TAG: "Patient care"

UCSF Medical Center, John Muir Health affiliate


Relationship to serve as cornerstone of Bay Area network to provide more integrated care.

By Karin Rush-Monroe, UC San Francisco

UCSF Medical Center and John Muir Health have finalized an agreement that will serve as the foundation for a Bay Area health care network intended to provide patients with high quality care at an affordable price.

The two health systems also have formed a new development company that will enable them to collaborate on building new medical facilities, increase the number of physicians in the health care network, and provide physicians and patients new tools to improve coordination of care, with the ultimate goal of an enhanced patient experience.

Under the agreements, both organizations remain independent. Together, UCSF Medical Center and John Muir Health:

  • Have invested in a collaborative effort, called the Bay Area Accountable Care Network, to form a regional health care network. Establishing a Bay Area-wide network will provide patients from throughout the Bay Area and Northern California with a competitively priced option to access, close to where they live or work, many of the Bay Area’s most trusted and respected hospitals, health systems and physician organizations.
  • Will equally own and operate a new development company. The formal affiliation will enable both organizations to build on their strengths and work together to develop joint initiatives and a shared services organization to support programs and initiatives focused on better health care, at lower costs, for Bay Area patients.

“UCSF Medical Center, and John Muir Health are leading the development of a comprehensive Bay Area network of providers who share a common commitment to providing safe, high quality, patient centered care at an affordable price. We intend to offer this network to health plans who serve patients throughout the Bay Area,” said Mark R. Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “We look forward to working not just with each other, but with other health organizations throughout the Greater Bay Area, in order to provide an exceptional health care experience for patients.”

The two organizations will apply for a restricted Knox-Keene license effective in the Greater Bay Area. This license, which is issued by the California Department of Managed Health Care, would enable the Bay Area Accountable Care Network to contract directly with health plans to develop an insurance product that provides access to high-quality care at an affordable price.

As a next step, UCSF Medical Center and John Muir Health will coordinate their Epic electronic medical record systems and patient communication portals to enable better physician and patient communications. UCSF Medical Center and John Muir Health also anticipate, with other provider partners, building enhanced physician practice management services to create alternatives for physicians throughout the Bay Area who wish to be participating providers in the Bay Area Accountable Care Network.

“Our affiliation brings together two forward-thinking organizations that share a vision for how health care will be delivered in the future,” said Cal Knight, president and CEO of John Muir Health. “We’re pleased to have finalized our affiliation so we can further our joint initiatives and efforts to develop a Bay Area Accountable Care Network. We’re focused on meeting the needs of patients by providing better access to high-quality and affordable care throughout the Bay Area from trusted and respected physicians, hospitals, outpatient facilities and health systems.”

Both John Muir Health and UCSF Medical Center already have experience in successful care models developed under the Affordable Care Act, such as accountable care organizations (ACOs), that have demonstrated lower health care costs and improved health care quality. These experiences, as well as those of other organizations that choose to be part of the provider network, will be translated into the Bay Area Accountable Care Network. The goal is to provide the right care at the right time and in the most appropriate setting, whether that is the primary care physician’s office, an outpatient center or a hospital. When better coordination of care results in lower costs, the savings achieved are passed along to consumers in the form of lower health care benefit premiums.

By working more closely, the two organizations also will offer more convenient access to care for patients in Northern California. For example, an outpatient clinic for liver transplant services will be established at the John Muir Health’s Walnut Creek Outpatient Center. This will allow patients who are waiting for transplants, or have recently received transplants, at UCSF Medical Center, which is nationally recognized for the quality of its program, to receive clinical services such as blood testing and monitoring at the new location. John Muir Health’s Physician Network is a comprehensive network of primary care and specialist physicians, covering virtually all conditions except transplants.

In addition, both organizations are widely recognized for the quality of care they provide. U.S. News & World Report recently ranked UCSF Medical Center, John Muir Medical Center, Walnut Creek and John Muir Medical Center, Concord as the top three hospitals in the San Francisco-Oakland area. In addition, the John Muir Physician Network recently received the highest possible “elite” ranking from the California Association of Physician Groups.

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UC Davis Children’s Hospital ranked among top in nation for quality of care


University HealthSystem Consortium ranks it in top five based on quality of pediatric care.

For the first time, UC Davis Children’s Hospital ranks as one of the top five U.S. hospitals based on the quality of pediatric health care it provides to infants, children and adolescents admitted to the hospital.

A ranking by the University HealthSystem Consortium (UHC) compares UC Davis Children’s Hospital to all other university-based, academic children’s hospitals based on a careful review of information about safety and quality. This top-tier ranking recognizes that teams caring for children at UC Davis work together across a wide range of services, from complicated surgery to intensive care to a brief overnight stay to treat asthma.

Gary Raff, co-chair of the Children’s Hospital Quality and Safety Committee, said, “Our nurses and doctors are working together to put patient care first. Whether it’s something as simple as careful handwashing or as complicated as advanced heart surgery, we’re all committed to quality.”

The rankings address Americans’ increasing awareness that hospitals are not only places of healing, but also of risk for problems such as complications of surgery or serious infections, said JoAnne Natale, co-chair of the Children’s Hospital Quality and Safety Committee.

“Nothing is more important to a family than the swift recovery of their sick or injured child, and every family wants to know their hospital is working hard to prevent such problems,” said Natale.

The federal Agency for Healthcare Research and Quality (AHRQ) has identified eight different measures of problems that might arise for hospitalized children. UC Davis Children’s Hospital is ranked number five on the UHC overall pediatric quality composite indicator, based on these measures from October 2013 to September 2014.

“At UC Davis, we carefully review any quality concerns that emerge, track data, and rapidly undertake changes to provide the highest quality care,” said Natale.

Judie Boehmer, Director of Patient Care Services, said, “All of us listen carefully to parents and other family members who help us understand how they think our care can be improved.”

Boehmer said that UC Davis Children’s Hospital particularly prides itself on the way that all those providing care — nurses, doctors, pharmacists, respiratory therapists and many others — work together as a team focused on providing quality care for every child.

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‘Smart bandage’ detects bedsores before they are visible to doctors


UC Berkeley findings could provide major boost to tackling a growing health problem.

By Sarah Yang, UC Berkeley

Engineers at the University of California, Berkeley, are developing a new type of bandage that does far more than stanch the bleeding from a paper cut or scraped knee.

Thanks to advances in flexible electronics, the researchers, in collaboration with colleagues at UC San Francisco, have created a new “smart bandage” that uses electrical currents to detect early tissue damage from pressure ulcers, or bedsores, before they can be seen by human eyes – and while recovery is still possible.

“We set out to create a type of bandage that could detect bedsores as they are forming, before the damage reaches the surface of the skin,” said Michel Maharbiz, a UC Berkeley associate professor of electrical engineering and computer sciences and head of the smart-bandage project. “We can imagine this being carried by a nurse for spot-checking target areas on a patient, or it could be incorporated into a wound dressing to regularly monitor how it’s healing.”

The researchers exploited the electrical changes that occur when a healthy cell starts dying. They tested the thin, non-invasive bandage on the skin of rats and found that the device was able to detect varying degrees of tissue damage consistently across multiple animals.

Tackling a growing health problem

The findings, published today (March 17) in the journal Nature Communications, could provide a major boost to efforts to stem a health problem that affects an estimated 2.5 million U.S. residents at an annual cost of $11 billion.

Pressure ulcers, or bedsores, are injuries that can result after prolonged pressure cuts off adequate blood supply to the skin. Areas that cover bony parts of the body, such as the heels, hips and tailbone, are common sites for bedsores. Patients who are bedridden or otherwise lack mobility are most at risk.

“By the time you see signs of a bedsore on the surface of the skin, it’s usually too late,” said Dr. Michael Harrison, a professor of surgery at UCSF and a co-investigator  of the study. “This bandage could provide an easy early-warning system that would allow intervention before the injury is permanent. If you can detect bedsores early on, the solution is easy. Just take the pressure off.”

Bedsores are associated with deadly septic infections, and recent research has shown that odds of a patient dying are 2.8 times higher when they have pressure ulcers. The growing prevalence of diabetes and obesity has increased the risk factors for bedsores.

“The genius of this device is that it’s looking at the electrical properties of the tissue to assess damage. We currently have no other way to do that in clinical practice,” said Harrison. “It’s tackling a big problem that many people have been trying to solve in the last 50 years. As a clinician and someone who has struggled with this clinical problem, this bandage is great.”

Cells as capacitors and resistors

The researchers printed an array of dozens of electrodes onto a thin, flexible film. They discharged a very small current between the electrodes to create a spatial map of the underlying tissue based upon the flow of electricity at different frequencies, a technique called impedance spectroscopy.

The researchers pointed out that a cell’s membrane is relatively impermeable when functioning properly, thus acting like an insulator to the cell’s conductive contents and drawing the comparison to a capacitor. As a cell starts to die, the integrity of the cell wall starts to break down, allowing electrical signals to leak through, much like a resistor.

“Our device is a comprehensive demonstration that tissue health in a living organism can be locally mapped using impedance spectroscopy,” said study lead author Sarah Swisher, a Ph.D. candidate in electrical engineering and computer sciences at UC Berkeley.

To mimic a pressure wound, the researchers gently squeezed the bare skin of rats between two magnets. They left the magnets in place for one or three hours while the rats resumed normal activity. The resumption of blood flow after the magnets were removed caused inflammation and oxidative damage that accelerated cell death. The smart bandage was used to collect data once a day for at least three days to track the progress of the wounds.

The smart bandage was able to detect changes in electrical resistance consistent with increased membrane permeability, a mark of a dying cell. Not surprisingly, one hour of pressure produced mild, reversible tissue damage while three hours of pressure produced more serious, permanent injury.

Promising future

“One of the things that makes this work novel is that we took a comprehensive approach to understanding how the technique could be used to observe developing wounds in complex tissue,” said Swisher. “In the past, people have used impedance spectroscopy for cell cultures or relatively simple measurements in tissue. What makes this unique is extending that to detect and extract useful information from wounds developing in the body. That’s a big leap.”

Maharbiz said the outlook for this and other smart bandage research is bright.

“As technology gets more and more miniaturized, and as we learn more and more about the responses the body has to disease and injury, we’re able to build bandages that are very intelligent,” he said. “You can imagine a future where the bandage you or a physician puts on could actually report a lot of interesting information that could be used to improve patient care.”

Other lead researchers on the project include Vivek Subramanian and Ana Claudia Arias, both faculty members in UC Berkeley’s Department of Electrical Engineering and Computer Sciences; and Shuvo Roy, a UCSF professor of bioengineering. Additional co-authors include Amy Liao and Monica Lin, both UC Berkeley Ph.D. students in bioengineering; and Yasser Khan, a UC Berkeley Ph.D. student in electrical engineering and computer sciences, who fabricated the sensor array.

Study co-author Dr. David Young, UCSF professor of surgery, is now heading up a clinical trial of this bandage.

The project is funded through the Flexible Resorbable Organic and Nanomaterial Therapeutic Systems (FRONTS) program of the National Science Foundation.

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Infant leaves UCLA’s Mattel hospital for home with a transplanted heart


Drayvn is the hospital’s second youngest heart transplant recipient.

Drayvn Johnson got a heart transplant when he was 23 days after he was born with a heart defect and only one coronary artery. Now 5 weeks old, he left Mattel Children's Hospital UCLA for home today with his mother, Nicole Eggleston. (Photo by Reed Hutchinson, UCLA)

By Amy Albin, UCLA

Staff at Mattel Children’s Hospital UCLA witnessed a happy ending today (March 11) instead of what could have easily been a tragic one  when they bid farewell to 5-week-old Drayvn Johnson, who went home with his mother, Nicole Eggleston, and two older brothers after becoming the hospital’s second youngest heart transplant recipient. He was only 23 days old when he received his new heart, which was the size of a strawberry.

“All of our heart transplant patients are special, but I think this one was special because we knew there was a risk we might not find a donor in time,” said Dr. Juan Alejos, professor of pediatric cardiology and director of the Pediatric Heart Transplant Program at Mattel Children’s Hospital UCLA

Dravyn was born with a condition called pulmonary atresia in which the pulmonary valve does not form properly. It was discovered during Eggleston’s pregnancy in a sonogram performed at 22 weeks. Doctors had thought initially that his heart could be repaired with a series of corrective surgeries performed over the first few years of Dravyn’s life.

However, when he was born in early February at an Orange County hospital, doctors found that he had only one coronary artery instead of two and determined that surgery would be too risky for the baby.

At 5 days old, Drayvn was airlifted to Mattel where doctors confirmed that the only hope for his survival was an urgent heart transplant. Miraculously, within two days after Drayvn’s name went on a list for a transplant, a donor was found. And Drayvn got his new heart. The hospital’s youngest heart recipient was a 16-day-old infant who received a transplanted heart in 1994.

The UCLA Pediatric Heart and Heart-Lung Transplant Program is one of the major referral centers for the western United States. The team has performed more than 300 pediatric heart transplants since 1984 when it did its first such surgery. The program is a coordinated effort among pediatric cardiologists, cardiothoracic surgeons, dentists, nurse practitioners, transplant coordinators, nutritional specialists, social workers and child developmental specialists. For more information, visit http://transplants.ucla.edu/heart.

The family has set up a website to help raise funds for Drayvn’s care.

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UC San Diego Health System named one of nation’s best


Truven Health Analytics includes UC San Diego on list of nation’s 100 Top Hospitals.

By Jackie Carr, UC San Diego

UC San Diego Health System was named one of the nation’s 100 Top Hospitals by Truven Health Analytics. This is the third time UC San Diego Health System has been recognized for this prestigious honor.

The Truven Health 100 Top Hospitals study identifies hospitals and leadership teams that provide the highest level of value to their communities based on a national balanced scorecard. The scorecard measures overall organizational performance across 11 key analytic measures including patient care, operational efficiency and financial stability.

“It is an incredible honor for UC San Diego to be named a top performing health system in the country,” said Paul Viviano, CEO, UC San Diego Health System. “This national recognition is the result of the extraordinary devotion of our staff and faculty to achieve excellence for our patients through improved safety, shorter hospitals stays, increased satisfaction, lower costs and demonstrably superior clinical outcomes.”

UC San Diego Health System is listed as a top hospital among 3,000 U.S. hospitals and is recognized among the nation’s most prominent teaching institutions, including Duke University Hospital, Emory University Hospital and Stanford Hospital.

To conduct the 100 Top Hospitals study, Truven Health researchers evaluated close to 3,000 short-term, acute-care, nonfederal hospitals. Risk-adjusted methodologies were used to analyze public information — Medicare cost reports, Medicare Provider Analysis and Review (MEDPAR) data, and core measures and patient satisfaction data from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare reports. Hospitals do not apply, and winners do not pay to market this honor.

“This year’s 100 Top Hospitals represent the highest national standards in hospital care and management today. They set the benchmarks for peers around the country to follow — consistently delivering outstanding quality of care, satisfaction and community value at a reasonable cost,” said Jean Chenoweth, senior vice president for performance improvement and the 100 Top Hospitals program at Truven Health Analytics. “The majority of the 2015 award winners have produced year-to-year performance improvement, as well. This speaks to the consistent focus on excellence by the entire organization and the men and women who serve patients.”

The study shows that if all hospitals in the U.S. performed at the level of this year’s winners:

  • 126,471 additional lives could be saved
  • 108,926 additional patients could be complication-free
  • $1.8 billion in inpatient costs could be saved
  • The average patient stay would decrease by half a day
  • Episode-of-illness expense would be 2 percent lower than the peer average

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Looking back and ahead, Shiley’s vision remains clear


UC San Diego emerges as regional hub for eye care, research, education, community service.

By Scott LaFee, UC San Diego

Time may blur, but the first quarter-century of the Shiley Eye Center – it celebrates that anniversary this year – remains sharply defined in its accomplishments and focus on the future.

When the $8 million center debuted in 1991, launched by a $1 million leadership gift from the late philanthropist Donald Shiley and his wife, Darlene, it stood alone – quite literally. The neighboring Perlman Ambulatory Care Center (now Perlman Medical Offices) and UC San Diego Thornton Hospital were both two years from completion. More to the point, the new Shiley Eye Center represented the first institution in San Diego entirely dedicated to eye care and science.

“No other major city had been without an eye center,” said Dr. Stuart Brown, then-chair of the Department of Ophthalmology and the center’s founding director at the opening gala in 1991. “And now we will be allowed to achieve our mission and our greatest potential.”

The ambition of the Shiley team was to establish an eye center unrivaled in the region. To a remarkable degree, they have succeeded. It’s a vision that has accelerated under the current Shiley director and ophthalmology chair, Dr. Robert N. Weinreb. “The Shiley has emerged as a hub for clinical care excellence, outstanding vision research and broad-based eye health education. By investing in unsurpassed facilities, equipment and brainpower, we have become a destination for preventing and curing blinding eye diseases for the residents of San Diego and beyond.” said Weinreb.

This week, Shiley expands upon that success, changing its name to the UC San Diego Donald P. and Darlene V. Shiley Eye Institute, which will encompass the Shiley Eye Center, the Anne F. and Abraham Ratner Children’s Eye Center, the Hamilton Glaucoma Center and the Joan and Irwin Jacobs Retina Center. The institute is part of the UC San Diego Health System.

“The new name more accurately captures the fullness of the work being done at Shiley,” said UC San Diego Chancellor Pradeep K. Khosla. “The institute and department of ophthalmology, working hand-in-hand with the School of Medicine and other programs across campus, will leverage every possible tool and expertise, from genetics, bioengineering and pharmacy to pathology, neurosciences and stem cell research, to improve the treatment of eye diseases, find new cures and hasten the day when blindness is entirely preventable.”

The institute will include the new Richard C. Atkinson Laboratory for Regenerative Ophthalmology, created last year with an anonymous $6.5 million gift from a grateful patient. The new lab will investigate cell replacement therapies, tissue engineering and other biomedical advances to reverse vision loss and blindness. Researchers will explore novel stem cell approaches and work closely with the Sanford Clinical Stem Cell Center at UC San Diego Health System, which was established in 2013.

Nearby, a new Vision Research Center is in the early stages of planning along with the creation of a framework to fund the project. The center is envisioned to accelerate the translation of new research into treatments for patient with blinding ophthalmic diseases.

“The center is intended to help bridge the gap between laboratory and clinic by bringing together brilliant minds and diverse talents in a shared facility,” said Weinreb. “This integrated approach will speed the transformation of discoveries into clinical applications that can be tested through clinical trials.”

If past is prologue, the future looks bright. Over the years, Shiley physicians and researchers have made major contributions to preventing and curing eye diseases such as macular degeneration, glaucoma, diabetic retinopathy, corneal disorders and cataracts.

Recently, for example, they have been involved in developing an artificial retina, a smart contact lens that wirelessly monitors intraocular pressure (a key risk factor in glaucoma) and the use of self-renewing stem cells to repair or restore vision lost to diseases like macular degeneration, glaucoma and corneal opacity. They are even helping explore the possibility of whole eye transplants.

Clinical care remains a cornerstone. In 2014, there were 106,470 patient visits and 4,862 surgeries. Patients ranged in age from one day to 105 years. The Shiley Eye Mobile conducted 12,238 vision screenings, 2,011 eye exams, dispensed 1,288 pairs of free glasses and referred 107 children for more serious follow-up care.

“It was always very clear that my late husband had a special place in his heart for the Shiley Eye Center,” said Darlene Shiley. “I will never forget how moved he was by Dr. Brown’s description of the work being done and the work that still needed to be addressed. And now, decades later, Dr. Weinreb is focused on patient-centric care excellence and leading the Shiley into new areas of eye research and treatment. Successful past, bright future – how lucky we all are to have such dedicated physicians, researchers, staff and eager volunteers.”

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UCSF receives $100M gift to advance health sciences mission


Landmark gift cements Chuck Feeney’s role as UC system’s top philanthropist.

Chuck Feeney

By Jennifer O’Brien, UC San Francisco

UC San Francisco has received a $100 million gift from visionary philanthropist Charles F. “Chuck” Feeney to support its new Mission Bay hospitals, world-class faculty and students, and research programs focused on the neurosciences and aging.

This donation brings the longtime supporter’s total UCSF giving to more than $394 million, making Feeney the single largest contributor to the University of California system.

“I get my gratification from knowing that my investments in medical research, education, and the delivery of health care at UCSF will provide lifelong benefits to millions of people not only in the Bay Area but also around the world,” said Feeney, who, despite his global presence as a successful entrepreneur and discerning philanthropist, prefers remaining out of the limelight. “I can’t imagine a more effective way to distribute my undeserved wealth.”

Reflecting on Feeney’s contributions, UCSF Chancellor Sam Hawgood, M.B.B.S., said, “As we celebrate UCSF’s 150th anniversary this year, it is only fitting that we acknowledge the unique role Chuck has played in our history. While his impact has been felt most profoundly during this past decade, his generosity will carry on forever at our university, in the San Francisco community, throughout the Bay Area and globally, as our faculty and students advance knowledge and provide the finest clinical care. We are honored that he has decided to invest again in UCSF.”

Feeney’s gifts to UCSF are most visible at the university’s Mission Bay campus, where he has provided indispensable support to create advanced facilities and foster the environment for the biomedical research and patient care that goes on within them.

Before the latest funding, Feeney’s most recent gift to the campus was to UCSF Global Health Sciences, enabling the October 2014 opening of Mission Hall, which houses global health researchers, scientists and students under the same roof for the first time. Feeney, who coined the term “giving while living,” also generously supported the building of the Smith Cardiovascular Research Building and the Helen Diller Family Cancer Research Building.

“Chuck Feeney has been our partner at Mission Bay for more than 10 years,” added Hawgood. “He immediately embraced the Mission Bay concept, and he has enthusiastically helped us shape a larger vision for the campus and finance its development because he knew that our research and clinical programs could not flourish without state-of-the-art buildings.”

Gift to support four primary areas

The Campaign for the UCSF Medical Center at Mission Bay
Funds will support the $600 million philanthropy goal of the $1.5 billion hospitals project. The latest donation builds upon the transformative $125 million matching gift Feeney made to support the hospitals complex and its programs in 2009, the largest gift received toward the campaign.

The opening of the 289-bed hospital complex – which includes UCSF Benioff Children’s Hospital San Francisco, UCSF Betty Irene Moore Women’s Hospital, UCSF Bakar Cancer Hospital, and the UCSF Ron Conway Family Gateway Medical Building – was the culmination of more than 10 years of planning and construction. Strategically located adjacent to UCSF’s renowned Mission Bay biomedical research campus, the new medical center places UCSF physicians in close proximity to UCSF researchers and nearby bioscience companies who are working to understand and treat a range of diseases, from cancer to neurological disorders.

“It’s been thrilling to see the reactions of our patients and their families as they encounter the amazing care offered at our new UCSF Mission Bay hospitals,” said Mark Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “This world-class experience would never have been possible without the support of Chuck Feeney who, as the largest contributor to the project, helped us create the hospitals of our dreams. Every patient cured, every breakthrough discovered at Mission Bay, will be thanks in part to Chuck. His legacy is unparalleled.”

Neuroscience and aging
The gift also supports UCSF’s pre-eminent neuroscience enterprise, including its Sandler Neurosciences Center and neurology programs at Mission Bay.

The center, a five-story, 237,000-square-foot building that opened in 2012, brings under one roof several of the world’s leading clinical and basic research programs in a collaborative environment. UCSF’s neurology and aging efforts are focused on finding new diagnostics, treatments, and cures for a number of intractable disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, migraine, epilepsy and autism. The programs also seek to integrate neuroscience and clinical disciplines with public health initiatives in order to disseminate and implement novel findings from research centers of excellence, as well as conduct community outreach to raise awareness about the diseases of aging.

“Chuck Feeney has taken a keen interest in the challenges of aging,” said Hawgood. “In turn, he has recognized UCSF’s extraordinary talent in the neurosciences, among both basic researchers and those who translate research into clinical care and public policy. This gift will build on UCSF’s strengths while encouraging strong partnerships at other research institutions around the world where Chuck also has made important investments.”

Student scholarships and housing
Even with its extraordinary academic firepower, UCSF has extremely limited funds to support scholarships for professional students in its schools of dentistry, medicine, nursing and pharmacy. Part of the gift will provide scholarship support, bolstering UCSF’s ability to recruit the best and brightest students, regardless of their financial circumstances.

Recent decreases in state funding led to tuition increases and higher demand for scholarships. This, in turn, increased student debt. Combined with Bay Area housing prices that are among the highest in the nation – from 2011 to 2013, the median rent increased by 24 percent – the prospect of overwhelming debt can deter economically vulnerable students as well as those from middle-class backgrounds from attending UCSF. By minimizing debt upon graduation, the scholarships will help ensure that a UCSF education remains in reach for students from underserved populations, as well as for those students who choose to become health care leaders in underserved communities.

“Scholarships give our students the gift of freedom: to make career choices based on purpose and passion, rather than the price of education; to use time to study, explore science, and volunteer to help others, rather than working to make ends meet; and to succeed because someone who never met them saw enough potential to invest in their dreams,” said Catherine Lucey, M.D., vice dean for education at UCSF’s School of Medicine. “These scholarships catalyze our schools’ ability to find, recruit, educate and nurture the workforce our country needs: talented professionals whose life experiences enable them to provide compassionate care to today’s diverse communities and advance science to improve the health of future communities.”

Faculty recruitment
The donation also will help UCSF recruit the next generation of promising faculty in an increasingly competitive marketplace.

New funding will attract junior faculty – who frequently find it more challenging to secure research funding – and provide initial startup funds as they launch their research careers and clinical practices. With decreasing federal support for young investigators, this gift will underwrite a new generation of brilliant upcoming faculty.

“While Chuck’s unprecedented generosity has been focused primarily on Mission Bay, he understands the power of the entire UCSF enterprise, from our cutting-edge stem cell research at Parnassus to our innovative cancer programs at Mount Zion,” Hawgood said. “We’re thrilled that Chuck has inspired other philanthropists to join him in creating one of the most vibrant life science communities in the world, where progress will ripple far beyond Mission Bay and the campus for generations to come.”

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Newly named Shiley Eye Institute projects bigger, bolder vision


UC San Diego emerges as regional hub for eye care, research, education, community service.

By Scott LaFee, UC San Diego

Reflecting its emergence as a regional hub for unparalleled clinical care, research, education and community service, the UC San Diego Shiley Eye Center has been renamed the UC San Diego Donald P. and Darlene V. Shiley Eye Institute, encompassing the Shiley Eye Center, the Anne F. and Abraham Ratner Children’s Eye Center, the Hamilton Glaucoma Center and the Joan and Irwin Jacobs Retina Center.

“The new name more accurately captures the fullness of the work being done at Shiley,” said Pradeep Khosla, chancellor of the University of California, San Diego. “The institute and Department of Ophthalmology, working hand-in-hand with the School of Medicine and other programs across campus, will leverage every possible tool and expertise, from genetics, bioengineering and pharmacy to pathology, neurosciences and stem cell research, to improve the treatment of eye diseases, find new cures and hasten the day when blindness is entirely preventable.”

Robert N. Weinreb, M.D., chair and Distinguished Professor of Ophthalmology and director of the Shiley Eye Institute, said the institute’s emphasis would remain focused upon achieving excellence – in the clinic and in the laboratory. “The department will continue to partner with groups in San Diego and throughout the world to translate research into better vision. We also will continue to nurture and grow our programs for community outreach and continuing medical education for physicians.”

The Shiley Eye Institute, part of UC San Diego Health System, employs 227 faculty and staff. In 2014, there were 106,470 patient visits and 4,862 surgeries. The Shiley Eye Mobile conducted 12,238 vision screenings, 2,011 eye exams, dispensed 1,288 pairs of free glasses and referred numerous children for more serious follow up care.

“It was always very clear that my late husband had a special place in his heart for the Shiley Eye Center,” said Darlene Shiley, a staunch supporter of the center since it was founded in 1991. “I will never forget how moved he was by (former director and department chair) Dr. Stuart Brown’s description of the work being done and the work that still needed to be addressed.  And now, decades later, Dr. Robert Weinreb is focused on patient-centric care excellence and leading the Shiley into new areas of eye research and treatment.  Successful past, bright future – how lucky we all are to have such dedicated physicians, researchers, staff and eager volunteers.”

Doctors and researchers at Shiley have made measurable progress in addressing some of the primary diseases of vision, such as macular degeneration, glaucoma, diabetic retinopathy, corneal and retinal disorders and cataracts. Patients range in age from 1 day to 105 years old.

Shiley physician-scientists are actively involved in diverse research and scholarship, from defining all of the cell types and synaptic connections that link the eyes to the brain, part of President Obama’s BRAIN Initiative, developing biosensors and an artificial retina, even exploring the possibilities of whole eye transplants. In 2013, Shiley Eye Center was ranked fourth in the nation in funding to departments of ophthalmology from the National Institutes of Health. Last year, the Department of Ophthalmology was awarded a prestigious K12 grant from the NIH to train clinician scientists, one of just a few such grants in the country. In 2014, Shiley researchers published 205 peer-reviewed studies and conducted 29 clinical trials.

The institute will include the new Richard C. Atkinson Laboratory for Regenerative Ophthalmology, created last year with an anonymous $6.5 million gift from a grateful patient. The new lab will investigate cell replacement therapies, tissue engineering and other biomedical advances to reverse vision loss and blindness. Researchers will explore novel stem cell approaches and work closely with the Sanford Clinical Stem Cell Center at UC San Diego Health System, which was established in 2013.

A new Vision Research Center is in the early stages of planning along with the creation of a framework to fund the project. The center is envisioned to accelerate the translation of new research into treatments for patient with blinding ophthalmic diseases.

“The center is intended to help bridge the gap between laboratory and clinic by bringing together brilliant minds and diverse talents in a shared facility,” said Weinreb. “This integrated approach will speed the transformation of discoveries into clinical applications that can be tested through clinical trials.”

The new Shiley Eye Institute embraces the larger mission of UC San Diego, its schools and programs and the UC San Diego Health System, said David Brenner, M.D., vice chancellor of health sciences and dean of the School of Medicine. “Our goal is unprecedented collaboration across all disciplines, moving basic science to real-world applications as quickly and as effectively as possible and doing so in a way that truly improves patient care and lives. I think people will see that vision come to life in the institute.”

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UC Irvine first in Orange County to use remote heart failure monitoring system


Implanted CardioMEMS sensor helps reduce heart failure-related hospital readmissions.

Pranav Patel, UC Irvine

UC Irvine Health is the first medical center in Orange County to offer heart failure patients a wireless system that allows cardiologists to remotely monitor their pulmonary artery pressure and heart rate measurements.

Real-time access to this data enables doctors to proactively manage a patient’s condition, helping to reduce the rate of hospital readmission related to heart failure, the leading cause of hospitalization among adults 65 and older in the U.S., according to the American College of Cardiologists.

Heart failure refers to the progressive weakening of the heart muscle until it no longer pumps enough blood to meet the body’s needs. Advances in treatment allow more patients to survive hospitalization for heart failure, but more than 50 percent of them experience a new onset of symptoms and end up being readmitted within six months. Cardiologists hope the CardioMEMS Heart Failure System will help break this cycle.

Dr. Pranav Patel, chief of the UC Irvine Health Division of Cardiology, implanted the sensor in an 84-year-old male patient on Feb. 6.

“This technology will help change the way we manage heart failure patients,” said Patel. “Once the patient returns home, they must pay careful attention to changes in weight, ankle or abdominal swelling and shortness of breath. CardioMEMS monitors their heart rate and artery pressure daily, and transmits that information to a secure database at the hospital or clinic for review by a physician or a nurse. We can identify early warning signals before the patient feels any symptoms.”

The implantable sensor is about the size the size of a dime, with thin loops at each end, and is placed in the pulmonary artery during a right heart catheterization procedure. Once implanted, the patient cannot feel the sensor, and it does not interfere with other devices such as a pacemaker or defibrillator. The system wirelessly captures and transmits the patient’s data to a secure database for analysis.

CardioMEMS received FDA approval in May 2014 and is designed for use with patients who have been hospitalized the previous year with New York Heart Association Class III heart failure. The American Heart Association uses this classification system, which is based on how much a patient’s physical activity is limited by their heart condition.

“If the patient is experiencing rising pressure or any deterioration of their heart failure condition, we can immediately make changes to their medication, diet and daily activities,” Patel said. “Early detection is the key to preventing more serious complications, avoiding another emergency room visit or hospital stay, and enhancing the patient’s overall well-being.

The UC Irvine Health Heart Failure Program uses state-of-the-science equipment and technologies to identify the cause of heart failure, or cardiomyopathy. A multidisciplinary team then works with patients to stabilize their condition and develops a comprehensive treatment plan.

In each of the last four years, the program has received the American Heart Association’s Get With The Guidelines – Heart Failure Gold Plus Quality Achievement Award. The recognition signifies that UC Irvine Health has achieved the goal of treating heart failure patients according to prevention guidelines recommended by the American Heart Association/American College of Cardiology.

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Stein, Doheny eye institutes join forces


Affiliation expands UCLA faculty, adds new clinics to UCLA Health, improves patient access.

Doris and Jules Stein (Photo from Stein Eye Institute archives)

By Elaine Schmidt, UCLA

Two of the nation’s top eye institutes have united in an affiliation that will improve patients’ access to leading vision specialists.

UCLA’s Stein Eye Institute and the Doheny Eye Institute — both created by families whose legacies helped shape Los Angeles — have joined forces to offer the best in patient care, vision research and training for future eye specialists. The affiliation adds 14 clinicians and researchers from Doheny, formerly associated with the University of Southern California, to the ophthalmology faculty at the David Geffen School of Medicine at UCLA.

“The Stein–Doheny affiliation is a beautiful fit,” said Dr. Bartly Mondino, director of the Stein Eye Institute and chair of ophthalmology at the David Geffen School of Medicine at UCLA. “We share similar missions and have a long history of collaboration. This partnership expands UCLA’s footprint tremendously by providing patients with greater access to the top doctors in cornea, retina, glaucoma, neuroophthalmology and oculoplastics.”

As part of the agreement, Doheny’s clinics will join the UCLA Health network. Two Doheny Eye Center UCLA sites will expand community access to specialty care in newly renovated offices in Arcadia and Fountain Valley. A third clinic, in a new medical–surgical suite in Pasadena, will act as Doheny Eye Center UCLA’s primary hub.

Each organization will preserve its identity while combining clinical and teaching operations. Both institutes have earned international recognition for the quality of their patient care and research. U.S. News and World Report’s 2015 “Best Hospitals” survey ranked the combined Stein Eye and Doheny Eye institutes as the No. 5 center for ophthalmology based on feedback from specialists in the field.

“Since our establishment in 1947, the Doheny Eye Institute has worked to become the premier vision research and education eye institute in the world through the discovery of new knowledge, innovative eye-care therapies and the education of the leaders of ophthalmology and vision science,” said Ed Landry, chair of the Doheny Eye Institute board of directors. “UCLA and the Stein Eye Institute share our values and high standards for education, patient care and research. We expect that the combination of our two leading programs will result in even greater recognition and accomplishments.”

“We are honored to work with the Doheny Eye Institute to improve patient care throughout Southern California, while simultaneously extending the Stein Eye Institute’s research and educational outreach, which hold immense value for the nation and world,” said Dr. David Feinberg, president of the UCLA Health System, CEO of the UCLA Hospital System and associate vice chancellor of the Geffen School of Medicine. “We appreciate this rare and unique opportunity to strengthen relationships with our distinguished colleagues at Doheny, many of whom have long collaborated with us in serving the Los Angeles community.”

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MRI technique developed for nonalcoholic fatty liver disease in children


UC San Diego study makes strides toward noninvasive diagnostic for pediatric liver disease.

By Heather Buschman, UC San Diego

Between 5 and 8 million children in the United States have nonalcoholic fatty liver disease (NAFLD), yet most cases go undiagnosed. To help address this issue, researchers at UC San Diego School of Medicine have developed a new magnetic resonance imaging (MRI)-based technique to help clinicians and researchers better detect and evaluate NAFLD in children. The study is published today (Feb. 5) in Hepatology.

“Currently, diagnosis of NAFLD requires a liver biopsy, which is not always available or performed. This leads to both misdiagnosis and missed diagnoses, hampering patient care and progress in clinical research,” said Jeffrey B. Schwimmer, M.D., professor of clinical pediatrics at UC San Diego, director of the Fatty Liver Clinic at Rady Children’s Hospital-San Diego and the first author of the study. “Thus, a noninvasive method for diagnosing and/or evaluating NAFLD has the potential to impact millions of children.”

NAFLD is characterized by large droplets of fat in at least 5 percent of a child’s liver cells. Obesity and diabetes are risk factors for NAFLD. Doctors are concerned about NAFLD in children because it can lead to hepatitis, liver scarring, cirrhosis and liver cancer.

Traditionally, NAFLD is diagnosed by a gastroenterologist in consultation with a pathologist, who examines the patient’s biopsied liver tissue under a microscope. The presence and severity of liver fat is graded by the pathologist as none, mild, moderate or severe, based on the percentage of liver cells that contain fat droplets.

In an effort known as the MRI Rosetta Stone Project, Schwimmer and colleagues used a special MRI technique known as magnitude-based MRI, which was previously developed by researchers in the UC San Diego Liver Imaging Group, to estimate liver proton density fat fraction (PDFF), a biomarker of liver fat content.

“Existing techniques for measuring liver fat are dependent upon the individual scanner and the center at which the measurements were made, so they cannot be compared directly,” said Claude B. Sirlin, M.D., professor of radiology at UC San Diego and senior author of the study. “By comparison, PDFF is a standardized marker that is reproducible on different scanners and at different imaging centers. Thus, the results of the current study can be generalized to the broader population.”

In this study, the researchers compared the new MRI technique to the standard liver biopsy method of assessing fat in the liver. To do this, the team enrolled 174 children who were having liver biopsies for clinical care. For each patient, the team performed both MRI-estimated PDFF and compared the results to the standard pathology method of measuring fat on a liver biopsy.

The team found a strong correlation between the amount of liver fat as measured by the new MRI technique and the grade of liver fat determined by pathology. This is an important step towards being able to use this technology for patients. Notably, the correlation was influenced by both the patient’s gender and the amount of scar tissue in the liver. The correlation between the two techniques was strongest in females and in children with minimal scar tissue.

Depending on how the new MRI technology is used, it could correctly classify between 65 and 90 percent of children as having or not having fatty liver tissue.

“Advanced magnitude MRI can be used to estimate PDFF in children, which correlates well with standard analysis of liver biopsies,” Schwimmer said. “We are especially excited about the promise of the technology for following children with NAFLD over time. However, further refinements will be needed before this or any other MRI technique can be used to diagnose NAFLD in an individual child.”

Study co-authors include Michael S. Middleton, Cynthia Behling, Kimberly P. Newton, Hannah I. Awai, Melissa N. Paiz, Jessica Lam, Jonathan C. Hooker, Gavin Hamilton and John Fontanesi, all at UC San Diego.

This research was funded, in part, by the National Institutes of Health (grants UL1RR031980, DK088925-02S1 and R56-DK090350-01A1) and the National Science Foundation (grant 414916).

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Paramedics may be best first lineof defense in treating stroke patients


First-of-its-kind study, led by UCLA, offers hope for faster, more effective care.

By Kim Irwin, UCLA

A consortium led by UCLA physicians has found that paramedics can safely start providing people with medication in the first minutes after the onset of a stroke instead of waiting for them to receive treatment at a hospital.

Although the drug tested, magnesium sulfate, did not improve patient outcomes, the research points to a new method for treating stroke patients quickly.

For people who have suffered a stroke, immediate treatment is key — the more time that passes before the restoration of blood flow, the higher the likelihood that stroke victims will suffer irreversible brain damage.

The study findings indicate that paramedics can give intravenous medications to stroke patients within the “golden hour,” the window during which treatments are most likely to help patients survive and avoid debilitating, long-term neurological damage. That finding is a game-changer, said Dr. Jeffrey Saver, the study’s co-principal investigator and director of the UCLA Stroke Center.

“The trial succeeded in its goal of devising a means to deliver promising drugs to stroke patients in the first minutes, when there’s the greatest amount of brain to save. We have opened a new therapeutic window that is now being used to test other compounds and deliver clot-busting drugs to patients in the field,” said Saver, who also is a professor of neurology at the David Geffen School of Medicine at UCLA. “Stroke is a true emergency condition. Time lost is brain lost — for every minute that goes by without restoration of blood flow, 2 million nerve cells are lost.”

The study appears in today’s (Feb. 5) issue of the New England Journal of Medicine.

The phase 3 Field Administration of Stroke Therapy–Magnesium (FAST–MAG) clinical trial involved collaboration among 315 ambulances, 40 emergency medical service agencies, 60 receiving hospitals, 715 emergency physicians, 210 neurologists, 26 neurosurgeons and 2,988 paramedics in Los Angeles and Orange counties. In the study, half of the 1,700 patients had the study drug administered within 45 minutes, while 74 percent were treated within the golden hour.

“This study involved an unprecedented cooperative effort of paramedics in the field and emergency physicians serving as investigators,” said Dr. Sidney Starkman, co-principal investigator and co-director of the UCLA Stroke Center.

“Through this study we were able to instill permanently in everyone’s mind the idea that ‘time is brain.’ We believe this represents a paradigm shift in the treatment of stroke and potentially numerous other neurological conditions,” said Starkman, who also is professor of emergency medicine and neurology at the Geffen School. “We demonstrated that paramedics not only are eager to provide the best possible patient care, but also are capable of being invaluable partners in an intense, time-dependent clinical trial.”

Today, the only ways to treat strokes caused by blocked blood vessels are to reopen the arteries with tissue plasminogen activator, a clot-busting drug, or to use catheters to remove the clot. But, in general, neither can be done until the patient arrives at the hospital and undergoes a CT scan to rule out bleeding in the brain. Additional treatments can only be offered after that, by which time substantial brain injury may already have occurred.

The FAST–MAG trial used magnesium because in animal studies it dilated blood vessels and increased blood flow in the brain. Magnesium also countered the damaging calcium buildup that occurs when cells are deprived of oxygen. It had been already approved for use in humans, it had a good safety profile and paramedics were familiar with it.

“Now we are tasked with finding a different agent or combination of agents that can improve stroke outcomes within that golden hour,” Saver said. “The ambulance treatment platform can be used around the world to test promising agents.”

Dr. Bill Koenig, medical director of the Los Angeles County Emergency Medical Service Agency, worked closely with Saver and Starkman on the FAST-MAG study.

“To assist paramedic recognition of stroke victims, the nationally recognized Los Angeles Pre-hospital Stroke Screen was developed,” Koenig said. “FAST-MAG also served as an impetus to create the Los Angeles County System of Stroke Hospitals, which every year treats over 10,000 stroke victims. When the day comes that a medication can successfully treat stroke in its early stages, this novel system in Los Angeles will be well positioned to immediately apply the treatment to our patients. I am confident that with the dedicated investigators, along with a finely tuned EMS system, that discovery will be sooner rather than later.”

Dr. Walter Koroshetz, acting director of the National Institute of Neurological Disorders and Stroke, said this study shows that it is possible to get treatments to stroke patients even before they arrive at a hospital.

“Because a blocked blood vessel causes brain damage over minutes to hours, this pre-hospital approach to treatment is sure to be adopted and refined in clinical research studies,” Koroshetz said. “Ultra-early brain salvage in stroke patients will someday surely reduce the tremendous burden of disability and death due to stroke.”

Saver said clinical trials currently being conducted in the U.S., Canada and England are testing new compounds using the early treatment infrastructure created by the FAST–MAG study.

Stroke is the fifth leading cause of death in the U.S. and is a major cause of adult disability. About 800,000 people in the U.S. have strokes each year, and one person dies from a stroke every four minutes, on average.

The study was funded by the National Institute of Neurological Disorders and Stroke at the National Institutes of Health.

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