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The brain’s complex network of neurons enables us to interpret and effortlessly navigate and interact with the world around us. But when these links are damaged due to injury or stroke, critical tasks like perception and movement can be disrupted. New research is helping scientists figure out how to harness the brain’s plasticity to rewire these lost connections, an advance that could accelerate the development of neuro-prosthetics.

A new study authored by Marc Schieber, M.D., Ph.D., and Kevin Mazurek, Ph.D. with the University of Rochester Medical Center Department of Neurology and the Del Monte Institute for Neuroscience, which appears today in the journal Neuron, shows that very low levels of electrical stimulation delivered directly to an area of the brain responsible for motor function can instruct an appropriate response or action, essentially replacing the signals we would normally receive from the parts of the brain that process what we hear, see, and feel.

“The analogy is what happens when we approach a red light,” said Schieber. “The light itself does not cause us to step on the brake, rather our brain has been trained to process this visual cue and send signals to another parts of the brain that control movement. In this study, what we describe is akin to replacing the red light with an electrical stimulation which the brain has learned to associate with the need to take an action that stops the car.”

Now in its twenty-fourth year, Neurology for the Primary Care Provider continues to attract a large audience of clinicians who manage patients with acute and chronic neurologic disorders in diverse settings. Each year, over 100 health care professionals – approximately one half of whom are physicians – attend this conference. The program highlights the most recent diagnostic and treatment advances in the field of neurology, utilizing a highly interactive case-based format.

The lecturers in this course are pre-eminent experts in their fields, who have also demonstrated superior skills at presenting material of this type to large audiences. This year’s speakers include Drs. Colleen Tomcik, M.D., Ralph Jozefowicz, M.D., Andrew Southerland, M.D. and Jonathan Marcus, M.D.

• Tomcik is an Assistant Professor of Neurology in the General Neurology Unit at the University of Rochester and will be speaking on headache.
• Jozefowicz is Professor of Neurology and Medicine, and Associate Chair for Education in the Department of Neurology at the University of Rochester and will be speaking on the Five Minute Neurological Examination.
• Southerland is an Assistant Professor of Neurology at the University of Virginia and will be speaking on stroke.
• Marcus is an Associate Professor of Neurology in the Sleep Disorders Unit at the University of Rochester and will be speaking on sleep disorders.

New research shows that the number of people with Parkinson’s disease will soon grow to pandemic proportions. In a commentary appearing today in the journal JAMA Neurology, University of Rochester Medical Center neurologist Ray Dorsey, M.D. and Bastiaan Bloem, M.D., Ph.D., with Radboud University Medical Center in the Netherlands, argue that the medical community must be mobilized to respond to this impending public health threat.

“Pandemics are usually equated with infectious diseases like Zika, influenza, and HIV,” said Dorsey. “But neurological disorders are now the leading cause of disability in the world and the fastest growing is Parkinson’s disease.”

The piece builds upon the Global Burden of Disease study, also co-authored by Dorsey, which appeared in The Lancet Neurology in September and showed that neurological disorders are now the leading source of disability globally. That study tracked the prevalence of neurological diseases like Parkinson’s, Alzheimer’s, stroke, epilepsy, meningitis, encephalitis, multiple sclerosis, and migraine, both globally and by country.

The University of Rochester Institute for Innovative Education is pleased to announce the upcoming event, Neurology for the Primary Care Provider XXIV. This educational program includes a one-day conference that will take place on Thursday, December 7, 2017, at the University of Rochester Medical Center in Rochester, NY.

Course Description

University of Rochester Medical Center neurologist Gretchen L. Birbeck, M.D., M.P.H., has been recognized by the American Neurological Association (ANA) with one of its 2017 scientific awards for her research on the neurological damage associated with malaria in sub-Saharan Africa. Birbeck divides her time between Rochester and health projects in Africa.

The ANA, a professional organization representing the nations top academic neurologists and neuroscientists, announced it 2017 scientific awards at its annual meeting last week in San Diego. The awards recognize leaders in academic neurology and neuroscience who have exemplified excellence in a number of areas, including stroke, dementia and neurodegenerative disease.

Birbeck was recognized with the ANAs Soriano Lectureship, which was established in 1987 by ANA member Victor Soriano and his wife to provide a brilliant lecture delivered by an outstanding scientist who is a member of the Association.

During her presentation, Birbeck described research to blunt neurological consequences and behavioral disorders, cognitive impairment, and seizures that can often accompany cases of pediatric cerebral malaria. The disease is a major global health concern and impacts approximately 400,000 children in Africa each year.

Stephen Steadman '64, center, presents Kevin Mazurek, left, with the first place honor and audience prize at the Meliora Weekend competition for the Steadman Family Postdoctoral Associate Prize in Interdisciplinary Research. Steadman, who received a BS in physics from the University of Rochester, is a scientific administrator at the Laboratory for Nuclear Science and the Department of Physics at MIT. Melissa Sturge-Apple, dean of graduate studies, is at right. (University of Rochester photo / Bob Marcotte)

Even simple movements require the integration of information from multiple areas of the brain. This process breaks down when brain damage occurs, resulting in neurological disorders.

But what if researchers could find a way to bypass those damaged areas and maintain the flow of information?

Kevin Mazurek, a postdoctoral fellow in the lab of Marc Schieber, professor of neurology, described how the lab is making progress in doing just that. He finished in first place and took the audience prize as well in the Meliora Weekend competition for the Steadman Family Postdoctoral Associate Prize in Interdisciplinary Research.

Mazurek’s prizes were worth $1,250.

Using micro electrical stimulation in primates, “we’ve shown that we can deliver the information successfully to two functionally different areas of the brain,” Mazurek explained. “This is an important first step.”

The next steps in the research, which incorporates neurology, neuroscience, electrical engineering, and biomedical engineering, include expanding the ability to communicate information across a wide reach of brain areas. This could “potentially improve the quality of living for individuals with injuries such as stroke, traumatic brain injury, or Alzheimer’s disease.”

This is the second year of the competition.

It is open to all postdoctoral scholars and appointees in the School of Medicine and Dentistry, and in Arts, Sciences & Engineering. Four prizes are awarded for research that exemplifies the importance of cross- disciplinary approaches toward examining high impact questions of science. Prizes were awarded based on 3-minute oral presentations to a panel of judges.

This year’s topics ranged from “Recent Breakthroughs in Understanding the Brain’s Waste Removal System” to “Catalytic Solar-Driven Generation of H2 in Artificial Photosynthesis” – and the benefits of yoga in helping cancer patients cope with the side affects of chemotherapy.

Complex, multi-system diseases like Parkinson’s have long posed challenges to both scientists and physicians. University of Rochester Medical Center (URMC) researchers are now reaching for new tools, such as algorithms, machine learning, computer simulations, and mobile technologies, to both improve care and identify new therapies.

Parkinson's disease is a progressive neurological disorder that erodes an individual’s control over their movements and speech. While many of the recent advances in treatment have transformed Parkinson’s into a manageable chronic illness, the individual patient experience can vary widely in both the onset and progression of the symptoms of the disease. This creates problems for clinicians who must constantly tweak the combination and doses of medications to effectively manage symptoms and researchers who are often confronted with a range of responses to experimental treatments.

The advent and spread of new technologies – such as to broadband internet, smartphones, and remote monitoring and wearable sensors – coupled with growing investments in computational resources and expertise in fields such as bioinformatics and data science have the potential to provide researchers with unprecedented insight into the complex variations of diseases like Parkinson’s.

An example of this approach is new research out in the journal The Lancet Neurology. The study sought to identify genetic markers that may explain why motor symptoms –stiffness or rigidity of the arms and legs, slowness or lack of movement, tremors, and walking difficulties – come on more rapidly for some patients with the disease.

The research involved Charles Venuto, Pharm.D., an assistant professor in the URMC Department of Neurology and the Center for Health + Technology (CHeT), and GNS Healthcare, and was funded by the Michael J. Fox Foundation for Parkinson’s Research and the National Institute of Neurological Disorders and Stroke.

The researchers tapped into huge data sets compiled by the Parkinson’s Progression Markers Initiative (PPMI) which has collected biological samples and clinical data from hundreds of individuals with the disease.

“We have access to more information about diseases like Parkinson’s than ever before,” said Venuto. “But all of that data has created a scientific conundrum akin to losing sight of the forest for the trees. In order to unlock the potential of this information we need to harness more sophisticated ways to understand what we are seeing.”

In a departure from traditional research approaches, the team turned over the vast quantities of genetic, clinical, and imaging profiles compiled by the PPMI study to a machine learning and simulation program. As the computer program analyzed the data, it was also “learning” by constantly refining and modifying its criteria and algorithms as it sifted through the information looking for patterns and associations.

The study identified a mutation in the LINGO2 gene that, together with a second gene and demographic factors, could identify patients with faster motor progression of Parkinson’s. The finding, if confirmed, could ultimately help clinicians refine care and help researchers more precisely understand how individual patients may respond to experimental therapies.

The application of data-driven technologies to biomedical research has exploded in the last several years. URMC neurologist Ray Dorsey, M.D., M.B.A., who is also the director of CHeT, has been at the forefront of this transformation. Dorsey has long been a pioneer in expanding access to Parkinson’s care via telemedicine.

On Saturday, September 16th in the Helen Wood Hall Auditorium 125 people gathered for the 1st Inherited Neuropathies Patient Day from 8:30 am – 3:30 pm. In attendance were patients with Inherited Neuropathies, caregivers, staff, and speakers. The Patient Day included speakers from the University of Rochester Medical Center and Round Table Discussions with Inherited Neuropathies patients and caregivers. The meeting allowed patients and caregivers to learn about patient care and research.

Some highlights from the Inherited Neuropathies Patient Day Meeting were Round Table Discussions which included patients, spouses, and parents talking about life with Inherited Neuropathies, lessons learned, and helpful resources. A second Round Table Discussion involved patients in Inherited Neuropathies research. Patients and caregivers had several opportunities to meet other individuals and to share their stories throughout the day during breaks, lunch, and at the end of the meeting.

Featured Presentations at the Inherited Neuropathies Patient Day Meeting included: Inherited Neuropathies: What are they and how are they diagnosed? by Dr. David Herrmann Role of Physical Therapy in the management of Inherited Neuropathies by Katy Eichinger, P.T., Ph.D. Orthotic Management of Charcot Marie Tooth Neuropathies (CMT) by Alicia Gotcsik, CO, CPed When is Orthopaedic Surgery a good choice and what does in entail? by Dr. Judy Baumhauer Neuropathic Pain Management: CMT and Fabry’s Disease by Dr. John Markman How We Do It: Round Table Discussion and Q & A session featuring insights from Patients featuring Patients affected by Inherited Neuropathies and Facilitated by Cindy Gibson, NP and Deb Guntrum, FNP Update on Inherited Neuropathy Research by Dr. David Herrmann Participation in Research by: Joan Mountain, RN and Janet Sowden, BSc (Hons) Round Table Discussion: Patient Perspective for participating in Research

New research will seek to understand why people who are HIV positive are more susceptible to a progressive cerebrovascular disease that can ultimately give rise to dementia. One of the goals of the research is to identify new ways to prevent the blockages that occur in blood vessels and cause damage in the brain.

The $3.6 million National Institute of Aging-sponsored study will be led by University of Rochester Medical Center (URMC) neurologist Giovanni Schifitto, M.D., M.S., and Sanjay B. Maggirwar, M.B.A., Ph.D., with the Department of Microbiology and Immunology.

While it is estimated that more than 1 million Americans are living with HIV, treatments such as combined anti-retroviral therapies (cART) have transformed the disease into a manageable chronic illness. However, as the population living with HIV ages, the long-term effects of both the infection and treatment have given rise to additional health problems.

One such problem is cerebral small vessel disease (CSVD). While the reason CSVD occurs is not clear and may ultimately be the result of a number of factors, a common mechanism is believed to be inflammation. The new study will examine the interaction of two types of blood cells – platelets and monocytes. When these cells become stuck together and form complexes the resulting blockages can lead to a hardening of the arteries.

The brain in particular is highly susceptible to damage when blood flow becomes impaired due its network of tiny vessels. When complexes of platelets and monocytes accumulate in the brain they can promote inflammation which can cause vessels to become leaky, plugged, or burst, resulting in micro-strokes or micro-hemorrhages that damage neurons and other tissue in the brain.

The URMC Movement Disorders team is participating this weekend in Moving Day, the Parkinson Foundation's annual community awareness and fundraising walk. The event is Sunday, October 1st on the MCC campus, with registration beginning at 9AM.

Funds raised from this event support programs in the community such as the PD education series, a variety of exercise programs and support groups, as well as grant funding for the University of Rochester's the Parkinson Foundation Center of Excellence. The event is family-friendly with kid's activities, a movement pavilion showcasing different exercise programs, and a "Parkinson's Experience" tent run by Michelle Burack, MD, PhD, equipped with a variety of accessories that reproduce PD symptoms for people without the disease to experience.

Show your support for our Movement Disorders team by donating here: Click Here To Donate

A new study has found that video conferencing can deliver quality care to patients who have Parkinson's disease. Published in the Aug. 16, 2017, online issue of Neurology®, this study is the first national randomized controlled trial of telemedicine to connect remote specialists to patients directly in their homes. The results support CAST's technology policy priorities.

"Over 40% of people with Parkinson's disease never receive care from a neurologist, yet studies have shown that people who see a neurologist are less likely to be hospitalized with illnesses related to Parkinson's disease, have greater independence, and are less likely to die prematurely," said study author Ray Dorsey, MD, the David M. Levy Professor of Neurology at the University of Rochester Medical Center (URMC) and lead author of the study.

Many Parkinson's patients live far from movement disorder specialists and/or have mobility and driving challenges that make doctor visits difficult. The 195 study participants received either their usual care from their usual providers or their usual care and up to four video conference visits with a neurologist who they had not seen before. The study did not include people with the disease who live in nursing homes, who account for nearly 25% of all Medicare beneficiaries with Parkinson's disease.

Each virtual house call provided the same quality of care and saved the patients an average of 169 minutes and nearly 100 miles of driving. "Telemedicine is especially valuable to patients in remote, rural, and underserved areas because it gives them the ability to consult specialists they would otherwise have to travel hours to see," said Peter Schmidt, Ph.D., Senior Vice President, Chief Research and Clinical Officer of the Parkinson's Foundation, said in University of Rochester Medical Center (URMC) news.

"Broader adoption of this technology has the potential to expand access to patient-centered care," Dorsey told URMC news. "We now have the ability to reach anyone, anywhere but the promise and benefits of telemedicine will not be fully realized until the changes are made in Medicare policy."

CAST and Study Results

This study supports a recent LeadingAge Aging Services Technology Issue Brief, which holds that telemedicine can help long-term and post-acute care providers deliver integrated and person-centered care, supporting older adults' health. These technologies are essential to strategic partnerships with physicians, hospitals, Accountable Care Organizations, and other coordinated care delivery models that will improve the quality of life and care, while easing care burdens and cost.

CAST's technology policy priorities, set at the March 2014 CAST Commissioners Meeting, include advocating with agencies of the U.S. Department of Health and Human Services, including CMS and its Center for Medicare and Medicaid Innovation, for more demonstration projects focusing on health IT and telehealth.

The Patient-Centered Outcomes Research Institute supported the recent study.

Researchers from the University of Rochester Medical Center recently set out to understand whether drugs used to keep HIV patients alive could be damaging their brains.  On the contrary, early results from their clinical study showed that short-term use of combination anti-retroviral therapy (cART) improved mental function in HIV-infected individuals. 

Giovanni Schifitto, M.D., M.S., professor of Neurology at the University of Rochester Medical Center, is leading the study to better understand the short and long term effects of combination antiretroviral therapy on HIV patients’ brains. At 12 weeks, the therapy appears to improve mental performance and functional connectivity in the brain.

HIV patients often experience mental decline ranging from mild impairment to full-blown dementia. Experts have long debated the cause of that mental decline: HIV itself, or the drug used to combat it.

Some of the first HIV drugs were known to cause damage to peripheral nerves. Newer anti-retroviral drugs are believed to be safer, but patients taking these drugs continue to experience mental impairment - even when their viral load is extremely low.  In fact, some studies have shown improvement in HIV patients’ mental function when they stop using cART.

“But those studies were very indirect,” said Schifitto, who is also the director of the Clinical Research Center and function leader for Participant and Clinical Interactions at the CTSI. “They studied cohorts of people who were already on medications, which makes it very hard to pull apart whether the virus or the drug is to blame for effects in the brain.”

Schifitto’s clinical study, on the other hand, followed 17 HIV-infected individuals who had not received any treatment prior to the study. These patients scored worse on mental function tests and brain imaging revealed fewer connections in their brains than the HIV-negative control group.

After receiving cART for 12 weeks, the HIV patients’ mental performance and functional brain connectivity improved nearly to the level of the HIV-negative group. This not only suggests that short term cART use does not damage the brain, but that the virus is the culprit for early mental impairment in HIV-infected patients.

However, this is just a first step of the study, which will enroll and follow over 150 participants for two years. It is possible that cART will cause mental decline after prolonged use and the team want to track if and when that happens.  They are also monitoring sleep, mood, and several other factors that can impact mental function in HIV patients taking cART. 

In the end, the outcomes of the short and long term studies may help health care providers tailor cART cocktails and treatment schedules to individual patients’ needs. The results could also have implications for preventative use of cART in individuals who are at high risk for contracting HIV, a practice called pre-exposure prophylaxis (PrEP).

The study started with just a single site at the University of Rochester Medical Center, but now includes sites at Cornell Medical Imaging Center, Gay Men’s Health Crisis, SUNY Upstate Medical, University at Buffalo, and University of Texas Health Science Center at Houston.  It also utilized the CTSI’s Clinical Research Center, a dedicated space for researchers to conduct safe and controlled clinical studies with the support of highly trained clinical research staff.

New findings from a nationwide program that links neurologists with patients with Parkinson’s disease in their homes via video conferencing shows that telemedicine can successfully deliver quality care. The study, which appears today in the journal Neurology, points to a new way to improve care for people who suffer from the disease, but may have not have access to a neurologist.

“Virtual house calls for chronic diseases like Parkinson’s are not only as effective as in-person care but broader adoption of this technology has the potential to expand access to patient-centered care,” said Ray Dorsey, M.D., the David M. Levy Professor of Neurology at the University of Rochester Medical Center (URMC) and lead author of the study. “We now have the ability to reach anyone, anywhere but the promise and benefits of telemedicine will not be fully realized until the changes are made in Medicare policy.”

“Telemedicine is especially valuable to patients in remote, rural, and underserved areas because it gives them the ability to consult specialists they would otherwise have to travel hours to see,” said Peter Schmidt, Ph.D., Senior Vice President, Chief Research and Clinical Officer of the Parkinson’s Foundation. “The Parkinson’s Foundation aims to narrow these gaps in Parkinson’s care, which is why we are working with experts from URMC, a Parkinson’s Foundation Center of Excellence.”

The results in the paper come from the Connect.Parkinson project, a research study funded by the federal Patient-Centered Outcome Research Institute. Connect.Parkinson is led by URMC in collaboration with the Parkinson’s Foundation and with additional support from PatientsLikeMe, the Michael J. Fox Foundation for Parkinson’s Research, SBR Health, Vidyo, and IDSolutions. The study is the first national randomized controlled clinical trial of telemedicine for Parkinson’s disease.

It is estimated that 40 percent of people who have Parkinson’s disease do not see a neurologist soon after diagnosis. This places them at significantly greater risk of falls leading to hip fractures, ending up in a nursing home or hospital, and even death. This challenge of providing care to these individuals will become ever greater as the population ages—it is projected that the number of people with Parkinson’s disease will double by 2030.

The most significant barriers to appropriate care for Parkinson’s patients are distance and disability. Most movement disorder specialists are located in academic medical centers in large urban areas. Most patients live in suburban and rural areas, have impaired mobility and driving ability, and are faced with the challenge of making frequent trips to the doctor’s office – a task that becomes more difficult as the disease progresses.

The goal of the Connect.Parkinson study was to see if telemedicine would allow neurologists to deliver care to patients in the comfort of their homes. A total of 195 individuals with Parkinson’s from across the U.S. were selected to participate in the study. Participants either received care through their primary care physician or had that care supplemented with up to four visits via video conference with the neurologist they had not seen before.

Parkinson’s disease particularly lends itself to telemedicine because many aspects of the diagnosis and treatment of the disease are “visual” – meaning that the interaction with the doctor primarily consists of listening to the patient and observing them perform certain tasks such as holding their hands out or walking.

The researchers found that the telemedicine visits were as effective as in-person visits in the doctor’s office, with the quality of life reported by the participants as no better or worse for people who received care in their homes compared with those who received standard care. The virtual house calls also saved patients an average of 169 minutes and nearly 100 miles of travel per visit.

While the current study is one of several that have demonstrated the potential benefits of telemedicine, widespread adoption of this technology is hindered by federal healthcare policies. Approximately two-thirds of Parkinson’s patients are on Medicare. However, the program does not reimburse for in-home telemedicine care. Legislation has been introduced in Congress to allow Medicare to expand reimbursement for telemedicine.

“We can shop, bank, make travel reservations, take classes, and buy groceries via the internet from the comfort of our own homes, but too many patients still cannot access health care,” said Dorsey. “Telemedicine is an option if you are a veteran, a member of the Armed Services, a Medicaid beneficiary, or a Canadian, but not if you have a chronic condition and are a Medicare beneficiary.”

Additional co-authors of the study researchers from URMC, the Parkinson’s Foundation, Simone Consulting, Johns Hopkins School of Medicine, the University of Pennsylvania Perelman School of Medicine, the University of California San Francisco, Northwest Neurology, Oregon Health and Science University, Baylor College of Medicine, Augusta University, Duke Medical Center, Massachusetts General Hospital, Struther’s Parkinson’s Center, Beth Israel Deaconess Medical Center, the University of Miami, Northwestern University, the Feinstein Institute of Medical Research, the Medical University of South Carolina, the University of Kansas Medical Center, the Parkinson’s Institute, the Mayo Clinic, the University of California Berkeley, the Karolinska Institute in Sweden, and PatientsLikeMe. The study was funded with support from the Patient-Centered Outcome Research Institute.

Strong Memorial Hospital’s Neurology and Neurosurgery specialty program has been ranked among the top 50 in the nation for 2017-2018 by U.S. News & World Report. The program ranked 39^th among the nation’s hospitals, and this is the seventh consecutive year it has been nationally ranked by U.S. News.

In June, UR Medicine’s Golisano Children’s Hospital was recognized as one of the nation’s best children’s hospitals in three specialty areas — Neonatology, Nephrology, and Neurology and Neurosurgery — in the U.S. News & World Report’s Best Children’s Hospital rankings.

For the 2017-18 adult rankings, U.S. News evaluated more than 4,500 U.S. hospitals; only 152 were ranked in at least one specialty.

Eight Strong Memorial Hospital specialty programs earned High Performing ratings: Cardiology and Heart Surgery, Diabetes and Endocrinology, Gastroenterology and GI Surgery, Geriatrics, Nephrology, Orthopaedics, Pulmonology, and Urology.

U.S. News recognized hospitals that were high-performing across multiple areas of care and ranked them within their states and by metropolitan areas. U.S. News rated Strong Memorial as the top hospital in the Rochester Metro area and fourth among New York state hospitals.

U.S. News evaluates nearly 5,000 hospitals nationwide for its Best Hospitals rankings; methodologies include objective measures such as patient survival, the number of times a given procedure is performed, infection rates, adequacy of nurse staffing and more.

Left to right: Brad Mahon, Frank Garcea, and Edward Vates

On a warm day in July 2005, Frank Garcea’s soccer playing days came to an abrupt end when he suffered what could have been a deadly stroke during a practice with his teammates. Instead, the events of that day and his subsequent treatment – which serve as the basis for a review published in the New England Journal of Medicine (NEJM) – set him on a career path that would ultimately lead to a Ph.D. studying how the brain recovers from injury.

Garcea, who was about to begin his senior year at the Aquinas Institute in Rochester, was in the middle of a training session when he started experiencing a pounding headache. He first suspected he might just be dehydrated on that hot summer day, but soon after his limbs began to tingle and grow numb, his eyes became sensitive to the bright sunlight, and he had difficulty walking. Very quickly it became obvious that something was wrong and someone called 911.

Garcea eventually ended up at Strong Memorial Hospital and was diagnosed with a subarachnoid hemorrhage. He would undergo surgery the next morning under the clinical care of UR Medicine neurosurgeon Edward Vates, M.D., Ph.D.

Subarachnoid hemorrhages account for approximately 5-10 percent of all strokes in the U.S. These occur when a blood vessel in the brain bursts causing bleeding. If not treated immediately, these strokes can cause major disability and, in many cases, death.

“When an aneurysm ruptures, it is an intracranial catastrophe,” said Vates, a co-author of the NEJM article. “In 25 to 50 percent of cases, these strokes result in death, and this estimate does not fully account for patients who die before receiving medical attention.”

Vates uses Garcea’s experience as jumping off point to describe the decision-making process required to diagnose and identify treatment options for subarachnoid hemorrhages.

Astrocytes help coordinate communication
between neurons. The one on the left is
derived from a healthy brain and the one on
the right is from an individual diagnosed
with schizophrenia.

New research has identified the culprit behind the wiring problems in the brains of people with schizophrenia. When researchers transplanted human brain cells generated from individuals diagnosed with childhood-onset schizophrenia into mice, the animal’s nerve cell networks did not mature properly and the mice exhibited the same anti-social and anxious behaviors seen in people with the disease.

“The findings of this study argue that glial cell dysfunction may be the basis of childhood-onset schizophrenia,” said University of Rochester Medical Center (URMC) neurologist Steve Goldman, M.D., Ph.D., co-director of the Center for Translational Neuromedicine and lead author of the study which appears today in the journal Cell. “The inability of these cells to do their job, which is to help nerve cells build and maintain healthy and effective communication networks, appears to be a primary contributor to the disease.”

Rapid changes in neuroscience and digital technology play important roles in improving neurological care at Cayuga Health System’s hospitals and building a seamless connection for local patients needing advanced care at UR Medicine in Rochester.

“The sub-specialties in neurology have grown rapidly in the last 20 years and are improving patient outcomes in complex areas of care,” says Dr. Richard L. Barbano, MD, PhD. and associate chair of Community Outreach and Regional Development at UR Medicine.

However, the most sophisticated neurological care is provided at major medical centers and not easily accessible to patients living far away from those programs. Upgrades in digital technology now allow Cayuga Health System hospitals to build a network of partnerships linking local health care to major research and teaching hospitals, such as UR Medicine.

“When Cayuga Health System’s strong general neurology program is combined with access to the broad range of neuroscience research, training, and sub-specialties in Rochester, patients with complicated neurological conditions receive the highest level of care,” Dr. Barbano says.

Emma Ciafaloni, professor of neurology, was jointly appointed as the Robert C. and Rosalyne H. Griggs Professor in Experimental Therapeutics of Neurological Disease for the period from April 1, 2017 through December 31, 2019. She retains her joint appointment as professor of pediatrics.

A specialist in the diagnosis and treatment of neuromuscular diseases and in clinical trials in both adults and children, Ciafaloni is codirector of the Muscular Dystrophy Association Neuromuscular Clinic, program director of the neuromuscular medicine fellowship, and Director of the Pediatric Neuromuscular Medicine program in the Medical Center’s Neuromuscular Disease Unit.

She published in the New England Journal of Medicine, JAMA, Journal of Child Neurology, the Journal of Immunology, and the Journal of Pediatrics.

Ciafaloni graduated from the medical school at the Universita’ Statale di Milano, in Milan, Italy; received training in mitochondrial diseases at Columbia University; and completed her neurology residency and neuromuscular fellowships at Duke University. She joined the Neurology Department at Rochester in 2002.

UR Medicine’s Golisano Children’s Hospital has been recognized as one of the nation’s best children’s hospitals in three specialty areas — neonatology, nephrology, and neurology and neurosurgery — in the U.S. News & World Report’sBest Children’s Hospital rankings.

The 2017-2018 rankings, released online Tuesday, placed the children’s hospital’s neonatology program at No. 27 nationally; nephrology at No. 43; and neurology and neurosurgery at No. 44.

“As with everything we do and have achieved, this recognition reflects a partnership with contributions from the interdisciplinary workforces of pediatrics, surgery and surgical subspecialties, emergency medicine, neurology, and obstetrics and gynecology,” said Nina Schor, M.D., Ph.D., pediatrician-in-chief at Golisano Children’s Hospital. “It also wouldn’t be possible without our community, and the health care organizations outside the hospital.”

The Division of Neonatology, which provides care for premature and critically ill newborns, admits about 1200 infants per year. Approximately 1 in 12 babies born in the Finger Lakes Region spend their first days in the children’s hospital’s Gosnell Family Neonatal Intensive Care Unit (NICU), which is the region’s only Level IV NICU.

The American Heart Association/American Stroke Association (AHA/ASA) has once again honored the UR Medicine Strong Memorial Hospital as having met its highest standards of care for stroke.

Strong Memorial Hospital has received the AHA/ASA Get With The Guidelines program’s Stroke Gold Plus Quality Achievement Award. The hospital was also tapped for the Target: Stroke Honor Role Elite Plus, which recognizes hospitals that have consistently and successfully reduced door-to-needle time – the window of time between a stroke victim’s arrival at the hospital, the diagnosis of an acute ischemic stroke, and the administration of the clot-busting drug tPA. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability.

“This recognition is a testament to the hard work of our outstanding team of nurses, physicians, and therapists and their dedication to provide the highest quality of care to stroke victims,” said neurologist Curtis Benesch, M.D., M.P.H., the medical director of the UR Medicine Comprehensive Stroke Center.

“This award reflects a singular focus on improving the care stroke victims receive from the first 911 call to when they arrive at the hospital through operating room, neurocritical care, and rehabilitation,” said Tarun Bhalla, M.D., Ph.D., the surgical director of the Comprehensive Stroke Center.

Strong Memorial Hospital is home to the region’s only Comprehensive Stroke Center, a designation by the Joint Commission that indicates that the hospital either meets or exceeds the highest standards of care required to provide timely and comprehensive care to patients with complex cerebrovascular disease.

The AHA/ASA Get With the Guidelines program recognizes hospitals that have reached aggressive goals of treating stroke patients and comply with core standard levels of care. For more information about the Get With The Guidelines program, visit the AHA/ASA website.

Retirements do not happen often. On June 30th, 2017 Drs. Richard Moxley and David Wang will be retiring. They both will become Emeritus Professors in recognition of their outstanding contributions to the Department, School and University.

They both started in the Department in 1974, 43 years ago, Dick as a faculty and David as a resident. And they stayed, one practicing primarily adult neurology (Dick) and the other (David) child neurology, but each doing a little bit of both along the way.

A program called Parkinson's Disease Care New York exists to help eliminate the obstacles facing patients who need to see a neurologist. This type of doctor can mainly be found in large metropolis areas so anyone in a rural community might have a tough time getting access to healthcare.

By linking the patient to the doctor via computer, the neurologist can monitor symptoms more regularly and follow the patient more closely—even diagnose new treatments without the patient even leaving their home. Currently 109 patients are enrolled and the program can provide for 500 people statewide. To find out more, go to the PDCNY Facebook page.

A recent scientific study shows that insufficient amount of sleep leads to the development of Alzheimer's disease. Researchers gain more evidence and are beginning to believe that lack and poor quality of sleep results to the fusion of Amyloids, proteins that bond together to form Alzheimer's plaques.

Dr. Maiken Nedergaard, the lead researcher from the University of Rochester Medical Center, explains the glymphatic system that is present in humans. She says that this system is 10 times more active when in slumber than when awake. The process allows cerebrospinal fluid to flow through spaces around the neurons of people's brains. This a method of purging unwanted proteins (Amyloids) and other wastes into the circulatory system garbage collectors and eventually flushes it out of the body.

In simple terms, Nedergaard explains that the brain has its own sanitation and public works department. It is like a network of sewer facilities mostly done during the brain's nightlife. An example of a housekeeping staff descending to building offices for a cleanup duty to avoid the lumping compound that causes Alzheimer's.

The fast-rising tide of telemedicine will transform health care nationwide. Here at URMC, dozens of faculty and departments are already ensuring our readiness to embrace the opportunities and meet the challenges of that transformation, even as we continue to help drive it forward with our innovative programs.

The recent appointment of Ray Dorsey, M.D., director of the Center for Human Experimental Therapeutics and professor of Neurology, as URMFG’s Medical Director of Telemedicine reflects our growing commitment to the technology, but the work his colleagues have been doing means he has a firm foundation to build on. We’ve been providing telemedicine in some form for well over a decade, and the already-significant number of services available here is constantly growing.

Waves of Innovation

Imagine a health care system in which a doctor can check a patient’s airway before surgery with a smartphone instead of bringing the patient in for an extra appointment, or listen to the heart and lungs of a recently discharged patient at home to help prevent readmissions.

For URMC, that’s already the reality, and in some departments it has long been routine. Pediatrics, for example, piloted telemedicine programs 15 years ago and remains a leader. Under the leadership of Kenneth McConnochie, M.D., M.P.H., professor of Pediatrics, and Neil Herendeen, M.D., M.S., medical director of the Strong Pediatric Practice, Rochester-area primary care physicians have offered pediatric telemedicine visits to students in the Rochester City School District and many childcare centers for over a decade in a highly successful effort that has provided care to thousands of children.

“A clearly demonstrated benefit for patients and their families is convenience,” said McConnochie, a nationally recognized expert who has appeared before Congress. “An important question has always been whether anything is lost when you gain that convenience. If telemedicine is done right—and that’s the challenge— our evaluations indicate that nothing is lost in diagnostic accuracy or in quality of communication with family. You get all the convenience of care when and where you need it, and equivalent quality of care.”

The benefits go beyond that. Parents get the peace of mind of having a quickly scheduled visit and the convenience of not needing to leave work to bring their children to the doctor. Childcares and schools get just-in-time physician guidance in addressing health issues. All of that leads to satisfaction for the providers involved.

“The impact ripples across all stakeholders in the care and education of children,” McConnochie said.

No wonder, then, that telemedicine is rippling across our institution and our service area. VNS monitors patients remotely, and primary care began piloting telemedicine visits this past July at their Manhattan Square Family Medicine and LeRoy Medical Associates locations. But those programs are only part of our effort.

We have nearly two dozen programs at various stages of implementation. Along with coordinating our telemedicine efforts, Dorsey works with Parkinson disease patients worldwide. Other faculty members offer genetic counseling, pediatric dental consultations for oral surgery, and mental health consultation and liaison services for primary care doctors, rural hospitals and long-term care facilities.

“Telemedicine means our highly skilled specialists can provide care to more people and make those interactions more convenient,” Dorsey said. “Our ultimate vision for URMC telemedicine is to enable any New Yorker to receive care from our faculty. We want to bring care to the patient, rather than the patient to care.”

The Center for Neural Development and Disease, led by Harris A. (Handy) Gelbard, M.D., Ph.D., since 2008, will now be the Center for NeuroTherapeutics Discovery, reflecting an increased emphasis on translation and the creation of intellectual property that will lead to new therapies for nervous system disorders.

Gelbard, professor of Neurology, Pediatrics, Neuroscience and Microbiology & Immunology, will continue as director. His research, coupled with the work of Charles Thornton, M.D., professor of Neurology and Neuroscience, and Marc Halterman, M.D., Ph.D., associate professor of Neurology, Neuroscience and Pediatrics, will serve as the anchor of the new center. The trio has a strong track record of grants, publications, and patents, as well as academic and commercial relationships that they are actively pursuing to bring new treatments to the public.

“The Center for NeuroTherapeutics Discovery was developed out of the Center for Neural Development and Disease to create more visibility for academic and commercial partnerships as a necessary bridge for bringing new therapeutics forward,” said Gelbard. “This represents a way to do the best and most cutting edge science possible in a time when the traditional avenues towards funding academic research are changing rapidly.”

The center will bring together many investigators from across the Medical Center and River Campus to identify the mechanisms that lead to various neurological disorders, including HIV-associated neurocognitive disorder (Gelbard lab), myotonic dystrophy (Thornton lab) and stroke (Halterman lab). The center remains committed to its members that investigate the molecular signaling events that lead to nervous system disease during development and aging. Industry partnerships and resources will be sought to fast-track existing therapies or create new molecules that affect these disease mechanisms.

Treatments that harness the immune system to help regenerate damaged cells will be a major focus at the center; the team believes that this approach is broadly applicable to a range of acute and chronic neurodegenerative disorders, such as Parkinson’s disease, multiple sclerosis and Alzheimer’s disease.

Elise Kayson, M.S., R.N.C., A.N.P., has been recognized by the Huntington Study Group with its Lifetime Achievement Award for her dedication to seeking treatments that make a difference and improving the quality of life and outcomes for families affected by the disease.

The Huntington Study Group (HSG) is a network of more than 400 investigators, coordinators, scientists, and Huntington's disease experts spread across more than 100 research sites across the globe. HSG brings together patients, families, academic and industry researchers, foundations, and government agencies to seek new treatments that improve the life of individuals with the disease.

Elise continues to be an essential ingredient and role model for the success of the HSG, the many patients and families who we serve, and is a real prize that we celebrate and emulate," said Ira Shoulson, M.D., the founder of the HSG, a former professor of Neurology at URMC, and currently a professor of Neurology at Georgetown University.

Elise's tireless commitment to Huntington's patients and their families and her 20 plus years of experience in pharmaceutical research has been essential to our efforts to develop new ways to treat this devastating disease," said URMC neurologist Ray Dorsey, M.D., M.B.A., chair of the HSG. This award recognizes her dedication and critical role she plays in managing the complex research necessary to bring new drugs to market."

Today’s office visit to a doctor involves a patient, a family member, and a physician 97% of the time. Tomorrow’s visit will engage nurse practitioners, nutritionists, genetic counselors, pharmacists, therapists, social workers, mental health professionals, and exercise coaches. The Internet enables clinicians to connect patients at different times based on need, not travel burden. Just as more clinicians will contact patients, more caregivers including children living in different cities and countries will participate remotely in visits through video conferencing.

The nature of visits will also change. Patient-generated data creates the opportunity for the visit to be a true data exchange. Tomorrow’s visit will include objective, high frequency and real-time streaming data, including blood pressure, glucose levels, activity levels, diet, and social engagement metrics. Patients will control the data from novel sensors and grant clinicians access at the patients’ direction.

University of Rochester Medical Center (URMC) researchers were instrumental in the U.S. Food and Drug Administration's (FDA) recent approval of SD-809 (deutetrabenazine) to treat Huntington's disease. Deutetrabenazine is the only the second drug authorized by the agency to treat this rare, inherited neurodegenerative disorder.

The FDA approval was based on results from the First-HD study, a Phase 3 clinical trial which was conducted through the Huntington Study Group (HSG) via a consortium of 34 sites across the U.S. and Canada on behalf of Teva Pharmaceuticals. The study results were published last July in Journal of the American Medical Association.

The URMC Clinical Trials Coordination Center (CTCC) and Department of Biostatistics and Computational Biology -- under the leadership of Elise Kayson, M.S., A.N.P., and David Oakes Ph.D. -- provided scientific, technical, logistical, and analytical support for the First-HD study The CTCC is part of the Center for Human Experimental Therapeutics (CHET) and is a unique academic-based research organization with decades of experience working with industry, foundations, and governmental researchers in bringing new therapies to market for neurological disorders.

The Technology & Rare Neurological Diseases Symposium (TRNDS), taking place Friday, May 12, aims to spark a national discussion among patients, researchers, and policy experts on how to accelerate clinical trials for rare diseases that attack the nervous system. New technologies may ease the burden of traveling to research sites for patients and increase the flow of information about these diseases for researchers and healthcare providers.

Finding enough patients to conduct clinical studies on rare diseases can be very difficult. Patients are spread far and wide and are often required to travel long distances or even move to access care and participate in clinical trials. And patients with rare neurological diseases often have physical and/or mental disabilities that make travel even more burdensome.

These difficulties lead to a lack of "natural history" knowledge about these diseases -- what they are, who they impact, how symptoms unfold over time.

UR Medicine’s Neuromedicine and Behavioral Health Center celebrates its opening on March 29. The center brings together Developmental and Behavioral Pediatrics, Child Neurology, and Child Psychiatry to collaborate on care for pediatric patients, and is home to the new William and Mildred Levine Autism Clinic that provides specialized care for patients with autism spectrum disorder.

This is the region’s first stand-alone center to integrate care of autism with pediatric neuromedicine and child and adolescent psychiatry services, and will serve more than 25,000 patients each year.

UR Medicine’s new 90,000-square-foot, three-story building, located at 200 East River Road, has created space to relocate outpatient imaging, interventional radiology clinics as well as autism/neuromedicine/behavioral health pediatric programs from the University of Rochester Medical Center campus to an easily accessible location along the I-390 corridor. The site will be a regional destination for patients and families seeking specialized pediatric services.

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.

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.

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.

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.

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.

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.

Major Step toward Longer-Lasting HIV Treatment

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.

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.

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 strategy—that is, providers virtually caring for consumers through a website such as MD Live or Doc-on-Demand—for 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 Therapeutics 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 program—and Dorsey’s interest—grew 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.”

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.

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.

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.