April 2018 dos newsletter

APRIL 2018

NEWS

IN THIS ISSUE: NOTES FROM THE CHAIR Rescue in Australia

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corresponding associations.

Great work!

Welcome New Hires

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Honors, Awards, Etc.

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Australia Continued

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The Department was recognized as 17th in the nation for the amount of NIH funding it receives. With 5 of our surgeons in the top 100 list for funding.

Older Surgical Patients

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New Heart on Valentines

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CU, GSK, & Immunotherapies

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Teens & Bariatric Surgery

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SLIRPS Trial Funding

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Guest Speakers for 12-13 Named Lectureships Burn Center ABA Verified

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Aurora Warms the Night

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Upcoming Events

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Thank you to everyone for the tremendous effort put forth to Improve Every Life.

As any group that has gone through the challenge of implementing a new vision knows,it can be strenuous work. I’m happy to say we have approached this challenge with great positivity. I enjoy reading our weekly messages about how we are improving each others lives and look forward to the continued responses.

One tremendous example of this positivity was our response to a colleague in a dire situation. This past December saw Dr. Robert Meguid’s family through a rough healthcare crisis while they were traveling out of the country. They have shared their story with us all in “A Rescue in Australia”, reprinted here. As you read this account, it will become apparent how much we support each other. It is truly a privilege to be part of such a close-

knit team. We are extremely grateful to have Rob back.

The past few months have been rewarding in a number of areas. We continue to add key faculty and staff throughout our department who will be instrumental in advancements in research, clinical and academic areas.

We have developed research partnerships and secured funding that allows for groundbreaking work. Our clinics continue to receive recognition as the top in their field; while our faculty continue to be recognized for their dedication to their specialties.

Congratulations to Vijay Vemulakonda, MD; Elizabeth Pomfret, MD, PhD; Joseph Cleveland, Jr., MD; Alberto Pena, MD; and Muhammad Aftab, MD for the recognition received from their

As always it continues to be my privilege to share our successes and upcoming events with you.

I hope you enjoy the newsletter that follows.

Richard D. Schulick, MD, MBA The Aragón/Gonzalez-Gíustí Chair Professor & Chair

Innovating Surgical Care Curing through Discovery Enlightening Tomorrow’s Leaders Daring to be Exceptional

www.cusurgery.com This publication is viewable online at: http://issuu.com/slangesurgery/docs/April_2018_dos_newsletter

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Race to Adelaide Cheryl roused the kids. Rob staggered out to the car. Cheryl drove a right-hand-drive vehicle for the second time in her life, this time tearing across 50 miles of Kangaroo Island at 100 mph. They arrived at Kangaroo Island Health Service hospital at about 7 a.m.

Rob walked straight past the emergency room front desk into the back. His skin had gone gray; his lips were blue.

Cheryl, Natalie, Rob and Cameron Meguid

A RESCUE IN AUSTRALIA By: Todd Neff, UCHealth

They had gone to the beach, watched colonies of sea lions, fed koalas and pet wallabies over a lovely couple of days on Kangaroo Island off the coast of Adelaide, Australia.

It was the afternoon of Dec. 23, and Dr. Robert Meguid, his wife Cheryl, and their two young children pulled into a supermarket to stock up for the next couple of days. With Christmas Eve, Christmas and Boxing Day coming up, things would be closed.

Rob felt a cold coming on. He stayed in the car as Cheryl, a nurse practitioner, went in to shop with the kids. As she did, a text hit her phone. It was from her husband: “Please hurry. I feel terrible.”

A man with a cold, Cheryl thought. Not a big surprise, really: she’d missed her last day of work before the big two-week family trip with a nasty one, and the kids, Natalie, 3, and 11-month-old Cameron, had come down with it, too. It was Rob’s turn, she supposed.

Both Rob and Cheryl work in the University of Colorado Department of Surgery and practice at UCHealth University of Colorado Hospital, he as a cardiothoracic surgeon, she as and director of multidisciplinary programs for the department.

Rob ceded the wheel to Cheryl despite her having never driven on the “wrong” side of the road.

He went straight to bed when they got back. Later, he was coughing enough that he and Cheryl agreed she should sleep in the other bedroom with the kids. At 6 a.m., just as the sun came up on Christmas Eve, pounding on the wall woke her up. Her husband yelled something. She went to check on him.

He was coughing up blood. He couldn’t catch his breath. His fingers and toes were numb.

This doctor wasn’t thinking about a diagnosis. He was thinking: I’m in shock.

“I need to go to the ER,” he rasped.

“I’m coughing up blood, I can’t breathe, my hands and feet are numb,” he told two nurses and a doctor. “I’m in shock, and I’m a physician.”

Quick tests confirmed that his lungs were failing and that other oxygen-starved organs – this despite now being on oxygen – weren’t far behind.

Another doctor, Jeremy Wells, gave instructions to the others over the phone as he rushed in from his home in the village.

Cheryl gave Rob a kiss before they sedated and intubated him. Within an hour of his arrival, he was gone – airlifted to Flinders Medical Center in Adelaide. Cheryl watched the helicopter disappear in the sky.

It was 8 a.m. the day before Christmas. Her husband was mortally ill. They had flown here from Melbourne. She didn’t know where Adelaide was. She was 9,000 miles away from home with two young children on an island named after a marsupial.

She started to cry.

Guardian Angels But right then, the first of many, many benefactors would

This publication is viewable online at: http://issuu.com/slangesurgery/docs/April_2018_dos_newsletter

come to the Meguids’ aid. Nigel Jefford, director of nursing at the Kangaroo Island hospital, drove Cheryl and the kids the 50 miles back to the bungalow, kept an eye on Natalie and Cameron as Cheryl packed suitcases, and drove them all the way back and on to the car ferry. On the ferry, a retired nurse, Geraldine Headley, overhead Cheryl explaining her predicament and offered to drive her and the kids to the hospital in Adelaide, where they lived. Her husband would pick them up.

By 3 p.m., Headley had walked Cheryl and the kids up to the hospital’s third floor, where Rob lay unconscious and intubated in the Flinders Medical Center’s medical intensive care unit.

He was already on dialysis for his failing kidneys. The working diagnosis was severe pneumonia that had cascaded into acute respiratory distress syndrome (ARDS) and septic shock, though what bacteria or virus was causing it wasn’t clear. The combination put the 42-year-old’s chance of survival at perhaps one in 10.

Rob’s cousin, Matt Perfect, with whom they’d stayed in Melbourne before flying to Kangaroo Island, had already flown to Adelaide and was waiting for Cheryl at the hospital. He would stay for four days, getting Cheryl and the kids set up in a little house he had rented for them across from the hospital. Others farther afield were already in the loop.

Continued on page 6 Page 2

NEWS WELCOME NEW FACULTY & STAFF! Faculty

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Erica Becker, PA Instructor Surgical Oncology

Melodie Biblis, ACNP Instructor Pediatric Surgery

Joslyn Brown, PAC Instructor Plastic & Reconstructive Surgery

Mohammad Al-Musawi PRA Cardiothoracic Surgery

Steven Bono Postaward Administrator Finance & Administration

Amber Camus Academic Services Professional Office of Education

Erica Case, NP Instructor Surgical Oncology

Kathryn Eckert, ACNP Instructor Cardiothoracic Surgery

Lauren Hill, CPNP Instructor Pediatric Surgery

Laniecia Demmer Pt. Affairs Coordinator Transplant Surgery

Anna Hubbell Administrative Assistant III GI, Trauma & Endocrine Surgery

Adam Jimenez Finance & Accounting Sr. Professional Finance & Administration

Meghan Houlihan, PA Instructor GI, Trauma & Endocrine Surgery

Josh Hutchison, PA Instructor GI, Trauma & Endocrine Surgery

Matthew Iorio, MD Associate Professor Plastic & Reconstructive Surgery

Trisha Keith Pt. Affairs Coordinator Cardiothoracic Surgery

Xueting Li Research Assistant Cardiothoracic Surgery

Jennifer Luzania Pt. Affairs Coordinator Cardiothoracic Surgery

Laura Ramsey, PAC Instructor Surgical Oncology

Lauren Steward, MD Assistant Professor GI, Trauma & Endocrine Surgery

Christian Wheelock, PAC Instructor Cardiothoracic Surgery

Erin Oglesby Academic Services Professional Office of Education

Chanelle Searles Pt. Affairs Coordinator GI, Trauma & Endocrine Surgery

Sarah Steinbergs Pt. Affairs Coordinator Surgical Oncology

Victoria Vorwald PRA Surgical Oncology

Heidi Wendt Revenue Cycle Manager Finance & Administration

Qingzhou Yao, PhD Research Associate Cardiothoracic Surgery

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Thoracic Surgery Residents Association Socrates Award

Joseph Cleveland, Jr., MD Professor, Cardiothoracic Surgery

HONORS : : AWARDS : : ACCOMPLISHMENTS AUA Rising Star Award

Vijaya Vemulakonda, MD Associate Professor, Urology

During a recent meeting of the American Urological Association (AUA) Board of Directors, significant time was spent discussing the many contributions that Vijay Vemulakonda, MD has made to the field of urology on local, regional and national levels.

This year, Vijay received the prestigious American Urological Association Rising Star Award. Given to only two urologists each year, this is an important and highly prestigious award that clearly demonstrates the value that our national organization places on Vijay’s research accomplishments. Vijay has also been recognized for the outstanding job that she has

done as Chair of the AUA Judicial and Ethics Committee.

This is an important position, typically held by the most senior members of our organization. To be entrusted with this level of responsibility so early in her career strongly acknowledges her leadership skills.

Vijay also deserves great recognition for achieving an AHRQ (Agency for Healthcare Research and Quality) Mentored Clinical Scientist Research Career Development (K08) Award.

This is a spectacular accomplishment, especially in view of the challenging and highly competitive nature of national research funding.

Vijay continues to make many important contributions as a urologic surgeon and as the Urology Associate Residency Program Director.

Congratulations Vijay and thank you for your many contributions to the University of Colorado’s Urology program and to the specialty!

Congratulations to Dr. Joseph Cleveland recipient of this years Socrates Award.

member in cardiothoracic surgery in recognition of their commitment to resident education and mentorship.

Each year, cardiothoracic surgery residents in North America are eligible to nominate a faculty member who has demonstrated a remarkable interest in resident training — inside or outside of the operating room. A winner is then selected from the nominees.

The Socrates Award is an award given annually by the Thoracic Surgery Residents Association to an outstanding faculty

2018 Francis Moore Excellence in Mentorship Award

Elizabeth Pomfret, MD, PhD Professor, Transplant Surgery

Elizabeth A. Pomfret, MD, PhD is a Professor of Surgery and Chief of Transplant Surgery at the University of Colorado Hospital in Aurora, Colorado.

She is an established multiorgan transplant surgeon with additional surgical training in Live Donor Liver Transplantation. Dr. Pomfret is an international leader within the field of transplantation, currently serving as the Executive Editor

This publication is viewable online at: http://issuu.com/slangesurgery/docs/April_2018_dos_newsletter

of Transplantation, the most highly cited journal in the field of organ transplantation.

She served as the President of the International Liver Transplantation Society (ILTS) from 2014-2015 and on various other organizational and governmental boards including the ASTS Board of Directors as a Councilor-atLarge from 2009 through 2012, and the OPTN/UNOS Board of Directors from 2011 – 2014. Dr. Pomfret is an active researcher with a record of peer-reviewed publications and has lectured worldwide on current issues in the field.

Congratulations Dr. Pomfret on this well deserved recognition.

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NEWS 2018 APSA Robert E. Gross Award for Excellence in Pediatric Research

Graham Surgical Investigator Award

these problems have been reproducible, durable with time, and have been widely accepted by pediatric surgeons as the “standard of practice.”

The Award was created by the APSA Board of Governors and is presented at their discretion.

Alberto Peña, MD Professor, Pediatric Surgery

It is my distinct pleasure to inform you that Dr. Alberto Peña has been selected by the Board of Governors of the American Pediatric Surgical Association (APSA) as the recipient of the 2018 APSA Robert E. Gross Award for Excellence in Pediatric Research and Achievement.

This award recognizes a seminal contribution by an individual who has made a major impact on pediatric surgery. Dr. Peña’s contributions have resulted in a major change in how pediatric surgeons worldwide manage congenital colorectal disorders, and the results of his approaches to

The President of APSA, Dr. Henri Ford, will present the award at the annual APSA meeting May 3-6, 2018 in Palm Desert, California.

Dr. Peña was also recently selected as the 2018 recipient of the Denis Browne Medal from the British Association of Paediatric Surgeons, to be conferred at their annual meeting in Liverpool England, in July 18-20, 2018. The Denis Browne award is made annually to mark an individual’s outstanding contributions to pediatric surgery world-wide.

Please congratulate Dr. Peña, trained by Dr. Gross himself, for the achievements that have resulted in his nomination and selection for these prestigious awards.

Department Ranks 17th in Country in NIH Funding The University of Colorado’s Department of Surgery ranked 17 in total amount of National Institutes of Health funding for surgery departments in 2017 according to the Blue Ridge Institute for Medical Research rankings. The $6,369, 053 in funding includes all awards made directly from the NIH to the University of Colorado.

Five of our researchers ranked in the top 100 for total NIH funding to individual surgery principal investigators: Drs. Anirban Banerjee; Thomas Inge; Dan Theodorescu; Xianzhong Meng; and Elizabeth Kovacs.

Muhammad Aftab, MD Assistant Professor Cardiothoracic Surgery

Muhammad Aftab, MD, FACS, FACC, Assistant Professor of Surgery in the Division of Cardiothoracic Surgery, received the Graham Surgical Investigator Award from the American Association for Thoracic Surgery (AATS) Graham Foundation for his research proposal entitled, “Augmentation of Spinal Cord ‘Precollateralization’ to Prevent Paraplegia After Aortic Surgery”. This award provides funding for Dr. Aftab’s research for two years as a Graham Surgical Investigator. His research work is focused on two areas of innovation. The first one is conceptual, in that he would like to better understand the mechanism of spinal cord ischemia after extensive aortic repairs. The second key area of innovation is related to development of new techniques to promote preemptive spinal cord pre-collateralization.

The mission of the AATS Graham Foundation is to drive leadership, learning, and innovation in the pursuit of excellence in cardiothoracic surgery. The Graham Surgical Investigator Program supports innovative clinical or translational research for young cardiothoracic surgeons.

Dr. Aftab trained in general surgery at the Hofstra North Shore – Long Island Jewish Health Systems in New Hyde Park, New York and in cardiothoracic surgery at the Michael E. DeBakey Department of Surgery at Baylor College of Medicine/ Texas Heart Institute in Houston, Texas. After completing his cardiothoracic surgery residency, Dr. Aftab served as a clinical associate surgeon in Advanced Aortic/ Endovascular Surgery in the Department of Thoracic and Cardiovascular Surgery at the Cleveland Clinic in Cleveland, Ohio from 2014-2016. He joined the faculty here in January 2016 in the Division of Cardiothoracic Surgery as an Assistant Professor.

Dr. Muhammad Aftab was among 1,827 Initiates from around the world who became Fellows of the American College of Surgeons (FACS) during the convocation ceremony at the College’s 2017 Annual Clinical Congress in San Diego, California.

The American College of Surgeons is a scientific and educational organization of surgeons founded in 1913 of more than 80,000 members.

It was founded to raise the standards of surgical practice and to improve the quality of care for the surgical patient. It is the largest organization of surgeons in the world.

Again, congratulations to Dr. Muhammad Aftab!

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and removed the breathing tube. Cheryl told him he had been out for a solid week. He couldn’t believe it. Wearing an oxygen mask and still connected to IVs, they wheeled him outside to a courtyard.

David Kuwayama, left, and Rob Meguid have been close friends since their surgical residencies in 2002. Here they are, in 2016, atop Blanca Peak, the fourth-highest of Colorado’s fourteener’s.

A RESCUE IN AUSTRALIA-CONTINUED FROM PG 2 By: Todd Neff, UCHealth Among them were Rob’s CU colleagues Dr. David Fullerton, Dr. Michael Weyant, Dr. John Mitchell and Dr. Richard Schulick, the department chair.

One of the first calls Cheryl made, though, was to Dr. David Kuwayama.

Kuwayama is a CU vascular surgeon practicing at UCHealth. But he’s also an old friend. He and Rob got to know each other in 2002, when they started their surgical residencies together at Johns Hopkins. They stayed close during their fellowships on opposite sides of the country, Rob at the University of Washington, Kuwayama at Dartmouth, where he specialized in vascular surgery.

Soon after Rob arrived at the Anschutz Medical Campus in 2012, he alerted Kuwayama to an opening for a vascular surgeon. Since then, they have collaborated on surgeries and climbed mountains together.

Kuwayama, a frequent Doctors Without Borders volunteer,

is used to traveling great distances to take care of people.

He booked a flight to Australia.

Improvement Meanwhile, Cheryl was in daily contact with Kuwayama and others in Colorado. She took cell phone photos of X-rays and CT scans and texted them to Mitchell and Weyant, Rob’s thoracic surgery partners. The providers at Flinders Medical Center, a 600-bed academic hospital, did their job well; the Colorado doctors provided remote support, looking after one of their own.

Meguid’s mother, Victoria, arrived on December 26. By then, pain in Natalie’s ear had been diagnosed as a perforated eardrum caused by a Group A Streptococcus infection. This was, they would learn, the same bug that had invaded her father’s lungs (Cheryl ended up with strep throat, too).

Rob was stable enough by December 30 that doctors let him wake from the sedatives

It was sunny. There was a pond. Cameron had, during the week Rob was sedated, walked for the first time. He toddled about; Natalie was here and there, checking out the ducks.

It dawned on him: “If this had gone a different way, I would have left my wife a single mother of two young children.”

Back under It still could have gone a different way. As the last night of 2017 turned into the first morning of 2018, Rob’s blood oxygen levels sank. Cheryl, at his bedside, “was trying to get me to breathe,” Rob said. He desperately wanted to avoid being put back on a ventilator.

“I was afraid the second time around I wouldn’t survive, because I was lucky I had survived the first time,” he said.

Natalie, who turned four when her dad was in an Adelaide, Australia intensive care unit, drew him as she remembered him, left, and with the accessories of an ICU patient.

It would take another nine days.

Rob’s condition was slowly improving, but there were setbacks, including a spiking

Cameron and Natalie celebrate their birthdays.

It had to happen, this time with a tracheostomy – a tube through the throat. The dialysis continued. Cheryl spent days at her husband’s bedside.

Geraldine Headley, who had driven Cheryl and the kids to Adelaide, reached out to friends, who reached out to teachers on summer break.

They took turns taking Natalie and Cameron to the beach, to the pool, to the zoo and to the park. A former patient and now friend of Cheryl’s, Cheri Foss

This publication is viewable online at: http://issuu.com/slangesurgery/docs/April_2018_dos_newsletter

and her husband Michael paid for Cheryl’s sister Sharon’s flight so she could be there to help. On January 4, Kuwayama arrived with presents for the kids, who were about to turn one and four. His personal mission was to get his old friend back to the U.S. and to University of Colorado Hospital.

fever and a whole-body rash – reactions to an antibiotic.

They worked on getting a life flight back to Denver. Sarah Kabat, UCHealth’s director of International and Executive Health Services, stepped in to help with arrangements.

Kuwayama plotted out the eight-seat Cessna Citation’s path back to Denver and the timing of refueling stops – in New Caledonia, American Samoa, Honolulu and San Francisco. He touched base with ICU staff at The Queen’s Page 6

NEWS Medical Center in Honolulu and UCSF Medical Center, who had ICU beds and dialysis machines ready in case Rob’s condition deteriorated on the flight. When the life-flight company needed $198,000 immediately, including a $9,500 processing fee, UCHealth CEO Elizabeth Concordia approved transfer of the processing fee, while Rob’s mom raided her retirement savings for the balance.

Rob’s father, recovering from pneumonia himself, arrived to see his son just before he left Adelaide. On Jan. 15, Rob was stable enough to fly. His mom accompanied him, a flight doctor, two nurses and two pilots on the life flight. Cheryl and Kuwayama monitored the flight’s progress. During the final leg, Kuwayama noted that weather was diverting Denverbound planes to Cheyenne, Wyoming, so Cheryl asked UCSF Medical Center to keep that ICU bed open just in case.

Home, sort of The Cessna landed at Denver International Airport 24 hours after it left Adelaide.

An ambulance brought Rob straight to the cardiothoracic ICU where Rob’s own patients often go after he operates on them. Fullerton led the care team; he had help from Dr. Scott Wolf, Dr. Karsten Bartels, Dr. Erik Peltz and Dr. Martin Krause, MD, as well as numerous other specialists enlisted to help manage Rob. Two days later, Rob’s kidneys had recovered enough that he was off dialysis, and the ventilator gave way to an oxygen cannula after about a week. The rash had subsided

after dermatologists made a diagnosis and initiated steroids.

One new complication was pancreatitis, probably from the lipid-based sedative propofol, which Rob had been on for so long.

it’s because I was a sick patient in an excellent ICU at a top medical institution in the U.S., and not that I’m a faculty member who has my own patients in there,” he said. “It has shown me that I have literally nothing to be concerned about when it comes to the care delivery for my patients.”

As Rob got better, the stream of visitors was welcome and unremitting. Kuwayama brought him rich homemade soups to help put back on some of the 35 pounds Rob had lost. Dr. Pamela Lipsett, a mentor during his residency at Johns Hopkins, set up a CarePages.com page to lighten the narrative burden piling The Meguid’s, back home together in early March. From left, up in Cheryl’s Natalie, Rob, Cameron and Cheryl. inboxes. Tamara Mayne, a nurse who runs the Home, really cardiothoracic OR service, After he got home, the help set up a list for volunteers to didn’t stop. Surgical residents, provide meals and babysitters Dr. Jason Samuels and Dr. Allie for Cheryl while Rob was still Halpern, Halpern’s husband, hospitalized. In the ICU, nurse Joey, and former surgery Gail Balbier, was there to “talk residency program manager me out of my drug-induced Michael Benge organized irrationality” and lift his right a fundraiser at a Colorado leg, which had ended up with Avalanche hockey game sores and nerve injury from followed by a silent auction at a the long flight back home, back local brewery. The guys either onto the bed (to him, it felt play or played with Meguid, a as heavy as cement). Another goalie, on the Department of nurse, Hailey Pash, arranged Surgery’s team, The Ten Blades. for Rob’s first shower in a month, which he described as At the Meguid home on a “one of the most incredible Saturday afternoon in early sensations of my life - I’m not March Natalie played with a joking.” She also arranged for cadre of Beanie Boo dolls as Rob to see his kids in an unused Cameron exploited his bipedal hospital conference room, since mobility, pinballing about the they were too young to visit him first floor. With a little dog in the ICU. named Monkey pressed up against him on the couch, Rob “The care I received was looked the same as ever, save outstanding. I’d like to think

the short purple scar at the base of his neck. He was still down 25 pounds of muscle, but was rehabbing hard, his right leg the laggard.

When he got home from the hospital, he had set April 2 as the date he would return to clinical work. He was, at the time, not ready to power through the hourslong, complex-surgeries he specializes in at UCH. As of early March, Rob was on track to meet that April goal, already spending time at Anschutz interviewing fellowship candidates and doing nonsurgical officerelated work.

His frightening experience changed him and it didn’t. He said he always had empathy for his patients. What’s changed is that now he has firsthand experience on what his patients’ families are going through.

And he recognizes much more overtly that, as he put it, “Life is precious. We’re all mortal.”

Cheryl had fetched Cameron and had hoisted him to her hip.

"Hold tight to your loved ones," she added, "because you never know what could happen."

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that he faced a 30 percent to 40 percent risk of dying from the surgery. If he survived, he would probably endure a long, difficult recovery and might not regain the functional abilities he had now.

HOW DOCTORS DECIDE IF OLDER PATIENTS CAN COPE WITH AN OPERATION By: Paula Span; The Independent (London, UK) Nov. 7, 2017

Tom Robinson, MD

This month, Dr Thomas Robinson, a general surgeon at the Denver Veterans Affairs Medical Centre in the US state of Colorado, saw a patient in his mid 80s. The man had gallstones that caused infections, with abdominal pain severe enough to send him to an emergency room every couple of months.

The surgical solution to this problem is usually clear: remove the gallbladder with a procedure called a cholecystectomy. “In a 60-year-old, chances are it’s an outpatient operation,” Robinson says. In this case, though, he hesitated. Like a growing number of surgeons, he wanted to know, before presenting the options, whether or not his patient was frail.

In geriatrics, frail is not merely an adjective. A syndrome signified by slowness, weakness, fatigue and often weight loss, frailty tells doctors a lot about their patients’ likely futures. It can, for example, predict how well older patients rebound from physical stresses – such as surgery.

“Some 86-year-olds live independently and are really healthy, and we take out their gallbladders all the time,” Robinson tells me. But this patient, a nursing home resident who also had heart disease and pulmonary disease, scored moderately to highly frail on a commonly used index.

In particular, the man performed poorly in what’s called the “timed up-and-go”, which measures how long it takes someone to rise from a chair, walk 10 feet, turn around, walk back and sit down again.

Along with the other frailty measures, that means that “surgery is not going to go very well”, Robinson says. In a frank half-hour conversation, he explained to his patient

Dilemmas like these will grow more common as the population ages. Already, more than a third of inpatient surgical procedures are performed on patients older than 65. But about 15 percent of the older population, excluding nursing-home residents, meets the criteria for frailty, rising to more than a third of those older than 85. “There’s a much higher prevalence in the Deep South and among AfricanAmericans,” says Dr Jeremy Walston, principal investigator at the Older Americans Independence Centre at research organisation Johns Hopkins Medicine.

Geriatricians like Walston have been publishing research on frailty for nearly 20 years, as measured by tools developed at Johns Hopkins, a separate Canadian version and variants thereof. The Hopkins approach uses tests such as grip strength and walking speed; the Canadian index relies on health deficits, including chronic illnesses and dementia.

Both assessments do a good job of identifying patients vulnerable to health problems, regardless of chronological age. A British group has used meta-analyses, for instance, to show that frail older adults are more prone to falls, fractures, hospitalisations, dementia and nursing-home placement.

In the United States, though, “it’s the surgeons who have

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picked up the banner”, Walston says. They’re starting to use frailty to help make decisions about which procedures make sense for which older patients. You can see why: frailty involves decreased physiological reserve, which helps determine how patients respond to physical stress.

Surgery brings plenty of that, says Dr Carolyn Seib, a general and endocrine surgeon at the University of California, San Francisco. The effects of anaesthesia and inflammation; the risk of blood clots or infection and muscle weakness caused by days in bed can all take a toll. “The more frail a patient is, the higher the risk of complications,” Seib says.

Researchers have shown that after major operations – including cardiac and colon cancer surgery and kidney transplants – frail older patients are more prone than others to longer hospital stays, being re-admitted within a month of a procedure and ending up in nursing homes after they’re discharged.

They’re also more likely to die.

But a study that Seib and her colleagues published in JAMA Surgery this month shows that frail seniors face higher complications even after ambulatory surgery: outpatient procedures that often are considered routine.

Hernia repairs, thyroid or parathyroid surgery, operations for breast cancer – “patients and providers often don’t think twice about these,” Seib says.

Yet when the researchers looked at 141,000 patients older than 40 in a national surgical database, they found that Page 8

NEWS serious complications were two to four times higher in patients with moderate to high frailty, although complication rates overall were low (1.7 percent, with 0.7 percent experiencing serious complications).

“We have to take frailty into account for any operation, big or small,” Seib says. Although surgeons increasingly screen for frailty, “I wouldn’t say it’s routine yet”, she adds. So she and other researchers recommend that before an operation, patients and families

an operation, “it improves your bounce-back capability”, Fried says. Physical activity, in particular, “seems to be the key to preventing frailty and its progression”, Fried adds – even for those not contemplating surgery.

Secondly, surgical decisionmaking is not a binary choice between patients agreeing to the standard operation or doing nothing. Alerted to frailty, a surgeon might opt for a less aggressive approach or a different kind of anaesthesia. A patient, understanding that they may be looking at an altered future even if the surgery fixes the physical problem, will have their own priorities to weigh.

With frailty, “I’m going to counsel the patient differently”, Robinson says. “Maybe change the Indexes use tests such as grip strength and the ‘timed surgery I do. Maybe find up and go’ to determine frailty (Getty) an alternative. There’s a ask: Is my mother showing spectrum of possibilities.” signs of frailty? Should we do an assessment that indicates Take, for example, his patient how frail she might be? with gallstone disease. After their discussion, the man Unlike some conditions, decided that instead of frailty is something patients undergoing what would be, and doctors can actually do for him, a high-risk operation, something about. “There he would go home and try to are interventions that can avoid foods that triggered his improve or even resolve it,” symptoms. If the pain flared said Dr Linda Fried, dean of again, Robinson would insert a the Mailman School of Public tube through his skin to drain Health at Columbia University the gallbladder, a much safer and a pioneer in frailty procedure. research.

Firstly, many surgical centres offer a “prehabilitation” programme, shown to improve patients’ results through exercise, better nutrition and smoking cessation. Undertaken even for a few weeks before

Because the tube, and the bag into which it drained, would be permanent, it might not represent a welcome alternative for a healthier patient. But “for a physiologically vulnerable older adult,” Robinson says, “it’s a whole different equation”

FATHER CELEBRATES NEW HEART ON VALENTINE’S DAY By: Kumasi Aaron; Denver 7, Feb. 14, 2018

DENVER - Valentine’s Day is a day many of us are celebrating love. But one couple is celebrating love and so much more. For them, the heart, is much more than a symbol.

After 22 years together, Valentine’s Day isn’t what it once was for Brad Keefer and Stephanie Eigenberg.

“You know his numbers haven’t been real good,” Eigenberg says. “And she’s like I just wanted to talk to you guys about that and she’s like you guys will never have to worry about that again because a heart came in.”

Dr. Muhammad Aftab is a heart surgeon at UCHealth and says there have been great improvements in the last decades to prevent organ rejection.

Muhammad Aftab, MD

“I will surprise her once in a while,” Keefer says. “Once you’re with someone for so long it’s one of those take it for granted things right?”

But this year, their hearts have been renewed, literally. Just a week ago, Keefer had a heart transplant that saved his life.

“That’s my valentine,” Keefer said touching his chest.

“Valentine’s Day, my love is my wife and so with her in this I can’t fail now.”

The 46-year-old father and grandfather was born with an abnormal heart valve, and as he got older things got worse. He desperately needed a heart, but struggled with the decision.

“I didn’t want to take someone else’s joy for me and they don’t even know me,” Keefer said.

“Why do I deserve it and not somebody else.”

“Currently our patients have really extra ordinary life expectancy and quality of life after heart transplantation,” Dr. Aftab said. “And we are talking in terms of decades.”

“I am really excited that he can now mow our yard,” Eigenberg says.

It’s the small things Keefer and Eigenberg are now looking forward to. More time with family, and enjoying every moment.

“My life just started over last week that’s the way I look at it,” Keefer says. “So I’m going to do everything in my power to keep it going and honor the person that gave me this.”

He’s planning to start, with the day of love. “Valentine’s Day?” Keefer muses. “Who knows we might go on a trip you never know. Without the kids.”

His family encouraged him as they waited, choosing to believe the heart would come. And months later Keefer’s nurse told them, it did.

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“Cancer has a way of evading the immune system, and when this checkpoint is blocked by an antibody, for example, it can activate the immune system to attack cancer cells,” explained Dr. Richard Schulick, Chair of Surgery at the University of Colorado Anschutz Medical Campus.

Richard Schulick, MD, MBA and Yuwen Zhu, PhD

CU ANSCHUTZ, GLAXOSMITHKLINE AND IMMUNOTHERAPIES FOR CANCER Every year, 14 million people around the world, including 1.7 million Americans, are diagnosed with cancer. One of the major challenges in fighting cancer is to understand and manipulate the response of the body’s immune system to cancer cells. Recently, an area that has received growing attention and has shown promise in clinical trials is the use of immune checkpoint inhibitors.

On the University of Colorado Anschutz Medical Campus, Drs. Richard Schulick and Yuwen Zhu have identified a series of novel checkpoint inhibitors and are now partnering with GSK (GlaxoSmithKline), a leading pharmaceutical company, to push their discoveries forward, with the aim of bringing new medicines to patients worldwide.

Our immune system is programmed to attack foreign cells, viruses, and microbes to protect us from illnesses. But how does it differentiate what is foreign and what is “self”? The answer is a two-way signaling mechanism.

The first type of signaling triggers an immune response when abnormal cells are detected. As cancer cells grow and multiply, they mutate their DNA unceasingly, which causes them to produce proteins that are different from those of normal cells. Due to small changes in their peptide sequences, cancer cells express defective neo-peptides (or neoantigens) which can be detected by the immune system, triggering T cells (the “soldiers of the body”) to destroy the cancer cells.

The second type of signaling acts in the opposite direction, decreasing or turning off the immune response via a “checkpoint” mechanism.

This kind of signaling evolved to prevent the body from inadvertently attacking its own healthy cells. Unfortunately, as cancer cells mutate, they sometimes manage to activate the checkpoint mechanism, turning off the body’s immune response. Therefore, blocking the checkpoint mechanism could be an effective way to reactivate the body’s immune response against cancer cells.

The novel checkpoint inhibitors developed at the Anschutz Campus were discovered in the lab of Dr. Yuwen Zhu in collaboration with Dr. Schulick. Dr. Zhu published their findings in the Journal of Experimental Medicine.

“Basically, we identify new immunomodulatory pathways,” said Dr. Zhu. “In this case, we identified a new immune checkpoint, which has the potential of being targeted to promote anticancer response in cancer patients.”

According to Dr. Zhu, the next steps in the research will focus on cancers that heavily express a particular ligand/ receptor pathway, as well cancers that are resistant to existing immunotherapies.

“It will provide doctors a new therapeutic option, especially for patients who can’t benefit from existing therapies,” Zhu said. He believes the discovery has broad applications and is not limited to one type of cancer but applies to multiple kinds, with the potential to improve the efficacy of current therapies via a combinatory approach.

CU Innovations, the office responsible for overseeing technology transfer at the Anschutz Medical Campus, saw the potential and worked

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to find a pharmaceutical partner to bring this revolutionary new science to patients. GSK’s Discovery Partnership with Academia (DPAc) was identified as an excellent fit for developing collaborative research.

“GlaxoSmithKline brings world-class pharmaceutical expertise onboard,” said Brian Bellesheim, Business Development Manager at CU Innovations. “They have the right mix of resources and scientific focus to develop new cancer treatments, and the right approach to working with academia, with a commitment to finding cures for disease, in a collaborative fashion.”

CU Anschutz Chancellor Don Elliman expressed his support for innovation and academiaindustry collaboration and said he is looking forward to deepening the university’s ties with industry to translate academic discoveries into services and products that will improve and transform healthcare. “Entering into this research collaboration with GSK is a testament to the groundbreaking science taking place at CU Anschutz Campus,” said Elliman. “We are extremely happy to have faculty members like Drs. Schulick and Zhu who are working to find a cure for one of the biggest challenges of humankind and whose cuttingedge science is opening the doors for broader academiaindustry collaboration. We are confident that bringing our world-class researchers and premier pharmaceutical companies like GSK together will lead to a positive impact.”

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NEWS STUDY LOOKS AT WEIGHT LOSS SURGERY FOR TEENS

SLIRPS TRIAL FUNDING

By: Dr. Comilla Sasson; 9News; Apr. 11, 2018

Thomas Inge, MD

A new study from Children’s Hospital Colorado compared obese adolescents who received traditional treatments for diabetes and obesity with those who received bariatric surgery.

Participants in the study had to be at least 100 pounds over their ideal body weight to enter the program. At the two year mark, the adolescents in the bariatric surgery group lost on average 97 pounds, decreased their body mass index by 28 percent, and 94 percent improved their hemoglobin A1c levels to non-diabetic ranges.

In comparison, those teens in the medical treatment group at two years experienced an average increase in body weight by 13 pounds, increase in body mass index by 3.5 percent and mean increase in their hemoglobin A1c levels from 6.3 percent to 7.6 percent.

The conclusions are surprising and potentially controversial.

Lead study author Dr. Inge, who also serves as the Director of the Bariatric Surgery Center at Children’s Hospital Colorado, has seen dramatic results for his severely obese adolescent patients who have had surgical procedures.

These adolescents are referred after failing to lose weight with nutrition counseling, exercise programs, psychological support, and behavioral interventions. There are two main types of bariatric (weight loss) surgery, the gastric sleeve and the Roux-en-Y procedure.

Both decrease the size of the stomach and/or reroute the way in which food is digested by the stomach and small intestine. These procedures are done using laparoscopic techniques with small incisions.

This new study raises the question, with such dramatic results, is the surgical option a treatment that should be considered more often in an effort to reverse type 2 diabetes for severely obese adolescents?

Surgery does have its complications, and each procedure has its risks and benefits. Twenty-three percent of the adolescents in the bariatric surgery group had to go back to the operating room for additional surgical procedures.

Surgery, although potentially considered an extreme option, could be an important part of a comprehensive treatment plan for caring for adolescents who are obese. If surgery can reduce the severe complications that diabetes has on the body, such as future heart attacks, strokes, kidney issues, and amputations, then these minimally invasive procedures might significantly reduce healthcare costs and lead to better health and productivity for these teens.

Jon Vogel, MD

The Short versus Long interval to loop Ileostomy Reversal after ileal Pouch Surgery in patients with ulcerative colitis trial (SLIRPS) is a multicenter, prospective, randomized trial of short interval (7-12 day) versus long/standard interval (at least 8 weeks) to diverting ostomy reversal after ileal j-pouch surgery for patients with ulcerative colitis. Ileal j-pouch surgery is the most commonly

performed surgical procedure for patients with ulcerative colitis. The study hypothesis is that a short interval to ileostomy reversal will result in decreased postoperative and ostomy-associated morbidity, and improved quality of life, for these patients. Dr. Jon Vogel is the primary investigator. Investigators from 14 other centers, including the Cleveland Clinic (Ohio and Florida), Washington University, Massachusetts General Hospital, University of Chicago, and other colorectal surgery referral centers will be participating. The trial has received grant funding in the amount of $110,000 from the Crohn’s and Colitis Foundation through their Surgical Research Network.

2018 SAGES RESEARCH GRANT RECIPIENT

Heather Carmichael, MD

Congratulations to Heather Carmichael, MD; R3 Research Resident, for being awarded a 2018 SAGES Research Grant.

The goal of the proposal, titled “Patient-Directed Intensive Ambulation After Colorectal Surgery Reduces Time to Bowel Function: A Randomized Control Trial”, is to conduct a randomized control trial

to determine the effect of intensive early postoperative ambulation on return of bowel function in a frail and comorbid population. Our intervention is designed to be patient centered, patient driven, and use minimal nursing or physical therapy support. We aim to achieve a significant increase in postoperative ambulation, as measured by daily steps on a pedometer, with minimal use of hospital resources. We believe that this increase in postoperative ambulation in the intervention group will also lead to reduction in duration of postoperative ileus as well as length of stay in our patient population.

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ALAN R. HOPEMAN LECTURESHIP IN CARDIOTHORACIC SURGERY

R. Morton Bolman, III, MD Lisa Ferrigno, MD; Catherine Velopulos, MD; Richard Schulick, MD; Jo Buyske, MD; James Chandler, MD

Dr. Bolman is a fourth generation physician who HENRY SWAN VISITING PROFESSORSHIP - SURGERY traces his roots to the Midwest.

He was born in Indiana, and SUPPORTED BY THE PLANK ENDOWMENT completed undergraduate studies at Williams College in Penn as an adjunct professor Williamstown, MA, in 1969. of surgery, and serves on the He then matriculated at St. emergency surgical service.

Louis University School of She also volunteers as a Medicine, where he received surgeon several weeks a year his MD, Magna cum Laude in resource-limited countries, in 1973. From there, Dr. most recently Nepal and Jo Buyske, MD Bolman pursued a residency Haiti, where she has been in general surgery at Duke instrumental in developing a We were pleased to host Dr. University Medical Center, new surgical training program.

Jo Buyske as this years visiting serving as Chief Resident in She received her surgical professor for the Henry Swan 1979-80. He followed this training at the Massachusetts Lecture. Dr. Buyske is the with a residency in thoracic General Hospital in Boston, Executive Director of the surgery at the University of and received her MD degree American Board of Surgery.

Minnesota between 1980 and from Columbia’s College of Her major initiatives include 1982. Following completion Physicians and Surgeons. ongoing improvement of of his formal training, Dr. assessment and education of She is a member of many Bolman remained at the surgeons, and standards in surgical societies, and is a University of Minnesota as training and beyond including past-president of the Society of Assistant Professor of Surgery. flexible training pathways and American Gastrointestinal and He was placed in charge of re-entry , and international Endoscopic Surgeons (SAGES) the new heart transplant relationships in surgery.

She has also served as a program. During these years, reviewer for multiple journals, Prior to moving to the ABS he worked in the incredibly and served on the Editorial fulltime, Dr. Buyske was fertile environment in solid Board of Archives of Surgery. chief of surgery at Penn organ transplantation at Presbyterian Medical Center of the University of Minnesota She has won numerous the University of Pennsylvania to establish a method of mentoring awards, been Health System for 10 years, immunosuppression (triplenamed as a Top Doc in where her clinical practice and drug therapy) for heart Philadelphia and nationally, research focused on minimally transplant patients that became and been featured in a Lifetime invasive surgery especially the standard therapy around documentary on women foregut surgery; general the US. doctors. She has given well over surgery; surgical education; 100 invited lectures, and has In 1984, Dr. Bolman was and diversity in the surgical published extensively. recruited to Washington workforce. She continues at This publication is viewable online at: http://issuu.com/slangesurgery/docs/April_2018_dos_newsletter

University, St. Louis and Barnes Hospital to initiate a heart transplant program at that institution. Over the next four years, his team performed more than 100 heart transplants. In addition, he performed the first heart-lung and lung transplant at that center. Dr. Bolman returned to the University of Minnesota in 1989 as Chief of the Division of Cardiovascular and Thoracic Surgery in the Department of Surgery. He was named the first recipient of the C. Walton and Richard C. Lillehei Professorship in Cardiovascular and Thoracic Surgery in 1989.

This prestigious Chair honored the brilliant and charismatic Lillehei brothers- C. Walton Lillehei, who is acknowledged as the founder of the field of open heart surgery, and his innovative brother, Richard C. Lillehei, who performed the world’s first pancreas transplant, among his many accomplishments. While at the University of Minnesota, Dr. Bolman was Chair of the Finance Committee and ViceChair of the Board of University of Minnesota Physicians, the practice organization of the University of Minnesota. In 1997, Dr. Bolman received a Faculty Teaching Award from the University of Minnesota.

Dr. Bolman remained in this position until June, 2005, when he relocated to Boston to become Professor of Surgery at Harvard University and Chief of the Division of Cardiac Surgery at Brigham and Women’s Hospital, a position he held until 2013. Dr. Bolman has Page 12

NEWS JOHN R. LILLY LECTURESHIP IN PEDIATRIC SURGERY been active on the national scene in transplantation and thoracic surgery. He served on the heart transplant committee and as the first thoracic transplant representative on the Board of the United Network of Organ Sharing.

He served for 6 years on the Residency Review Committee of the ACGME for Thoracic Surgery from 2005-2011. This is the entity that oversees and credentials all training programs in thoracic surgery in the US. He served as the Chair of the Education Committee of the American Association for Thoracic Surgery from 20072011. He was a Councillor of the AATS from 2009-2011.

While in Boston, Dr. Bolman and his wife, Ceeya PattonBolman, co-founded Team Heart Rwanda. This is a 501C3 non-profit organization formed in 2006 to address the need for cardiac surgery services for the population of Rwanda, an East African country of 12 million people which lacks any sustainable cardiac surgery. Each year, from 2008 through 2016, Team Heart has travelled to Rwanda to perform humanitarian open heart surgery for the vulnerable population of that country.

The organization is currently raising funds for the creation of a dedicated cardiac care center for Rwanda and the surrounding region. Since July, 2015, Dr. Bolman is a Professor of Surgery in the Division of Cardio-Thoracic Surgery at the University of Vermont.

Erik D. Skarsgard, MD, MSc

Dr. Erik Skarsgard is the chief of surgery at BC Children’s Hospital and professor of surgery at the University of British Columbia. He is a graduate of the UBC medical school and received training in pediatric surgery at Toronto’s Hospital for Sick Children, followed by specialized training in fetal surgery at the University of California San Francisco. After seven years on the surgical faculty at Stanford University and Lucile Packard Children’s Hospital in Palo Alto, California, Dr. Skarsgard joined BC Children’s Hospital in 2001. In May 2012, he was appointed Chief of Surgery.

Dr. Skarsgard is co-chair of the Centre for Surgical Research at UBC, and a member of the Scientific Advisory Board, Canadian Institutes of Health Research. He serves on the boards of the Canadian Association of Pediatric Surgeons and the American Pediatric Surgical Association.

He has also served as the hospital representative on the BC Children’s Hospital Miracle Weekend executive.

H. JAMES FOX LECTURESHIP FUNDED BY THE H. JAMES FOX ENDOWMENT

Keith D. Lillemoe, MD

Dr Lillemoe has served as Secretary, President and Chairman of the Board of Trustees of the Society for Surgery of the Alimentary Tract. He has served as President of the Society of Clinical Surgery, Secretary and President of the Society of University Surgeons, and as the Recorder for the American Surgical Association. He is a Senior Director of the American Board of Surgery.

Dr. Keith D. Lillemoe received his undergraduate education at the University of South Dakota and his MD from The Johns Hopkins University School of Medicine in l978. He served Dr. Lillemoe’s clinical research his surgical training at Hopkins interests are in pancreatic and joined the faculty there cancer, IPMNs and other in l985, rising to the rank of benign pancreatic disorders, Professor of Surgery in l996. and biliary tract injuries. His He served as Associate Program bibliography lists over 300 Director for the Hopkins journal articles and 115 book Surgical Residency from l993 chapters. He has served as a to 2003 and Vice-Chairman visiting professor over 70 times of the department from l997 and has spoken nationally and to 2003. He was recognized internationally on over 315 with the Hopkins Department occasions. He is currently the of Surgery Faculty Teaching Editor of one of the leading Award on five occasions. In surgical texts Surgery: Scientific 2003 he was appointed the Principles and Practice and is Jay L Grosfeld Professor and Editor-in-Chief of Annals of Chairman of the Department Surgery. of Surgery at the Indiana University School of Medicine.

In May 2011, Dr Lillemoe was appointed to the position of Surgeonin-Chief and Chief of the Department of Surgery at the Massachusetts General Hospital and the W Gerald Austen Professor of Frederick Grover, MD; James Chandler, MD; Keith Lillemoe, MD; Surgery at Richard Schulick, MD the Harvard Medical School.

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No match for these services The breadth of coverage is what distinguishes an ABA-verified center from other facilities that care for burn patients, said Anne Wagner, MD, medical director for the Burn Center.

UCHealth Burn Center and University of Colorado Hospital leaders with American Burn Association surveyors during the centers re-verification site visit.

BURN CENTER IS ONLY ABA-VERIFIED CLINIC IN ROCKY MOUNTAIN REGION By: Tyler Smith, UCHealth, April 10, 2018

The Burn Center at UCHealth University of Colorado Hospital recently received a plaque from the Chicago-based American Burn Association (ABA). The token recognized the Burn Center’s reverification by the ABA, a 2,000-member, worldwide organization dedicated to improving care for individuals and families whose lives have been blighted by burns. Receiving the plaque is now something of a ritual for the Burn Center, but for the providers and staff who work on the unit, it’s far more than a piece of hardware and receiving it is hardly routine.

The Burn Center remains the only ABA-verified adult facility in the state and region, a distinction it has held for 20 years. Earning the threeyear reverification required an on-site visit and report by two ABA surveyors whose job was not to hand out plaudits but to critically assess the Burn Center’s capacity to deliver the best possible care to its patients, all of whom require a

complex array of clinical and support services.

Over the past three years, the Burn Center has continued to build a team specifically trained to treat and care for these patients – not only those with burns, but also others with a variety of skin injuries and diseases. The “core” team encompasses: Physicians; Advanced practice providers; Nurses with multiple skills and responsibilities; Researcher; Physical, occupational, and speech therapists; Social worker/case manager; Pharmacist; Psychologist; and Dietitian.

Many other services around the hospital assist the Burn Center, as evidenced by the more than a dozen representatives, from Trauma to Emergency Services to Spiritual Care Services, who attended a breakfast meeting with the ABA surveyors Dec. 15. Nursing, physician and administration leaders were also on hand to express their support.

“It’s more and more being recognized that centers of excellence, like ours, that treat high volumes of patients have better outcomes,” Wagner said.

“We’re always teaching and always reading.”

Wagner also noted that ABAverified centers can’t simply cherry-pick successful cases as evidence of their skills.

They are required to report their mortality and morbidity rates and quality measures, such as preventing central line-associated bloodstream infections and deep vein thromboses. The Burn Center also reviews every case, looking for potential areas for improvement.

“If there are any concerns, we work on action plans to show how we as a system are going to improve patient care,” said Linda Staubli, RN, CCRN, the Burn Center’s clinical coordinator.

For example, Staubli said, the Burn Center recognized in reviewing case data that its infection rates were higher than the national average for burns.

After research and discussion, the team installed sterile water filters in the unit’s tub rooms, where severe burn victims receive early, critical treatment – and where skin loss makes them especially vulnerable to

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infection. The infection rate decreased by 50 percent after the decision.

Outreach and expansion Many of the changes that occurred after the last reverification, late in 2014, centered on strengthening the continuity of patient care.

For example, shortly after the 2014 visit, the Burn Center completed a long-term project that added beds to its inpatient unit and adjoined it with the outpatient clinic, which had been in the hospital’s outpatient pavilion. The result: a comprehensive care center that improved efficiency and service to patients.

In addition, the Burn Center added four advanced practice providers – two nurse practitioners and two physician assistants, with plans to add a fifth – ensuring that burn patients receive continuous care from specialists. The coverage is especially important because new patient admissions increased nearly 30 percent, from 316 to 409, between fiscal year 2016 (which ended June 30, 2016) and fiscal year 2017, Staubli said. The volume has sometimes exceeded the inpatient unit’s 19-bed capacity, requiring more stable patients to move to other units.

The volume growth is just one reason why the Burn Center continues to concentrate on building relationships with clinicians, EMS workers and community members throughout the state and region. “It’s a requirement that we work on burn prevention and outreach,” Page 14

NEWS said Laura Madsen, RN, outreach coordinator for the Burn Center.

burns. The Burn Center evaluates the injury, saving time if it requires the patient to come to UCH, but allowing those with less serious problems to get care closer to home.

She went on to tick off a host of conditions of non-burn conditions the Burn Center treats, including road rash, degloving (large sections of skin torn from their blood supply), necrotizing fasciitis (tissue-killing skin infection), and Stevens-Johnson syndrome (a skin reaction that can cause severe blistering and peeling). She pointed to a recent case of a patient discharged from another hospital who was admitted to UCH and diagnosed with exfoliative disorder, a primarily autoimmune condition that causes the body to shed skin.

It took two months, but a Burn Center team effort that included considerable contributions from wound care, nutrition, and pharmacy, got the patient’s condition under control.

To that end, Madsen, Wagner and associate medical director Arek Wiktor, MD, travel extensively around Colorado and the Rocky “The ABA wants to see Mountain region that patients get the throughout the proper care,” Wagner year. They work as said. “That’s why we’re a regional team to required to teach at help provide optimal every stage: EMS, fire, care and outcomes nursing, emergency for patients, starting departments. Many get with first responders Arek Wiktor, MD no training in burn.” and carrying through More than burn care to outpatient clinics.

The outreach is also important “We’re trying to reduce to helping communities burn risk and make sure understand that the Burn that communities have the Center treats many conditions, resources they need,” Madsen Wagner said. said. “Not all of them are as “There is a misconception that aware of the risks of burns as we only treat burns,” she said. they are of strokes, cancer and Outcomes like that one, For example, the Burn Center heart attacks.” repeated many times over the is a leader in frostbite past three years, led to the ABA Madsen said an important treatment, which includes presenting the plaque that now goal of outreach is to help administering clot-busting hangs in the Burn Center. But community providers recognize tissue plasminogen the push is on to meet ever the difference between burns activator (tPA) under the higher standards. and other trauma that require right circumstances.

For example, the the specialized care that UCH surveyors asked “There are many in the provides and those that can be the team for more world who still think safely treated in local hospitals. published research. that frostbite has no “We want to make sure we’re treatment,” she added.

“With the growth admitting patients who truly “We’re a frostbite center.” we’ve had, we’ve need to be admitted,” Madsen been buckling down The mobile app is a said. “Some patients can be to focus on patient valuable tool in frostbite Anne Wagner, MD treated as outpatients and not care,” Madsen said. cases because it can save incur that cost.”

“The surveyors precious time, Wagner said, encouraged us to get the great To help community providers noting that every hour delayed things we’ve done out to other make that call, in 2016 the Burn in rewarming frigid tissue burn centers and to share the Center rolled out UCHealth decreases the salvage rate 30 hard work we’ve done.” One Burn Center Consult, a free percent. By contrast, a patient big assist in that eff ort: Wagner downloadable smartphone who gets clot-busters to frozen assumes the presidency of app that providers in the field fingers or toes has 40 to 70 the ABA’s Research Committee can use to transmit HIPAApercent less risk of amputation, in April. protected photos of patients’ Wagner said.

Another goal recommended by the reviewers is to train more residents in burn surgery and to install a fellow position. “The Burn Attending reviewers noted that they want future surgeons coming through the hospital to see how burn surgery should be done,” Staubli said. A third surgeon fellowship-trained in burn surgery and critical care is slated to join the team this year.

The Burn Center also aims to extend its commitment to improving the quality of care to the outpatient setting, Madsen said. That means consistently evaluating processes, as the team does now for inpatient care. It’s not yet a requirement of reverification, but signs point in that direction, she noted.

“We want to create a more robust program for the future,” Madsen said. “We’re staying ahead of the curve with outpatient care. We’re not waiting for the ABA.”

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UPCOMING EVENTS DEPARTMENT OF SURGERY PARTNERS WITH AURORA WARMS THE NIGHT On March 28, 2018 the Department of Surgery partnered with Aurora Warms the Night to pack over 200 food kits for distribution.

Executive Director, Brian Arnold provided an overview of what the center has to offer. Aurora Warms the Night (AWTN) shelters those experiencing

The purpose of providing these services is to ensure families and individuals meet basic

April 23, 2018

April 30, 2018 Grand Rounds 6:30 am - 8:00 am

Extirpative Therapies for Hepatic Lesions Carlton Barnett, MD Professor; GITES VA Eastern CO Health Care System Surgical Education Joyce Aycock, MD Assoc. Professor; Plastic Surgery University of Colorado Hospital

Grand Rounds 6:30 am - 8:00 am Demographics of Intimate Partner Violence Catherine Velopulos, MD Assist. Professor; GITES University of Colorado Hospital Palliative Care in the ICU Barry Platnick, MD Assist. Professor; GITES Denver Health Medical Center May 14, 2018

May 7, 2018

Grand Rounds 6:30 am - 8:00 am

Grand Rounds 6:30 am - 8:00 am

needs, learn new skills, and have access to resources to transition out of homelessness.

In the weeks prior to the event donations of food items and cash were accepted. Each kit was packed into a gallon size ziploc bag and contained: a can of soup; a bowl, cup and spoon; chips/crackers; fruit cup and granola bar.

homelessness in the winter when temperatures reach 20 degrees or colder. They also provide year round services which include meals, warm clothing, hygiene items, transportation to shelter, laundry vouchers, bus passes, partner agency referrals, and advocacy.

Adjuncts to Damage Control Safety Ryan Lawless, MD Assist. Professor; GITES Denver Health Medical Center The Who, What, When, Where and Why of Adult Congenital Heart Disease David Campbell, MD Professor; Caridothoracic Surgery Children’s Hospital Colorado

Implicit Bias Brenda Allen, PhD Vice Chancellor Diversity and Inclusion University of Colorado Disaster Preparedness: Lessons Learned from the Crash of Asiana 214 Eric Campion, MD Assist. Professor; GITES Denver Health Medical Center

May 21, 2018

May 28, 2014 No Conferences

2018 Research Symposium

June 4, 2018 2nd Annual Sarah V. & Ernest E. Moore 6:30 am - 8:00 am

We greatly appreciate the department’s generosity and were excited to be able to provide these meals.

Memorial Day

July 14, 2018 SMASH 6 Peak to be Determined

Title TBD David B. Hoyt, MD Executive Director American College of Surgeons

RSVP: shelly.lange@ucdenver.edu

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