Daniel Roberts, the team collaborates with specialists from nearly a dozen departments and will encompass clinical care, research, and teaching.

“One of the core principles of patient care at UConn Health is a multidisciplinary approach to providing personalized care to optimize patient outcomes,” Bulsara says. “The Cranial Nerve and Brainstem Disorder Program extends that core principle by bringing together world-renowned experts in their fields. We are fortunate at UConn Health to have such an accomplished team across so many different specialties that is willing to work together to provide the best care for our patients.”

The program guarantees rapid evaluation of patients, regardless of whether they were diagnosed recently or long ago. Patients or practitioners can submit a request through the center referral portal, which is staffed by Bulsara and Roberts. For neurosurgical or ear, nose, and throat issues, the patient will be offered an initial evaluation appointment that is within a week of their request.

If the cranial nerve or brainstem issue is not related to the ear, nose, and throat or a neurosurgical issue, the physicians will connect the patient with the appropriate service.

“To have patients be able to access care in a very timely and expedited fashion is key,” Roberts says. “A patient can call us and we’ll say, ‘We’ll see you within a week’ to get the ball rolling and help direct them through this complicated process.”

Areas of care include acoustic neuromas; blood vessel problems including aneurysms, arteriovenous malformation, and cavernomas; brain tumors; hemifacial spasm; meningioma; neurofibromatosis; skull base tumors; trigeminal neuralgia; and taste and smell disorders.

“Brainstem and cranial nerve disorders are quite rare, and often require experts from different areas for complicated issues,” Roberts says. “We’re excited about the future of this.”

Care is offered at UConn Health’s Outpatient Pavilion in Farmington and at its community clinics in Southington and West Hartford.

Visit the Cranial Nerve and Brainstem Disorders Program website for more information.

UConn Med Students First to Learn With New Handheld Ultrasound

handheld ultrasound tool

Photo courtesy of Butterfly Network Inc


Students at the UConn School of Medicine are the first in the nation to use Butterfly iQ, a new handheld, full-body ultrasound system that plugs into an iPhone and is powered by a microchip, as part of their curriculum.

Guilford, Connecticut-based Butterfly Network Inc. created the first-of-its kind device, which at $2,000 is much more affordable than cart-based portable ultrasound machines that can cost tens of thousands of dollars.

Dr. Meghan Herbst, School of Medicine associate professor and ultrasound director in UConn’s Department of Emergency Medicine, is spearheading use of the device in medical education at UConn. She envisions the Butterfly iQ becoming as essential as a physician’s stethoscope.

“I will have an ultrasound unit on me, kind of like my stethoscope but a different tool — I think a better tool — to really look inside patients’ bodies,” she says. “Not only can you do everything that the cart-based machine can do, but the cart-based machine has a different probe for each frequency of sound.”

Butterfly iQ eliminates the need for multiple probes, with the silicon chip system able to create linear, curved, or phased ultrasound beams.

Students who tested out the device were impressed by the ease of use and image quality.

“It’s totally intuitive,” says third-year medical student Sam Southgate.“It’s like a modern tech device rather than a piece of medical equipment.”

Third-year medical student Zach Bovin agrees: “The first thing I noticed was that the [image] quality was as if I had the big ultrasound machine next to me.”

First- and second-year medical students are using the devices in their anatomy lessons, Herbst says, and fourth-year students recently used them during a four-hour ultrasound session as part of their preparation to transition to residency.

Butterfly Network aims to democratize health care, marketing director Guru Sundar says, whether that means providing devices to physicians in underserved areas or to students who might not have previously had the opportunity for such hands-on ultrasound experience.

“I hope to incorporate ultrasound into the first- and second-year Delivery of Clinical Care course, where they can ‘see’ the heart after learning how to listen to it, or ‘see’ the liver and thyroid after learning how to examine these organs,” Herbst says. “I also hope to have some of the fourth-year students independently scan while on certain clerkships, such as emergency medicine and critical care.”

The units are also being used in the Emergency Medicine Residency Program.

Those at UConn and in the health care industry at large believe the technology could revolutionize health care. According to Forbes, the company has raised $250 million in investments, including from the Bill and Melinda Gates Foundation.

“For us at UConn to be right at that cutting-edge, right at the future, is very exciting,” Southgate says.

Old Drug, New Hope for Pediatric Brain Cancer

Dr. Ching C. Lau sees a patient.

Dr. Ching C. Lau sees a patient.


Some drugs for heart disease might also work against brain cancer, according to an analysis by researchers from The Jackson Laboratory (JAX), Connecticut Children’s Medical Center, and UConn Health. The researchers used a new approach to identify five heart medicines that might also be effective at fighting the most common type of childhood brain cancer, they report in Science Translational Medicine.

Medulloblastoma is the most common malignant brain tumor in children, accounting for 20 to 25 percent of pediatric brain tumors. Current treatments have significantly increased the survival rate, but many children face difficult side effects that impact their brains, hormones, and fertility for the rest of their lives. There are also a handful of patients who either don’t respond to available treatment options or suffer and die from relapses.

To quicken the long route to developing cancer drugs, the research team used a process called drug repositioning, reanalyzing drugs previously approved by the FDA and looking for crossover among the diseases that a drug is likely to treat. Using computational modeling methods, they compared approved drugs’ effects on gene expression profiles — that is, what genes they work with or against — to the genes active in patients with various diseases.

But medulloblastoma tumors are complex and often very different from patient to patient, and even internally in a single patient. Dr. Ching C. Lau thought drug repositioning could work to find better drugs for medulloblastoma, but suspected the technique could be improved. Lau, who is jointly appointed as a professor at JAX, UConn Health, and Connecticut Children’s Medical Center, heads the division of pediatric hematology-oncology at UConn Health and is the medical director of hematology-oncology at Connecticut Children’s.

Lau worked with a team of researchers from those institutions, as well as from Houston Methodist Research Institute and Texas Children’s Hospital, to devise a new integrated drug repositioning method that could work against something as complicated as medulloblastoma.

Their new method has identified eight drugs as possible medulloblastoma-fighting agents, including three already used as chemotherapy against other cancers and five previously used to treat heart failure.

The researchers also showed that one of the heart drugs, digoxin, helped mice with medulloblastomas live longer. The mice survived even longer when digoxin was combined with radiation.

“This is exciting because not only can we potentially improve overall survival of medulloblastoma patients with digoxin, but the results also suggest that we could potentially reduce the dose of radiation necessary when combined with digoxin, and thereby minimize long-term side effects of radiation among the survivors,” says Lau. “Because digoxin has been used for so many years to treat heart failure, its potential side effects are well known, and could potentially help speed up the subsequent clinical trial.”

School of Medicine Reaccredited

Through a vote at an October 2018 meeting, the Liaison Committee on Medical Education (LCME) accredited the University of Connecticut School of Medicine medical education program for another eight-year term.

The School of Medicine was deemed satisfactory in 92 of the 93 elements and compliant with all 12 standards of the accreditation criteria by the LCME, which is recognized by the U.S. Department of Education as the authority for the accreditation of medical education programs.

“We are pleased with this positive outcome and would like to thank the various faculty and staff members who were so instrumental in this remarkable achievement,” says Dr. Bruce T. Liang, dean of the School of Medicine, who directed the effort to prepare for the accreditation of the medical education program.

“Since a new curriculum was recently introduced, there are several elements that will continue to be monitored, but we are committed to working diligently toward strengthening the program even further.”

Follow-Up

Research doesn’t stop when we report it. Here are updates on past UConn Health Journal stories:


Hearing Loss

UConn Health otolaryngologist Dr. Kourosh Parham and his colleagues are collaborating with French pharmaceutical company Sensorion to develop a blood test that can warn patients and their doctors of early damage to the inner ear, before hearing loss is noticeable. Parham and his colleagues report in Hearing Research that levels of prestin, a protein found only in cells in the inner ear, rise sharply when those cells are damaged and start to die. Currently, hearing loss can only be identified after it has occurred.

Physician-scientist Dr. Kourosh Parham looks in patients ear

Fall 2016, “Detecting Vertigo, Hearing Loss via Blood Tests”


Health Disparities

Men and boys of color in Connecticut are less likely to have health insurance, more likely to be victims of violence, and more likely to die early from preventable diseases than their non-Hispanic white counterparts, UConn’s Health Disparities Institute reports in its inaugural Connecticut Report Card on Health Equity Among Men and Boys of Color. The report identifies social experiences that can negatively impact health in the population, as well as actions the state can take to address the disparities. Read more at UConn Today.

young black father looks over his ailing son on a hospital

Summer 2018, “Bridging the Health Care Gap”

Forming Alliances to Build a Better Care Model

In her first year as dean of the UConn School of Dental Medicine, Dr. Sharon Gordon seeks to apply the concept of interprofessional learning to shape the future of health care.

Cloe Poisson, Copyright © 2019. Hartford Courant. Used with permission.
Cloe Poisson, Copyright © 2019. Hartford Courant. Used with permission.


As medicine moves toward an integrated approach to care, UConn’s new dental dean sees a greater role for dental medicine in the delivery of that care, and a strong foundation already in place to make that happen.

Dr. Sharon Gordon, who arrived from the East Carolina School of Dental Medicine last summer, says it’s part of what drew her to UConn: more broadly, the rich history of partnership between the medical and dental schools, but notably the basic sciences curriculum they share in the first two years, focusing on interprofessional training.

“We’re perfectly poised to move to the next steps, which would be providing clinical care together,” she says. “The idea is students moving into the clinics together, learning how to take care of patients together, so when they graduate they will be prepared for interprofessional practice.”

The evidence shows that more comprehensive care of the patient gives better health outcomes overall.

Health care financing already is trending toward a more holistic view of the patient and greater emphasis on outcomes; a next step is recognition of the connection between oral health and
overall health, Gordon says.

“Thinking about dentistry and where it is on the spectrum of reimbursement, if we don’t embrace that, we’re going to be left behind,” Gordon says. “But more importantly, the evidence shows that more comprehensive care of the patient gives better health outcomes overall.”

To help UConn Health get there, Gordon wants to continue building on the concept of students working in group-practice clusters in the clinic. A program fittingly known as CONNcept (Connecticut Comprehensive Education and Practice Team), established under the leadership of Gordon’s predecessor, Dr. R. Lamont “Monty” MacNeil, aims to simulate a true practice setting. As part of this, Gordon’s vision also includes incorporating nursing students, students from Tunxis Community College’s dental hygienist program, and, eventually, expanded-function dental assistants. Collectively, these disciplines can train together and, ultimately, practice together, improving patient outcomes through this new model of care.

Trauma Director Puts Patients First

Emergency vehicle heading towards an emergency room


As he marks his first year as Medical Director of Trauma at UConn Health, Dr. Ryan Millea hasn’t lost focus on what drives him, whether responding at a moment’s notice to the surgical needs of a car accident victim or to an intensive care patient with a life-threatening gastrointestinal burst.

“My philosophy is to always deliver patient-centered care,” says Millea, who is also a general and critical care surgeon. “I’m very hands-on to improve a patient’s overall experience. No one likes being sick, so I try to make things as seamless and smooth as possible from preoperative care to recovery.”

I’m very hands-on to improve a patient’s overall experience.

Millea applies this attitude not only on a patient-by-patient level but also through large-scale initiatives to better the experience of all surgical and critical care patients.
For one, Millea is leading efforts to make UConn John Dempsey Hospital an American College of Surgeons–verified trauma center, improving systems to optimize trauma care and become a certified center of excellence for patients in the Farmington Valley.

In addition to overseeing the treatment of each critically ill trauma patient at UConn Health, Millea’s board certifications and experience in general surgery and surgical critical care mean he can provide a wide range of skilled care.

“My experience as a critical care surgeon allows me to treat the highest- risk patients who have complex, coexisting medical issues such as high blood pressure, diabetes, heart disease, and lung disease,” Millea says.

As a general surgeon, Millea focuses primarily on surgeries involving the gastrointestinal tract, including appendix or gallbladder removals and hernia surgeries.
Because of his dedication to maintaining an excellent experience for his patients, the majority of general surgical procedures Millea conducts are outpatient, minimally invasive procedures, often done laparoscopically. Recently, Millea and other general surgeons at UConn Health began offering robotic general surgery operations for such procedures as complex hernia repair.

A Massachusetts native, Millea says UConn Health is the perfect place to put his unique skill set to use.

“I joined UConn Health to be part of an academic medical institution with a strong focus on patient care. A cutting-edge academic medical center affords each of my patients access to the most modern approaches and treatments for their surgical diseases.”

Sharing Knowledge for Better Patient Care

Q&A with Dr. Leo J. Wolansky, professor and chair of UConn Radiology

Q

You’ve spearheaded a teaching tool on the UConn Health Radiology website that features cases with images, diagnoses, and even a quiz mode. Where did this idea come from, and how do you envision physicians using it?

Technology has changed the way we get information, and we find that most people answer questions by looking online. Radiology, which relies so heavily on technology, is a specialty that is much more visual than most other fields of medicine. Every day we encounter an abundance of complex digital images created by sophisticated equipment. The digital images can be captured, uploaded, and sent throughout the world with relatively little effort. I thought it would be a waste not to share this valuable material with everyone.

Medical students and radiology residents will likely use it the most. Furthermore, resident doctors in many different fields are tested on the imaging that relates to their specialty. Even after their training, patients expect doctors and other providers to be knowledgeable about everything related to their care, including imaging. Radiology Online can further educate providers and even educate patients about their health. It also provides the contributing physicians and students from UConn as well as other institutions with an academic outlet that is beneficial for career development. It’s UConn’s own open-access radiology review book.


Q

What other projects are you focused on?

We have a number of other initiatives, such as the Linda Clemens Foundation Free Mammogram Program, which provides funds for screening and diagnostic mammograms, breast ultrasounds, and breast biopsies for uninsured and underinsured UConn Health patients. We have added a new CT scanner in the Musculoskeletal Institute building that will increase our capacity significantly and will create a more patient-friendly outpatient setting. We will also offer weekend MRI appointments at the Musculoskeletal Institute. Additionally, we have a new attending, Dr. Abner Gershon, who strengthens our stroke service and is opening a minimally invasive neck and back pain clinic. In the area of nuclear medicine, we are now offering DaTscan brain scans for differentiation of Parkinsonian syndromes from essential tremor.


Q

What can you tell us about the new imaging center in Storrs? How will it benefit patients in the area?

When I started here, I immediately saw how important to the state the UConn athletics program is. It seemed strange that it was so difficult for us to image our own athletes, or any UConn students, in Storrs. From my previous research, I was aware of the Brain Imaging Research Center (BIRC) in Storrs, which has a fabulous scanner. It occurred to me that their MRI scanner could provide patient care without interfering with the research mission of the BIRC.

Once we converted it, we’d be able to read the images here at UConn Health. This would allow us to care for our own student-athletes, other students, faculty, staff, as well as the general public in the Storrs area, sparing them the 45-minute trip to Farmington. I explored a partnership with the BIRC leadership, working closely with Inge-Marie Eigsti, Jay Rueckl, and now the new director, Fumiko Hoeft, who has been extremely helpful. While the scanner will continue to be primarily an instrument of research, soon we will be rolling out this clinical service at the BIRC.

Tracking Opioid Overdoses in Real Time to Save Lives

psychedelic image od opioid


A pilot program led by the Connecticut Poison Control Center and UConn Health’s Emergency Medicine department has been tracking opioid overdoses in Hartford in real time to improve surveillance of the opioid epidemic. More than 1,000 people died from opioid overdoses in Connecticut in 2017, including 80 in Hartford.

The project, launched May 1, has emergency medical service (EMS) personnel in Hartford report overdose cases to the state’s Poison Control Center, part of UConn’s Emergency Medicine department, immediately after the incident. The Center’s poison information specialists ask the emergency responders a series of brief questions and record the data.

The test program is a collaboration with American Medical Response (AMR) ambulances, which provide coverage to two-thirds of Hartford’s communities, and nearby Saint Francis Hospital and Medical Center’s emergency department.

“This new program is increasing our awareness of what is happening on the ground,” says Peter Canning, UConn John Dempsey Hospital’s EMS coordinator.

UConn Health hopes the program establishes an effective early warning system to alert public health and safety officials and community stakeholders of any sudden spike in overdoses or the potential threat of a potent batch of opioid drugs released in certain neighborhoods.

Since the program began in May, the AMR ambulance crews in Hartford reported 211 overdose cases to the Connecticut Poison Control Center. In 147 of the reported cases, emergency crews had to administer the opioid antidote naloxone to revive the overdose victims.

Early data attributes 98 percent of the overdoses where the substance was known to heroin and fentanyl, and 2 percent to other opioids such as oxycodone and methadone. The majority of victims — 77 percent — were male, 51 percent of whom were between the ages of 35 and 49. In addition, 67 percent of the overdoses occurred in public areas such as city parks, roadways, sidewalks, and restrooms. EMS also reported cases of victims who thought they bought cocaine, but instead overdosed on powdered heroin.

This fall the pilot program may expand to include Aetna Ambulance Service in the south end of Hartford.​

“This new program is an important step forward and a great example of multi-agency collaboration,” says Dr. Suzanne Doyon, Connecticut Poison Control Center medical director. “Rapid real-time identification of potentially troubled areas of the state is important to public health. Using the connectivity and round-the-clock expertise of the Poison Control Center is both novel and forward-thinking.

“We hope this becomes the model for reporting statewide. The ultimate goal here is to reduce overdoses and save lives.”

Connecticut Student Researchers Shine

CT researcher

Affrin Ahmed of Bloomfield, a UConn second-year international graduate student majoring in applied genomics, is seen working on her Partnership for Innovation and Education (PIE) summer research project.

Ahmed was among the local college students who presented their innovative projects to distinguished guests including state legislators at UConn Health Aug. 1 during Innovation Fellows Research Day, an event that showcased PIE, a newly launched statewide consortium.

The inaugural class of PIE summer program fellows comprises 79 students from UConn, Trinity College, University of St. Joseph, Central Connecticut State University, Southern Connecticut State University, University of Hartford, and Tunxis Community College.