Wednesday, August 22, 2012

Student Innovators: Neurology Inpatient Rounds

As part of the institute’s commitment to education, each year we host a class of Student Innovators who spend the summer working side by side with our investigators. Larry Kim, one of those student innovators, periodically shares commentary about his time with us.
By Larry Kim

Recently, I was afforded an amazing opportunity to shadow the Neurology team at Children’s National Medical Center. Even as a public health guru, these intimate opportunities to shadow physicians and visit patients are exceptionally rare. Experiences such as this are typically reserved for third-year medical students and above. At the Summer Student Innovators Program at the Sheikh Zayed Institute, you get to skip all three years of medical school and jump right in! Jealous? I would be too. Here are a few highlights and interesting notes from my morning rounds with the neurology team:
  • Pre-Round Meeting: Prior to the neurology team’s morning rounds, they have a pre-round meeting where all the patient cases are discussed. It was a lot like the television show, “House,” where Dr. House asks his terrified residents tough questions about the cases. It has been about 4 years since I have taken medical terminology, so I understood about every 4th word he said. If you think you are on top of your medical terminology game, try to figure these words out:
  1. Subfalcine herniation
  2. Parenchyma
  3. Diencephalon
  4. Homonymous Hemianopsia 
  5.  Cortical homunculus

  • Patient Rounds: The majority of the patients we encountered had suffered from various types of seizures. The patients ranged in age from 15 months to 18 years old. Here are some interesting observations: 
    •  Patients who had a history of seizures were attached to a machine that measured their brain activity. The device also had a camera mount, similar to a web cam, which recorded the physical/psychological symptoms of the patient as they experienced an “episode.”
      • The most interesting aspect of the camera is that physicians can review a patient’s brain activity during a seizure and watch the physical/psychological changes that occur. During our morning round, the neurology team was able to identify a previously undetected seizure in a patient.
    • Collaboration was highly emphasized in the treatment and diagnosis of the patients. At one point, I counted 15 people involved in diagnosing a patient. The collaboration between neurologists, residents, pharmacists, nurses, case workers, and primary care physicians ensures that all parties are fully informed of the treatment plan. 
    • In one patient room, a child was to be discharged from the hospital later in the evening. As we were leaving, the nurse made a comment to the parent of a training video that would be streamed directly to their in-room television. From a public health perspective, Children’s National Medical Center gets a big thumbs-up for post-hospitalization patient/parent education. 
    • The field of neurology is interesting in that the symptoms of neurological disorders affect personality, mood, temperament, etc. Neurological disorders have less definitive symptoms, unlike other illnesses where you can physically identify a runny nose, a fever, or a cough. To see the effects of these neurological conditions first-hand made a lasting impression upon me and really fortified my passion for improving pediatric health.
  • Lasting Impressions: There were a few patients that I visited that made a lasting impression. I was touched by the strength and bravery that these children displayed despite their health condition. As a society, we characterize bravery as individuals who exhibit courage in the face of danger. If this definition holds true, then I have just met 6 of the bravest people I’ve ever had the honor of meeting. Here’s one such example of bravery: We visited one young patient who was recovering from a recent seizure. The attending physician asked her to smile to determine if her facial muscles had been affected by her seizure. I’ve seen a lot of amazing smiles over the years, but her smile was something special. It was the most beautiful smile that I have ever seen, period. Don’t mind the squadron of physicians hovering around her or the dozens of monitors and IV’s attached to her arm. For just a second, nothing was more tangible then her beautiful smile.

Monday, August 13, 2012

Changing the Future of Health through Pediatrics: Guest Lecture in United Arab Emirates

Children’s National CEO and President Kurt D. Newman, MD, gave a talk titled, “Changing the Future of Health through Pediatrics,” in Abu Dhabi at the invitation of His Highness Sheikh Mohamed bin Zayed al Nahyan, the Crown Prince of Abu Dhabi. The talk was given before a prestigious gathering of distinguished guests, including key government and health leaders within the United Arab Emirates. 

Dr. Newman spoke at the invitation of HH Sheikh Mohamed bin Zayed al Nahyan, the Crown Prince of Abu Dhabi.

Dr. Newman's remarks focused on how health care professionals around the world must think differently about the care they provide:

“Traditionally, doctors look at an adult and think backwards, asking, how can I treat the disease this person has developed? But what I propose is that more doctors should be thinking ‘forward’—trying to get upstream of these common diseases before a person becomes ill.”

The Majlis

Thinking forward, he noted, is what pediatricians have been doing for years. He explained that pediatricians predict a child’s growth and development based on established benchmarks, which then help them provide care and advice that keep children from getting sick. He highlighted Safe Kids Worldwide, which was created by Children’s National surgeon Martin Eichelberger, MD.

Dr. Newman's talk focused on how doctors should "Think forward."
 “25 years ago, Marty noticed that he was operating on many, many children who came into the emergency department due to accidental, preventable injuries. So he asked himself, ‘why not try to prevent more injuries instead of just fixing them?’”

Dr. Eichelberger’s program now works around the world including Abu Dhabi and Dubai, implementing training programs to combat accidental injuries. Their work to introduce car seats and encourage the use of helmets and seat belts, has led to a 53 percent reduction in accidental injuries in the United States alone.

Dr. Newman also highlighted how Abu Dhabi is already headed toward a more upstream model, evidenced by the emirate’s successful implementation of the pulse oximetry screening for critical congenital heart disease.

“In the old way of doing things, a baby that seems fine at birth would be sent home. But what if that baby had a heart problem that just hasn’t caused her to be ill yet? When that problem happens, she would be rushed back to the hospital and could possibly die. Now, a simple, non invasive screening that takes hardly any time at all can detect these heart issues before that baby leaves the hospital and has a dangerous complication problem.”

Since its adoption in 2011, 18,000 babies have been screened in Abu Dhabi, and 10 babies with critical congenital heart disease have been detected and treated.

After touching on existing successful models, Dr. Newman previewed the future of “thinking forward.” This includes the promise of technology, especially advanced genetics screenings. High speed, low cost genetic analysis will identify markers for diseases like heart disease and diabetes, and also determine how a person’s environment impacts their genetic predisposition—known as epigenetics. These advances could allow doctors to identify at birth a person’s likelihood of developing a disease, and help plan interventions that avoid them.

Finally, he stressed the importance of shared vision and creative connections between government, health care institutions, and stakeholders, to make these ideas of how to impact global health issues for children a reality. He used the example of the Sheikh Zayed Institute, which was made possible by the $150 million gift from the government of Abu Dhabi. He highlighted how that institute, in collaboration with partners in the United Arab Emirates, are building new tools, providing better education, and truly changing children’s health care around the world.

Dr. Newman reported he was humbled and honored by this opportunity to share his ideas, and also by the gracious and generous way in which he has always been received by the people of Abu Dhabi and the UAE.

Dr. Newman’s talk was held at a Majlis of HH Sheikh Mohamed bin Zayed al Nahyan. During the holy month of Ramadan, these special Majlis lectures, which are privately held gatherings of leaders in the United Arab Emirates, are held regularly, with His Highness extending invitations to prestigious government leaders and other key stakeholders from across Abu Dhabi.

Tuesday, August 7, 2012

Better Weight Loss Surgery Options for Adolescents with Obesity

This month, Sheikh Zayed Institute Principal Investigator Evan Nadler, MD, published a study in the journal Surgery about the effectiveness of laparoscopic sleeve gastrectomy for teens. Well documented complications for patients undergoing gastric bypass make that procedure less than ideal for teens with morbid obesity who require surgery to combat their weight, and have led to surgeons exploring other surgical options. However, in his own practice, Dr. Nadler found that sleeve gastrectomy had many of the same benefits as the more invasive gastric bypass--patients lost an average of 65 lbs, or 40 percent of their weight and reduced their obesity related complications significantly--and fewer negative side effects, for the teens he treats through his Weight Loss (Bariatric) Surgery Program.

Like most of our principal investigators, Dr. Nadler is not only an investigator, but also a pediatric surgeon as well as the co-director of the Children’s National Obesity Institute. He is one of the few doctors in the country who performs bariatric surgeries for adolescents who qualify for this surgical weight loss option. His experiences as a surgeon and as an advocate for change in how this continuing epidemic is addressed around the world, make him uniquely able to see the challenges of obesity—particularly how every person is different, has different complications, and responds to treatments differently. This motivates him to try and get ahead of the disease, and advance the treatment options through finding new, better methods, but also getting more precise in how doctors decide which treatment will work best. The next level, he says, is personalizing these weight loss tactics for each child (or patient).

His research in the Systems Biology initiative of the institute uses genetic analysis to see if it is possible to predict how well someone will respond to a particular weight loss strategy, for example one bariatric surgery procedure over another (i.e. sleeve gastrectomy). It might be, that for some people, surgery isn’t the best option and for others, it may be the only option. Another recently funded project is looking at the fat tissue in patients of differing weights and ethnicities to determine why different people get sick with different diseases if they are obese.

“We want to use our surgical experience to identify the safest and most effective surgeries to help these teens find a way to a healthier life, as soon as possible,” he said.

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