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November 16, 2012
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Northwest Kidney Centers marks 50th anniversary
This year marks the 50th anniversary of Northwest Kidney Centers, established in 1962 as the world’s first outpatient dialysis treatment center. This remarkable institution has had a profound influence locally, regionally, and worldwide.
The community-based, nonprofit organization delivers about 80 percent of all life-sustaining dialysis treatments in King and Clallam counties in 14 dialysis centers and 11 hospitals. It also has one of the nation’s largest training and support programs for people who choose to self-dialyze at home. Besides patient care, the organization devotes significant resources to public health education and to research, including strong collaborations with UW Medicine.
An invention at the UW sparked the organization’s birth. This device allowed repeated access to the bloodstream and changed dialysis from a stopgap therapy to one that a patient could use for a lifetime. The Scribner shunt was the brainchild of the late Belding H. Scribner, a preeminent UW faculty member. His UW colleagues, engineers Wayne Quinton and Jack Cole and surgeon David Dillard, made Scribner’s idea come to life.
When the team had refined dialysis therapy beyond the experimental stage, community supporters established the new out-of-hospital dialysis clinic, the first in the world. The UW and Northwest Kidney Centers have remained intertwined. For example, in the mid-1980s, Northwest Kidney Centers conducted the first clinical trials of Epogen in humans, under the direction of Joseph W. Eschbach, who chaired Northwest Kidney Centers’ board of trustees at the time and who held a UW clinical faculty appointment in the Department of Medicine.
To ensure the region’s kidney care remains top-notch well into the future, Northwest Kidney Centers funds nephrology fellowships annually at UW Medicine, and collaborates in the training of many allied health professionals in other UW schools and departments.
Cooperation and communication between the dialysis provider and UW Medical Center contribute to the stellar performance of the UW kidney transplant center.
Despite robust basic research, development of new treatments lagged in succeeding years. To address this, Northwest Kidney Centers joined with UW Medicine in 2008 to form the Kidney Research Institute, which focuses on developing early detection, prevention and treatment of kidney disease. The institute director is Jonathan Himmelfarb (photo, left), a professor of medicine in the UW Division of Nephrology and the first holder of the Joseph W. Eschbach, M.D. Endowed Chair in Kidney Research at UW.
Seed money from Northwest Kidney Centers and generous individuals equipped the research facility and laboratory on the Harborview Medical Center campus in Seattle. Today, 36 studies are under way and investigators have been awarded more than $30 million in research funding from the National Institutes of Health (NIH) and other sources.
Led by Dr. Himmelfarb, a multidisciplinary UW team of researchers will participate in a new federal initiative to engineer a three-dimensional chip containing living tissues that imitate the structure and function of the human kidney. The device will evaluate the uptake, breakdown and elimination of potentially toxic substances, and could provide early screening of prospective drug formulations before testing in humans.
The Kidney Research Institute also will conduct the first U.S. clinical trials — in Northwest Kidney Centers patients — of a 10-pound, battery-powered wearable artificial kidney. The idea is considered so promising that it is part of a Food and Drug Administration fast-track approval program. If it works as planned, the device could free kidney failure patients from being tethered to a dialysis machine.
In recognition of its many contributions to the University over the years, in 2010 UW Medicine honored Northwest Kidney Centers with the Ragen Volunteer Service Award.
Among its 50th anniversary events, Northwest Kidney Centers last week opened a kidney resource center at 700 Broadway in Seattle. The new Haviland Pavilion features a pharmacy, a dialysis clinic, and clinical research space for the Kidney Research Institute.
In addition, the center includes spaces for teaching and collaboration about kidney concerns and a demonstration kitchen for education about healthy eating. A museum and gallery showcase important artifacts of Northwest Kidney Centers’ history and the UW’s development of dialysis — including an original Scribner shunt and several generations of dialysis machines developed at the UW. The museum is free to the public.
Congratulations to Northwest Kidney Centers and the Kidney Research Institute for outstanding work on behalf of treatment and prevention for this vitally important organ.
And special congratulations and thank you to Northwest Kidney Centers for 50 years of groundbreaking service to the community.
Paul G. Ramsey, M.D.
University of Washington scientists have succeeded in removing the extra copy of chromosome 21 in cell cultures derived from a person with Down syndrome, a condition in which the body’s cells contain three copies of chromosome 21 rather than the usual pair.
A triplicate of any chromosome is a serious genetic abnormality called a trisomy. Trisomies account for almost one-quarter of pregnancy loss from spontaneous miscarriages, according to the research team. Besides Down syndrome (trisomy 21), some other human trisomies are extra Y or X chromosomes, and Edwards syndrome (trisomy 18) and Patau syndrome (trisomy 13), both of which have extremely high newborn fatality rates.
In their report appearing in the Nov. 2 edition of Cell Stem Cell, a team led by Li B. Li, a postdoctoral fellow in the Division of Hematology,(photo, above), described how they corrected trisomy 21 in human cell lines they grew in the lab. The senior scientists on the project were gene therapy researchers David W. Russell and Thalia Papayannopoulou, professors of medicine in the Division of Hematology.
The targeted removal of a human trisomy, they noted, could have both clinical and research applications. In live births, Down syndrome is the most frequent trisomy. The condition has characteristic eye, facial and hand features, and can cause many medical problems, including heart defects, impaired intellect, premature aging and dementia, and certain forms of leukemia.
“What we are looking at is the possibility that medical scientists could create cell therapies for some of the blood-forming disorders that accompany Down syndrome,” Russell said.
Figuring out the exact techniques for removing the extra chromosome was tricky, Russell said, but his colleague Li worked hard to solve several challenges during his first attempts at deriving the engineered cell lines.
The researchers used an adeno-associated virus as a vehicle to deliver a foreign gene called TKNEO into a particular spot on chromosome 21, precisely within a gene called APP, which sits on the long arm of the chromosome. The TKNEO transgene was chosen because of its predicted response to positive and negative selection in specific laboratory growth mediums. When grown in conditions that selected against TKNEO, the most common reason for cells to survive was the spontaneous loss of the chromosome 21 harboring the transferred gene. Other survival tactics were point mutations, which are single, tiny alterations in DNA base pairs; gene silencing, which meant TKNEO was “turned off” by the cell; or deletion of the TKNEO.
Russell explained a key advantage of this technique for getting rid of the entire extra chromosome: once it was gone, nothing was left behind. “Gene therapy researchers have to be careful that their approaches do not cause gene toxicity,” he said. This means, for example, that removal of a chromosome must not break or rearrange the remaining genetic code. This method shouldn’t do that.”
Read more in UW Today.
A cure for colorblindness might be in the offing. Jay Neitz, UW professor of ophthalmology, and his colleagues are building on their 2009 breakthrough in which they restored red-green vision in two colorblind squirrel monkeys by inserting the missing gene into a virus and injecting it into their retinas. Four years later, the monkeys, Sam and Dalton, still pass daily vision tests, identifying colors on a computer screen correctly.
Neitz and his colleagues are working on a similar therapy for humans, but many hurdles remain. "We know it's effective. The issue is whether it's safe," Neitz said in the Nov. 6 issue of The Wall Street Journal.
Many colorblind people aren't even aware they have a "color-vision deficiency," as it's officially known, unless they apply for a job that requires precise color recognition. Even people with mild colorblindness can be barred from being pilots, air-traffic controllers, police officers, lab technicians and electricians — usually for safety reasons.
The impact goes beyond missing just one color Neitz says. "A colorblind person who can't see red can't see the red in purple —he just sees blue. Since red and green make brown, people with red-green blindness often have trouble telling the three colors apart.”
The vast majority of colorblind people have trouble seeing red or green, due to a genetic defect in the color-sensing cells, called cones, at the back of the eye. About 75 percent of them are specifically green-deficient; another 20 percent are red-deficient. Either way, the impact on their vision is so similar that it is considered one disorder, red-green colorblindness. The most common single-gene disorder in humans, affecting 1 in 8 men and 1 in 230 women of Northern European descent world-wide (and slightly fewer in other racial groups).
Red-green colorblindness is far more common in men than women because it is a recessive gene carried on the X chromosome. Blue-yellow colorblindness is rarer and develops later in life, often brought on by aging, illness, medication or head injuries. Rarer still is achromatopsia, the inability to see any color.
Read more in The Wall Street Journal online.
UW Medicine’s top research awards have been listed for July through September 2012. The list draws from all awards, including those for new projects or for an additional installment to an existing project. Awards granted January through March 2012 and April through June 2012 are also available online.
(Correction: This article was published in Online News Nov. 2. Due to a technical error, the link to the listing for July through September 2012 in the e-mail was broken.)
Stanley Herring, director of sports spine and orthopedic health at UW Medicine, was among more than 150 medical experts to convene in Zurich earlier this month to discuss the safety of youth football. Herring is a UW clinical professor of rehabilitation medicine.
Experts, including advisers to the National Football League and National Hockey League, participated in the Consensus Conference on Concussion in Sport, a meeting held every four years. The conference is backed by the International Olympic Committee.
Herring played a leadership role in passing the state's landmark Zackery Lystedt Law in 2009. The primary elements of this law have been passed in 40 states and the District of Columbia, benefiting millions of young athletes by mandating that concussion information is read by student-athletes and their parents. The law also established a ground-breaking, return-to-play protocol: following a concussion, only a health care professional, not a coach, parent or athlete, may clear an athlete to return to play.
Herring serves on the NFL's Head, Neck and Spine Committee and USA Football's Football and Wellness Committee. He is active in USA Football's program, Heads Up Football, which teaches the safest tackling techniques, designed to take the head out of the play. Richard Ellenbogen, UW professor and chair of neurological surgery, is a co-chair of the NFL Head, Neck and Spine Committee.
"As a physician with a specific interest in head and neck injury who has cared for football players for three decades, I find Heads Up Football very valuable in helping to make players on the field better and safer," Herring said. "Also, introducing this proper tackling technique early in a player's career is essential to its success.
"Avoiding unnecessary head contact is a major part of concussion and cervical spine injury prevention teaching in the medical and sports communities, and this program is the best — by far — of any I have seen."
Read more in the San Francisco Chronicle online.
Elspeth Mann, a trauma specialist at Valley Medical Center (photo,left), has earned her credential as a Certified Specialist in Trauma Registry (CSTR). Although there are 88 trauma centers in the state, Mann is one of only six certified specialists in trauma registry in Washington and the only certified specialist between Seattle and Tacoma.
As a trauma specialist, Mann scours Emergency Department patient files, coding injuries and mining the minutia for data. This data is then transferred to the Trauma Registry where it is used on a state, national and international scale. While the data serve to improve patient care, sometimes they also create an impetus to improve national product safety standards. The Trauma Registry data on car crashes caused by running red lights were directly responsible for designing side air bags in cars. As a result, side-impact injuries have been greatly reduced.
“Elspeth is a model for all trauma registrars,” said Mary Rotert, Trauma Nurse Consultant for the Washington State Department of Health, Office of Community Health Services, EMS & Trauma Systems. “We have few CSTRs in our state. It is wonderful for our state and facility registry to have this preparation for registry work.”
Among the requirements for CSTR certification are at least two years of full-time experience, or the equivalent of 4,000 hours in trauma registry practice and passing a rigorous Certification Examination for Trauma Registrars.
“The data I’m inputting are helping hospitals and people around the world improve patient care — that makes my job satisfying,” says Mann.
Nearly 450 UW Health Sciences students from four schools convened as teams Oct. 30 to apply their diverse skills in a medical scenario. First-year physician assistant students, second-year pharmacy and medical students, and senior nursing students participated in an interprofessional education exercise in which they had to reconsider their treatment plan for a hospitalized patient. In this case, an actress portrayed a fictionalized patient, Doris.
The student teams started by discussing diagnoses for Doris’s condition. Thirty professionals from all areas of the health sciences offered assistance when students were stuck. Teams created and submitted an initial care plan, keeping in mind elements like medications, patient safety, comfort, follow-up, and psychosocial needs. Then, teams watched a video of Doris, in which she told them that she refused their recommendations. The student teams then brainstormed on the ethical, clinical and personal issues they experienced in figuring out what to do next in caring for Doris.
During the second half of the training event, videos were shown of medical professionals who had cared for patients in similar situations and who applied their experiences to the complex case at hand. A physician explained efforts made to educate the patient about heart medications. A nurse talked about wanting to support the patient’s autonomy, yet being frustrated with the decisions the patient was making. The social worker addressed safety issues in the community. The pharmacist talked about trying to explain prescribed medications in a difficult situation. The occupational therapist shared concerns for the patient’s well-being.
In the end, student teams developed a care plan that met Doris’s preferences and she was discharged to her home. Students were disappointed at this outcome. They recognized that it is easier when patients do what the team wants, but that occurrences like this require teams to communicate well and coordinate their care expertly.
UW faculty coordinators were Karen McDonough, associate professor of medicine; Sarah Shannon and Mayumi Willgerodt, both associate professors of nursing; Jennifer Danielson, clinical assistant professor of pharmacy; and Linda Vorvick, senior lecturer in the MEDEX physician assistant program. The Josiah Macy Jr. Foundation provided funding that helped to build this faculty teaching team. The UW Center for Health Science Interprofessional Education, Research, and Practice hosts and designs other events like this and is dedicated to teaching collaboration among health professionals.
Visit the UW Center for Health Science Interprofessional Education, Research and Practice website for more information.
Read more in UW Today.
(Photo: In a team training session, UW health sciences students receive guidance from a faculty member as they work on a patient case. Photo by Ashley Wiggin.)
Graduate Medical Education Housestaff Quality and Safety Council (HQSC) will host two presentations on patient safety Wednesday, Nov. 28, at UW Medicine South Lake Union, Room C123AB.
Joshua Seidman, visiting professor in patient safety in the Department of Medicine, will speak on Making Meaningful Use of EHRs to Transform Care Delivery, from 6 to 7 p.m. Seidman is former director for Meaningful Use at the Office of the National Coordinator for Health Information Technology in the U.S. Department of Health & Human Services. Seidman’s expertise includes quality measurement and improvement, the intersection of e-health and health services research, and structuring consumer e-health interventions to support improved health behaviors and informed decision making.
Dena Brownstein, UW associate professor of pediatrics and associate medical director of patient safety at Seattle Children’s, will review Patient Safety Fundamentals from 7:15 to 7:45 p.m. Brownstein is coordinator for the Seattle Children’s pediatric internship for paramedic students and director of the paramedic course. She was co-editor of the American Academy of Pediatric's national pediatric EMS curriculum, Pediatric Education for Prehospital Professionals (PEPP), and the recipient of numerous awards, including the University of Washington Outstanding Public Service Award. Brownstein’s presentation is a feature of the regularly scheduled HQSC monthly meeting.
Residents, fellows and the GME community are invited to both presentations. A reception begins at 5:30 p.m. in the South Lake Union Administration Building Lobby.
Internationally renowned medical education researcher Geoff Norman of McMaster University will offer two forums on how people learn and teaching strategies that optimize learning, from 11 a.m. to 1 p.m., Thursday, Dec. 6., in the Turner Conference Room, E202, Magnuson Health Sciences Center. The event is hosted by the UW School of Medicine Center for Medical Education.
Norman is the Canada Research Chair in Cognitive Dimensions of Clinical Expertise and professor of clinical epidemiology and biostatistics at McMaster University in Hamilton, Ontario. His primary research interest is in cognitive psychology applied to problems of learning and reasoning.
He will present A Cognitive Perspective on How People Learn: Implications for Teaching from 11 a.m. to noon. In this talk, he will review findings from the psychology of learning in five domains: memory (learning and remembering), transfer (using old concepts to solve new problems), deliberate practice and its critical role in transfer, experiential knowledge as a component of expertise, and the role of general strategic skills (problem-solving, critical thinking, reflection, etc.). In each area, he will begin with examples, review the evidence, and then draw implications for more effective teaching.
Norman received a doctoral degree in nuclear physics from McMaster University in 1971, and a master’s degree in educational psychology from Michigan State University in 1977. He is the author of 10 books in education, measurement and statistics, and 300 journal articles. He was elected a Fellow of the Royal Society of Canada in 2007. In 2008, he was awarded the prestigious Karolinska Prize for lifetime achievement in medical education research.
The talk will be followed by lunch (provided for those who R.S.V.P.) and a discussion of educational scholarship from noon to 1 p.m.
To R.S.V.P for either or both events or for more information, please contact Shalley Lane at firstname.lastname@example.org.
Nominations are now open for the 2013 David B. Thorud Leadership Award and the Distinguished Staff Award, both honoring extraordinary achievements of UW community members who lead and inspire. Nominations close Friday, Dec. 7.
The David B. Thorud Award recognizes one faculty member and one staff member who have demonstrated exceptional abilities to lead, serve, inspire and collaborate with broad impact. This award recognizes leaders who have excelled at supporting the work and people at the UW. Submit David B. Thorud Award nominations online.
The Distinguished Staff Award honors individual UW staff members or teams who have provided superior sustained service or a special one-time contribution to the mission of the unit or University; exhibit exceptional resourcefulness, innovation, or creativity; continually contribute to a respectful, diverse and collaborative work environment; and exemplify excellence and integrity in workplace relationships, interactions and decision making. Submit Distinguished Staff Award nominations online.
William Weppner, UW acting assistant professor of medicine, has received the 2012 Richard M. Tucker Excellence in Teaching Award. Weppner is on faculty with the UW Boise Internal Medicine Residency and the co-director of clinical outcomes at the Boise VAMC Center of Excellence in Primary Care Education. He completed his medical degree, internal medicine residency and master’s in public health at the UW School of Medicine.
Weppner was recognized by the Department of Medicine for his enthusiasm and dedication in providing outstanding teaching and service to medical students as reflected by the following comment from his nomination package:
"Dr. Weppner is a model attending. He is exceedingly knowledgeable about evidence-based medicine, and expects his students/trainees to be equally enthusiastic about learning. He has a wonderful way with patients, and is always sure to include them in the decision-making process when determining a plan for the day. I always felt respected, included, and appreciated."
A former Idaho WWAMI student, Weppner completed much of his training in the WWAMI region and was lucky enough to meet and work with Richard Tucker during his third-year internal medicine clerkship in Wenatchee. He enjoyed working with Tucker and was impressed by his enthusiasm and energy in training future physicians, as well as how open, easy-going and personable he was with the students. Weppner said he is “delighted to receive this award in Tucker’s memory and hopes to live up to the high standard he set for medical education."
Each spring since 1998 four to five WWAMI physicians are selected for the regional teaching award from nominations submitted by students, residents, and faculty in Washington, Wyoming, Alaska, Montana, and Idaho. The annual teaching award was named for Richard M. Tucker, an infectious disease specialist in Wenatchee who died in May 2007 at the age of 50 from injuries incurred in an automobile accident. Tucker, director for quality and education at the Wenatchee Valley Medical Center, was dedicated to the teaching of medical students and residents from the University of Washington.
The following events may be of interest to the UW Medicine community:
Seymour Klebanoff to be honored for 50 years of excellence, Nov. 16
Seymour J. Klebanoff, professor emeritus of medicine in the Division of Allergy and Infectious Diseases, will be honored Nov.16 for a remarkable career that includes 50 years of exemplary service and outstanding contributions to the UW School of Medicine and the Department of Medicine. The event will be held from 3:30 to 5 p.m., Friday, Nov. 16 in the Orin Smith Auditorium at UW Medicine South Lake Union. Henry Rosen, UW professor of medicine and a former fellow and research colleague, and Paul G. Ramsey, CEO of UW Medicine, dean of the UW School of Medicine, and a former postdoctoral fellow with Klebanoff, will highlight Kebanoff’s achievements and contributions. William Bremner, UW professor and chair of the Department of Medicine, will introduce and moderate the event. A reception will follow. Contact Gina Franco at email@example.com or 206.543.3293 for more information.
Seattle Marathon, Nov. 25
UW Medicine runners and volunteers will participate in Seattle Marathon and Half-Marathon races during the Thanksgiving Holiday Weekend. More than 10,000 runners are expected to participate. The medical team, directed by Mark Harrast, UW clinical associate professor of rehabilitation medicine, and orthopaedics and sports medicine, will manage six stations along the course and two at the finish line. For more information, contact Mia Coleman at firstname.lastname@example.org.Institute of Medicine Seattle Regional Meeting, Dec. 6
Global Burden of Disease: Implications for the U.S., 4 to 5:30 p.m., Thursday, Dec. 6, Kane Hall, Room 120. Speakers are Christopher J.L. Murray, director of the Institute for Health Metrics and Evaluation and professor of global health at the University of Washington, and Paul G. Ramsey, CEO, UW Medicine, executive vice president for medical affairs, and dean of the School of Medicine at the University of Washington. Ramsey will make introductory remarks. Harvey Fineberg, president, Institute of Medicine, will make closing remarks. A reception follows. This portion of the program is open to the general public. Register online or send an email to iomregWA@nas.edu. A private dinner will be held for IOM members following the reception.
Paul Ramsey’s annual address to the UW Medicine community, Feb. 7, 2013
Paul Ramsey, CEO, UW Medicine, executive vice president for medical affairs and dean of the School of Medicine, University of Washington, will review progress at UW Medicine over the last year and cover challenges and opportunities for the upcoming year. The address will be held in Hogness Auditorium in the Health Sciences Building, UW campus 4 to 5 p.m. A reception will follow in the Health Sciences Lobby. The address will be recorded and available starting the next day on the UW Medicine website for those who cannot attend. For more information, contact Julie Monteith at email@example.com or 206.543.7718.
Continuing Medical Education
Visit Continuing Medical Education for information on upcoming classes.
UW Medicine magazine fall issue now available
The fall issue of UW Medicine magazine is now online. This issue of the magazine features UW Medicine’s work on the new frontier of protein design, how we manage high-risk pregnancies, several inspiring stories of life-changing generosity. The site also features alumni news, slideshows and much more.
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