The Jewish Hospital Trager Transplant Center and the University of Louisville are celebrating an important milestone – the 300thlung transplant performed at the hospital since the lung transplant program began there 27 years ago.

“Three-hundred lung transplants is a significant milestone for Jewish Hospital Transplant Care,” said Chris Jones, M.D., director of the Transplantation Program at Jewish Hospital and chief of the division of Transplant Surgery at University of Louisville Physicians and the UofL School of Medicine. “We recognize the selfless sacrifice of all organ donors, celebrate the improved lives of our organ recipients, and recognize the impact of everyone on the transplant team for their lifesaving and life-changing work.”

The 300th lung transplant was performed Tuesday, Sept. 18, on a 71-year-old man from northern Kentucky who suffered from pulmonary fibrosis. The patient was on the transplant list for two months before undergoing a lung transplant. The surgery was performed by Victor van Berkel, M.D., Ph.D., surgical director of the Lung Transplant Program at Jewish Hospital and chief of Thoracic Surgery at UofL Physicians and the UofL School of Medicine.

“Each year, we are performing more and more lung transplants at Jewish Hospital, and it is exciting to hit this milestone as this momentum continues,” said Dr. van Berkel, “When I first started, we were doing between five to 10 lung transplants a year. Now we are closer to 20 lung transplants a year, and we’re trying to grow that even further.”

The first lung transplant at the hospital took place in 1991, and the first double lung transplant in 1995. Since then, transplantation has seen significant advancements in anti-rejection medications, surgical techniques and other technologies, helping Jewish Hospital achieve one-year survival rates higher than the national average.

In 2017, the Jewish Hospital Trager Transplant Center’s program with UofL became the first transplant program in Kentucky, and only the second program in the region, to begin offering Ex Vivo Lung Perfusion (EVLP). EVLP is a leading-edge technology that allows for an expansion of the Lung Donor Pool that will allow more patients to receive lifesaving lung transplants.  

“The Jewish Hospital and UofL transplant team are helping save lives in our community each day,” said Ronald Waldridge, M.D., president of Jewish Hospital. “The team is one of the leading providers of organ transplantation in the United States, and milestones like the 300th lung transplant remind us how important this work is daily. We’ve come so far since the first lung transplant in 1991, and we’re looking forward to many more lives impacted.”

On Thursday, doctors and lung transplant recipients gathered at the Jewish Hospital Rudd Heart and Lung Center to celebrate the 300th milestone and the many lives that have been saved over the years thanks to lung transplantation. 

“When I first started my training, we used to have a firm age limit of 65. That was the absolute limit for transplantation,” said Allan Ramirez, M.D., medical director of the Lung Transplant Program at Jewish Hospital and a pulmonologist with UofL Physicians and assistant professor at the UofL School of Medicine. “These days, we are extending that age and our oldest recipient got their lungs at age 75, so we are continuing to push the envelope in terms of being able to offer transplants to older patients, and patients who are sicker who we would not have considered doing a transplant on 5 to 10 years ago.”

Dr. Jill Jacobs is among the 300th lung recipients at Jewish Hospital. Jacobs was the 271st recipient, and was also a double lung transplant recipient. Jacobs says she smoked cigarettes for about 40 years, and by the time she stopped, had already developed chronic obstructive pulmonary disease (COPD).  

“I had the transplant in February of 2017,” Jacobs said. “I have been extremely happy and grateful that I had doctors who have given me my life back. They’ve given me a new life, in fact.”

Jacobs said before the transplant, she couldn’t even do simple things, like getting dressed, without being short of breath. She says the Jewish Hospital Trager Transplant Center has helped change her life.

“I can’t tell you how happy I am that I went to Jewish to have this done,” Jacobs said. “It’s a gift nobody can believe. It’s a miracle, in my opinion. A miracle.”

Earlier this year, the Jewish Hospital Trager Transplant Center – a joint program with the UofL Physicians, the UofL School of Medicine and KentuckyOne Health – also celebrated its 500th heart transplant. In addition to Kentucky’s first heart transplant, the program is known for performing Kentucky’s first adult pancreas, heart-lung and liver transplants.

For information on the Jewish Hospital Trager Transplant Center, visit www.kentuckyonehealth.org/transplant-care.

Today is the first day of medical school for 163 students at the University of Louisville, who received their first white coat as a doctor over the weekend.

On Sunday, there were lots of smiles, hugs, cheers and tears from students and their families at the School of Medicine’s White Coat Ceremony, which formally marks the students’ entry into medical school. The ceremony was held Sunday afternoon in the ballroom at the Marriott Louisville Downtown.

At the annual ceremony, UofL faculty and the local medical community formally welcome first-year medical students (known as “M1s”) by presenting them with their first white coat, a gift from the Greater Louisville Medical Society. They also received their first stethoscope, courtesy of the Stethoscopes for Students program, an effort funded by alumni of the UofL School of Medicine.

The class of 2022 is a diverse group, with the youngest being 19, and the oldest 32. Forty-three percent of the class is female, and 11 percent are from groups underrepresented in medicine. Twelve percent are from rural Kentucky counties. The 163 were selected from a pool of 3,558, and come from 18 different states and 58 different colleges and universities.

Compassion was a theme of the ceremony. Speakers urged students to take care of themselves, so that they could take better care of others.

UofL President Neeli Bendapudi, Ph.D., gave the students three pieces of advice: to take care of themselves, to look out for one another, and to recognize that being a doctor meant they were part of a broader community.

“Remember, you will be treating a whole human,” she advised. “When you are physicians and you are working with a patient, the patient is more than an aching knee or a tumor, or something else that’s wrong with them. You need to see the psychosocial dimensions of every individual. The more you cultivate your own humanity, the more you cultivate who you are and the better off you will be.”

She told them they had chosen a noble profession. “You will see us when we are at our most vulnerable, our most nervous, most scared, and we will look to you to be our partners, our coaches, to be our cheerleaders, and I am thrilled that you’ve chosen to embark on that journey with us at UofL.”

Keynote speaker Barry Kerzin, M.D., a Buddhist monk and founder and president of the Altruism in Medicine Institute and the personal physician to the Dalai Lama, also urged the students to practice self-care, along with humility and gratitude.

“The more you give, the more you receive. That’s enough. It says it all. … The more you love, the more you are loved. The more you are kind, the more kindness is shown to you,” he said.

He noted “these are kind of compasses to try to orient our lives. Of course we won’t achieve these things overnight, maybe not – probably not – fully achieved in a lifetime. But these are goals, these are aspirations.”

He said gratitude was “extremely important.”

“To feel gratitude for the next breath that you take. That you’re alive. It’s wonderful stuff,” he said. “It makes you feel good, makes you appreciate life. Even when you’re having a rough time.”

He said humility, by decreasing the ego and arrogance, increases compassion and love.

“So in terms of a doctor, make a proper diagnosis, give a treatment, but also support the patient emotionally and the family emotionally. That’s critical, and that’s what makes a good doctor.”

After Kerzin’s speech, the students filed across the stage in groups, where UofL doctors helped them don their coats. The students’ first white coat is a short white coat, and after they graduate from medical school, they are entitled to wear a long white coat.  The white coat symbolizes cleanliness and the compassion that inspires students to become physicians. As they walked from the stage, they were handed their stethoscopes.

Led by Greg Postel, M.D., executive vice president for Health Affairs at UofL, the students then took the Declaration of Geneva, a more modern version of the Oath of Hippocrates, in which a new physician swears to uphold professional ethical standards.

“A Taste of Health” event will be held on Thursday, July 26, to thank nurses and other health care workers for their service to the community during the recent hepatitis A outbreak.

The event, which is open to the public, will feature healthy food options from more than 20 different restaurants and local grocers, as well as a cash bar, live music from Joe DeBow (blues, R&B, reggae, jazz), a silent auction and raffles.

Hosted by University of Louisville Physicians – Infectious Diseases, the Kentucky Nurses Association and the Kentucky Restaurant Association, the event will be held from 6-8 p.m. at the UofL Kosair Charities Clinical and Translational Research Building at 505 S. Hancock St. on the UofL Health Sciences Campus.

The cost of the event is $45 for members of the Kentucky Nurses Association, and $50 for others. The money will go toward scholarship funds, education and research at the UofL School of Nursing, and some also will go to UofL Physicians - Infectious Diseases for vaccine supplies. The event also will feature a “Giving Tree.” 

“The event is a way for restaurants and the community to say ‘thank you’ to nurses for their efforts to mobilize and come to restaurants and vaccinate all workers against hepatitis A,” said Ruth Carrico, Ph.D., RN, clinical director of the UofL Physicians Vaccine and International Travel Center and an associate professor at the UofL School of Medicine.

Nurses from UofL vaccinated around 6,000 people at restaurants in Louisville and Jefferson County. Hepatitis A is a highly contagious liver infection, most likely to be spread from contaminated food or water or from close contact with an infected person or contaminated object.

“It’s important to recognize their contribution to public health,” Carrico said. “It’s also important to realize what a resource UofL is, in that we have the ability to mobilize and respond to a public health crisis such as this.”

RSVPs are requested by July 20 by visiting the Kentucky Nurses Foundation site here, or by calling the Kentucky Nurses Association office at 502-245-2843.

University of Louisville researcher Steven P. Jones, Ph.D., was named the 2018 Outstanding Investigator from the International Society for Heart Research on Tuesday at the society’s meeting in Amsterdam.

The annual Outstanding Investigator Award, one of the society’s highest and most prestigious, recognizes a scientist who is making major and independent contributions to the advancement of cardiovascular science, and is leading a growing research program likely to play a major role in the future.

Jones is a senior faculty member at UofL’s Institute of Molecular Cardiology and a professor at the UofL School of Medicine. A goal of his research is to understand the mechanisms of cardiac muscle damage during a heart attack, and to develop novel therapeutics to preserve the heart. He also is investigating the confounding influence of risk factors, such as diabetes, on the development of heart disease, and the molecular explanations of ventricular remodeling and heart failure.

Jones was chosen by an international panel of experts from among some of the best scientists in the world. The winner presents a major lecture and receives a $1,500 honorarium and plaque. Jones delivered his lecture Tuesday morning at the meeting, which is taking place July 16-19 at Vrije University Medical Center in Amsterdam. The meeting is focused on basic and translational research in cardiology. The topic of his lecture was “Non-catabolic Fates of Glucose in the Heart.”

The International Society for Heart Research, which has 3,000 members on five continents, is an international organization devoted to promoting cardiovascular research.  It is dedicated to the discovery and dissemination of knowledge in cardiovascular science worldwide, and publishes the Journal of Molecular and Cellular Cardiology.

The Outstanding Investigator Award was created by UofL researcher Roberto Bolli, M.D., when he served as the society’s secretary general nearly two decades ago. Bolli is the director of UofL’s Institute of Molecular Cardiology and scientific director of UofL’s Cardiovascular Innovation Institute. He is also a professor and chief of the Division of Cardiovascular Medicine at UofL. The award is for established investigators in the intermediate phase of their academic career.

“The roster of previous recipients for the Outstanding Investigator Award is simply amazing,” Bolli said. “We are proud of Steven, and grateful for his support in the research mission of the Institute of Molecular Cardiology here at UofL. He has been one of my best recruits ever.”

Jones serves on the editorial boards of several journals, including the Journal of Molecular and Cellular Cardiology, Basic Research in Cardiology, and Circulation Research. Since 2012, Dr. Jones also has been associate/consulting editor for the American Journal of Physiology — Heart and Circulatory Physiology.

He regularly serves on editorial boards and review panels for the American Heart Association and the National Institutes of Health. He recently started a term as chairperson of the Myocardial Ischemia and Metabolism Study Section of the NIH’s Center for Scientific Review. In addition to Jones, the study section consists of 18 experts from around the U.S.

Jones received his doctorate in physiology in 2002 from Louisiana State University. After graduation, he joined Johns Hopkins University, where he focused on mitochondrial function with the goal of developing a deeper understanding of the metabolism-dependent mechanisms of cell death and survival. He came to UofL in 2004.

University of Louisville Hospital and community partners will be offering free hepatitis C screenings at 18 locations in Louisville and surrounding counties for World Hepatitis Day on Saturday, July 28.

Hepatitis C, a blood-borne illness, is prevalent in the Louisville area and throughout the state. Currently, providers are encouraged to test for hepatitis C only in patients with certain risk factors or are from the Baby Boom generation (born 1946-1964). 

“A growing body of evidence suggests age and risk-based screening is missing a significant number of people, including children, with hepatitis C infection. Universal hepatitis C screening will be a future standard of care,” said Barbra Cave, a family nurse practitioner specializing in gastroenterology and hepatology who leads the Hep C Center at UofL Hospital. Cave is helping to organize the event.

Kentucky has one of the highest hepatitis C infection rates in the country – seven times the national average. “Up to half of patients who have it may not know they are infected, and people may carry the disease for decades before they have symptoms,” Cave said.

While in the past certain groups were known to be at risk, Cave said a recent spike in hepatitis C cases among those who have no or unrecognized risk factors has prompted health officials to consider screening all adults. This spring, the state of Kentucky passed a law requiring all pregnant women to be tested for hepatitis C, as the disease can be passed from mother to baby. The law went into effect July 1. Kentucky is the first state in the nation to require universal hepatitis C screening in pregnant women.

“The goal of the World Hepatitis Day screening event is to expand testing and awareness, link more people to curative treatment, and normalize the conversation about hepatitis C,” said Cave. “There should be no stigma surrounding hepatitis C. Anyone could have it, including babies.”

Screenings will be offered from 10 a.m.-6 p.m. on Saturday, July 28. Screening is done with a simple finger prick, similar to checking a blood sugar, and results will be available on site in 20 minutes. Hepatitis C experts will be available at all sites to answer questions, and help link those affected by hepatitis C to appropriate care.

This is the second year UofL Hospital and community partners are offering the free screenings on World Hepatitis Day. Screening sites, staffed by more than 130 health care volunteers, will be set up in Louisville and Jefferson County, along with sites in Oldham, Shelby and Bullitt counties and Clark County, Indiana. Last year, 488 people were tested. Cave said she hopes to double that number this year.

There are some known risk factors for hepatitis C:

• Born between 1945 and 1965. The U.S. Centers for Disease Control and Prevention recommends  screening for all baby boomers.
• A blood transfusion or organ transplant prior to 1992
• Had blood filtered by a machine (hemodialysis) for a long period of time because kidneys were not working
• IV drug use at any point in life, even if just once
• Intranasal drug use at any point in life
• HIV or hepatitis B infection
• Healthcare workers exposed to blood through a needle stick or other contact with blood or bodily fluids
• Exposure to contaminated tattoo equipment, including ink
• Men who have sex with other men
• Prior military service. “Older veterans are particularly at risk due to the use of the old ‘jet gun’ vaccinators by the military, and from combat injuries requiring blood transfusion,” Cave said.

Contaminated dental equipment, such as that used before most items were single patient/single use, may have also spread hepatitis C, and Cave said the virus can live on a surface for six weeks if not sterilized properly.

But there are many cases of hepatitis C that are not tied to any risk factors, Cave said.

Left untreated, the disease can cause major complications. It can cause cirrhosis of the liver or liver cancer, and is a leading cause of liver transplant. Hepatitis C may also predispose those infected to diabetes and depression, and has an association with joint pain, certain skin disorders and lymphoma.

World Hepatitis Day is marked across the globe on July 28 every year. The purpose is to increase awareness of viral hepatitis, including hepatitis A, B and C. “We have a local goal to decrease the stigma about hepatitis C, and let people know it is easy to test for and treat,” said Cave.

“Some may still remember the old days of treating hep C when treatment was difficult,” Cave said. “It involved a triple therapy with interferon that lasted almost a year, with multiple side effects. Not everyone was a candidate for treatment, and some patients opted to not get treated at all.

“Today, hepatitis C is easily curable and relatively inexpensive to treat. Treatment is one pill, once a day, for 8-12 weeks – with minimal side effects. It is covered by almost all insurance plans, including Medicare and Medicaid. Cost and side effects are no longer an excuse to defer treatment.”

Partners with UofL Hospital in the screening event include the Louisville Metro Department of Health and Wellness, the Kentucky Department of Public Health, KentuckyOne Health, Volunteers of America, the Sullivan University College of Pharmacy, the nursing programs of Galen University and Bellarmine University, and University of Louisville Schools of Medicine, Nursing, Dentistry and Public Health.

Free hep C testing sites on July 28

• St. Matthews Mall (2 sites within the mall), 5000 Shelbyville Road, Louisville, 40207
• Walgreens, 3980 Dixie Highway, Louisville, 40216
• Walmart, 10445 Dixie Highway, Louisville, 40272
• Walmart, 500 Taylorsville Road, Shelbyville, 40065
• Walgreens, 152 N. Buckman St., Shepherdsville, 40165
• Walgreens, 4310 Outer Loop, Okolona, 40219
• Wayside Christian Mission, 432 East Jefferson St., Louisville, 40202
• CVS Pharmacy, 1002 Spring St., Jeffersonville, IN 47130
• CVS Pharmacy, 1950 State St., New Albany, IN 47150
• Kroger, 10645 Dixie Highway, Louisville, 40272
• Walmart, 7100 Raggard Road, Louisville, 40216
• Southwest Family YMCA, 2800 Fordhaven Road, Louisville, 40214
• Oldham County Family YMCA, 20 Quality Place, Buckner, 40010
• Kroger, 2710 W. Broadway, Louisville, 40211
• CVS Pharmacy, 3229 Poplar Level Road, Louisville, 40213
• Walmart, 11901 Standiford Plaza Drive, Louisville, 40229
• St. Stephen Church, 1018 S. 15th St., Louisville, 40210
• Churchill Downs, Backside

A beloved high school basketball coach suffers cardiac arrest at practice. Alone with his players, they are forced to step in to help save his life until an ambulance can arrive.

Dramatic, yes, but it’s a scene that could happen, and it’s the plot of a new CPR training film developed by a University of Louisville doctor. Lorrel Brown, M.D., physician director for resuscitation at UofL Hospital and an assistant professor at the UofL School of Medicine, is hoping the novel approach will improve high school CPR training by helping students remember what they have learned by applying it to a real-life situation they can relate to.

CPR instruction in high school is now required by law in a growing number of states. Thirty-nine states have passed laws requiring the training before graduation, including Kentucky, which passed its law in 2016. Similar laws are being considered in the remaining states.

“The goal is to create a real, emotional scenario,” said Brown. “There are so many lives that could be saved if more Americans knew CPR, and we have all of these students coming out of high school with CPR training.”

About 4 million students per year now graduate with CPR training. Brown has studied CPR training in high school, with her work recently published in the Journal of the American College of Cardiology. She found CPR skill retention in high school students was poor, with only 30 percent able to perform adequate CPR six months after training. She also found that there was no standard method of implementation.

“We wanted to know, is there a better way to do it?” she said.

That’s where the film comes in. Working with the local Start the Heart Foundation and using $10,000 in grant money she received from winning the prestigious Stamler award for young researchers at Northwestern University last October, she modeled the film after one done in the United Kingdom, where CPR training also is required.

The interactive film, designed for classroom use in high schools and shot at Ballard High School by a local film company, forces students to make choices along the way about how to respond. It will be rolled out in local high schools this fall, then Brown will determine whether it improves skill retention. If it does - and Brown said she believes it will - the plan is to expand it across Kentucky and the nation.

“This could be a game-changer in the way CPR is taught in the United States,” she said.

The film used six local high school and college actors, and paramedics from Louisville Metro Emergency Medical Services, who brought an ambulance for one scene. In the film, the coach (Brown’s real-life husband, who auditioned for the part) stuffers cardiac arrest during basketball practice, and staggers out into the lobby, where he becomes unconscious and falls onto the floor. He is found by a player, who, along with the other students at practice, must call an ambulance and perform CPR on the coach together until the paramedics arrive. The coach regains consciousness, and the students are congratulated by paramedics for saving his life.

In the United States, 350,000 people suffer cardiac arrest outside a hospital each year. Only 30 percent get bystander CPR, which affects whether they survive, Brown said. Only 11 percent of the 350,000 receive CPR. Brown has said that if CPR survival improved by just 1 percent, 3,500 more people would live.

Expanding and improving CPR training has been a personal mission for Brown, who has worked for several years on unique approaches.  These days, effective CPR is hands-only, removing a barrier for some from the old mouth-to-mouth method. She also founded and directs a program called “Alive in 5” (www.alivein5.org), a five-minute method of teaching CPR she developed.

The American Heart Association wants to double the percentage of cardiac arrest victims who receive bystander CPR by 2020, and CPR training in high schools has been endorsed by a variety of organizations.

“It’s important that people be willing to act, and that they remember the skills that they’ve learned,” she said. “As most cardiac arrests that don’t occur in a hospital happen in homes, it is likely they will save the life of someone important to them.”

See the filming

To watch a video on the making of the film, click here.

More on CPR training

Watch a video on how to perform hands-only CPR, and find printable posters and fact sheets, on the American Heart Association’s web site here.

About the Start the Heart Foundation

The Start the Heart Foundation is a group dedicated to teaching hands-only CPR classes to improve survival from cardiac arrest in the community.  Classes are free and taught by CPR-certified college students. The foundation educates people about cardiac arrest and empowers them to act during a cardiac emergency. For classes and other information, visit the website at www.starttheheartfoundation.org.

Laura Jones, an oncology social worker at the University of Louisville Brown Cancer Center, received a Marc A. Lehmann Spirit of Service Award for her compassion in her work with cancer patients.

On Tuesday, an unsuspecting Jones was led by co-workers into the M. Krista Loyd Resource Center at the cancer center, where she was presented with her award by Marc Lehmann’s father, George.

Marc Lehmann, a UofL student, passed away in 2012 after an eight-year battle with cancer. He had been diagnosed with acute myeloid leukemia just a few months after high school graduation.

The Spirit of Service Awards in his name are given to oncology support staff who show compassionate patient support.

At the Brown Cancer Center, Jones provides psychosocial support and clinical case management for patients in the neuro, bone marrow transplant and gynecological oncology clinics. She works closely with bone marrow transplant patients with complicated issues that require lengthy care.

In her award nomination, nurse manager Dianne Thomas wrote that Jones “possesses a warm and friendly mannerism that is evident on your first encounter.” She noted Jones’ dedication and compassion to low-income patients, and her ability to build a strong rapport. Thomas noted that Jones has carved out new avenues for funding for patients, and “has become a valuable asset to her peers, as well as patients.”

She said Jones “deserves to be recognized for her dedication and loyalty.”

The Marc A. Lehmann Spirit of Service Award Foundation’s mission is to conduct and promote initiatives that encourage medical care with empathy and compassion, and to recognize physicians, caregivers and support staff with long-standing service to patients and their families in the areas of hematology and oncology.

Each October, the foundation holds an awards banquet at Vincenzo’s Italian restaurant, where five deserving oncology support staff from the community are recognized, along with one physician.

This year’s banquet will be held on Oct. 26. The featured speaker will be Jason Chesney, M.D., director of the Brown Cancer Center, and the featured physician will be Kelly McMasters, M.D., chair of the Hiram C. Polk Jr. M.D., Department of Surgery at UofL and director of the Multidisciplinary Melanoma Clinic.

Paul Resch, director and advisory committee member of the foundation, is a leukemia survivor himself. He told Jones that in addition to doctors, he knew from experience how important the support staff was to cancer patients.

“It’s the feet on the ground that touch us every day that make a difference - whether it’s a touch, or a conversation. You’re blessed that you have those skills, and you’re sharing them with others. And it does make a difference.”

A new study published this week in the New England Journal of Medicine found that for hospitalized patients with type 2 diabetes who were receiving noncritical care, the use of an automated, closed-loop insulin delivery system (an artificial pancreas) to deliver basal insulin resulted in better glycemic control than standard insulin therapy injected under the skin.

With increasing evidence that an artificial pancreas can improve glucose control in patients with type 1 diabetes, investigators had sought to see if it could also help patients with type 2 diabetes.

The study also found the improved glucose control in patients with type 2 diabetes was achieved without increasing the risk of hypoglycemia. One of the major limiting factors in achieving improved glucose control is the increase in hypoglycemic events.

Conducted by researchers at the University of Cambridge and Manchester University in the United Kingdom, along with the University of Bern in Switzerland, the study was published to coincide with a presentation at the American Diabetes Association’s 78th Scientific Sessions in Orlando, Fla., this week.

It was notable as most studies of automated closed-loop insulin delivery systems include patients with type 1 diabetes, said Sri Prakash Mokshagundam, M.D., an endocrinologist and diabetes specialist with University of Louisville Physicians. It also focused on hospitalized patients, where most studies have focused on outpatients who were already on insulin, he said. About 25 percent of hospitalized individuals have diabetes.

In the study, patients who were not already on a pump or sensor to control their diabetes prior to admission were placed on the system upon admission to the hospital. Mokshagundam said that using the technology in an inpatient setting has certain advantages, such as less burden on nursing staff as they try to manually adjust insulin doses. Meal-time insulin delivery still has to be planned by the health care team.

He said that while the technology helps in the acute setting, procedures need to be developed to transition it from acute to chronic care after patients leave the hospital.

He noted there also are some hurdles at this time to implementing the technology in the United States, as the technology used in the study has not yet been approved by the U.S. Food and Drug Administration for inpatient use here. A slightly different type of system has been approved for outpatient use, which uses a different algorithm to calculate the dose.

“The study that shows that this can be done, but we are still a ways off, before this becomes routine practice,” Mokshagundam said. “There is some refinement needed.”

A University of Louisville cardiologist and data scientist stressed the need for more accurate heart disease risk-prediction models in an editorial published in the Annals of Internal Medicine this week.

The editorial by Andrew DeFilippis, M.D., director of Cardiovascular Disease Prevention at the UofL School of Medicine and a cardiologist with UofL Physicians, and Patrick Trainor, a data scientist on DeFilippis’ research team, accompanied a study of a new risk prediction model that could improve the guideline-recommended scoring systems for who is at risk.

That study, by a group of researchers from Stanford University, the University of Michigan, the University of Washington, the University of Mississippi and Harvard Medical School, showed a widely used scoring system that helps physicians identify who is at risk for heart disease may inaccurately estimate risk, especially for certain patients, such as African-Americans. The scoring system, last updated in 2013, is recommended by the American College of Cardiology and the American Heart Association.

DeFilippis said that accurate risk predication is needed to effectively balance the risks and benefits of medicines used to prevent heart disease, and is important to help doctors decide who needs a statin, blood pressure medications or aspirin.

“Doctors must balance the risk of medication side effects with the risk of disease,” DeFilippis said. “Medications are expensive, and unnecessary treatment also costs the healthcare system, which is not an endless resource.”

DeFilippis has led efforts to evaluate cardiovascular disease risk prediction scoring systems, analyzing how they perform using data from clinical studies. He said the while this new study is helpful, risk scoring must continue to evolve based on demographic and societal trends and the availability of new biomarkers for assessing cardiovascular disease.

“Risk prediction is of tremendous benefit,” DeFilippis said. “The guideline-recommended scoring models were created from data collected from groups of patients decades ago. This new study used more modern patient groups and new methods for making the risk calculations.”

He noted that as heart disease is the leading killer of Americans, assessing risk is a critical issue. And while the calculator isn’t perfect, “there is no question these calculators are better than the eyeball test and certainly outperform a physician just saying ‘I think this person is high or low risk’ after looking at them.”

In previous studies, DeFilippis and other researchers at the University of Louisville, Johns Hopkins University and the University of Washington looked at the 2013 scoring system, along with three others, in a study of different ethnic groups. They collected information on patients who began participating in 2000-2002 and followed them for 10 years, evaluating the accuracy of the 2013 scoring model and publishing the results in 2015 in the Annals of Internal Medicine. That study found that the guideline-recommended calculator overestimated a person’s risk.

A 2017 study in the journal The BMJ (formerly the British Medical Journal) noted more than one in five Americans between the ages of 40 and 75 takes a statin. It has been hotly debated who should take statins, and several studies have questioned the accuracy of the risk calculator.

DeFilippis said the new study published this week rebuilds the risk score using a different statistical approach. It re-analyzed data from participants in multiple large studies. The new risk prediction model was shown to make more accurate predictions of risk for many patients, especially for some ethnicities, though further validation is needed.

Because of the need to continually update data, the team in the study that was published this week made the statistical model and computer code public so other scientists could evaluate them.

DeFilippis said that ultimately, “the decision on who should take statins or other medications to reduce risk should be a conversation between doctor and patient.”

While the guidelines still generally recommend them for some groups with a particular score, he said treatment should be individualized.

By instructing key immune system cells to accept transplanted insulin-producing islets, a team of researchers including those from the University of Louisville have opened a potentially new pathway for treating type 1 diabetes. If the approach is  successful in humans, it could allow people with type 1 diabetes to be treated without the long-term complications of immune system suppression.

The technique, reported this week in the journal Nature Materials, uses synthetic hydrogel particles (microgels) to present a protein known as the Fas ligand (FasL) to immune system T-effector cells along with the pancreatic islets being transplanted. The FasL protein “educates” the effector cells – which serve as immune system watchdogs – causing them to accept the graft without rejection for at least 200 days in an animal model.

The FasL-presenting particles are simply mixed with the living islets before being transplanted into the mice, which suffer from chemically-induced diabetes. The researchers believe the FasL-presenting hydrogels would not need to be personalized, potentially allowing an “off-the-shelf” therapy for the transplanted islets.

Researchers from the University of Louisville, Georgia Institute of Technology and the University of Michigan collaborated on the work, which was supported by the Juvenile Diabetes Research Foundation and the National Institutes of Health.

“We have been able to demonstrate that we can create a biomaterial that interrupts the body’s desire to reject the transplant, while not requiring the recipient to remain on continuous standard immunosuppression,” said Haval Shirwan, Ph.D., the Dr. Michael and Joan Hamilton Endowed Chair in Autoimmune Disease at the University of Louisville School of Medicine and director of the Molecular Immunomodulation Program at the Institute for Cellular Therapeutics at UofL.

“We anticipate that further study will demonstrate potential use for many transplant types, including bone marrow and solid organs,” he said.

In the United States, some 1.25 million persons have type 1 diabetes, which is different from the more common type 2 diabetes. Type 1 diabetes is caused by immune system destruction of the pancreatic islet cells that produce insulin in response to glucose levels. Current treatment involves frequent injection of insulin to replace what the islets no longer produce. There is no long-term cure for the disease, though persons with type 1 diabetes have been treated experimentally with islet cell transplants – which almost always fail after a few years even with strong suppression of the immune system.

“Drugs that allow the transplantation of the islet cells are toxic to them,” said Andrés García, the Rae S. and Frank H. Neely Chair and Regents' Professor in Georgia Tech’s George W. Woodruff School of Mechanical Engineering. “Clinical trials with transplantation of islets showed effectiveness, but after a few years, the grafts were rejected. There is a lot of hope for this treatment, but we just can’t get consistent improvement.”

Among the problems, García said, is toxicity to the islet cells from the immune system suppression, which also makes patients more susceptible to other adverse effects such as infections and tumors. Other researchers are exploring techniques to protect the islets from attack, but have so far not been successful.

The research reported in Nature Materials takes a totally different approach. By presenting the FasL protein – which is a central regulator of immune system cells – the researchers can prevent the immune system from attacking the cells. Once they are educated at the time of transplantation, the cells appear to retain their acceptance of the transplanted islet cells long after the FasL has disappeared.

“At the time of transplantation, we take the islets that are harvested from cadavers and simply mix them with our particles in the operating room and deliver them to the animal,” García explained. “We do not have to modify the islets or suppress the immune system. After treatment, the animals can function normally and are cured from the diabetes while retaining their full immune system operation.”

The hydrogels can be prepared up to two weeks ahead of the transplant, and can be used with any islet cells. “The key technical advance is the ability to make this material that induces immune acceptance that can simply be mixed with the islets and delivered. We can make the biomaterial in our lab and ship them to where the transplantation will be done, potentially making it an off-the-shelf therapeutic.”

In the experimental mice, the islets were implanted into the kidneys and into an abdominal fat pad. If the treatment is ultimately used in humans, the islets and biomaterial would likely be placed laparoscopically into the omentum, a tissue with significant vasculature that is similar to the fat pad in mice. Garcia’s lab has previously shown that it can stimulate blood vessel growth into islet cells transplanted into this tissue in mice.

In future work, the researchers want to see if the graft acceptance can be retained in more complex immune systems, and for longer periods of time. By reducing damage to the cadaver islets, the new technique may be able to expand the number of patients that can treated with available donor cells.

García’s lab uses polymer hydrogel particles that are about 150 microns in diameter, about the same size as the islet cells. They engineer the particles to capture the FasL – a novel recombinant protein developed by Shirwan and Esma S. Yolcu, associate professor of microbiology and immunology at the University of Louisville – on the particle surface, where it can be seen by the effector cells.

Thousands of women diagnosed with the most common type of breast cancer can now skip chemotherapy and still have the same outcome, according to a new study presented this week.

The long-awaited study, presented at the American Society of Clinical Oncology meeting over the weekend in Chicago, confirmed what many breast cancer specialists, including those at the James Graham Brown Cancer Center at the University of Louisville, had already believed.

For women with this common type of cancer - early stage estrogen-receptor positive - anti-estrogen treatment alone provide the same benefit as chemotherapy, without the harsh and sometimes devastating side effects. Chemotherapy can cause hair loss, a weakened immune system and heart problems, among other issues. Breast cancer is the most common cancer in women worldwide.

“The name of the study is TAILORx, which is perfect, because what this means is that for a large group, treatment can be truly tailored to a woman’s circumstances,” said Elizabeth Riley, M.D., FACP, a breast cancer expert at UofL’s Brown Cancer Center and deputy director of the center. “We now have solid data that chemotherapy is not needed for many in this group and helps validate what many specialists already knew.

“For years, physicians made treatment decisions solely based on a woman’s stage of breast cancer. TAILORx now confirms the biology of the tumor may be more important. This study should reassure a woman with very early stage, estrogen-driven breast cancer that chemotherapy can be avoided without increasing her risk of breast cancer,” Riley said.

The study, published Sunday in the New England Journal of Medicine, analyzed how well a widely used genetic test called the Oncotype DX Breast Recurrence Score assessed the risk of breast cancer returning. The Oncotype DX test looks at 21 genes linked with a likelihood of recurrence. The test has a range between 0 and 100, and determines whether these genes are turned off or on, or are over expressed.

The study’s lead author, Joseph Sparano M.D., associate director for clinical research at the Albert Einstein Cancer Center and Montefiore Health System in New York City, said the data confirms women can be spared “unnecessary treatment if the test indicates chemotherapy is not likely to provide benefit.”

Riley noted there are multiple types of breast cancer, with multiple genes involved in the growth of tumors. She said those patients who will benefit from the study’s findings are estrogen sensitive, test negative for HER2 (human epidermal growth factor receptor 2), a gene that can play a role in the development of breast cancer, and have early-stage tumors below 5 centimeters that have not spread to lymph nodes.

They also have what is considered an intermediate score on the OncotypeDX test, one between 11 and 25.

Riley said that past research has shown women with scores between 0 and 10 could safely forego chemotherapy, while those with scores over 25 were best treated with a combination of chemotherapy and anti-estrogen hormonal treatment, as the cancer recurrence risk in this group was high.

“There have been clear guidelines on treatment for woman with a high or low score OncotypeDX score. It was the group in the intermediate range, from 11 to 25, that the degree of benefit of chemotherapy was not well established,” Riley said.

The study followed over 10,000 women diagnosed with breast cancer between 2006 and 2010. Of those, 6,711 had intermedia scores between 11 and 25. That group was split into two: one receiving hormone therapy and chemotherapy, and the other only hormone therapy.

The women were followed for an average of nine years, and researchers found the outcome in recurrence and survival was virtually the same.

“If you are seen by a doctor tomorrow and have a low to intermediate score on the test, you should expect not to be offered chemotherapy, unless you are under the age of 50,” Riley said.

That is the caveat, she said. Breast cancer in younger women is biologically different, and typically comes with a poorer prognosis. In premenopausal women and those younger than 50, the TAILORx results suggested that hormonal therapy alone may not be enough and chemotherapy may still be needed, she said.

While these patients should discuss their options with their doctor, they would be likely candidates for the more aggressive combination therapy, she said.

“In that case, the treatment decisions are going to depend on more than just the test, such as a thorough analysis of a patient’s particular tumor type. We can’t say that everyone under 50 needs chemotherapy, but future studies may be necessary to interpret the test in this age group,” Riley said.

Breast cancer in younger women is a focus of Riley’s. At the Brown Cancer Center, she also leads the HER Breast Cancer Program, which addresses the challenges this group faces with regional experts in the management of breast cancer in young women. The program also addresses the impact of treatment on fertility, the patient’s young children, and her career. HER stands for Hope, Empower and Restore.

The University of Louisville and the Jewish Hospital Trager Transplant Center marked an important milestone on Wednesday – the 500^th heart transplant performed at the hospital since the heart transplant program began there nearly 35 years ago.

“As we end American Heart Month, it’s the perfect time to share this wonderful news,” said Mark Slaughter, M.D., surgical director of heart transplant for University of Louisville Physicians and Jewish Hospital, and professor and chair, Department of Cardiovascular and Thoracic Surgery, UofL School of Medicine.

Dr. Slaughter performed the 500^th transplant on Wednesday, Feb. 21, on a 59-year-old man who had a left ventricular assist device implanted to support his heart until the donor heart was available for transplant. An LVAD is a surgically implanted mechanical pump attached to the heart.

The first heart transplant at the hospital, which was also the first heart transplant in Kentucky, took place on Aug. 24, 1984, performed by the University of Louisville’s Laman Gray Jr., M.D. The state and region waited in suspense as 40-year-old Alice Brandenburg received a new heart. The surgery, which took seven hours, was groundbreaking at the time. The UofL and Jewish Hospital transplant team is one of the leading providers of organ transplantation in the country.

“Jewish Hospital is a place where miracles happen every day and patients’ lives are changed forever,” said Ronald Waldridge II, M.D., president of Jewish Hospital. “Five-hundred hearts is much more than a milestone. It represents the life-changing impact on our patients, their families and the entire region. Together, with UofL, Jewish Hospital’s Trager Transplant Center is investing in research, technology and advance procedures to increase access to transplant services.”

On Wednesday, doctors and heart transplant recipients gathered at the Jewish Hospital Rudd Heart and Lung Center to celebrate the 500^th milestone and the many lives that have been saved over the years thanks to heart transplantation. 

“The 500^th heart transplant is a reminder of the commitment by Jewish Hospital and the University of Louisville to provide advanced therapies for patients with advanced heart failure,” said Dr. Slaughter. “We’ve come a long way since Dr. Gray broke ground with that first heart transplant more than 30 years ago. Every day, we continue to advance the science of heart transplantation here at UofL and Jewish Hospital. I’m excited about the future of this program, and I’m confident that we’ll mark a lot more milestones over the next 30 years.”

For Dr. Gray, Wednesday’s celebration marked decades of dedication to the heart transplant program.

“After performing the first heart transplant, it means a lot to me to see the 500^th and where we are today,” said Dr. Gray.

Gray continues to research new ways to help patients with heart disease at UofL’s Cardiovascular Innovation Institute, a center focused on bio-adaptive heart innovations, including the integration of heart-assist device, biodfeedback sensors and related technologies. In 2001, Gray and the Trager-UofL surgical team implanted the first fully implantable replacement heart, the AbioCor™.

Today, patients like Jeffrey McMahan continue to benefit from the heart transplant program. McMahan was the center’s 479^th heart transplant, and he attended the celebration on Wednesday along with other recipients.

Before his heart transplant, McMahan, 61, was no stranger to the procedure – it had helped save many of his family members. The Memphis, Indiana, resident had four family members receive heart transplants - two by University of Louisville surgeons at Jewish Hospital. In 2015, McMahan learned he, too, needed one.

“I was serving in the military at Fort Knox when I developed a cough,” said McMahan. “It finally got bad enough that doctors flew me to Jewish Hospital, where I was diagnosed with a cardiomyopathy, a condition where the heart muscle is weakened. I learned that I would need a transplant in the next 10 years, but that timeframe quickly changed to 10 months after my condition worsened.”

On Aug. 15, 2015, McMahan was added to the organ donor transplant list. A month later, he received the transplant that forever changed his life.

“I wouldn’t have lived without the transplant,” McMahan said. “It means a lot to be here to celebrate the 500^th. I’m forever thankful to the transplant team that helped save my life and gave me more time with family.”

It has been an exciting year for the Jewish Hospital Trager Transplant Center and University of Louisville team. In December 2017, the center – a joint program with the UofL School of Medicine and KentuckyOne Health – broke its all-time record for number of organs transplanted in the center’s 53-year history, with 175 organs transplanted in a year. The center also achieved several other milestones in 2017, including its 5,000^th transplanted organ, its 3,000^th kidney transplant and its 900^th liver transplant. In addition to Kentucky’s first heart transplant, the program is known for performing Kentucky’s first adult pancreas, heart-lung and liver transplants.

But the 500^th heart transplant and other milestones wouldn’t have been reached without organ donors, noted David Lewis, director of Transplant Services at the Jewish Hospital Trager Transplant Center.

“We often encourage people to sign up as organ donors to help save lives. The need for organ donors is unfortunately greater than the number of people who donate, so each day, an average of 20 people pass away while waiting for a transplant in the United States,” Lewis said. “Knowing that we have helped save 500 people in need of a new heart is a wonderful feeling, and it would not be possible without the donors and their families.”

For information on the Jewish Hospital Trager Transplant Center, visit www.kentuckyonehealth.org/transplant-care.

For video of the first heart transplant at Jewish Hospital, visit https://youtu.be/b8AFYN-TsDY.

Smoking harms nearly every organ in the body. It causes about 1 in every 5 deaths in the United States each year, and is the main preventable cause of death and illness. We know the harmful effects of tobacco, so why is it so hard for people to quit?

“The benefits of not smoking, in particular to the heart, are huge. And with February being American Heart Month, it’s a good time to think about quitting,” said the University of Louisville’s Rachel Keith, Ph.D., APRN, a specialist in cardiovascular medicine and tobacco treatment. “But it’s a lot more than just halting a bad habit. That’s why we can say our relationship with tobacco is, ‘complicated.’”

Keith, who runs the new UofL Physicians Tobacco Treatment Clinic, said there are “strange dynamics” with tobacco.

“Smoking cessation is hard in general,” she said. “Helping patients to quit smoking often involves a lot of talking and figuring things out.

“We have to really get at WHY they smoke. Perhaps their grandmother died at age 100 even though she smoked, so they don’t believe there’s a connection. Or, she got them smoking and that’s their connection to her now that she’s gone.”

She said many people who come to the clinic have smoked for 30 or 40 years, and they are hesitant to quit. “That’s because it’s almost a part of them. In their view, you are taking away something they don’t know how to replace.”

She said she encourages patients to try different things and look for healthier alternatives when they have the urge for a cigarette.

“But when I ask them, ‘What are some other things you like to do for 10-15 minutes?,’ a whole lot of people can’t name those things. Many don’t have anything else. We try to help them find them, whether it’s a hobby or something like taking a walk,” she said.

But again, it’s complicated.

“A lot of patients feel sick, so they think they can’t get out and walk, even though they know it will be easier when they quit. There’s just a lot that goes into smoking, culturally and hormonally.”

People “can’t see the immediate effects of quitting, but they can quickly gain the rewards of smoking, because it’s almost instant. The body actually gets hard-wired to anticipate the effects from tobacco.”

That’s why the new clinic approaches all the factors that make it hard for people to stop, making it Louisville’s only comprehensive tobacco treatment program.

Keith meets with patients and develops a personal, individualized approach that best suits each patient’s needs. During sessions, Keith and patients discuss the benefits of stopping smoking, medication options, and different skills, such as mindfulness and relaxation, to help overcome anxiety.

Medications to treat withdrawal symptoms are paired with the cognitive-behavioral therapy to help patients sustain attempts to quit. Any medical issues also are addressed. One treatment Keith is studying is how to increase people’s motivation with virtual reality therapy, where an immersive session allows patients to imagine what life will be like once they’ve quit.

“The good news is, this type of program has been proven over and over as the most effective method for long-term cessation,” Keith said. “But until we opened, it was hard to find one in this area to get into.”

She said those who try to quit on their own have about a 6 percent chance of succeeding. If they work with a health provider, their chances improve to 10 percent to 15 percent. But with the comprehensive program, patients see a success rate of 30 percent and above.

“Those who have come through the program have done really well,” she said. “Almost everyone who comes through has quit.”

It generally takes about six sessions, usually once a week or every other week, to complete. Afterward, patients return on a more limited basis, and Keith follows up by phone.

Anyone who wants to quit smoking can come to the clinic, and many insurance plans will cover the program at little or no cost to the patient. It is located in Suite 310 of the UofL Physicians Health Care Outpatient Center, 401 E. Chestnut St.

To make an appointment, call 502-588-4600.

According to The Beatles, love is all you need. While it may not be all you need, there’s evidence it makes the heart healthier.

On Valentine’s Day, people may find themselves celebrating their relationships, or contemplating their lack of one. However, it’s not just love in the traditional sense that affects the heart, but also social bonds with friends and family.

University of Louisville cardiologist Lorrel Brown, M.D., studies the heart and says there is definitely a correlation between heart attacks, heart failure and other cardiac problems and loneliness, depression and anxiety.

While doctors know about the effects of diet, blood pressure and cholesterol on the heart, “now the medical community is interested in other components of heart health, that whole body connection,” Brown said. “Emotions are definitely part of this new way of understanding the body. Ideal cardiovascular health is now going beyond things you’ve already heard.”

In fact, some experts – including former U.S. Surgeon General Vivek Murthy, M.D. - are calling loneliness and social isolation a sort of epidemic, noting the increased risk for cardiovascular disease, among other health problems. Last month, the United Kingdom even appointed a “Minister for Loneliness” to address the finding that 9 million British people often or always feel lonely.

In an article in the Harvard Business Review in September, Murthy wrote, “Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day and even greater than that associated with obesity.

“But we haven’t focused nearly as much effort on strengthening connections between people as we have on curbing tobacco use or obesity.”

Brown said Eastern medicine has long correlated the connection between emotions, love and health, and Western medicine is now starting to apply science to those observations.

“There’s ongoing research now into the question, ‘Is there some way to intervene?’” Brown said.

She said “Broken Heart Syndrome” (clinically named stress-induced cardiomyopathy or takotsubo cardiomyopathy) is the most clear and dramatic example of the effect of the emotions on heart health.

The phenomenon, where people actually suffer from a broken heart, is common in medical literature, and named after a Japanese takotsubo, a ceramic pot used to trap octopus, as the stressed heart takes on the pot’s shape. The condition was first identified in Japan.

It starts abruptly, with chest pain and often shortness of breath, usually triggered by an emotionally stressful event, Brown said, and it is not uncommon to see after spouses argue or one passes away. People experiencing Broken Heart Syndrome often end up in the emergency room because they think they are having a heart attack, which is caused by a blocked coronary artery.

Tests will show an unusual shape of the heart’s left ventricle (the pumping chamber), with a narrow neck and ballooned lower portion, giving the condition the “takotsubo” name. While cause is still unknown, it may be due to an increase in stress hormones such as epinephrine and norepinephrine, and is treated with medication to block those hormones.

While all of our social bonds are important, “it does seem that married people live longer than those who aren’t,” Brown said.

There are a few small studies that show the benefits of traditional love on the heart, and “we do know that people react most positively to stress when they are in love,” she said. The hormone released in love is the powerful oxytocin, which also acts as a neurotransmitter in the brain. When oxytocin levels go up, blood pressure goes down, and the heart rate slows. Inflammatory markers also tend to go down.

“However, love can apply to other types of relationships as well,” Brown said. “Happiness and companionship are an important part of heart health. People with strong bonds, whether it’s a spouse, many friends, or a close family, tend to have healthier hearts. While we don’t understand yet the nuances, there’s certainly a significant connection.”

A University of Louisville study has found a connection between Medicaid expansion and improved quality of breast cancer care, including an increase in the early-stage diagnosis of the disease and greater utilization of breast-conserving surgery instead of more invasive treatments, such as mastectomy. 

The study, “Evaluating the Early Impact of Medicaid Expansion on the Quality of Breast Cancer Care in Kentucky,” appears today on the website of the Journal of the American College of Surgeons in advance of print publication.

“We found several good things happened by the expansion of Medicaid,” said the study’s senior author, Hiram C. Polk, Jr., M.D., of the division of surgical oncology in the Department of Surgery at the UofL School of Medicine. “It really did work. The care was better because people were getting what they need.”

Since passage of the Affordable Care Act in 2010, 32 states and the District of Columbia have expanded Medicaid coverage, with the federal government covering the increased costs. Kentucky is one of the Medicaid expansion states, and the study looked at the effects of the expansion here.

“What we learned is that the expansion of some form of third-party coverage for health care leads to people doing more things that are intrinsically good for their health,” said Polk, who also has served as Kentucky’s public health commissioner.

UofL researchers who were co-authors on the study were Nicolas Ajkay, M.D., as first author; Neal Bhutiani, M.D.; Jeffrey Howard, M.D.; Charles Scoggins, M.D.; and Kelly McMasters, M.D., Ph.D. Also involved were researchers from the University of Kentucky.

The researchers looked at breast cancer as a marker of the impact of Medicaid expansion as it is “a very common cancer,” Polk said. “Our goal was to get an early measure of what really happened with Medicaid expansion.”

The study evaluated measures related to breast cancer from 2011 to 2016, using 2014 - the year Kentucky’s Medicaid expansion went into effect- as the cutoff between pre- and post-expansion.

“We knowingly took on the possibility of making too early of an observation on Medicaid expansion, but the degree of change that occurred so promptly in two years surprised me,” Polk said. “It’s amazing these changes happened in just two years.”

Researchers examined the Kentucky Cancer Registry for all women ages 20 to 64 who were diagnosed with breast cancer between 2011 and 2016.

From 2011 to 2013, 635,547 screening mammograms were performed in the state. That number increased to 680,418 from 2014 to 2016.

In 2011, 208,600 screening mammograms were performed, compared with 234,315 in 2016.

The number of screening mammograms covered by Medicaid increased from 5.6 percent before expansion to 14.7 percent after, and the number of women who had screening mammograms and were uninsured declined almost tenfold, from 0.53 percent before to 0.05 percent after expansion.

Breast cancer incidence and treatment rates did not vary significantly from year to year. But the changes in the rates of early-stage vs late-stage disease treated in the pre- and post-Medicaid expansion periods were statistically significant. 

Early stage (stage I-II) breast cancers accounted for 64.5 percent of the diagnoses in 2011-2013, compared with 66.7 percent in 2014-2016. Late-stage (III-IV) cancers accounted for 15 percent, compared with 12.9 percent.

Rates for breast-conserving surgery increased significantly after Medicaid expansion, from 44 percent pre-expansion to 48.8 percent, while rates of other resections, including mastectomy, declined, falling from 50.5 percent to 44.5 percent.

While the time from diagnosis to surgical treatment for the disease was shorter before expansion, an average of 28.6 days compared with 36, two other key treatment variables were either unchanged or improved after expansion:  time from the operation to chemotherapy (47.5 days before, and 46.6 days after); and time from the operation to radiation (96.4 days before, and 91.5 after).

“Chemotherapy and radiation didn’t happen as quickly as we’d like,” Polk said.

The study noted the findings were mirrored by experiences in other states, but Polk said a thorough analysis of the Medicaid expansion in Kentucky requires longer-term study. 

“Two years is a very short run,” Polk said. “But on the other hand, it’s a very pure study.”

University of Louisville cardiologist and researcher Roberto Bolli, M.D., has been awarded the 2018 Honorable Maestro Award by the Kentucky Chapter of the American College of Cardiology, the chapter’s highest honor.

Bolli is director of UofL’s Institute of Molecular Cardiology and serves as scientific director of the Cardiovascular Innovation Institute at UofL. He is also a professor and chief of the Division of Cardiovascular Medicine at the School of Medicine.

The Maestro Award recognizes achievements in the field of cardiology and medicine, leadership in the regional and national cardiology community, charity work, mentorship and vigilant care of the sick.

In the past year, Bolli received one the largest grants ever for medical research at the University of Louisville, saw the impact factor jump on a major medical journal he edits, and led the Stem Cell Summit at the annual meeting of the American Heart Association in Anaheim, Calif.

The $13.8 million grant Bolli and his UofL team received from the National Institutes of Health is to study a promising new type of adult cardiac stem cell that has the potential to treat heart failure.

Bolli’s research focus has been on how to repair the heart and cure heart failure using a patient’s own stem cells. It is an approach that could revolutionize the treatment of heart disease.

He also serves as editor of the journal Circulation Research, which achieved its highest-ever “impact factor,” a measure of its importance in the medical field, last year. Circulation Research is an official journal of the American Heart Association and is considered the world’s leading journal on basic and translational research in cardiovascular medicine.

Bolli will be recognized and presented with the Maestro Award on stage at the Kentucky chapter’s annual meeting at the Lexington Center in Lexington, Ky., on Oct. 13, 2018.

A national talk the following year will be named in his honor.

While CPR instruction in high school is required by law in a growing number of states, there is no standard method of implementation, according to a study by a University of Louisville doctor published in the Journal of the American College of Cardiology.

The study by Lorrel Brown, M.D., an assistant professor at the UofL School of Medicine and physician director for resuscitation at UofL Hospital, is titled “CPR instruction in U.S. high schools: What is the state in the nation?”

In the U.S., 350,000 people suffer cardiac arrest outside a hospital each year. Only 30 percent get bystander CPR, which affects survival, Brown said. Only 11 percent of those 350,000 survive.

“If we improve survival by just 1 percent, that’s 3,500 more people who will live,” Brown said.

The American Heart Association wants to double the percentage of cardiac arrest victims who receive bystander CPR by 2020, and CPR training in high schools has been endorsed by a variety of organizations. Thirty-nine states have passed laws requiring the training before graduation, including Kentucky, which passed a law last year. Similar laws in the remaining 11 states are being considered.

For the study, Brown examined the state laws and characterized them based on stringency of training. 

“We know high school students can learn CPR. However, we have found CPR skill retention in high schoolers is poor, with only 30 percent performing adequate CPR six months after training,” she said. “We wanted to know, is there a better way to do it? How can we make the best use of this opportunity?”

The study had two parts: 1) what the law in each state requires and 2) how the laws are being implemented in schools.

To find out, Brown sent a survey to schools in the 39 states. She asked how CPR was being taught, who was doing the teaching and at what grade level.

“We found a wide degree of variability from state to state, and even school to school,” she said. “While the laws all have some similar features, such as teaching the hands-only method, they still leave a lot to the individual schools to decide.”

Most laws don’t recommend a specific program. Some require the training take place in a specific grade, while others don’t.  Most training was being taught as part of a physical education class, but it varied widely who taught it, from a firefighter, a nurse, to the American Red Cross. Most laws don’t require the instructor to be certified to teach, an important distinction, Brown said, since not everyone who is certified in CPR will necessarily be a good instructor.

She said a major barrier for schools is the cost of CPR training.  Certified instructors are not always readily available, and most states don’t provide funding for CPR training, leaving it to individual schools and districts.  And high-quality mannequins, which are important for a more realistic experience and muscle memory, are expensive, Brown said. Thirty-six percent of schools surveyed were using a low-quality, inexpensive inflatable one.

She said the study “hopefully will help standardize the process to provide high-quality training.” Brown was assisted in the study by two UofL medical students, third-year Carlos Lynes, and fourth-year Travis Carroll, with Henry Halperin, M.D., of Johns Hopkins University School of Medicine, advising on the study.

She said it’s too early to tell whether the training in U.S. high schools has been effective in saving lives, but in some places such as Denmark, similar laws lead to increased rates of bystander CPR and survival.

“We’re still about 10 years out in the U.S.,” she said. With about 4 million students per year now graduating with CPR training, “by then we’ll have an army of people trained in CPR.”

Expanding CPR training has been especially important to Brown, who has worked for several years on unique approaches such as halftime demonstrations at UofL men’s basketball games.  She founded and directs a program called “Alive in 5” (alivein5.org), a five-minute method of teaching CPR she developed that could become a standard for training. She studied the method at the Kentucky State Fair and found adults could learn high-quality CPR in just 5 minutes.

“We are still investigating the best method that is effective and efficient,” she said.  

When she was eight years old, Meliha Hrustanovic-Kadic and her family fled war-torn Bosnia as refugees. They settled in Bowling Green, Ky., adapting as quickly as they could to the new language and culture.

Soon afterward, her grandfather arrived in the United States as well, but his health quickly deteriorated.

“I was the oldest of my siblings and the oldest of the grandchildren. I found myself riding in an ambulance with my grandfather on a frequent basis. I became his interpreter for every emergency room visit and hospital stay. As his condition unfortunately worsened, my curiosity and passion for medicine grew.”

Early in her college career, she made it official.

“I declared pre-medicine as my major during my sophomore year at Western Kentucky University. I can’t imagine myself doing anything else.”

Hrustanovic-Kadic considered other medical schools, but knew she wanted to be at UofL.

“I felt a welcoming atmosphere from the start and loved how diverse it was. I wanted to attend a medical school that excelled in patient care, research, teaching and was involved in the community. UofL has surpassed all of my expectations.”

Hrustanovic-Kadic appreciates the school’s commitment to students’ well-being, with wellness initiatives, mental health counseling, an active LGBT program and diversity events. As a medical student at UofL, she has served as a representative on the diversity committee and volunteers for Kentucky Refugee Ministries.

“So many individuals, from instructors and attendings to fellow medical students to the medical student affairs staff, have become like family over the years.”

Wartime displacement prevented her parents from completing higher education, which, combined with learning a new language, put the best jobs out of reach. Ultimately, they reached for the American Dream, opening their own transportation company.

“I was 15 at the time and have helped them manage it ever since,” Hrustanovic-Kadic said. She has continued to support the family business even during medical school.

“We function as a team and everyone tries to pitch in to help when they can. Don’t ask me how I’ve balanced everything because I don’t even know – perhaps a mix of good time management and organization, along with a ‘when there’s a will, there’s a way’ attitude!”

Her family has supported her during her medical education as well, with frequent visits to Louisville and even preparing her favorite Bosnian foods – krofne, pita, hurmasice and others – during exam weeks.

“You name a way and I can assure you they’ve done it – emotionally, spiritually, physically, financially,” Hrustanovic-Kadic said. “I cannot even begin to describe just how important a supportive family is, especially through medical school.”

She will receive her diploma at the UofL School of Medicine Convocation on Saturday, but her days at UofL are not over. Hrustanovic-Kadic will remain at UofL to pursue residency in internal medicine.

“I enjoy taking care of patients in both inpatient and outpatient settings and there are so many interesting routes one can take with a career in internal medicine. I am looking forward to the experiences I will gain during residency.”

The University of Louisville has expanded its oncology research strength through the addition of approximately 33,000 human tissue samples and specimens. The samples were transferred by Catholic Health Initiatives (CHI) to further the shared commitment and collaboration in advancing research and action in the fight against cancer.

Researchers from the University of Louisville and James Graham Brown Cancer Center are partners with CHI through national oncological research between the two organizations, as well as locally as part of KentuckyOne Health. This close collaboration has delivered significant impact in the understanding of a variety of cancers and is supporting physicians and patients in Kentucky and across the country.

“These specimens provide our researchers with opportunities to build on existing research initiatives and open the door for new areas of study in fighting cancer,” said Dr. James Ramsey, president of the University of Louisville. “We now will be able to extend our efforts to build upon our advances and we continue to work to reduce the human costs of cancer.”

Research teams in Louisville now have access to triple the number of medical specimens to guide cancer research. The more than 47,000 samples in the University of Louisville biorepository cover 111 unique primary tumor sites and include cancer types that are particularly prevalent in Kentucky, including breast, lung, colon and kidney cancers.

“Cancer is one of the most prevalent health issues facing the people of the Commonwealth,” said Ruth Brinkley, CEO of KentuckyOne Health. “The gifting of these specimens reinforces our shared commitment to bring wellness, health and hope to patients in Kentucky and across the country. The innovative treatments, diagnostic tests and other insights our local researchers are developing are critical to helping us reduce the rate and impact of cancer.”

The specimens will arrive at the University of Louisville on May 24, 2016, enabling immediate access for research teams.

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.

About University of Louisville/James Graham Brown Cancer Center

The James Graham Brown Cancer Center is a key component of the University of Louisville Health Sciences Center. As part of the region's leading academic, research and teaching health center, the cancer center provides the latest medical advances to patients, often long before they become available in non-teaching settings. The JGBCC is a part of KentuckyOne Health and is affiliated with the Kentucky Cancer Program. It is the only cancer center in the region to use a unified approach to cancer care, with multidisciplinary teams of physicians working together to guide patients through diagnosis, treatment and recovery.

Individuals in the early stages of Huntington’s Disease (HD) or who are at risk of developing it may be able to play a part in efforts to conquer the disease. Patients are invited to apply for participation in SIGNAL, a Phase 2 research trial that will assess the safety, tolerability and effectiveness of VX15, a novel monoclonal antibody that may delay onset or slow the progression of HD.

Kathrin LaFaver, M.D., Raymond Lee Lebby Chair for Parkinson’s Disease Research in the Department of Neurology at the University of Louisville, will lead the study in Louisville, one of 23 sites around the United States participating in SIGNAL. LaFaver also is the director of the Parkinson’s and Movement Disorders Clinic at UofL Physicians.

Animal models have shown that monoclonal antibodies bind to and block a molecule that may cause inflammation in the brain of individuals who develop HD. In addition, VX15 may protect against the inflammation that has been shown to affect the thinking, movement and behaviors that affect HD patients.

Huntington’s Disease is a genetic disorder that causes the progressive breakdown of nerve cells in the brain. It is characterized by personality changes, mood swings, depression, forgetfulness and impaired judgment. Patients experience unsteady gait and involuntary movements (chorea), slurred speech, difficulty in thinking and mood disturbances. HD affects approximately 30,000 Americans and more than 200,000 have the gene that causes the disease. HD is autosomal dominant, meaning that a parent with Huntington’s Disease has a 50/50 chance of passing the gene trait that causes the disease on to his or her children.

The SIGNAL trial is the first time a monoclonal antibody will be investigated for potential treatment of HD. Participants in the trial will receive monthly intravenous infusion of the drug and be monitored with advanced brain scan techniques and analyses utilizing MRI and PET.

“This is a great opportunity for patients in early stages of Huntington’s to be involved in a study that may slow the progression of the disease,” LaFaver said. “The drug was already tested for safety in patients with multiple sclerosis and was well tolerated.”

Trial participants should be individuals who:

• Are at risk for developing HD
• Have undergone genetic testing
• Are thought to be in the early stage of HD
• Are able to undergo brain scans (MRI and PET)
• Are at least 21 years of age

SIGNAL will enroll study participants through the second part of 2016. Participants in the study will receive monthly infusions for 12 months and follow up for an additional three months. Participants will receive study related medical care, tests and drugs used in the study, along with reimbursement for time spent during in-person visits and reasonable travel and lodging costs.

For information on participating in SIGNAL, contact Annette Robinson, RN, BSN, CCRC at 502-540-3585, annette.robinson@louisville.edu.

Individuals also may contact the Huntington Study Group at 1-800-487-7671, email info@hsglimited.org or http://www.huntington-study-group.org.

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