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Protein Key to Nerve Health Hitches a Ride on Brain’s Garbage Truck

Thursday, March 9, 2017

astrocytes and neuronsA new study shows that the brain’s waste removal system serves as both trash collector and delivery service, providing neurons with a protein important to maintaining cognitive function while simultaneously cleaning brain tissue. The research may help explain why different genetic varieties of the protein, called apolipoprotein E (apoE), can indicate risk for Alzheimer’s disease or promote longevity.

The study was led by Rashid Deane, B.Sc., Ph.D., a research professor in the University of Rochester Medical Center Department of Neurosurgery and member of the Center for Translational Neuromedicine, and appears in the journal Molecular Neurodegeneration.

ApoE is responsible for delivering cholesterol to nerve cells in the brain and plays a key role in synaptic plasticity, the process by which neurons build new connections in order to learn and store memories.

Read More: Protein Key to Nerve Health Hitches a Ride on Brain’s Garbage Truck

Protein Key to Nerve Health Hitches a Ride on Brain’s Garbage Truck

Wednesday, March 8, 2017

A new study shows that the brain’s waste removal system serves as both trash collector and delivery service, providing neurons with a protein important to maintaining cognitive function while simultaneously cleaning brain tissue. The research may help explain why different genetic varieties of the protein, called apolipoprotein E (apoE), can indicate risk for Alzheimer’s disease or promote longevity.

The study was led by Rashid Deane, B.Sc., Ph.D., a research professor in the University of Rochester Medical Center Department of Neurosurgery and member of the Center for Translational Neuromedicine, and appears in the journal Molecular Neurodegeneration.

Read More: Protein Key to Nerve Health Hitches a Ride on Brain’s Garbage Truck

Study: Home Care Improves Stroke Outcomes

Thursday, March 2, 2017

Photo of Strong Memoroial Hospital ED

Stroke patients who are paired with caregivers that help them transition back to their homes are significantly less likely to be readmitted to the hospital. The results of the pilot study, which showed a 39 percent reduction in the readmission rates of stroke patients at Strong Memorial Hospital, were presented last week at the International Stroke Conference in Texas.

The study was authored by Ann M. Leonhardt Caprio, M.S., R.N., A.N.P. and Curtis G. Benesch, M.D., M.P.H. with the UR Medicine Comprehensive Stroke Center, and Denise Burgen, M.B.A., M.S.N., F.N.P, R.N. with UR Medicine Home Care.

The study focused on one of the measures used by the Centers for Medicare and Medicaid Services to determine quality of stroke care – whether or not a patient is readmitted to the hospital within 30 days of being discharged after suffering a stroke.

Read More: Study: Home Care Improves Stroke Outcomes

Schor to Receive Child Neurology Society's Highest Honor

Tuesday, February 21, 2017

Photo of Nina Schor

Nina Schor, M.D., Ph.D., William H. Eilinger Chair of Pediatrics and the pediatrician-in-chief at UR Medicine’s Golisano Children’s Hospital, has been named the recipient of the Child Neurology Society’s 2017 Hower Award, the organization’s highest honor.

The award is given annually to a child neurologist for being an outstanding teacher, scholar, and for making high levels of contributions to the field and to the Child Neurology Society. Schor, who has spent much of her career researching neuroblastoma, one of the most common childhood cancers, will be recognized at the society’s annual meeting in October, in Kansas City, Mo. She will also have the honor of giving the annual Hower lecture.

“I am so honored and excited to accept this award and present the associated lecture to an audience comprised of my colleagues, friends, mentors, and trainees,” said Schor.

The Child Neurology Society is the preeminent non-profit professional association of pediatric neurologists in the United States, Canada, and worldwide. Schor, the University of Rochester Medical Center’s seventh Chair of the Department of Pediatrics, joined the university in 2006.

Read More: Schor to Receive Child Neurology Society's Highest Honor

Faculty Reflect on SMH Stroke Center Highlighted in Super Bowl Ad

Wednesday, February 1, 2017

A new ad that will premiere during the Super Bowl focuses on Strong Memorial Hospital’s Comprehensive Stroke Center. You can watch it here. We asked neurologist Curtis Benesch, M.D., M.P.H., and neurosurgeon Tarun Bhalla, M.D., Ph.D., about UR Medicine’s stroke care and what is being done to improve access for patients across the region.

What does SMH’s designation by the Joint Commission and American Heart Association/American Stroke Association as a Comprehensive Stroke Center mean?

Benesch: Designation as a Comprehensive Stroke Center indicates that our center either meets or exceeds the highest standards of care required to provide timely and comprehensive care to patients with complex cerebrovascular disease. Our site has undergone rigorous site visits and annual reviews by the Joint Commission to ensure that we satisfy all the requirements for this designation, including metrics for primary stroke care, surgical stroke care, endovascular care, critical care, longitudinal outpatient care, research, education and outreach.

How does this designation differentiate the hospital from other stroke centers?

Bhalla: All Comprehensive Stroke Centers must provide neurosurgical care, endovascular care, and neuro-critical care. These efforts are enabled in part by a well-established interdisciplinary infrastructure of exemplary stroke care (EMS, emergency medicine, nursing, therapy, and rehabilitation). Although other sites in the region may provide some of these aspects of care, UR Medicine is the only certified Comprehensive Stroke Center in Rochester, reflecting our willingness to submit to the scrutiny of external review to ensure we meet those high standards. It is not just a label but rather a public affirmation of the breadth and depth of a large multidisciplinary team of providers working together.

What is being done to extend stroke care across the health system? For example, if you are a stroke patient and you arrive at a regional hospital supported by UR Medicine, what does that mean for the care you receive?

Benesch: We support all of our regional partners with immediate availability of consultations with experts in Cerebrovascular Neurosurgery, Stroke Neurology, and Neurocritical care. These experts can help in acute treatment decisions and, with our transfer center, can facilitate transfer of patients to Strong Memorial Hospital as needed. Furthermore, we have developed a coverage model to provide 24/7 telestroke consultation to hospitals across the region in an effort to enhance acute stroke care.

Providing timely, appropriate, and comprehensive care for stroke patients requires a high level of coordination and collaboration among caregivers. What is necessary to facilitate communication, coordination, and continuity of care across the team?

Bhalla: First and foremost, the team has to believe in the concept that the more of a difference that we can make up front, the better a stroke patient will fare in the long run. The care they receive from the first 911 call to when they arrive at the hospital is only the beginning of a journey that continues through operating room, neurocritical care, and rehabilitation and is one that will determine how much function a stroke victim will ultimately recover. We all play a part, but everyone must share the same vision. Internally, it means that all the groups that represent the continuum of care must continually focus on ways to improve communication and coordination. But this also requires building awareness and education within the community. People need know how to identify the signs of stroke and EMS providers need to know what to do and where to take patients.

What does the future hold for stroke care?

Bhalla: We are committed to continuing to find creative ways to deliver the highest level of stoke care to patients where and when they need it. This includes working with community providers and partnering with EMS to leverage the resources of our Comprehensive Stroke Center to diagnose and potentially begin treatment for stroke patients even before they reach the hospital.

URMC Drug Extends Effectiveness of HIV Therapy

Monday, January 30, 2017

Major Step toward Longer-Lasting HIV Treatment

Image of hand stating Stop HIV

A drug developed at the University of Rochester Medical Center extends the effectiveness of multiple HIV therapies by unleashing a cell’s own protective machinery on the virus. The finding, published today in the Journal of Clinical Investigation, is an important step toward the creation of long-acting HIV drugs that could be administered once or twice per year, in contrast to current HIV treatments that must be taken daily.

The drug, called URMC-099, was developed in the laboratory of UR scientist Harris A. (“Handy”) Gelbard, M.D., Ph.D. When combined with “nanoformulated” versions of two commonly used anti-HIV drugs (also called antiretroviral drugs), URMC-099 lifts the brakes on a process called autophagy.

Normally, autophagy allows cells to get rid of intracellular “trash,” including invading viruses. In HIV infection, the virus prevents cells from turning on autophagy; one of the many tricks it uses to survive. When the brake on autophagy is lifted, cells are able to digest any virus that remains after treatment with antiretroviral therapy, leaving cells free of virus for extended periods of time.

Photo of Dr. Gelbard

Harris A. (“Handy”) Gelbard, M.D., Ph.D.

“This study shows that URMC-099 has the potential to reduce the frequency of HIV therapy, which would eliminate the burden of daily treatment, greatly increase compliance and help people better manage the disease,” said Gelbard, professor and director of UR’s Center for Neural Development and Disease, who has studied HIV/AIDS for the past 25 years. The finding builds on previous research that Gelbard conducted with Howard E. Gendelman, M.D., professor and chair of the Department of Pharmacology/Experimental Neuroscience at the University of Nebraska Medical Center.

Read More: URMC Drug Extends Effectiveness of HIV Therapy

The House Call of the Digital Age: Ray Dorsey to Lead URMFG’s Telemedicine Efforts

Thursday, January 19, 2017

Ray Dorsey

Neither telemedicine’s increasing prominence nor URMFG’s growing commitment to it comes as a surprise to Ray Dorsey, M.D.

After all, he, like many other URMC faculty members, has spent the last decade building expertise in the field. He knows its potential, believes in its future, and is ready to help us capitalize on existing programs to ensure our group practice is embracing this technology as it increasingly transforms the national health care landscape.

And now, he will be applying his knowledge and skills as URMFG’s Medical Director of Telemedicine.

“This appointment reflects our commitment to new technologies and care modalities, as well as to faculty leadership,” said Michael F. Rotondo, M.D., F.A.C.S., CEO of URMFG. “Ray and many of his colleagues have long been on telemedicine’s cutting edge. His new role will provide a focal point for those efforts and help us further define our telemedicine strategy, leading to better access and increased convenience for our patients, and to an improved experience for providers.”

UR Medicine is not actively pursuing a retail telemedicine strategythat is, providers virtually caring for consumers through a website such as MD Live or Doc-on-Demandfor its primary care network, Rotondo noted. However, it does want to offer telemedicine visits for existing patients and ensure access to specialists. Like other URMC faculty, Dorsey does exactly that, providing digital Parkinson’s care to patients worldwide—a knowledge base he can now put to work across our organization.

“For patients, it can be incredible,” said Dorsey, director of the Center for Human Experimental Therapeautics and professor of Neurology. “They love the fact that a doctor is coming to them. It’s the house call of the digital age. In a traditional visit, we the healthy ask the sick to come to us on our terms, whereas telemedicine allows us to connect with the sick on their terms.”

Benefits for Patients – and Providers, Too

The impetus to develop our telemedicine presence comes from many sources, including national trends. Some experts predict that fully 25 percent of patient care will be delivered digitally by 2020. Meanwhile, reimbursement changes are likely to hasten telemedicine’s growth and make it more attractive to providers.

But Dorsey articulates the main reason behind our efforts: Telemedicine is all about the patient.

It can bring our expert care to rural areas where specialists are scarce. It can meet the growing demand for convenient care, eliminating long drives or even allowing patients to see their doctors from home. And it can enhance the doctor-patient relationship by allowing providers to see patients in their own environments.

That means telemedicine serves many of our strategic goals, from becoming the local health system of choice to improving access to care.

But telemedicine also brings concrete benefits to providers, and to our health system as a whole. The easy access to care that it facilitates will help us as reimbursement models shift toward outcome-based payments and population health. Digital visits can cut down on drive time for providers, as they did for Imran Chaudhary, M.D., assistant professor of clinical medicine. He exchanged his once-a-week, hour-and-a-half trip to Jones Memorial Hospital in Wellsville for monthly telemedicine visits, during which he listens to patients’ hearts remotely.

Dorsey himself became involved in telemedicine when a nursing home in New Hartford asked him and another URMC doctor to help treat 50 residents with Parkinson’s who would find it difficult or impossible to travel for specialty care. The programand Dorsey’s interestgrew from there.

“Our vision is to enable any New Yorker to receive care from UR Medicine,” he said. “We’ll see what we can do to fulfill it.”

While telemedicine’s impact and effectiveness are still under study and debates on when it’s appropriate to use are ongoing, patients consistently report higher satisfaction when we treat them on their terms. Overcoming the barriers that prevent that from happening, from discomfort with technology to limited Internet and broadband access, will be a big part of Dorsey’s task.

“We need to find simple solutions,” he said. “The key is to do things that have never been done – something that’s integral to the spirit of Meliora.”

New Trial Innovation Network Offers More Opportunities for Clinical Trials

Wednesday, January 11, 2017

URMC researchers will soon be able to take advantage of a new clinical trial network offering expertise on trial design and development as well as participant recruitment and retention. Researchers can propose a clinical trial for inclusion in the Trial Innovation Network, become a participating investigator in an existing multi-site trial or request consultation on clinical trial design through the network.

The Trial Innovation Network is the result of a major new national initiative to improve the nation's research infrastructure to make clinical trials faster, better, and more efficient.  According to recent estimates, it can take 12 or more years to get a new therapy from discovery, through clinical trials, and onto the market. That’s a very long time – especially for patients who could benefit from these drugs.

“The Trial Innovation Network will increase research opportunities for patients in all areas,” said Robert Holloway, M.D., M.P.H., chair of Neurology and medical/faculty director of the Trial Innovation Network Hub Liaison Team at URMC. “We don't know how many trials the network will host, but there will be many - from neonatal to geriatric trials and various conditions from rare to common diseases.”

Building off previous clinical trial network models that are devoted to specific diseases, the Trial Innovation Network speeds the process by connecting institutions across the U.S. to share resources, recruit more trial sites, and maximize the number and diversity of trial participants. The Trial Innovation Network is part of the Clinical and Translational Science Award (CTSA) Program and will redefine the 64 CTSA hub institutions as clinical trial expert sites.

Read More: New Trial Innovation Network Offers More Opportunities for Clinical Trials

Brain Protein Predicts Recovery Time Following Concussion

Monday, January 9, 2017

Elevated levels of the brain protein tau following a sport-related concussion are associated with a longer recovery period and delayed return to play for athletes, according to a study published in the January 6, 2017 issue of Neurology®, the medical journal of the American Academy of Neurology. The findings suggest that tau, which can be measured in the blood, may serve as a marker to help physicians determine an athlete’s readiness to return to the game.

Despite the 3.8 million sports-related concussions that occur annually in the United States, there are no objective tools to confirm when an athlete is ready to resume play. Returning to play too early, before the brain has healed, increases an athlete’s risk of long-term physical and cognitive problems, especially if he or she sustains another concussion. Currently, physicians and trainers must make return-to-play decisions based on an athlete’s subjective, self-reported symptoms and their performance on standardized tests of memory and attention.

A team led by Jessica Gill, R.N., Ph.D. of the National Institute of Nursing Research at the National Institutes of Health and Jeffrey Bazarian, M.D., M.P.H. of the University of Rochester Medical Center evaluated changes in tau in 46 Division I and III college athletes who experienced a concussion. Tau, which plays a role in the development of chronic traumatic encephalopathy or CTE, frontotemporal dementia and Alzheimer’s disease was measured in preseason blood samples and again within 6 hours following concussion using an ultra-sensitive technology that allows researchers to detect single protein molecules.

Read More: Brain Protein Predicts Recovery Time Following Concussion

Yurcheshen receives ASMF award for sleep telemedicine

Sunday, January 8, 2017

Michael E. Yurcheshen MD, associate professor of neurology and medicine, has been granted a 2017 Focused Projects Award by the American Sleep Medicine Foundation. The award will fund a clinical trial aimed at exploring the reliability of telemedicine in evaluating patients with sleep apnea. The $20,000 award will allow Dr. Yurcheshen along with neurology, internal medicine, and psychiatry colleagues to study telemedicine for a medical condition that is both under recognized and undertreated. The results of this clinical trial are expected to lay the groundwork for a regional clinical program, and additional longitudinal sleep-telemedicine trials. Additional investigators on the grant include E. Ray Dorsey MD MBA, Carolina Marcus MD, Jonathan Marcus MD, and Wilfred Pigeon PhD.