2006
UVa Health System Specialities Honored By U.S. News & World Report
Fifty UVa doctors top in their field
UVa Team Invited to Prestigious Real-Time Cardiovascular Demonstration
In Speed and Quality, UVa's Emergency Cardiac Care Outpaces Goals of New Lifesaving Initiative
UVa Researchers Demonstrate Value for the First Genetic Test for High Blood Pressure and Sensitivity to Salt
Charlottesville, Va., Feb. 22, 2006 -- Researchers led by UVa Health System pathologist Robin Felder, Ph.D., have demonstrated that looking for several variations of genes that control blood pressure can predict the risk for high blood pressure caused by high levels of salt. Once it is fully developed, this effective diagnostic test will be the first of its kind, says Dr. Felder, whose work will be published in the Feb. 23 issue of the journal Clinical Chemistry. When a subject had three or more variations in these genes, the new genetic test correctly predicted risk for salt-induced high blood pressure in 94 percent of cases. Health is adversely affected by high salt intake in up to half of Americans.
In a separate finding, two genes at most were necessary to predict with a 78 percent accuracy which people with high blood pressure (hypertension) had a low renin levels, a substance that is currently measured to help establish the diagnosis of salt (sodium chloride) sensitivity. Thus, the researchers found different genetic bases for low renin in the blood and for salt sensitivity. Salt sensitivity is defined as a greater than 10 percent increase in blood pressure following a high-salt meal.
The researchers also determined that the increase in subjects' blood pressure and inability to eliminate excess salt from their systems was directly related to how many variations were found in the participants' salt regulating genes, a phenomenon called a gene dosing effect. The more gene variants, the bigger the health problems.
"A genetic test for high blood pressure and/or salt sensitivity will be instrumental in motivating Americans to adopt heart healthy lifestyles and help to improve their overall health and quality of life," Dr. Felder said. "In addition, because the treatment of hypertension costs the U.S. health system more than $13 billion per year, this test could result in significant cost savings as well."
"Diagnostic genetic tests with this high level of predictive value for hypertension simply don't exist at this time," said Dr. Hironobu Sanada, M.D., Ph.D., Fukushima Medical University , who led the clinical trials of the diagnostic genetic panel with Japanese subjects. Dr. Sanada is a former UVa pathology fellow who studied and worked with Dr. Felder.
Performing extended studies among people with different ethnic origins, the research group hopes to demonstrate the effectiveness of this test in particular among African Americans, who have a higher incidence of salt-sensitive hypertension than other races. While 98 million Americans suffer from either high blood pressure or sensitivity to dietary salt (or both), until now no genetic test had been created that could predict who may develop these diseases. Salt sensitivity, with or without high blood pressure, has the same deleterious consequences as high blood pressure. Left undiagnosed, high blood pressure and/or salt sensitivity can lead to devastating consequences such as stroke, blindness, heart attack and kidney failure.
The studies were conducted by a team of collaborators including Pedro A. Jose, M.D., Ph.D., at Georgetown University School of Medicine (Washington D.C. ), Hironobu Sanada, M.D., Ph.D., Fukushima Medical University (Fukushima , Japan ), and Scott Williams, Ph.D., Vanderbilt University (Nashville , TN ). Funding for these studies was provided in part by a $10.2 million grant from the National Heart, Lung and Blood Institute.
The grant will allow this group of collaborating investigators, including Dr. Robert M. Carey, M.D. (University of Virginia ) to extend their studies on the genetic bases for high blood pressure and salt sensitivity and their mechanisms in subjects from many different ethnic backgrounds, which could influence the predictive value of the diagnostic test. The team's work will examine the normal mechanisms associated with sodium (salt) management by the kidney and how the failure of these mechanisms contributes to high blood pressure.
Dr. Carey will recruit an additional 3,000 volunteers who will receive genetic screens to identify gene variants that contribute to elevated blood pressure. Dr. Jose's research will determine how dopamine receptors and angiotensin II receptors regulate each other. The information from these studies will provide new insights into how hypertension develops, how it can be tested and how it can be treated.
Right now, no definitive diagnostic test exists for salt sensitivity, except for a protocol in which diet is controlled rigorously over a two-week period. "Through these grant funds, we wish to stimulate broader research in the area of cardiovascular disease, hypertension and salt sensitivity," said Dr. Felder. "It's important because cardiovascular diseases, including stroke, account for more disability and death than the next top five causes combined."
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UVa Health System Specialities Honored By U.S. News & World Report
CHARLOTTESVILLE, Va, July 10, 2006 - Five medical specialties at the University of Virginia Health System are listed in the 17th annual survey of "America's Best Hospitals" from U.S. News & World Report. The rankings appear in the magazine's July 17 issue and can be found online at http://www.usnews.com/usnews/home.htm.
UVa specialties ranked in this year's guide from U.S News are: endocrinology (6); gynecology (25); ear, nose and throat (26); cancer (31); and heart (49). UVa's endocrinology (hormonal disorders) program has consistently ranked 5th or 6th in the nation by U.S. News since the 1990s, while the UVa heart program makes a return to the list this year.
"It is gratifying to be named once again as one of America's best hospitals in each of these specialties, which reflects the excellent care we provide to our patients," said R. Edward Howell, vice president and chief executive officer of the UVa Medical Center. "As a premier medical research center in Virginia, we are committed to finding new treatments, tests and technologies that benefit our patients from the Commonwealth and beyond."
According to U.S. News, out of 5,189 hospitals studied, only 3 percent, 176 in all, are ranked in one or more of the 16 specialties in this year's "America's Best Hospitals." Ranked hospitals tend to offer more advanced treatments, use new research in patient care and conduct more research that gives critically ill patients better options in their treatment.
Most ranked institutions are referral centers, says the U.S. News website, where the sickest patients are sent for advanced care. Such hospitals follow, and pioneer, new treatment guidelines. They also conduct bench-to-bedside research and exploit the latest advances in imaging, surgical devices, and other technologies.
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FIFTY UVA DOCTORS TOP IN THEIR FIELDS
CHARLOTTESVILLE, Va., Oct. 24, 2006 - This year, the number of doctors from the University of Virginia Health System selected for inclusion in the annual guide America's Top DoctorsTM (sixth edition) totaled 50. Published annually by Castle Connolly Medical Ltd., the book recognizes physicians who are considered among the top one percent in the nation in their medical specialties and sub-specialties.
To be selected for inclusion in the book, doctors must be nominated by their peer physicians. The nomination process involves tens of thousands of board-certified physicians across the nation, as well as presidents, vice presidents of medical affairs [or an equivalent position] and chiefs of service in eight medical specialties from more than 1,000 hospitals across the United States. These doctors receive letters inviting them to go online to a special website to enter nominations of other physicians whom they feel are clinically outstanding, on the national and regional level. The Castle Connolly research staff also conducts extensive interviews by telephone with leading physicians, specialists, chiefs of service and healthcare executives to strengthen the information-gathering processes.
The book is designed to help people find the most outstanding specialists to meet their medical needs, be they locally, regionally or nationally available.
The U.Va. doctors designated as America's Top Doctors by specialty in 2006 are:
- Cardiac Electrophysiology - Dr. John DiMarco
- Cardiology - Dr. George Beller
- Colon and Rectal Surgery - Dr. Eugene Foley
- Endocrinology, Diabetes and Metabolism - Dr. Eugene Barrett, Dr. Alan Dalkin, Dr. John Marshall, Dr. Mary Lee Vance
- Gastroenterology - Dr. Fabio Cominelli, Dr. James K. Roche
- Geriatric Medicine - Dr. Diane Gail Snustad
- Geriatric Psychiatry - Dr. Suzanne Holroyd
- Gynecologic Oncology - Dr. Peyton T. Taylor, Jr.
- Medical Oncology - Dr. William W. Grosh, Dr. Maureen Ross, Dr. Geoffrey Weiss, Dr. Michael Williams
- Infectious Diseases - Dr. Richard Guerrant, Dr. Richard Pearson, Dr. Michael Frank Rein, Dr. William Michael Scheld
- Internal Medicine - Dr. Eugene Charles Corbett, Jr.
- Neonatal Perinatal Medicine - Dr. Robert John Boyle, Dr. John Kattwinkel
- Nephrology - Dr. Warren Kline Bolton, Dr. Mark Okusa
- Neurological Surgery - Dr. Edward Laws, Dr. Chris Shaffrey
- Neurology - Dr. Elliott Clark Haley, Jr., Dr. George Frederick Wooten
- Orthopaedic Surgery - Dr. Cato Laurencin
- Otolaryngology - Dr. Paul Levine
- Pathology - Dr. Stacey Mills
- Pediatric Otolaryngology - Dr. Charles Gross, Dr. Robert A. Jahrsdoerfer
- Pediatric Surgery - Dr. Bradley Rodgers
- Physical Medicine & Rehabilitation - Dr. D. Casey Kerrigan; Dr. Paul Diamond
- Plastic Surgery - Dr. Raymond Morgan
- Pulmonary Disease - Dr. Steven Michael Koenig
- Radiation Oncology - Dr. Tyvin Andrew Rich
- Radiology - Dr. Michael D. Dake, Dr. Mary E. Jensen
- Surgery - Dr. John B. Hanks, Dr. Bruce Schirmer
- Thoracic Surgery - Dr. Thomas M. Daniel, Dr. David R. Jones, Dr. Irving L. Kron
- Urology - Dr. Stuart S. Howards, Dr. William D. Steers
- Vascular Surgery - Dr. Kenneth J. Cherry Jr.
Additionally, UVa has 19 physicians on faculty who made the listing for a sister publication earlier this year, America's Top Doctors for Cancer, second edition:
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Dr. Reid Adams |
Surgical Oncology |
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Dr. Thomas M. Daniel |
Thoracic Surgery |
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Dr. Eugene F. Foley |
General Surgery |
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Dr. William W. Grosh |
Hematology/Oncology |
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Dr. John B. Hanks |
General Surgery |
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Dr. James Larner |
Radiation Oncology |
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Dr. Edward R. Laws, Jr. |
Neurological Surgery |
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Dr. Paul A. Levine |
Otolaryngology-Head and Neck Surgery |
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Dr. Stacey E. Mills |
Pathology |
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Dr. Tyvin Andrew Rich |
Radiation Oncology |
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Dr. Maureen Ross |
Hematology/Oncology |
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Dr. David Schiff |
Neurology |
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Dr. Mark E Shaffrey |
Neurological Surgery |
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Dr. Craig Slingluff |
Surgical Oncology |
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Dr. Peyton T. Taylor, Jr. |
Gynecologic Oncology |
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Dr. Daniel Theodorescu |
Urology |
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Dr. Mary Lee Vance |
Endocrinology and Metabolism |
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Dr. Geoffrey R. Weiss |
Hematology/Oncology |
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Dr. Michael Williams |
Hematology/Oncology |
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UVa Team Invited to Prestigious Real-Time Cardiovascular Demonstration
CHARLOTTESVILLE, Va., Oct. 25, 2006 - Teams of UVa radiologists and surgeons under the leadership of Radiology Chair Dr. Michael Dake participated in a worldwide, real-time video broadcast of a cardiovascular surgery case on Oct. 24. This less-invasive (endovascular) surgery was performed as part of the TCT 2006 Conference (Transcatheter Cardiovascular Therapeutics), and 12 countries participated.
At the time of surgery, 3,200 specialists gathered at the TCT main arena in Washington, D.C., and watched the surgery as it unfolded in Charlottesville, and UVa experts treated a patient with a thoracic (chest area) aortic aneurysm. This operation was also beamed by satellite transmission to thousands of doctors worldwide as a learning experience.
"It was prestigious to be one of the few teams invited to perform a live surgical case that was broadcast in the main arena," Dr. Dake says. "This is an unparalleled opportunity for doctors to learn and share in their specialty."
This year, only 24 of the more than 100 live cases were beamed into the main arena of physicians. The UVa team participated in other surgical live cases during the TCT meeting. Other countries participating in the worldwide case transmission included Germany, France, Israel, China, England, Australia, Canada, Brazil, Italy, Korea and the Netherlands.
To learn more about this surgery, please contact Eric Huffman at 434-982-6299. DVD video footage and photographs of the procedure as it was beamed worldwide are available.
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In Speed and Quality, UVa's Emergency Cardiac Care Outpaces Goals of New Lifesaving Initiative
CHARLOTTESVILLE, VA, November 17, 2006 - Headlines and news stories across the nation in recent days have announced the launch of a major national initiative to improve the speed and quality of lifesaving care for heart attack victims.
At the University of Virginia Health System, many of the rapid measures recommended by the new initiative are already in place and producing results achieved by only a few hospitals nationwide.
Called, "Door to Balloon (D2B): An Alliance for Quality," the national initiative aims to boost patient survival rates by accelerating treatment of a common type of heart attack. In medical terminology, these heart attacks are described as ST-elevation myocardial infarction (STEMI). One of the most effective treatments for STEMI is angioplasty, which uses a small balloon to open up blocked arteries.
Door-to-balloon time refers to the interval between a patient's arrival at a hospital and the insertion of an angioplasty balloon into their artery. Current guidelines call for D2B to be accomplished within 90 minutes, an interval in which STEMI patients have the best outcomes.
Propelling the launch of D2B is data showing that, nationwide, less than a third of STEMI patients receive treatment within 90 minutes and that even a 30-minute delay increases their mortality risk by 42%. The program aims to save lives by bringing hospitals performing emergency angioplasty into compliance with national guidelines.
At UVa, D2B care is already outpacing the 90-minute mark and fast approaching the hospital's own goal of 60 minutes or less. Since September, 100% of STEMI patients have received emergency angioplasty in less than 70 minutes after their arrival; the majority of them have been treated in well under 60 minutes.
"We updated our treatment procedures five years ago and continuously improve them. For the STEMI patients we treat each month, this means top-notch care and extraordinary results," said Dr. William J. Brady, vice chair of the Department of Emergency Medicine. "Our continuum of care starts on the street with EMS personnel and proceeds through our Chest Pain Center in the Emergency Room to the Catheterization Lab where angioplasty is performed and on to the Cardiac Care Unit (CCU)."
Three factors have been vital to UVa's responsiveness. First is the pre-hospital care that patients receive while traveling in ambulances or the Pegasus helicopter.
"Our rapid response begins with the review of 12-lead electrocardiograms (ECG's) by physicians while patients are en route to the hospital," noted Dr. Chris A. Ghaemmaghami, director of UVa's Chest Pain Center.
Next is the Chest Pain Center, which earlier this year became the first in the area and the fifth statewide to earn accreditation from the Society of Chest Pain Centers. In qualifying for this designation, the center met stringent patient management criteria for early recognition and treatment of heart attacks and other acute cardiovascular emergencies.
The third factor is the STEMI Alert Team, which Ghaemmaghami said operates much like a Trauma Response Team. "This multidisciplinary group of doctors and nurses is in action within a half hour of being paged," he explained. "When STEMI patients arrive at the hospital, they are surrounded by a medical team that ensures they receive the quickest and best care possible, from the emergency room to the Cath Lab and then onto the CCU for recovery."
As part of its continuum of care for heart attack patients, UVa also offers the area's only cardiac surgery program and cutting edge treatments through clinical trials. Continuous education keeps physicians and nurses updated on rapid assessment and treatment procedures for emergency cardiac patients.
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