November 2012 Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine

 

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Dr. John Sweeney
Dr. John Sweeney
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Stephanie at home with family.
Dr. Tom Pearson

Dr. Larsen's appointment to new Dean of School of Medicine brings change and reflection

Dr. Chris Larsen at a Surgery faculty meeting

Dr. Chris Larsen, chair of the Department of Surgery since 2009 and an Emory faculty member since 1991, has been named dean of Emory University School of Medicine. Following a gradual period of training and acclimation with former dean Dr. Thomas Lawley, he will assume the position effective January 15, 2013. Dr. John Sweeney, chief of the division of general and gastrointestinal surgery and director of clinical quality and patient safety of the Department of Surgery, will serve as interim chair as well as interim surgeon-in-chief of Emory University Hospital. Dr. Sweeney will begin training with Dr. Larsen in mid-December.

"Dr. Larsen provided me with the tools to build the quality and safety program and the independence to move it forward. I don't think that our successes would have been possible without this recipe," says Dr. Sweeney. "I will do my best to emulate and continue his positive leadership style and his commitment to excellence in patient care, education, and discovery."

Dr. Larsen has also been promoted to chair of the Board of Directors of The Emory Clinic and vice president for Health Center Integration for the Robert W. Woodruff Health Sciences Center. These roles will harness his expertise in developing multidisciplinary, patient-centered care—skills he exercised as chair of Surgery and executive director of the Emory Transplant Center—to create new connections and initiatives throughout Emory's vast training, research, and clinical resources. Fittingly, his position at the transplant center will be assumed by longtime colleague and research collaborator Dr. Tom Pearson.

When Dr. Larsen was appointed chair of Emory Surgery, he inherited a department on the rise. "Bill Wood had been chair since 1991, and he led us into a new era of excellence," says Dr. Tom Dodson, chief of the division of vascular and endovascular surgery and a faculty member since 1988. "He took a department that had no NIH grants when he started and left it as the 5th leading academic department of surgery in NIH funding nationwide. Chris sustained and built on that momentum, presiding over the continuation of that ranking three years in a row, a significant feat considering the economic picture for academic medical centers around the country. Perhaps his greatest contribution, however, was his ability to articulate our priorities in a period of great turmoil for health care. I'm fond of sports analogies, so I'll paraphrase Wayne Gretzky by saying that Chris didn't just skate to where the puck was, he skated to where the puck was going to be. This ability will serve him and us well in his new position."

As chair, Dr. Larsen directed the reinforcement of Emory Surgery's infrastructure, which in turn strengthened administrative systems in sections and across the department, provided more direct and comprehensive support to a rapidly growing number of investigators, and allowed the evolution of a nationally respected quality control office. Along the way he maintained his robust kidney and pancreas transplant practice and achieved various landmarks in his immunology research, including his continued development with Dr. Pearson and others of the co-stimulation blocker belatacept, which received FDA approval in June 2011 for kidney transplants, and being named PI of a new NIH grant for nearly $20 million in 2012. The grant will allow him to lead a research team of Emory physician/researchers to develop better treatments for organ transplant recipients that help avoid both organ rejection and drug toxicity.

Dr. Larsen's influence on those he worked with regularly has been and will remain profound. Dr. Keith Delman, surgical oncologist and program director of the general surgery residency, views Dr. Larsen's support and mentorship as having been critical to his own development as an educator and instrumental to the progress the residency has experienced. "I can't think of a chairman more committed to education in any surgical department in the country," he says. "His accessibility and dedication always impressed me, such as his monthly meetings with our PGY-4s and 5s and spearheading the renovation and repurposing of the H wing in Emory University Hospital to provide badly needed space for our education programs. He will be an outstanding dean."

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Stephanie Lindstrom with Dr. Brian Kogon.
Stephanie Lindstrom with Dr. Brian Kogon.
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Stephanie at home with family.
Home with family.

Emory transplant team performs Georgia's 1st triple organ transplant

When she was seven-weeks old, Stephanie Lindstrom was diagnosed with tricuspid atresia with a ventricular septum defect. The following week, she underwent the first of a series of five heart surgeries that would intermittently interrupt her life. After the performance of the fifth procedure in December 2009 at Emory, she learned that her heart could not withstand another procedure and that she would eventually need a transplant. She was in her mid-thirties and married with two young children.

As time went on Ms. Lindstrom's health worsened and was further complicated by the development of cirrhosis. Her Emory Healthcare cardiologist Dr. Wendy Book approached Emory chief of transplantation Dr. Stuart Knechtle and his liver transplant team. "Dr. Book asked if we would consider participating in a combined heart-liver transplant with (Emory cardiac surgeons) Dr. Brian Kogon and Dr. David Vega," says Dr. Knechtle. "We agreed, and Ms. Lindstrom went through the transplant evaluation process."

By September 2011, she was on the transplant waiting list for a heart and liver. With the progression of her illness a new kidney became necessary as well, and by May 2012 her heart began failing and she had to enter Emory University Hospital. For this entire period, there was never any assurance that Ms. Lindstrom would get the organs she needed. "Her resilience was inspiring," says Dr. Knechtle, "and the outstanding support she received from her family bolstered her will to hold on."

After Ms. Lindstrom reached the point of requiring 24 hour ventilator and renal support in the ICU, a heart, liver, and kidney became available from a single donor. On July 7, 2012, she underwent a combined heart-liver procedure, with Dr. Kogon and Dr. Vega performing the heart transplant and Dr. Knechtle and Dr. Andrew Adams the liver. The next day, Drs. Knechtle and Adams performed her renal transplant.

Following a favorable course of in-hospital recovery and rehabilitation, Ms. Lindstrom has returned home to Greer, South Carolina. Her new heart, liver, and kidney are functioning well, and she has been able to resume a degree of normal activity and interaction that has been missing from her life for some time. "I am just so thankful for everything that I can do, like eat normal food, do homework with my daughter, and play cars and trucks with my son," she says.

In addition to great appreciation for the successful outcome of a procedure that has minimal precedent, Dr. Knechtle is extremely thankful for the efforts of all of the Emory personnel involved with Ms. Lindstrom's transplants and her recovery. "To make something like this happen requires so much more than just surgery," he says. "Of course, it all begins with the gift made by the donor and donor's family, and for that we will be forever grateful. Then, there are the anesthesiologists, perfusionists, OR nurses, and other staff who performed their various skills tirelessly, efficiently, and without complaint for what amounted to hours in the OR. After that, we have the critical care teams, cardiologists, hepatologists, nephrologists, and nurses that worked to help Ms. Lindstrom realize her goal of returning home. They regularly put the welfare of the patient above all else, and I salute them."

Fox-Carolina News coverage of Stephanie Lindstrom's story

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Dr. Luke Brewster
Dr. Luke Brewster

Dr. Brewster receives AHA Innovative Research Grant

The American Heart Association has awarded a National Center Research Program (NCRP) 2012 Innovative Research Grant to vascular surgeon-scientist Dr. Luke Brewster. Over the course of two years, the award will support Dr. Brewster's project to improve the angiogenic capacity of adipose-tissue derived mesenchymal stem cells for the purpose of saving ischemic limbs. The study will involve the culturing of cells harvested from ischemic limbs that required amputation.

"Currently, about 50% of patients with critical limb ischemia have no therapeutic options other than amputation, which is a life-changing event with a significant 30-day mortality rate," says Dr. Brewster. "Non-surgical therapies capable of improving tissue perfusion and decreasing amputation rates are critically needed, and cellular therapies are an attractive approach to solving this problem."

However, applying these therapies to promote the regeneration of limb tissue and subsequent healing is restricted by the limited number, location, and capacity of patients' stem cells to restore blood vessel networks throughout the length and width of the leg. "This study seeks to overcome these limitations by using advanced tissue culture methods and three-dimensional cellular assays," Dr. Brewster says.

This work complements Dr. Brewster's ongoing evaluation of the potency and regenerative capacity of bone marrow-derived mesenchymal stem cells, a collaborative effort he is undertaking with Dr. Ian Copland of Emory's Personalized Immunotherapy Center (EPIC), Dr. Todd McDevitt of the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, and Dr. Alexandra Peister of Morehouse College. An Emory/Georgia Tech Regenerative Engineering and Medicine seed grant is funding this study.

Combined, these projects aim to discover critical preliminary evidence for the clinical translation of cellular therapies to provide expedient wound healing and prevent amputation for patients with critical limb ischemia.

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Emory Healthcare & St. Joseph's Hospital
 

New Advanced Heart Failure Network benefits patients and physicians

In mid-November, the new Advanced Heart Failure Program, a network of subspecialists at Emory University Hospital, Emory University Hospital Midtown, and Saint Joseph's Hospital of Atlanta, opened its collective doors to heart failure and heart transplant patients. The new collaboration aims to not only meet the needs of patients and referring physicians in Georgia, but in the entire Southeast as well.

For over 20 years Emory and Saint Joseph's have had the largest advanced heart failure programs in the state. Combining the two programs increases the pool of highly qualified specialist providers, magnifies the number of multi-disciplinary teams available to patients, makes comprehensive cardiac care an even more seamless process, and creates a broader expanse for clinical trials.

Within the network, heart transplants will only be performed by Emory heart transplant surgeons at EUH. Heart failure patients can receive pre- and post-operative care from their physician of choice at any of the three facilities. Advanced heart failure management, medical and surgical management of all heart conditions, and related therapies can also be accessed at EUH, EUHM, and St. Joseph's. Implantation of ventricular assist devices (VADs) will be done at EUH and Saint Joseph's, while medical management of VADs will be undertaken at all three hospitals.

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Great App: drawMD
 

App review: drawMD is a welcome clinical companion

by Michael Konomos, MS, CMI, biovisualist and lead multimedia developer, Emory Surgery, and Ankit Patel, MD, endosurgery fellow, Emory Surgery

"Developed by doctors for doctors" and marketed by Visible Health, Inc., drawMD can enhance patients' understanding of the processes and goals of surgical procedures. Featuring sketching, typing, and stamping capabilities in multiple colors, the app allows medical professionals to visually describe procedures by editing either selections from its extensive library of anatomic illustrations or images/photos uploaded by the user. Final drawings can be saved, printed, and emailed, eliminating the need for bedside sketches.

With a smooth and efficient functionality, drawMD's components load quickly, even on a first generation iPad. The stamps are selected from large palettes of organs, structures such as stents and catheters, and surgical instruments, and can then be resized, spun, dragged, and flipped. While the stamps can be difficult to uncover for instruction-skippers, as most of us are, they are quickly accessible after some random button-pushing.

When choosing anatomical scenes to work from, first-time users may consider the options for organ configurations limited. In fact, the app works best when the illustrations are treated as being a step above blank canvases, and the stamps, typed notes, and freehand drawings are applied to individualize the image according to the procedure being described. The user can also create their own templates—perhaps corresponding to frequently performed surgeries—to edit and resave as the need arises.

The app's most significant flaw is the absence of an erase tool, the only option being to undo the last action. Visible Health claims to be working on rectifying this deficiency. The app also claims that it "provides detailed, beautiful, anatomically correct images that are the foundation for all drawMD apps." While most of the illustrations are generally accurate, many are in fact not beautiful and some cross the boundary into crudity.

Shortcomings aside, we highly recommend drawMD for any medical professional responsible for educating patients. In addition to improving patient satisfaction and eliminating the need for having generic printed diagrams on hand, the program is FREE. Versions are available for general surgery, pediatrics, vascular surgery, urology, orthopedics, ob/gyn, otolaryngology, cardiology, and anesthesia . While drawMD is currently only available for the iPad, other platforms are being developed.

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Beth Begley
Beth Begley
Christina Cowart
Christina Cowart

Staff update

Beth Begley, RN, who has served for the last seven years as the supervisor for clinical research nursing of the division of transplantation, has been promoted to manager of clinical research nursing for all other Department of Surgery research efforts on the Clifton Campus of Emory University. "We are grateful to Beth for her past service to Emory, and excited about her future contributions in her new and critical role," says director of academic affairs Lisa Carlson, MPH, MCHES.

The newly restructured, portfolio-wide group was developed in response to the growth of the Department's Clifton-based clinical research enterprise, which includes projects in general and GI surgery, oral and maxillofacial surgery, pediatric surgery, transplantation, and vascular surgery. Overseen by Ms. Begley, the new team will provide clinical research infrastructure support with the goal of standardizing research approaches, conserving resources, ensuring quality, and maintaining stability.

Christina Cowart, MBA, has recently joined the department's research administration team as a post award research accountant. A graduate of the University of Southern Mississippi and Strayer University, she worked for two years as a research accountant for the Center for BrainHealth at the University of Texas at Dallas before moving to Atlanta.

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Upcoming events

EVENT DATE/TIME LOCATION
SURGICAL GRAND ROUNDS
The Aging Surgeon

Presented by Keren Aviva Bashan, MD
– Chief Resident, Department of Surgery, Emory University School of Medicine
6:30 - 7:30 a.m., Dec. 6, 2012 EUH Auditorium
SURGICAL GRAND ROUNDS
Transcatheter Valve Therapies: A Magic Bullet or Not Worth It?
Presented by Vinod H. Thourani, MD
– Associate Professor of Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine
– Associate Director, Structural Heart Program, Emory Heart and Vascular Center
– Associate Director, Cardiothoracic Surgery Residency Program, Emory
7:00 - 8:00 a.m., Dec. 13, 2012 EUH Auditorium
Surgery Holiday Party 7:00 - 10:00 p.m., Dec. 15, 2012 The Miller Ward House
815 Houston Mill Road
RSVP by 12/5/12
Monthly Clinical Ethics Seminar
Hosted by the Emory Center of Ethics
5:00 - 6:00 p.m., Dec. 20, 2012 Center for Ethics, seminar room 162
Surgery Faculty Meeting 5:30 - 7:00 p.m., Jan. 29, 2013 TEC, B6300
Melanoma Conference
Sponsored by Winship Cancer Institute
Feb. 9, 2013 Intercontinental Buckhead
registration and more information
     
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