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April 15, 2011
Table of contents
UW Medicine excels in out-of-hospital emergency and trauma care
The historic development of Medic One by Leonard Cobb, professor emeritus of medicine in the Division of Cardiology, Michael Copass, professor of medicine in the Division of Neurology, and the late Seattle Fire Chief Gordon Vickery started a strong tradition of excellence in out-of-hospital emergency and trauma care at UW Medicine. Our faculty and staff have long been world leaders in this area and are routinely cited for groundbreaking work. The results are often dramatic. According to research drawn from the Resuscitation Outcomes Consortium and recently published by Graham Nichol, professor of medicine, holder of the Medic One Foundation Endowed Chair in Prehospital Emergency Care, and director of the UW-Harborview Prehospital Center for Emergency Care, there is a 500 percent variation in cardiac arrest survival depending on geographic location. Similar work shows that there is a more than 200 percent variation in survival after major traumatic injury depending on geographic location. Seattle and King County have among the very best cardiac arrest and traumatic injury survival rates in the world, thanks to the exceptional work of our many leaders in this field.
A few of the many research, clinical and training activities related to emergency and trauma care currently underway are:
The HeartRescue Project, initiated and funded by the Medtronic Foundation, assembles leading emergency and resuscitation experts committed to improving how Sudden Cardiac Arrest (SCA) is recognized, treated and measured. The project’s goal is to significantly improve SCA survival rates in each state within five years by expanding and replicating successful city and county out-of-hospital cardiac arrest response programs to statewide levels.
Washington is one of five pilot states selected to implement programs that align emergency medical service (EMS) programs and hospitals. Participants of Washington’s Cascade HeartRescue include: the UW-Harborview Center for Prehospital Emergency Care, the Harborview Paramedic Training Program, the Medic One Program of the Seattle Fire Department, King County Emergency Medical Services, and multiple community-based partners, including the American Heart Association, Medic One Foundation and Nick of Time Foundation. The physician team consists of Graham Nichol (photo, left); Tom Rea, associate professor of medicine in the Division of General Internal Medicine and medical director of King County Medic One; Mickey Eisenberg, professor of medicine in the Division of Emergency Medicine and medical program director of King County Emergency Medical Services; and Michael Copass, professor of medicine, medical director and co-founder of Seattle Medic One and director of paramedic training.
The Resuscitation Outcomes Consortium (ROC) conducts clinical research in the areas of CPR and traumatic injury. The NIH-funded consortium performs randomized clinical trials in out-of-hospital cardiac arrest and life-threatening trauma. Seattle/King County is one of 10 Regional Clinical Centers (RCCs) nationwide. Peter Kudenchuk, professor of medicine in the Division of Cardiology and associate medical director of King County Emergency Medical Services, is principal investigator for the Seattle/King County RCC. Eileen Bulger, professor of surgery and medical director of Harborview Emergency Services, and Tom Rea are co-PIs. The Consortium’s Clinical and Data Coordinating Center is also located at the UW and is directed by Susanne May, associate professor of biostatistics in the School of Public Health. ROC’s extraordinary level of success during its initial five years was recently recognized by NIH with a six-year renewal of the network.
The Harborview Injury Prevention and Research Center, formed in 1985, was one of the first centers in the nation devoted to research on and prevention of injuries. The CDC-funded center, now one of 12 in the nation, conducts programs to diminish the personal impact of trauma and broaden the effectiveness of injury prevention and treatment programs. Beth Ebel, associate professor of pediatrics and adjunct associate professor of epidemiology, directs the center.
The work of these and other centers and groups are widely cited. In a study reported in The New England Journal of Medicine, Tom Rea and colleagues compared dispatch-assisted telephone CPR by laypersons using chest compression alone or compression plus rescue breathing and found no significant difference in outcome. These findings are expected to increase the percentage of people willing to perform CPR.
In a study led by Eileen Bulger (photo, right) and published in JAMA, ROC investigators have tested early use of hypertonic fluids to improve outcomes for severe traumatic brain injury. In contrast to smaller, earlier studies that suggested physiologic and clinical benefits, this large randomized trial found no indication for out-of-hospital administration of hypertonic fluids compared with normal saline. Bulger is also first author on a recent paper in the Annals of Surgery that provides results of a multicenter, randomized clinical trial examining out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock.
A recent article in JAMA presented results from a study from the Harborview Injury Prevention and Research Center to determine the long-term mortality of patients following trauma admission. Among adults treated for trauma, 16 percent died within three years of their injury, compared to an expected population mortality rate of about six percent. The researchers also found that trauma patients who were discharged to a skilled nursing facility had a significantly increased risk of death compared with patients discharged home without assistance. The paper’s first author is Giana H. Davidson, a resident in general surgery.
Many more individuals and groups at UW Medicine are performing outstanding work in this important area. I would especially like to thank Jerry Jurkovich, professor of surgery and chief of the trauma service at Harborview, and Ron Maier, professor of surgery and chief of surgery at Harborview, for their superb work in leading a service that sets an example for the nation. My thanks go as well to all the individuals involved in teaching, research and patient care related to emergency and trauma care. Your exceptional work is literally a lifeline.
Paul G. Ramsey, M.D.
Persons who have tested positive for herpes simplex virus type 2 (HSV-2) but who do not have symptoms or genital lesions still experience virus shedding during episodes without clinical manifestations. This suggests a high risk of transmission from persons with unrecognized HSV-2 infection, according to a study in the April 13 issue of JAMA.
Anna Wald, UW professor of medicine in the Division of Allergy & Infectious Diseases, presented the findings of the study at a JAMA media briefing April 12 at the National Press Club in Washington, D.C.
"Herpes simplex virus type 2 is one of the most prevalent sexually transmitted infections worldwide, with global estimates of 536 million infected persons and an annual incidence of 23.6 million cases among persons aged 15 to 49 years. In the United States, 16 percent of adults are HSV-2 seropositive, but only 10 percent to 25 percent of persons with HSV-2 infection have recognized genital herpes. Moreover, most HSV-2 infections are acquired from persons without a clinical history of genital herpes," according to the study’s investigators.
The risk of sexual transmission does not correlate with the recognition of clinical signs and symptoms of HSV-2 but most likely correlates with the activity of the virus on the genital skin or mucosa (viral shedding).
Wald and colleagues compared the rates and patterns of genital HSV shedding in 498 immunocompetent HSV-2-seropositive persons between March 1992 and April 2008. Each participant obtained daily self-collected swabs of genital secretions for at least 30 days. The rate of viral shedding (the presence of virus that is actively replicating and can thereby be transmitted to another person) was measured by polymerase chain reaction (testing method for viral DNA) from the swabs.
Among the findings of the researchers, HSV-2 was detected on 4,753 of 23,683 days in 410 persons with symptomatic genital HSV-2 infection compared with 519 of 5,070 days in 88 persons with asymptomatic infection. Genital HSV was detected at least once in 342 of 410 persons with symptomatic HSV-2 infection and in 60 of 88 persons with asymptomatic HSV-2 infection during the two-month study.
Persons with symptomatic infection had more frequent genital shedding episodes compared with persons with asymptomatic infection (median 17.9 vs. 12.5 episodes per year). Days with lesions accounted for 2,045 of 4,753 days (43.0 percent) with genital viral shedding among persons with symptomatic genital HSV-2 infection compared with 85 of 519 days (16.4 percent) among persons with asymptomatic infection. These findings indicate that the bulk of days of shedding in persons with asymptomatic HSV-2 are unrecognized, and people may engage in sexual activity not knowing that they are at risk for transmitting the virus to sexual partners.
Read about the study in JAMA.
About one in 44,000 National Collegiate Athletic Association athletes has sudden cardiac death each year, according to a new study in Circulation: Journal of the American Heart Association. UW Medicine physicians co-authored the study.
The death rate — higher than many previous estimates for young athletes — could influence health screening guidelines for youths in organized sports, researchers said.
According to the American Heart Association, athletic training and competition can increase the risk of sudden cardiac death in people with underlying heart disease. Various heart conditions can kill young athletes, including the most common cause — hypertrophic cardiomyopathy, an abnormal growth of heart muscle fibers.
Estimates of the number of such deaths often have been based on inconsistent data sources such as media reports, said study co-author Kimberly Harmon, a UW clinical associate professor of family medicine and orthopedics and sports medicine, who practices at Hall Health. In addition, some studies lack solid figures on how many young people play sports overall, which also affects risk estimates.
The new study used news reports, insurance claims and data from the NCAA, the governing body for intercollegiate sports in the United States. About 400,000 students, ages 17-23, participate in NCAA sports each year.
Researchers tracked deaths from 2004 through 2008 and identified:
Of deaths from medical causes, 56 percent (45 athletes) were cardiovascular-related sudden deaths. Of the 36 deaths that occurred during or shortly after exertion, 75 percent (27 athletes) were related to cardiac causes. In all, the study found that annually one in 43,770 athletes died of sudden cardiac death.
Read the article in Circulation.
UW Medicine has been selected to receive the 2011 NAPH Safety Net Award Honorable Mention for its efforts to improve patient care by the National Association of Public Hospitals and Health Systems (NAPH).
One of NAPH’s strategic priorities is to support the work of safety net hospitals and health systems in providing high quality and safe health care.
UW Medicine’s UW Medical Center and Harborview Medical Center implemented a multifaceted approach to reduce central line infections across the health care system.
UW Medicine developed a standardized training and patient care program to address the challenge of improving care for patients who require central venous catheters (CVC) placement. Physicians and residents in the specialties of internal medicine, anesthesiology, family medicine, and surgery were trained and tested with methods developed by the UW Medicine Institute for Simulation and Interprofessional Studies (ISIS). The ISIS CVC initiative offers a curriculum with computer-based interactive training and active simulation training and testing.
Mika Sinanan, associate director of ISIS and professor of surgery, Brian Ross, ISIS executive director and professor of anesthesiology, and Sara Kim, associate director of ISIS curriculum and evaluation and associate professor of medical education & biomedical informatics, played key roles in curriculum development and implementation. Rick Goss and Tom Staiger, medical directors of Harborview Medical Center and UW Medical Center, respectively, facilitated the use of identical medical staff policies for CVC placement, training, and resources.
Representatives from UW Medicine, UW Medical Center and Harborview Medical Center have been invited to accept the award during the 2011 NAPH Annual Conference, June 22 – 24, in Chicago.
Read more about the CVC initiative here.
David Heimbach, UW professor of surgery, has received the International Burn Foundation’s Tanner-Vandeput-Boswick Burn Prize for his contributions to the field of burns.
“Dr. Heimbach was selected for his remarkable and enduring contributions to the field of burns,” Jane Bostwick-Caffrey, chairman of the IBF, said in a statement. “His contributions to the field have played a significant role in education, training and research, and he has been a highly influential physician in the field of burn treatment."
In accepting the award, Heimbach noted the importance of a multidisciplinary team approach to burn care.
“Winning the most prestigious prize for burn care is the apex of my career in burn care. The TVB prize puts me at the feet of my heroes and mentors who have been previous awardees—giants all—John Burke, Charles Baxter, and Basil Pruitt….Their leadership and inspiration have brought burn care out of the back halls and wards of neglect to a primary surgical specialty of excellence, and they have been the champions of the team approach to multidisciplinary care.”
The TVB Burn Prize was established in 1984 by the late J.C. Tanner of Atlanta. Tanner, assisted by Jacques Vandeput, invented the Tanner-Vandeput mesh dermatome, a device that enables skin grafts to be expanded to replace a larger area of a patient’s skin destroyed by burns. The prize is the legacy of their contribution and promotes the mission of the IBF by honoring individual achievement in the field of burn treatment. Tanner honored the contributions of the late John Boswick, first chairman of the foundation, by adding his name to the prize. The prize is quadrennial and will be awarded again in 2014.
Heimach was awarded the $100,000 cash prize and gold and diamond pin at the Congress of the International Society for Burn Injuries in Istanbul, Turkey in June.
Raghu “Rags” Durvasula, UW assistant professor of medicine in the Division of Nephrology, has been appointed director for UW Medical Center Dialysis. He also serves as associate medical director for inpatient care at UW Medical Center.
Durvasula succeeds Suhail Ahmad, UW professor of medicine in the Division of Nephrology, who has held the position for the past two decades and stepped down because of his recent appointment as chief medical officer of Northwest Kidney Centers. Ahmad will continue to direct liver dialysis and dialysis-related research at UWMC.
Durvasula completed a nephrology fellowship at UW and joined the faculty in 2003. He recently completed the Certificate Program in Medical Management at the UW School of Public Health.
John M. Harlan has been appointed the first Elo Giblett Professor of Medicine in the Division of Hematology. Harlan is professor of medicine, adjunct professor of pathology, associate medical director for blood services, and chief of the Section of Hematology/Oncology at Harborview Medical Center. He conducts research in endothelial cell and leukocyte biology. He joined the faculty in 1978 and served as division head from 1989 to 2004.
Eloise Giblett, who died in 2009, was a faculty member in the Division of Hematology from 1955 to 1980. She served as the head of immunogenetics and then executive director of the Puget Sound Blood Center, among other leadership positions. A member of the National Academy of Sciences, she made major contributions to hematology including discovery of the first immunodeficiency disease, adenosine deaminase (ADA) deficiency.
“John Harlan is a spectacular clinician, providing outstanding care to patients with benign hematology issues, hematologic malignancy, and solid tumors; an astute clinical observer; and a stellar scientist. Like Elo, he is a rigorous investigator who studies the physiological basis of important clinical issues. As importantly, he shares Elo’s passion for scientific investigation, her creativity, her insight, and her modesty. I am very pleased that he was selected as the first holder of the Elo Giblett Endowed Professorship.”
Alisa Becker, a third-year medical student, has been named a 2011 Magnuson Scholar, one of the highest awards given annually by the University of Washington. She is one of six UW health sciences students to receive the award.
The Magnuson Scholars are selected on the basis of their academic performance and their potential contributions to research in the health sciences. The award was named after the late Sen. Warren G. Magnuson, who was known for his efforts to improve the nation’s health.
Becker, of East Wenatchee, Wash., graduated in 2006 from the UW honors program with a Bachelor of Science degree in neurobiology. As an undergraduate, she studied connections between the brain, hormones and metabolism in the reproductive endocrinology labs of Robert Steiner and Donald Clifton. As a college senior, Becker became involved in community health. A fellowship with the Multidisciplinary International Research Training program led her to rural Chile to investigate local barriers to health care. As a medical student, she became a member of Al-Shifa, a student-run organization that seeks to bring health services and education to Seattle’s underserved populations.
Becker, who was diagnosed with type 1 diabetes when she was 17, is interested in diabetes education and research. She wants to become an adult medicine physician and specialize in managing chronic diseases and advocating for people with diabetes.
The five other health sciences Magnuson Scholars are: Karen Tabb Dina, School of Social Work; Mollie Hogan, School of Public Health; Kajohnkiart Janebodini, School of Dentistry; Nora Lee, School of Pharmacy; and Rebecca O’Connor, School of Nursing.
Valerie Lengfelder, a UW School of Medicine graduate and a member of the first WWAMI Wyoming class in 1997, now serves as a preceptor for the Powell, Wyo. WRITE (WWAMI Rural Integrated Training Experience) site at Powell Valley Healthcare. She participated in the WRITE program in Thermopolis, Wyo. as part of her undergraduate medical training.
“What I most like about working with students is what they teach me. They keep me on my toes and up-to-date on current medical standards. I like their energy,” Lengfelder said of her new role.
As a clinical faculty member, Lengfelder helps UW Medicine meet its mission of improving health with her commitment to excellence in patient care and her involvement in her community. These are qualities she hopes to instill in WWAMI medical students during their time in Powell.
Lengfelder, a family medicine physician, works closely with five other family physicians and a pediatrician/internist at the Powell Valley Clinic. Prior to joining the clinic three years ago, Lengfelder completed her residency training and worked for three years at Group Health Cooperative in Seattle.
Lengfelder volunteers at Heart Mountain Volunteer Medical Clinic in Powell. The clinic provides free basic medical care to people in need and do not qualify for other medical assistance programs or services. She not only serves as a volunteer physician, but also is a Board member and helps the organization with fundraising activities. Lengfelder became the medical director for the local Migrant Health & Women’s Wellness program in Powell on April 1.
The following is a listing of some upcoming events that may be of interest to the UW Medicine community. Additional events are listed on the UW Medicine events calendar.
World Voice Day Celebration, April 18
The Power of the Human Voice by Speight Jenkins, general director of the Seattle Opera, 6:30 p.m., Monday, April 18, and Local Voices: An Insider’s View by Tanya Meyer, UW Medicine otolaryngologist [laryngologist or otolaryngologist??? Not sure I’ve ever heard of a laryngologist], at 7:30 p.m., Research & Training Building auditorium, Harborview campus. World Voice Day was established in 2002 to promote global awareness of vocal health and to celebrate this primary modality for communication.
Controlling Chronic Diseases: Lessons from the Tobacco Epidemic by Jonathan Samet, 5 p.m., Tuesday, April 19, Turner Auditorium, Health Sciences Building, Room D-209. Samet is director of the University of Southern California (USC) Institute for Global Health and professor and Flora L. Thornton Chair of Preventive Medicine, Keck School of Medicine, USC. He investigates the health risks of inhaled pollutants and causes of cancer and respiratory diseases. Contact the Global Health Resource Center at firstname.lastname@example.org or 206.685.7362 for more information.
Bioethics Grand Rounds, April 21
Pre-Curriculum Review Advisory Committee Feedback
Visit Continuing Medical Education for more information on upcoming classes.
UW Medicine magazine
The Spring 2011 issue of UW Medicine magazine, the biannual magazine for alumni and friends of the UW School of Medicine, is now available online. Discover how UW Medicine is pioneering minimally invasive brain surgery with a procedure called TONES and how the UW Medicine Stroke Center saves time and brain with high-tech treatments. Learn about a physician assistant’s journey from Cambodia to Seattle, and read what students think about medical school.