Exemplars of compassion in health care

UofL faculty, UofL Hospital staff honored with Commitment to Compassion Award
Exemplars of compassion in health care

Commitment to Compassion Award winners

Recognized as individuals who improve the lives of others, two UofL faculty and two UofL Hospital staff are honored with the Commitment to Compassion Award.

Presented by the Partnership for a Compassionate Louisville, the award is given to health care professionals who inspire others to be more compassionate.

Matt Adamkin, M.D., and assistant professor in the Division Physical Medicine & Rehabilitation, UofL School of Medicine, is among this year’s winners for his work with Special Olympics athletes. Adamkin is a physical medicine and rehab physician in the UofL Department of Neurological Surgery and UofL Physicians – Physical Medicine & Rehabilitation.

His volunteer work with Special Olympics Kentucky includes providing no cost physicals to the special athletes who often suffer from intellectual or developmental difficulties.

Amanda Corzine, M.S.N., R.N., S.A.N.E.-A., and Vicki Yazel, B.S.N., R.N., S.A.N.E.-A., are receiving a joint award for their work at UofL Hospital’s Sexual Assault Forensic Examiner (SAFE) Services, a program that has helped hundreds of sexual assault and domestic violence victims in the Louisville area.

Corzine, coordinator of SAFE Services, was instrumental in implementing an evidence-based domestic violence screening tool in the UofL Hospital Emergency Department that connects victims to immediate advocacy services. She has expanded the office to provide 24-hour availability and new services, including domestic violence forensic exams, the first in Kentucky. Yazel, assistant coordinator of SAFE Services, has strengthened the hospital’s relationships with law enforcement agencies and is improving human trafficking screening in the emergency department.

The fourth UofL recipient is Joseph D’Ambrosio, Ph.D.,Director of Health Innovation and Sustainability at the UofL Trager Institute. He is a licensed marriage and family therapist, and a professor at the UofL School of Medicine. He also teaches couples and family therapy courses for students at the Kent School of Social Work.

D’Ambrosio also is developing a Compassionate Cities Index – a validated measurement of a city’s compassion. The index will be a reliable and accurate tool for measuring the prevalence of compassion in cities.

These honorees will receive an award during the 4th Annual Commitment to Compassion Luncheon at the Muhammad Ali Center on Wednesday, Feb. 27. The event is hosted by Passport Health Plan, Insider Louisville and the Compassionate Louisville Healthcare Constellation. Read more on the Insider Louisville website.


‘Game changing’ new minimally invasive treatment for brain aneurysms available at UofL Hospital

First WEB device procedures in Kentucky successfully performed by UofL neurosurgeon Robert James, M.D.
‘Game changing’ new minimally invasive treatment for brain aneurysms available at UofL Hospital

WEB® Aneurysm Embolization System. MicroVention

After learning she had a family history of brain aneurysms, Mary Steinhilber went in for testing to see whether she also had an aneurysm.

Doctors found she had not one, but three. Robert James, M.D., a neurosurgeon at UofL Physicians – Neurosurgery, treated two of her aneurysms with minimally invasive stents, but the location of the third, at a juncture of arteries, was not conducive to stent treatment.

In January, the U.S. Food and Drug Administration (FDA) approved the WEB® Aneurysm Embolization System for treating this type of aneurysm, and on Feb. 13, Steinhilber was one of the first three patients in Kentucky to be treated with the device at UofL Hospital.

An aneurysm is an enlarged, weakened area of an artery that results in a bulging or ballooned area in the artery. Untreated, an aneurysm in the brain may rupture, causing severe disability, cognitive loss or death. The WEB system, James said, provides a new, minimally invasive option for treating wide-necked bifurcation aneurysms, which occur at the juncture of two arteries. In the procedure, a mesh basket is placed inside the aneurysm, allowing blood to bypass the opening, which seals itself off over time, creating a permanent cure.

“If we can fix the aneurysm before it bursts and cure it, then the threat of this aneurysm bursting and the patient dying from it essentially goes away,” James said. “The WEB device is a game changer for the minimally invasive treatment of aneurysms.”

Steinhilber is grateful to have more advanced options for treating her condition. Two of her sisters were treated for aneurysms in the past. One required re-treatment and another was unable to be treated for one aneurysm due to its location. A third sister died suddenly from what may have been a ruptured aneurysm.

“Seeing the history of my sisters, I feel very good about what the UofL doctors are doing here,” Steinhilber said. “It’s wonderful to see the progress made in treating aneurysms.”

As many as 6 million people in the United States are estimated to have an unruptured brain aneurysm. Coils and stents have provided minimally invasive options for some types of aneurysms, but James explained those options have limitations in their use, and may have negative features.

The WEB (an acronym for Woven Endo-Bridge) device is approved for treating wide-neck bifurcation aneurysms, which may account for 35 percent of all brain aneurysms. James completed the first three procedures in Kentucky with the device since it received FDA pre-market approval on Jan. 7. He had previous experience in performing the procedure, having participated in the device’s clinical trials.

During the WEB system procedure, a small catheter is threaded from the groin area through the patient’s artery to the aneurysm site. Using fluoroscopy imaging, the surgeon deploys the WEB device into the “sack” of the aneurysm, where its flexible mesh conforms to the aneurysm walls, minimizing blood flow inside the aneurysm. In most cases, over time, the body seals off or occludes the neck of the aneurysm, essentially curing it.

In clinical testing, the WEB system was shown to be highly effective and safer than other options. In addition, the minimally invasive nature of the procedure means most patients, including Steinhilber, are able to go home the next day.

In addition to unruptured aneurysms, the WEB system may be used in some cases in which the aneurysm has already ruptured, providing more desirable options for treatment.

“This device also gives us the ability to use flow diversion in already ruptured aneurysms to prevent them from re-rupturing, which we have never been able to do before,” James said.

The WEB system, marketed by MicroVention, Inc., a U.S.-based subsidiary of Terumo and a global neurovascular company, has been used safely in more than 6,000 cases outside the United States as well as clinical studies here and abroad.



Feb. 19, 2019

Immune stimulant molecule shown to prevent cancer

UofL researchers discover that an immune checkpoint stimulator, SA-4-1BBL, as a single agent prevents against multiple types of cancer
Immune stimulant molecule shown to prevent cancer

Confocal microscope image shows SA-4-1BBL (green) bound to its receptor on an immune cell (red)

A research team at UofL has discovered that an immune checkpoint molecule they developed for cancer immunotherapy also protects against future development of multiple types of cancer when administered by itself.

The recombinant protein molecule SA-4-1BBL has been used to enhance the therapeutic efficacy of cancer vaccines with success in pre-clinical animal models. It accomplishes this by boosting the effectiveness of CD8+ T cells, adaptive immune cells trained to target the tumor for destruction. Surprisingly, when the researchers treated normal healthy mice with SA-4-1BBL alone, the mice were protected when the researchers later exposed them to different types of tumor cells.

“The novelty we are reporting is the ability of this molecule to generate an immune response that patrols the body for the presence of rare tumor cells and to eliminate cancer before it takes hold in the body,” said Haval Shirwan, Ph.D., professor in the UofL Department of Microbiology and Immunology and the UofL Institute for Cellular Therapeutics. “Generally, the immune system will need to be exposed to the tumor, recognize the tumor as dangerous, and then generate an adaptive and tumor-specific response to eliminate the tumor that it recognizes. Thus, our new finding is very surprising because the immune system has not seen a tumor, so the response is not to the presence of a tumor.”

The researchers have determined that the molecule generates a tumor immune surveillance system through activation of what are known as CD4+ T cells and innate NK cells, thereby protecting the mice against various cancer types they have never had. This function is an indication of the molecule’s effectiveness in cancer immunoprevention.

In the research, published today in Cancer Research, mice that had never had cancer were treated with SA-4-1BBL alone, then challenged with cervical and lung cancer tumor cells at various time intervals. The mice showed significant protection against tumor development, with the greatest protection when challenged two weeks after treatment with SA-4-1BBL. The cancer immunoprevention effect generated by SA-4-1BBL lasted more than eight weeks.

“Just giving SA-4-1BBL alone prevents the formation of tumors in animal models,” Shirwan said. “To our knowledge, this is the first study to demonstrate that an immune checkpoint stimulator, known for its function for adaptive immunity, as a single agent can activate an immune system surveillance mechanism for protection against various tumor types.”

Additional testing showed that CD8+ T cells were not required for the protection, but when CD4+ T and NK cells were eliminated in the mice, protection failed, indicating these two cell types were necessary to achieve the effect. The lack of necessity for CD8+ T cells indicates the process is not one of conventional acquired immunity.

Although the research, which was conducted in collaboration with FasCure Therapeutics, LLC, tested the mice for cervical and lung cancers, the protective function of SA-4-1BBL works without context of specific tumor antigens, giving it the potential to be effective in preventing any number of tumor types.

“We are very excited about the cancer immunoprevention possibilities of this molecule. Its effectiveness is not tumor specific, and as a natural ligand, it does not cause toxicity, as is found with 4-1BB agonist antibodies. Plus, the fear of autoimmunity is highly minimized, as evident from our data, because it is activating the innate immune cells,” said Esma Yolcu, Ph.D., associate professor at UofL and co-author of the study.

Immune checkpoint stimulators and inhibitors are major regulators of the immune system and work in a similar fashion to the “brake” and “gas” pedals in a vehicle. Cancer evades the immune system by various means, including immune checkpoint inhibitors, which apply the brake on the immune response against a tumor. Stimulators, on the other hand, serve the accelerator function, improving immune responses against cancer.

Drugs to block the action of immune checkpoint inhibitors already have shown therapeutic efficacy for several cancer types in the clinic and are approved by the Food and Drug Administration (FDA). According to Shirwan, the focus now is on immune checkpoint stimulators.

“Several antibody molecules are in clinical testing for cancer immunotherapy as immune checkpoint stimulators. However, nothing so far is approved by the FDA that gives a positive signal to the T cells,” Shirwan said. “The immune checkpoint inhibitors take the foot off the brake, so to speak. This ligand, as an immune checkpoint stimulator, puts the gas on the immune system to destroy the tumor.

“Another big surprise is that an antibody to the same receptor targeted by SA-4-1BBL did not protect against tumors, demonstrating unique and desired features of SA-4-1BBL for caner immunoprevention.”

Shirwan and Yolcu plan to conduct further tests for SA-4-1BBL in cancer immunoprevention.

“Although the notion of cancer immunoprevention is an attractive one, the design of clinical trials presents a challenge with respect to the target population,” Shirwan said. “However, with advances in cancer screening technologies and genetic tools to identify high-risk individuals, we ultimately are hoping to have the opportunity to test the SA-4-1BBL molecule for immunoprevention in individuals who are predisposed to certain cancers, as well as in the presence of precancerous lesions.”

To encourage and accelerate research in cancer prevention, the National Institutes of Health have created a network for research into immunoprevention, outlining possible methods for testing promising preventive substances and provided opportunities for associated funding. The Immuno-Oncology Translational Network is designed to create a fertile environment for research and to facilitate cancer immunoprevention research projects focusing on people who are genetically predisposed to certain cancers, those who have been diagnosed with pre-malignant lesions or polyps, and individuals exposed to cancer-causing substances, such as smokers and asbestos workers.



Feb. 15, 2019

Celebrating survivorship

Beshears and Luallen lead slate of speakers at April 30 Cancer Survivors Celebration
Celebrating survivorship

UofL President James R. Ramsey, second from right, is shown with survivors of cancer at the 2014 Cancer Survivors Celebration. The 2015 event will be April 30 at 3 p.m. at the Kosair Charities Clinical and Translational Research building.

People who have survived cancer and their loved ones and caregivers will again gather at the University of Louisville for celebration, inspiration and support at the annual Cancer Survivors Celebration. The event is set for 3 p.m., Thursday, April 30, at UofL’s Kosair Charities Clinical and Translational Research building, 505 S. Hancock St.

Traditionally held on the Thursday before the Kentucky Derby, it has become a highlight of the Derby Season, and attendees are invited to dress in their Derby finery. The event is sponsored by the Kentucky Cancer Program at UofL (KCP) and UofL’s James Graham Brown Cancer Center, a part of KentuckyOne Health.

Joining the event this year will be Gov. Steve Beshear, First Lady Jane Beshear and Lt. Gov. Crit Luallen. Also speaking will be UofL President James R. Ramsey and James Graham Brown Cancer Center Director Donald M. Miller, M.D., Ph.D.

“All Louisville comes together at this time of year to celebrate the traditions and pageantry of the Kentucky Derby with the world,” Ramsey said. “And we come together at the James Graham Brown Cancer Center to celebrate everyone who has faced cancer. This event is a celebration of every person who has walked through our doors.”

“This is our opportunity to celebrate the courage of our patients,” Miller said. “I am always so moved every year when see the growing number of survivors and their loved ones at this event. Their victories over cancer are why we come to work every day.”

“Each year, we dedicate time for cancer survivors to celebrate and enjoy a day of food, fun and fellowship,” said organizer Pam Temple-Jennings of the KCP. “This year, we will feature a raffle for tickets to the Kentucky Derby Festival’s Pegasus Parade and entertainment from Turner’s Circus. We also are so pleased that Gov. and Mrs. Beshear, Lt. Gov. Luallen, President Ramsey and Dr. Miller will be joining us once again.”

The Pegasus Parade will be held shortly after the survivor celebration, beginning at 5 p.m. The parade route traverses Broadway and is an easy two-block walk from the survivor celebration.

Turner’s Circus is an aerial, Cirque-du-Soleil-like troupe that incorporates gymnastics, dance and aerial acrobatics into performances set to music.

For additional information, contact the KCP at 502-852-6318 or



University of Louisville physicians host symposium on heart disease in women

University of Louisville physicians host symposium on heart disease in women

Two of Louisville’s leading heart physicians will host a one-day symposium designed to provide the community, physicians, nurses and health professionals up-to-date information on the prevention, diagnosis and treatment of cardiovascular disease in women. The 2015 Louisville Symposium on Heart Disease in Women: Case Studies from the Heart of Louisville, will take place Saturday, May 16, 2015 and is open to the public.

The event, co-directed by Kendra Grubb, M.D., cardiovascular surgeon with University of Louisville Physicians, director of minimally invasive cardiac surgery for the University of Louisville at Jewish Hospital, and assistant professor at the University of Louisville School of Medicine, and Lorrel Brown, M.D., a cardiologist with University of Louisville Physicians, associate director of the Cardiovascular Medicine Fellowship and assistant professor at the University of Louisville School of Medicine,will feature presentations, case studies and panel discussions from leading experts.

“Cardiovascular disease is often viewed as a ‘man’s disease’ but the fact is, it kills more women than men each year,” Grubb said. “This symposium will offer case-based perspectives from top physicians on the best strategies for prevention and treatment of cardiovascular disease in women.”

The keynote address – “The One Minute Mindset” – will be given by Haley Perlus, Ph.D., peak performance consultant, author, international speaker, professor and industry leader in the psychology of helping people perform their best. Perlus is a known as a success coach with clients including members of the U.S., Canada and Australian national teams, NCAA athletes and more.

"We are excited to have Dr. Perlus as our keynote speaker,” Brown said. “Not only is she an expert in sport and exercise physiology, she also is a world-class Alpine skier. With her emphasis on translating the principles of top athletes into healthy living principles for everyday life, Dr. Perlus is a fantastic addition to our symposium this year."

The event will be held from 8 a.m. until 5 p.m. at the Jewish Hospital Rudd Heart & Lung Center, part of KentuckyOne Health, in the Hank Wagner Conference Center, located on the top floor.

Admission is free to students, residents and fellows and $25 for community members. Continuing medical education credits are available for physicians ($100) and allied health professionals/nurses ($50). Registration is available at:

Topics will include emerging controversies in cardiovascular disease and treatments; current guidelines in the medical management of heart disease in women; cardiac risk factors in women and opportunities for implementing new prevention strategies; trends, treatments and intervention strategies of cardiovascular disease in women; the differences in risk, presentation, diagnosis, and treatment for women with atrial fibrillation; emerging data in support of specific medical recommendations and surgical procedures in management of heart disease; emerging novel approaches and strategies to treating heart, vascular and valve conditions; and utilization of surgical techniques in the treatment of heart disease in women.

About KentuckyOne Health

KentuckyOne Health, the largest and most comprehensive health system in the Commonwealth, has more than 200 locations including, hospitals, physician groups, clinics, primary care centers, specialty institutes and home health agencies in Kentucky and southern Indiana. KentuckyOne Health is dedicated to bringing wellness, healing and hope to all, including the underserved.  The system is made up of the former Jewish Hospital & St. Mary’s HealthCare and Saint Joseph Health System, along with the University of Louisville Hospital and James Graham Brown Cancer Center. KentuckyOne Health is proud of and strengthened by its Catholic, Jewish and academic heritages.

Updates in autism to be discussed April 16

UofL child psychiatrists will cover recent advances in understanding autism

Parents of children who are on the autism spectrum will have the opportunity to learn about recent advances in understanding the causes and detecting signs of the condition from a University of Louisville psychiatrist and a child psychiatry fellow on April 16. The physicians also will discuss updates in the treatment of autism.

“Autism 2015:  Updates and Roadmaps for Hope” will be presented by W. David Lohr, M.D. and Allison Yoder, M.D., on Thursday, April 16 at 7 p.m. at Second Presbyterian Church, 3701 Old Brownsboro Road. Admission is free and the public is invited.

Lohr and Yoder will discuss recent advances in understanding the causes and the ability to detect signs and symptoms of autism, as well as present updates in treatment. Families also may learn steps to maximize chances for success for their children with autism.

Lohr is an assistant professor of child psychiatry in UofL’s Department of Psychiatry and Behavioral Sciences and clinical co-director of the UofL Autism Center at Kosair Charities.

Yoder is a fifth-year fellow in child psychiatry in the UofL Department of Pediatrics.

The lecture is a part of the “Building Hope” public lecture series sponsored by the UofL Depression Center, Kentuckiana’s leading resource for depression and bipolar disorder treatment, research and education.

For more information, contact the UofL Depression Center at 502-588-4886.

Beer with a Scientist: Will GMO crops doom the planet or save it?

Learn exactly what genetically modified plants are and why they are modified at the next Beer with a Scientist, April 13
Beer with a Scientist:  Will GMO crops doom the planet or save it?

Paul Vincelli, Ph.D., University of Kentucky

You may have heard about genetically modified organisms (GMOs) along with predictions of dire consequences for the planet or claims the technology is necessary to feed the Earth’s growing population. At the April edition of Beer with a Scientist, Paul Vincelli, Ph.D., professor in the Department of Plant Pathology at the University of Kentucky College of Agriculture, Food and Environment, will set the record straight with peer-reviewed science.

Vincelli will make the trip across I64 to share his expertise on the scientific understanding of GMOs based on the substantial body of scientific literature. He will explain exactly what constitutes a genetically engineered crop, whether eating recombinant DNA is safe, and why scientists would want to change a plant’s genes in the first place.

At UK, Vincelli serves as coordinator for the United States Department of Agriculture (USDA) Sustainable Agriculture Research and Education Program. He provides science-based outreach on risks and benefits of genetically engineered crops in Kentucky, the nation and internationally.

The program begins at 8 p.m. on Wednesday, Apr. 13 at Against the Grain Brewery, 401 E. Main St. A 30-minute presentation will be followed by an informal Q&A session.

The Beer with a Scientist program began in 2014 and is the brainchild of UofL cancer researcher Levi Beverly, Ph.D. Once a month, the public is invited to enjoy exactly what the title promises:  beer and science.

Admission is free. Purchase of beer, other beverages or menu items is not required but is encouraged.

Organizers add that they also encourage Beer with a Scientist patrons to drink responsibly.

For more information and to suggest future Beer with a Scientist topics, follow Louisville Underground Science on Facebook.

Optimal aging lecture provides practical legal information for seniors, Nov. 11

October 28, 2015

The Institute for Sustainable Health & Optimal Aging at the University of Louisville concludes its fall Optimal Aging Lecture Series with “Practical Legal Information for Seniors and Those Who Love Them,” Wednesday, Nov. 11. The lecture will be held from 11:30 a.m. to 1 p.m. at the University Club, 200 E. Brandeis Ave.

Misty Clark Vantrease and Kelly Gannott, partners at Kentucky ElderLaw PLLC, will engage the audience on how to navigate the financial maze and challenges that aging poses for individuals and their families.

The financial decisions of advancing age can be challenging for both individuals and their loved ones. Families who are faced with long-term care and increasing medical expenses can feel overwhelmed in managing the financial demands of this life-phase. This lecture will provide essential “financial caregiving” tips to help individuals and their families stay financially stable.

The Institute’s Optimal Aging Lecture Series will resume in February for the spring season.

Admission is $17 per person and includes lunch. Reservations are required online. For information, call 502-852-8953 or email

National aging expert comes to UofL Oct. 8 to challenge perceptions of growing older

National aging expert comes to UofL Oct. 8 to challenge perceptions of growing older

Bill Thomas, M.D.

A national expert known for “disruptive aging” will challenge perceptions about getting older in an Aging Reconsidered Workshop addressing “Louisville’s Aging Revolution: Becoming an Age-Friendly City.” The one-day event will be held at the Brown & Williamson Club of Papa John’s Cardinal Stadium, Thursday, Oct. 8 from 2:30 to 4 p.m.

The event is free to the public and hosted by the University of Louisville Institute for Sustainable Health & Optimal Aging. Reservations are requested at

This event is part of Bill Thomas’ national Age of Disruption2015 Tour. A medical doctor, Thomas is traveling to multiple states throughout the southeastern United States to spread what he terms his highly disruptive understanding of aging with the mission to inspire positive change for the communities he reaches. In Louisville, Thomas will be featured in four events throughout the day of Oct. 8; another event in Louisville includes a “non-fiction” theatrical performance at the Kentucky Center for the Preforming Arts at 7 p.m.

At the afternoon workshop, participants will learn how to challenge community leaders and members to have a voice and to take charge in making changes to better support livable aging. The afternoon forum will feature a dialogue about age-friendly cities, with participants sharing expectations of what an age-friendly city looks like. The community will be invited to engage with Thomas to develop an action plan in the development of an age-friendly city map for Louisville and surrounding communities.

Thomas’ presentation will be followed by a panel discussion of area aging leaders who have been identified by the institute as community change agents. Panelists include:

  • Keith Knapp, President/CEO, Christian Care Communities
  • Keisha Deonarine, Economic Development Manager, Louisville Forward: Lifelong Wellness & Aging Care
  • Barbara Gordon, Executive Director, KIPDA
  • Hannah Ruggles, Western Kentucky University student

“Thomas’ message is invigoratingly simple – the transition into our elder years should not be spent in frenzied disharmony,” said Anna Faul, D.Litt., director of the institute. “To successfully ‘play life’s most dangerous game’ – aging – we need to reimagine and create a clear and satisfying purpose to how we spend the rest of our lives.”

“Everything we think we know about getting older is wrong,” said Thomas, a Harvard-educated physician and author of the book Second Wind: Navigating the Passage to a Slower, Deeper, and More Connected Life. “It’s time we shake ourselves out of the misery of aging and repurpose and restore the wonders and integrity of the second half of life.”

For more information about the Aging Reconsidered Workshop and the Institute for Sustainable Health & Optimal Aging, call 502-852-5629.

Annual UofL lecture will examine genetic-based precision medicine

Annual UofL lecture will examine genetic-based precision medicine

Ali J. Marian, M.D.

“Sir William Osler and Modern Genetic-Based Precision Medicine” will be the topic of the 2016 Leonard Leight Lecture at the University of Louisville.

Ali J. Marian, M.D., will speak at noon, Wednesday, Oct. 5, at the 16th Floor Conference Center of the Rudd Heart and Lung Center, 201 Abraham Flexner Way. Admission is free. Marian is the George and Mary Josephine Hamman Foundation Distinguished Professor in Cardiovascular Research and the director of the Center for Cardiovascular Genetic Research at The Brown Foundation Institute for Molecular Medicine, University of Texas Health Science Center at Houston.

The Leonard Leight Lecture is presented annually by the Division of Cardiovascular Medicine in the Department of Medicine at the University of Louisville School of Medicine. For 30 years until 1996, Leight was a practicing cardiologist in Louisville and played a major role in developing cardiology services and bringing innovative treatment modalities in heart disease to Louisville.

The Leonard Leight Lecture series was established in 1994 and is made possible by gifts from Dr. and Mrs. Kurt Ackermann and Medical Center Cardiologists to the Jewish Hospital & St. Mary’s Foundation.

Regarded as the “Father of Modern Medicine,” Sir William Osler was a Canadian physician and in 1889, became founding physician-in-chief of Johns Hopkins Hospital in Baltimore. He later was a founding professor of Johns Hopkins School of Medicine, created the first residency program for specialty training of physicians and was the first to bring medical students out of the lecture hall for bedside clinical training.

Osler was known to have recognized the differences in the way disease manifests itself in each patient. “Variability is the law of life,” he said, “and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease.”

This recognition of the variability of patients’ reaction to disease is at the heart of today’s genetic-based precision medicine, and Marian will examine how Osler’s observations can provide insight in 21st Century medicine.

About Ali J. Marian, M.D.

Recognized internationally for his research achievements and expertise in genetics of cardiomyopathies, Marian earned his M.D in 1981 from Tehran University in Iran. He completed post-doctoral training at Cook County Hospital in Chicago in 1988 and at Baylor College of Medicine in Houston through the American Heart Association-Bugher Foundation Fellowship in 1991. He was appointed to the faculty at Baylor College of Medicine in 1992, and joined The Brown Foundation Institute of Molecular Medicine in 2006.

A past recipient of both the American Heart Association’s Established Investigator Award and the Burroughs Wellcome Fund’s Clinician-Scientist Award in Translational Research, Marian has served on the editorial boards of Circulation, Circulation Research, Journal of The American College of Cardiology and Genetics in Current Atherosclerosis Reports, among others, and has been lead or co-author of more than 100 manuscripts in peer-reviewed journals. He is actively involved with NIH grant reviews and has been a member of review committees on several panels and study sections.



Francis named chair of UofL obstetrics, gynecology and women’s health

Francis named chair of UofL obstetrics, gynecology and women’s health

Sean Francis, M.D.

Jan. 15, 2016

Sean L. Francis, currently the interim chair of the Department of Obstetrics, Gynecology and Women’s Health at the University of Louisville, has been named to the post permanently. The appointment was approved by the UofL Board of Trustees at its Jan. 14 meeting.

“Dr. Francis brings a patient-centered approach to care that enables him to partner with our patients to identify the best treatment options and infuses that approach in his work leading the department, its residents and students,” said Toni M. Ganzel, M.D., dean of the UofL School of Medcine.

Francis was named interim chair in February 2015. He came to UofL in 2012 as associate professor and chief of the divisions of Female Pelvic Medicine and Reconstructive Surgery (FPMR) and Minimally Invasive and Gynecologic Surgery. He also is FPMR fellowship director and practices with University of Louisville Physicians-Urogynecology. Prior to his tenure at UofL, he was on the faculty of the Medical College of Georgia in Augusta.

Francis is board-certified in both obstetrics and gynecology and FBMR and completed a fellowship at the Mayo Clinic Scottsdale’s Department of Gynecology, Urogynecology and Pelvic Reconstructive Surgery.

He has been named to “Top Doctors in America,” “Best Doctors in America,” “Top Doctors in Louisville” and “Top Surgeons in Louisville.” The author or co-author of chapters in two reference manuals and 20 journal articles, Francis has made 47 oral, video and poster presentations at professional meetings in the United States, Canada and Wales.

He is a past winner of the Faculty Award for Excellence in Resident Education by the Council on Resident Education in Obstetrics and Gynecology of the American College of Obstetrics and Gynecology; the Association of Professors of Obstetrics and Gynecology Award for Excellence in Undergraduate Teaching; and the American Association of Gynecologic Laparoscopists’ Special Excellence in Endoscopic Procedures Award.

Francis earned a bachelor’s of science degree, cum laude, in biology from Morehouse College, Atlanta, Ga., and his medical degree from Case Western Reserve University in Cleveland, Ohio. He completed a residency in internal medicine at Case Western’s Mount Sinai Hospital and another in obstetrics and gynecology at the Medical College of Georgia.

Supporting future professionals

Minority Pre-Health Symposium provides guidance for high school and undergraduate students interested in health professions
Supporting future professionals

Students at the 2018 Minority Pre-Health Symposium

Kyle Castaneda knows the value of mentors and connections for applying to medical school. A University of Louisville senior majoring in biochemistry, he credits the networking and advice he gained at events such as the Minority Pre-Health Symposium with helping him achieve admission to the UofL School of Medicine, where he will enroll this fall.

“I was from a very rural county. I was not prepared when I got to college to become a successful applicant for medical school,” Castaneda said. “I didn’t know a lot about when to shadow, when to volunteer or when to apply to medical school.”

High school and undergraduate students interested in health professions visited the UofL Health Sciences Center (HSC) campus Feb. 10 to learn about career and educational opportunities, tour the Schools of Dentistry, Medicine, Nursing and Public Health & Information Sciences, and meet with advisors and potential mentors. Representatives from the four HSC schools were on hand to discuss with students the skills needed to navigate the road to higher education in the health sciences.

Hannah Granholm, a high school sophomore from Louisville, attended the symposium to learn more about becoming a nurse practitioner. “I learned that a nurse practitioner does more than just give people shots and medicine. They do a lot more, and it takes a lot of work to do it,” Granholm said.

Glenda Granholm, Hannah’s mother, encouraged Hannah to attend. “I thought she could get exposure to different fields and could talk to people who know the field. That way she’ll be more comfortable asking questions.”

Vivian Doyle, a second-year UofL medical student, took a group of the students on a tour of the School of Medicine. She said a mentor provides essential support for students aspiring to careers in medicine, dentistry or graduate studies.

“It’s definitely important to find mentors – a physician, a medical student or an upper classman. That way, if you do get nervous or you have your doubts, you can go to your mentor and ask advice,” Doyle said.

Barbara Ekeh, another second year medical student, said the event also provided an opportunity to learn about the lesser-known careers in health-care, such as public health, graduate studies or dentistry.

“There are so many avenues in medicine and some are more visible than others. One student was asking, ‘What is public health?’ I didn’t know what that was until I was in college. Sometimes it can be a little overwhelming.” Ekeh said. “This is an avenue where they can meet other students to try and figure out what they are interested in doing.”

The event also allowed the students to connect with advisors and faculty members who could help them along in the process. Ashley O’Neil, a program coordinator in the UofL HSC Office of Diversity and Inclusion, helps students determine the best fit and guides them through the application process.

“There are people like me who will help you figure out your path and what it is going to take for you to succeed. I’m here to help in your journey with shadowing, clinical work, understanding the MCAT and its whole process, and the application itself,” O’Neil said.

Alona Pack, M.S.N., M.A., R.N., assistant professor in the UofL School of Nursing, said student organizations also can be important resources for the students.

“We have support systems for minority students here, particularly the Black Student Nurses Association. They provide mentorship and academic support to the students. They also do community outreach and develop leadership skills. It’s a good network for the students.”

The Student National Medical Association, Student National Dental Association, Health and Social Justice Scholars, Black Student Nurses Association, and the UofL Health Sciences Center Office of Diversity and Inclusion hosted the program, attended by 85 high school and undergraduate college students. The event was funded by the UofL Student Government Association Club Programming Committee (CPC) and the UofL Commission of Diversity and Racial Equality (CODRE).

Castaneda said events such as the symposium can help students connect with other programs and student organizations, which he found helpful. Castaneda attended the Professional Education Preparation Program (PEPP) prior to college, and joined the Multicultural Association of Pre-Medical Students (MAPS) once he arrived on campus.

“PEPP particularly got me up to speed and it made me feel a lot more comfortable when I got to college. I just kept doing the programs. They give you more exposure to the field. They let you meet great people and they help you along the process.”

See a photo gallery from the event here.

For more information on mentoring programs, visit the UofL HSC Office of Diversity and Inclusion website.

Show support for breast cancer research with the James Graham Brown Cancer Center Facebook frame

Show support for breast cancer research with the James Graham Brown Cancer Center Facebook frame

The UofL James Graham Brown Cancer Center has made this frame available for Facebook cover photos to show support for breast cancer research.

October is National Breast Cancer Awareness Month, and the James Graham Brown Cancer Center at UofL invites you to show your support on your Facebook page all month long.

The stats are sobering: Breast cancer is the second most common kind of cancer in women, and about one in eight women born today in the United States will get breast cancer at some point.

You can show support for all that the Brown Cancer Center does to end breast cancer by adding our Facebook profile frame. It’s easy:

From your phone: 1. Click on your profile picture. 2. Click “Add Frame.” 3. In the search function, type in “Brown Cancer Center.” 4. Click “Change Frame.”

From your desktop or laptop: 1. Go to 2. In the search function type in “Brown Cancer Center.” 3. Once you have found the correct frame, click “Use as Profile Picture” to save.

While you are at it, like the Brown Cancer Center on Facebook and follow us on Twitter to keep up-to-date with the latest news and events.


UofL cardiovascular surgeon implants two patients with new heart-support device at Jewish Hospital

Minimally invasive device in trial stage for use as bridge to heart transplant or for long-term cardiovascular support in patients with severe heart failure
UofL cardiovascular surgeon implants two patients with new heart-support device at Jewish Hospital

iVAS illustration courtesy NuPulseCV, Inc.

University of Louisville heart transplant surgeon Mark Slaughter, M.D., has implanted two patients with an investigational device, the intravascular ventricular assist system (iVAS), at Jewish Hospital to improve heart function. The iVAS is a minimally invasive alternative to ventricular assist devices for use in patients with severe heart failure, allowing more mobility and implant without open-heart surgery. The iVAS supports heart function and can be used temporarily while patients await a heart transplant or as a more permanent treatment. UofL is the only site in Kentucky participating in the iVAS trial.

The iVAS is a counterpulsation heart device, assisting the heart by pumping between beats while the heart is resting to increase the flow of blood and oxygen to the heart. Manufactured by NuPulseCV, Inc., the device consists of a balloon-type pump placed in the descending aorta. This pump is inflated and deflated to help move blood through the body. The intra-aortic pump is connected through the skin to an external drive unit. The new technology is an improvement over other heart assist devices such as the left ventricular assist device (LVAD) most significantly in that the iVAS is implanted with a minimally invasive procedure, not requiring open heart surgery.

“The iVAS is put in through a peripheral artery so it does not require opening the chest or placing the patient on a heart-lung machine,” said Slaughter, chair of the Department of Cardiovascular and Thoracic Surgery in the UofL School of Medicine and surgical director of heart transplant and mechanical assist devices for UofL and Jewish Hospital. “Through this clinical trial, we may find additional advantages such as the opportunity for patients to disconnect from the device intermittently. With the VAD, you are always tethered to the device. With the iVAS, you may be able to be untethered or turn it off for short periods,” Slaughter said.

Another benefit, Slaughter said, is patients are not required to be on long-term blood thinners, which can have serious side effects.

Robert Hughes, one of the patients who received the iVAS implanted by Slaughter in Louisville, had a heart attack in May and subsequently learned he had heart failure.

“I finished chemo for leukemia in January. I had gone from 200 pounds to 145 pounds and I was pretty weak,” Hughes said. “Then I had the heart attack on May 17. Afterward I was getting dizzy just standing. I felt like I would faint. It was very unnerving. I didn’t want to get out and do a nosedive at Pic Pac,” Hughes said.

Hughes’s diagnosis was advanced heart failure, but he did not qualify for either a heart transplant or open-heart surgery, so when he was presented with the iVAS as a long-term option, he was ready to participate in the trial. His iVAS was implanted on Aug. 13. Within a few weeks, he was able to go home.

“Since the surgery, I feel stronger and haven’t had dizzy spells. I am gaining my weight back,” Hughes said. “I am very pleased with the outcome. As far as I’m concerned, everything is a plus.”

Hughes said he has been able to get out for trips to the drug store or grocery store without fear of passing out. The external drive unit for iVAS weighs only 8 pounds, permitting patients to be discharged from the hospital to await transplant or continue their lives at home and free to go out in the community.

The goal of the clinical trial is to determine whether iVAS is as effective as the LVAD. Including the two patients at Jewish Hospital, 70 patients have been implanted with the iVAS device in 12 centers across the United States. 

Learn more about clinical trials at UofL here.




Sept. 30, 2019

First patient enrolled in NanoKnife® DIRECT study for treatment of stage III pancreatic cancer

First patient enrolled in NanoKnife® DIRECT study for treatment of stage III pancreatic cancer

Dr. Robert Martin

The University of Louisville has enrolled the first patient in AngioDynamics’ NanoKnife® Irreversible Electroporation (IRE) “Data IRE Cancer Treatment” clinical study (DIRECT). The DIRECT Study supports a proposed expanded use of the NanoKnife System in the treatment of stage III pancreatic cancer.

“We are pleased to be the first enrolling site. The DIRECT Study represents an important milestone in the standardization of care for patients with stage III pancreatic cancer,” said Robert C.G. Martin, MD, co-principal investigator of the DIRECT Study; director, Division of Surgical Oncology; professor of surgery, University of Louisville and surgical oncologist with UofL Physicians – Surgical Oncology.

“Our goal is to generate important data that should standardize and optimize the use of IRE in the treatment of locally advanced pancreatic cancer, significantly improving outcomes for patients with this late-stage diagnosis,” Martin said.

Annually, there are approximately 57,000 new cases and 46,000 estimated deaths from pancreatic cancer in the United States. Deaths from pancreatic cancer are projected to increase dramatically in the coming years, with a trajectory of becoming the second leading cause of cancer-related deaths before 2030.

The mortality rate is high due to the aggressive nature of the disease and lack of early warning signs. Less than 20 percent of patients are candidates for surgical resection at time of diagnosis.

Approximately 35 to 40 percent of patients will initially present with stage III and 45 to 55 percent with metastatic disease. Regardless of the stage of pancreatic cancer, it is one of the least survivable cancers, and survival rates have not improved substantially for more than 40 years. For all stages combined, the five-year relative survival rate is 8 percent and, for those with advanced disease at the time of diagnosis, the five-year survival rate remains at 3 percent.

The DIRECT study continues the research of Martin and other health care providers at UofL that has helped lead to results that have tripled the overall survival in stage III pancreatic cancer.

AngioDynamics’ DIRECT clinical study features a comprehensive data collection strategy that will provide meaningful clinical information to health care professionals, support a regulatory indication for the treatment of stage III pancreatic cancer and facilitate reimbursement for hospitals and treating physicians. The next-generation study is classified as a Category B IDE by the U.S. Food and Drug Administration, which allows participating sites to obtain coverage for procedures performed, in addition to related routine costs.

The DIRECT Study includes a randomized controlled trial at up to 15 sites, as well as a real-world evidence, next generation registry at up to 30 sites, each with a NanoKnife System treatment arm and a control arm. AngioDynamics expects each NanoKnife arm to consist of approximately 250 patients with an equal number of control patients. The primary goal of the study is overall survival.

As part of the DIRECT Study, AngioDynamics launched to facilitate the enrollment of participants. The online platform provides patients and their families with information about pancreatic cancer and details about the study. It also features a physician locator to help prospective participants and referring health care professionals identify clinical study locations.

UofL Physicians ALS Clinic named Recognized Treatment Clinic

UofL to launch ALS research program
UofL Physicians ALS Clinic named Recognized Treatment Clinic

UofL President James Ramsey has kicked off the new UofL ALS research fund with a personal donation of $10,000.

The University of Louisville Physicians ALS Clinic, located at Frazier Rehab Institute, part of KentuckyOne Health, was named a Recognized Treatment Clinic by The ALS Association on Tuesday, Sept. 16. The clinic is one of 50 in the United States to earn such a designation.

The designation follows a rigorous clinical and administrative review by the association and a vote of its board. Earning the recognition means the clinic meets a national standard of quality and implements best-practice care for patients with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease.

In addition to celebrating the designation, the University of Louisville announced the establishment of a research fund to further the activities of the clinic as it pursues its goal of becoming a Certified Center for Excellence. Dr. James Ramsey, president of the University of Louisville, kicked off the new UofL ALS research fund with a personal donation of $10,000, which he announced at the news conference Tuesday.

“For me, ALS is personal,” Ramsey said. “My mother-in-law passed away from ALS, and developing this clinic and an ALS research program at UofL has been a goal of mine for a long time. I hope others will choose to donate to UofL’s ALS research program as well so we might help find the cause and a cure for this devastating disease.”

Ramsey made his donation as part of the “ice bucket challenge” that has swept the nation since July and greatly raised awareness of ALS and contributions to ALS research. He participated in the challenge on Aug. 28 on the UofL Health Sciences Campus. (Watch here:

On Tuesday, The ALS Association’s Kentucky Chapter also presented the UofL Physicians ALS Clinic with a $10,000 check.

“We are proud to present this one-time donation to the UofL Physicians ALS Clinic, which is made possible by a gift from Heaven Hill Distilleries through the sale of Parker’s Heritage bourbon to help us continue to fulfill our three mission priorities, one of which is to expand our care services,” said Mari Bacon, executive director of the chapter.

Parker’s Heritage Collection bourbon is named for Parker Beam, a sixth-generation master distiller for Heaven Hill who has ALS. As a way to help The ALS Association raise funds to find a cure, Heaven Hill donates a portion from the sale of every bottle to The ALS Association.

Recognition process

The ALS Association’s Certified Center Program – which includes Recognized Treatment Clinics and Certified Centers of Excellence – selects, recognizes and supports distinguished institutions recognized as the best in the field when it comes to knowledge, skill and experience with ALS; access to care; and neurological diagnostics and imaging. Recognized Treatment Clinics must also have an on-site designated multidisciplinary team.

Other requirements to become a Recognized Treatment Clinic are serving a number of patients living with ALS, and an ongoing relationship with the local chapter to provide programs to assist those with ALS and their families. The primary goal of the ALS recognition process is to ensure each patient receives the best evidence-based care closely linked to positive outcomes.

The designation confirms to patients and families, as well as government institutions and other key stakeholders, the validity and comprehensiveness of the UofL Physicians program.

“We are honored to recognize the University of Louisville Physicians ALS Clinic for the staff’s expertise, and for all they have done and are continuing to do for patients living with the disease,” said Shawn Mullennex, president of the board for The ALS Association’s Kentucky Chapter. “Becoming a Recognized Treatment Clinic is not easy to achieve, and patients who come to the UofL Physicians clinic can feel confident that they are receiving the best care possible, in a compassionate and caring environment.”

Mullennex presented clinic director Dr. Martin Brown with a plaque designating the UofL Physicians ALS Clinic as an ALS Recognized Treatment Clinic, a goal that was years in the making. Brown was joined by Dr. Kerri Remmel, chief of vascular neurology at University of Louisville Physicians, and Randy Napier, president of Frazier Rehab Institute, in receiving the plaque.

Lisa Shannon, chief operating officer of KentuckyOne Health, said the UofL Physicians ALS Clinic at Frazier Rehab “is indeed yet another example of the partnership between UofL, Frazier Rehab and KentuckyOne Health to advance medical care and research in the Commonwealth.”

“It is our mission to bring wellness, healing and hope to all, including the underserved. The ALS clinic and the research that will be done here is part of that mission, and I want to emphasize the word ‘hope,’” Shannon said. “ALS is a devastating disease. But through research, there is hope. Hope for better care and advancements in treatment that can improve quality of life for these patients, and maybe one day find a cure.”

Napier added “We are honored to be the home of the ALS Clinic and the physicians, staff and researchers that will work with us every day to make a difference in the lives of the patients and their families who entrust us for care. The Frazier Rehab team that cares for ALS patients is an incredibly dedicated group of professionals – from physical therapy, occupational therapy and speech therapy to psychology, pulmonary rehab and case management.”

UofL ALS research

Brown said the new UofL research program will have two components: clinical research, which includes trials of possible treatments for existing patients; and basic science research of ALS to try to determine how the disease starts and why it progresses.

“We don’t know what causes ALS, why it starts or how it spreads from one limb to another,” Brown said. “It’s hard to come up with a treatment if we don’t know the underlying cause. Our goal is to try to answer some of those questions, and give patients more hope through clinical trials that might make a difference. Research is the key to fighting ALS.”

For more on the University of Louisville Physicians ALS Clinic and the new UofL ALS research fund, visit or email

History of the UofL Physicians ALS Clinic

UofL’s quest to serve patients with ALS started with a conversation nearly 10 years ago between Dr. Kerri Remmel, chair of the Department of Neurology at the University of Louisville School of Medicine, and UofL President Dr. James Ramsey. It was an important cause for both – for Remmel as a neurologist, and for Ramsey for his family.

Dr. Martin Brown was then hired in 2007 to help develop the clinic, and in 2011, he met with The ALS Association’s national chief of care services, Kim Maginnis, and the Kentucky Chapter’s executive director, Mari Bacon, to discuss becoming a Recognized Treatment Clinic. He had already begun seeing patients, and he and clinic coordinator Johanna Harris had started working with the association’s Kentucky care services manager, Patricia Peak.

In June 2013, the clinic became a reality, seeing patients on the sixth floor at Frazier Rehab Institute, 220 Abraham Flexner Way. On Tuesday, Sept. 16, 2014, the clinic became a Recognized Treatment Clinic by the ALS Association.

UofL pediatric spinal cord injury research program garners significant support

The Helmsley Charitable Trust provides $1.5 million grant
UofL pediatric spinal cord injury research program garners significant support

Andrea Behrman, Ph.D.

At three months of age, Emmalie Smith suffered a spinal cord injury leaving her paralyzed. Her parents, Amy and Bryce, took her to traditional physical and occupational therapy three times a week with the hope that their little girl would regain her ability to move.

Amy says the results were underwhelming, with Emmalie using her forehead to activate a motorized wheelchair.

Unsatisfied with that as an option, Amy contacted the University of Louisville and Andrea Behrman, Ph.D., who had brought to UofL her research into the use of Locomotor Training to provide better rehabilitation to children with paralysis from spinal cord injuries.

Nine months after the intense physical therapy at the Frazier Rehab Institute, a part of KentuckyOne Health, Emmalie was able to better move her arms, roll over and come to sit in bed, and use a manual wheelchair. After her most recent work with Behrman and the pediatric team, the now 4-year-old from Brighton, Mich., is beginning to stand. With an injury at such a very young age, these are new experiences in Emmalie’s growth and development.

“This has made a tremendous difference in Emmalie’s life,” Amy said. “Her core strength is to where she is able to sit on her own and doesn’t need a chest belt. She’s able to get herself around and is much more independent. Working with Dr. Behrman and her team has had a huge impact on Emmalie and our entire family.”

More children like Emmalie will be able to benefit from Behrman’s groundbreaking efforts, thanks to a three-year, $1.5 million grant provided by The Leona M. and Harry B. Helmsley Charitable Trust.

“The work of Dr. Behrman and her team is a perfect example of the goal of every researcher at the UofL Health Sciences Center -- transforming peoples’ lives through creating and translating into actions new knowledge about how to prevent, treat and cure medical issues,” said James R. Ramsey, Ph.D., president of the University of Louisville, in announcing the grant at a news conference today (Sept. 4). “We are very excited and grateful that the Helmsley Charitable Trust shares our vision and is providing significant support to help us achieve this ambitious objective.”

To date, the Helmsley Charitable Trust has provided nearly $16.5 million to support UofL researchers investigating both cancer prevention and cures and rehabilitation efforts for adults and children who are paralyzed.

“Dr. Behrman’s work has the potential to be truly transformative for adults and children who are affected by paralysis -- not just in Louisville and Kentucky, but around the world.” said John Codey, a trustee of the Helmsley Charitable Trust.  “With this latest grant that is focused on treating pediatric spinal cord injuries, the Trust is thrilled to build upon our relationship with UofL’s world-class team of researchers, who continue to break new ground in the quest to understand and solve some of the most critical medical challenges that we face today.”

“The importance of support from our partners cannot be over-emphasized,” said David L. Dunn, M.D., Ph.D., UofL executive vice president for health affairs. “The current research funding environment does not guarantee that projects like Dr. Behrman’s will receive support from the typical funding agencies. We are extremely grateful that the Helmsley Charitable Trust recognizes that the work taking place at the University of Louisville has the significant potential to change the lives of children throughout the world.”

Behrman, professor of neurosurgery and director of the UofL Kosair Charities Center for Pediatric Neurorecovery, is a pioneer in the use of Locomotor Training in children. The intense physical therapy regime was developed by Behrman and fellow UofL faculty member Susan J. Harkema, Ph.D., professor of neurological surgery and the Owsley B. Frazier Chair in Neurological Rehabilitation at UofL and the Rehabilitation Research Director of the UofL Kentucky Spinal Cord Injury Research Center.

Locomotor Training allows individuals with certain kinds of spinal cord injuries to repetitively practice standing and stepping using body weight support and a treadmill with manual facilitation from therapists and technicians. The ultimate goal is to re-train patients with spinal cord injuries to sit independently, stand and walk again. Further benefits including improved respiration, bladder control, and sensation have made a significant impact on the quality of life for children. Behrman’s goal is to help children who not only have spinal cord injuries, but also conditions such as head trauma and tumors.

“The generous support we are receiving from the Helmsley Charitable Trust will enable our team to develop equipment that better fits children as they participate in Locomotor Training,” Behrman said. “Also, we now will be able to develop a systematic database for immediate and long-term outcomes for the children who are participating in our program. We also will gain a better understanding of the value of sensory cues such as surface texture, heat/cold or vibrations and their potential impact on the child’s rehabilitation effort.”

Breast radiation trial provides more convenience, better compliance, lowered cost and patient outcomes on par with current treatment

UofL researcher finds once-weekly regimen successful with no adverse effects
Breast radiation trial provides more convenience, better compliance, lowered cost and patient outcomes on par with current treatment

Anthony E. Dragun, M.D.

An experimental regimen of once-weekly breast irradiation following lumpectomy provides more convenience to patients at a lower cost, results in better completion rates of prescribed radiation treatment, and produces cosmetic outcomes comparable to the current standard of daily radiation.

These interim results of the 5-year Phase II clinical trial using the experimental regimen were presented Sept. 4 at the Breast Cancer Symposium 2014 in San Francisco by Anthony E. Dragun, M.D., vice chair and associate professor of radiation oncology at the University of Louisville.

Dragun, a radiation oncologist with University of Louisville Physicians, launched the trial three years ago at UofL’s James Graham Brown Cancer Center, a part of KentuckyOne Health and the only site offering the experimental regimen in the United States. A second KentuckyOne Health site is being planned, he said, and is expected to begin enrolling patients this autumn.

Reviewing data from Europe – the United Kingdom in particular – Dragun found an alternative to the currently standard daily radiation treatments prescribed to patients after a lumpectomy. Physicians in the U.K. and other European countries were reporting excellent results with a regimen of radiation administered once-weekly.

“Instead of daily treatments for 25-30 days, five to six treatments administered once each week were being used,” he said. “I thought this regimen would give our patients here in Kentucky a great deal of access and choice, so we developed the trial and launched it in 2011.”

Approximately 150 female patients have been enrolled in the trial thus far, he said. Patients undergoing a lumpectomy following diagnosis of breast cancer are given a choice of the current standard of daily radiation treatments or the option to enroll in the trial and receive treatment one time per week.

The radiation dosing has been calibrated to compensate for the change in how the treatments are administered, but no adverse effects have been seen, Dragun said. “The outcomes with once-weekly treatments are absolutely in line with what we see in daily breast irradiation,” he said. “The standard of care is maintained.”

Giving women the choice of how their treatment is administered means more women complete their treatment, he said. “Finding time for daily treatments for 6 weeks or more just isn’t possible for many women,” Dragun said. “Scheduling once-weekly treatments is much easier to fit into the busy lives our patients lead.

“We also see many patients who depend on public transportation or live in rural areas that are 30 miles or more from our center, and they have told us that they would not have been able to complete a traditional course of daily radiation treatment.  Their only alternative would be a mastectomy,” he said.

Because radiation treatment is reimbursed on a per-treatment basis, Dragun said the overall cost is lowered. “We have reduced the number of treatments to about one-fourth to one-third of what the current daily treatment regimen is,” he said. “Medicare reimburses radiation costs on a per-treatment basis, and most private insurers do likewise.

“This means we’ve been able to reduce the cost by 50 to 60 percent without jeopardizing the quality of care.”

Dragun plans to enroll another 50 patients at the Louisville site and 30 at the future trial site. After the completion of this trial, he intends to expand into a multi-center Phase III trial at facilities in other states.

“We believe the once-weekly regimen such as this will become a standard option in the next decade,” he said.





Bhatnagar leads group developing first policy statement on e-cigarettes

Bhatnagar leads group developing first policy statement on e-cigarettes

Aruni Bhatnagar, Ph.D.

A University of Louisville professor chaired a 10-member American Heart Association panel of experts in formulating the association’s first-ever policy statement on e-cigarettes.

Aruni Bhatnagar, Ph.D., the Smith and Lucille Gibson Chair in Medicine and director of the UofL Diabetes and Obesity Center, is lead author of the statement as published in the journal CirculationAug. 24.

While much is still unknown about the rapidly growing electronic cigarette industry, e-cigarettes are dangerous because they target young people, can keep people hooked on nicotine, and threaten to “re-normalize” tobacco use, according to the policy statement.

The battery-powered e-cigarettes that contain nicotine are tobacco products and should be subject to all laws that apply to these products, according to recommendations in the policy statement. The association also calls for strong new regulations to prevent access, sales and marketing of e-cigarettes to youth, and for more research into the product’s health impact.

“People need to know that e-cigarettes are unregulated and there are many variables that we don’t know about them,” Bhatnagar said. “Recent studies raise concerns that e-cigarettes may be a gateway to traditional tobacco products for the nation’s youth, and could re-normalize smoking in our society.”

Manufacturers present e-cigarettes as “cool and sexy and acceptable, which is a problem because you’re increasing addiction,” Bhatnagar said. Companies also use terms like “vaping” rather than smoking to gain public acceptance and try to break the connection between e-cigarettes and traditional, “combustible” cigarettes, he added.

In April the Food and Drug Administration proposed rules banning the sale of e-cigarettes to people under the age of 18 and subjecting the $2 billion industry to federal regulation for the first time. Such rules had been long sought by the AHA and other organizations.

The FDA’s proposal fell short of what was hoped for by the AHA and other public health advocates, however, because it did not go far enough in limiting online sales, advertising and flavored products, all tactics used to make e-cigarettes appealing to young people.

Liquid nicotine used by e-cigarettes comes in many flavors like bubble gum, caramel, chocolate, fruit and mint, all attractive to young people, and many brands use colorful, candy-like packaging.

“That’s an unfortunate trend, to make them palatable and attractive to children,” Bhatnagar said.

UofL pediatricians make changes to improve care for community’s children

The University of Louisville Department of Pediatrics is reorganizing its general pediatrics division, positioning itself to respond better to the needs of the community’s children and to the changing health care enrivonment.

The division provides primary care services to children in Louisville and Campbellsville, Ky., and helps train students and residents in medicine, nursing, dentistry, psychology and social work.. In 2013, its 22 pediatricians were responsible for more than 22,000 patients. Approximately 12 percent of the children in metro Louisville sees a UofL pediatrician as their primary care provider.

“Health care reform has placed a greater emphasis on primary care, where providers can promote health and safety,” said Gerard Rabalais, M.D., MHA, chair of the UofL Department of Pediatrics. “Pediatric programs like ours may be the best place to achieve success with health care reform since we have the ‘longest runway’ to influence attitudes about prevention and healthy lifestyle.”

A number of changes are planned for the coming months.

Consolidating offices, redeploying physicians

The department created a single, expanded practice site in Downtown Louisville, moving the office formerly located on Broadway at Floyd Street a few blocks north  of the Children & Youth Project (C&Y) at 555 S. Floyd St.

C&Y will offer all of the services previously offered at the Broadway office, and the expanded downtown clinic will serve as a medical home with a wider array of on-site ancillary services: social work, psychology, dental care, home health, speech therapy, WIC nutrition services and legal counseling.

“This practice demonstrates the power of a university to bring multiple disciplines together to provide comprehensive health care for children,” Rabalais said.

Patients may see a UofL pediatrician at C&Y or one of the department’s other general pediatrics practices: the Stonestreet location at 9702 Stonestreet Road; or the Sam Swope Kosair Charities Centre at 982 Eastern Parkway.

Families who want a Spanish-speaking provider will have three office locations to choose from in Downtown Louisville, Germantown and South Louisville.

“Consolidating these two offices and deploying our physicians to different locations lays the groundwork for increasing access and building partnerships in the communities we serve,” said Gil Liu, M.D., chief of the UofL general pediatrics division. “Increasingly, we want to be able to say, ‘Our pediatricians are coming to a neighborhood near you.’”

Adding pediatric practices

This summer, the UofL Department of Pediatrics will partner with an East Louisville pediatric practice, bringing the number of general pediatricians and nurse practitioners in the department to 36.

The department will also expand its Campbellsville, Ky., practice – located at 73 Kingswood Dr. – later this summer, partnering with Taylor Regional Hospital to open a satellite office in Columbia, Ky.

Plans also are underway to provide general pediatric care in the West End of Louisville.

“We see these additions as opportunities to expand availability to patients and support community practitioners, who don’t have the resources to support multiple disciplines or the buying power and advantage in contract negotiations that we do,” Rabalais said.

Creating a network

All of the Louisville pediatric practices will soon operate as a network. That means patients will have a medical home for routine visits as well as access to urgent care at any of the other Louisville general pediatric practices. The network also will enable families to access ancillary services headquartered at C&Y and specialty care by UofL pediatric specialists.

“We think an arrangement that offers ‘one-stop shopping’ for multiple health care providers will be good for all our patients,” Dr. Liu said.

Creating additional learning opportunities for trainees

The department’s reorganization also ensures that residents, medical students and trainees from other programs will have places to learn primary care pediatrics. Historically, trainees have spent time in community pediatric practices but these practices may struggle to continue hosting students because of changes in the health care landscape.

“It is part of our educational mission to expand primary care opportunities,” Rabalais said.