VA Pittsburgh Healthcare System
VA Pittsburgh Healthcare System
News Article | April 20, 2017
Shari M. Ling, MD has been selected to receive the first-ever Public Service Award from NKF, established to honor those who have dedicated their careers to public service and who have helped to shape public policies or government programs that improve outcomes for kidney patients. Dr. Ling currently serves as the Deputy Chief Medical Officer for the Centers for Medicare and Medicaid Services (CMS) and Medical Officer in the Center for Clinical Standards and Quality (CCSQ). In her role at CMS, she assists the CMS Chief Medical Officer in the agency's pursuit of better health care, healthier populations and smarter spending. Dr. Ling's committed focus is on the achievement of meaningful health outcomes for patients and families through the delivery of high quality, person-centered care, across all care settings. Her clinical focus and scientific interest is in the care of persons with dementia, multiple chronic conditions and functional limitations. Derek Forfang, a kidney patient and long-time kidney disease advocate, has been selected to receive the first-ever Celeste Castillo Lee Patient Engagement Award, established in honor of Celeste Castillo Lee, a longtime advocate for patient-centered care and empowerment. It is the highest honor given by NKF to a distinguished kidney patient who exemplifies NKF's mission and Celeste's legacy of putting patients at the center of all aspects of healthcare through their involvement with NKF and community partners. Mr. Forfang, of San Pablo, California, has been an end-stage renal disease (ESRD) patient since 1999. He received a kidney transplant and has also been on peritoneal dialysis and hemodialysis. A regional leader of NKF's Kidney Advocacy Committee and a member of the Public Policy Committee, Derek has worked tirelessly to protect and improve care for the kidney community. Merck been selected to receive the 2017 Corporate Innovator Award which recognizes industry partners that advance the field of nephrology by addressing an unmet medical need, or improving upon an existing practice, therapeutic or technology. Merck's innovative new treatment for hepatitis C, ZEPATIER, is the only direct anti-viral agent specifically tested and approved for use in patients with chronic kidney disease stages four and five. Paul Palevsky, MD has been selected to receive the Dr. J. Michael Lazarus Distinguished Award established to honor Dr. Lazarus for his major contributions to the clinical science and care of dialysis patients, and to recognize individuals whose research has yielded novel insights related to renal replacement therapy. Dr. Palevsky is Professor of Medicine and Clinical and Translational Science in the Renal-Electrolyte Division at the University of Pittsburgh School of Medicine; and serves as Chief of the Renal Section at the VA Pittsburgh Healthcare System. Dr. Palevsky's research has primarily focused on acute kidney injury and critical care nephrology. He will be presenting the Lazarus lecture on "We Don't Have to Fail at Acute Renal Failure: A Multidisciplinary Approach to Quality Improvement" on Friday, April 21st at 8:45 a.m. at the NKF Spring Clinical Meetings. Susanne Nicholas, MD, MPH, PhD has been selected to receive the Medical Advisory Board Distinguished Service Award established to recognize an individual for their educational activities and community service in promoting the mission of NKF on a local level. Dr. Nicholas is a tenured Associate Professor of Medicine at UCLA in the Division of Nephrology where she maintains her clinical responsibilities, and the Division of Endocrinology, Diabetes and Hypertension, where she conducts research. She is also a Clinical Hypertension Specialist. Dr. Nicholas' research interests include understanding and identifying key factors that promote the pathogenesis of diabetic kidney disease (DKD); uncovering and validating novel biomarkers that may predict DKD progression; and quantifying renal structural changes associated with DKD in response to novel therapeutics, using stereology principles. Her research over the past 15 years has led to the identification of a novel biomarker of DKD, which is currently being validated in clinical studies. Katherine R. Tuttle, MD, FASN, FACP, FNKF, has been selected to receive the prestigious Garabed Eknoyan Award, created to recognize an individual who has promoted the mission of NKF in Making Lives Better for people with kidney disease through the exceptional contributions to key initiatives of NKF such as the Kidney Disease Outcomes Quality Initiative (KDOQI) or clinical research in the field of kidney disease. Dr. Tuttle is the Executive Director for Research at Providence Health Care in Spokane, and serves as Co-Principal Investigator of the Institute of Translational Health Sciences, Investigator at Kidney Research Institute, and Clinical Professor of Medicine for the University of Washington. Dr. Tuttle's major research interests include diabetic kidney disease, hypertension, renal vascular disease, nutrition in chronic kidney disease, and transitional care. She has chaired numerous workgroups focused on diabetes and kidney disease including NKF's KDOQI Workgroup for Diabetes and Chronic Kidney Disease. Jonathan Himmelfarb, MD has been selected to receive the Donald W. Seldin Award, established to recognize excellence in clinical nephrology in the tradition of one of the foremost teachers and researchers in the field, Dr. Donald W. Seldin. Dr. Himmelfarb is a Professor of Medicine, Director of the Kidney Research Institute, and holds the Joseph W. Eschbach, M.D. Endowed Chair in Kidney Research at the University of Washington School of Medicine. He is the author of more than 200 peer-reviewed publications, has served on numerous grant review committees and scientific advisory boards and has held leadership positions in many national and international nephrology societies. Dr. Himmelfarb has served on expert panels for the U.S. Food and Drug Administration, Veterans Health Administration, and Centers for Medicare & Medicaid Services. He is also a nephrologist who cares for patients with kidney disease, and an internationally recognized educator about kidney disease. Raymond R. Townsend, MD has been selected to receive the Shaul G. Massry Distinguished Lecture Award, established to honor Dr. Massry for his scientific achievements and contribution to the kidney health care community and to NKF. Dr. Townsend is Professor of Medicine and an Associate Director of the Center for Human Phenomic Studies at the University of Pennsylvania. He is currently a Principal Investigator evaluating the role of demographic, phenotypic, humoral and genetic factors in the progression of kidney disease and the development and progression of cardiovascular disease in patients with chronic kidney disease. He was also the Principal Investigator of a multicenter effort evaluating the specific role of pulse wave velocity in the renal and cardiovascular consequences of chronic kidney disease. Dr. Townsend led the work group that wrote the KDOQI Commentary on the 2012 KDIGO Guideline on this subject, and most recently co-chaired the NKF workshop on Potassium Homeostasis in Disease and Health, the report on which will soon be published in the American Journal of Kidney Disease and Journal of the American Society of Hypertension. Tilakavati Karupaiah, PhD, APD, AN has been selected to receive the Joel D. Kopple Award, an annual award honoring an individual who has made significant contributions to the field of renal nutrition. Dr. Karupaiah is an Accredited Practicing Dietitian with Dietitian's Association of Australia, a Professor and Head of the Dietetics Program at the National University of Malaysia; and also Adjunct Associate Professor at Wayne State University, Detroit. Dr. Karupaiah's involvement in renal nutrition began because of a lack of dietitians in this field in Malaysia, and dialysis patients needed patient-friendly information about local diets. At the National University of Malaysia, she encouraged early exposure of dietetic students to renal patient care through community engagement, outpatient counseling and practical skills on patient diet planning. Dr. Karupaiah is now targeting capacity building mentorship for developing renal dietitians in Malaysia through nutrition research. For the past 26 years, nephrology healthcare professionals from across the country have come to NKF's Spring Clinical Meetings to learn about the newest developments related to all aspects of nephrology practice, network with colleagues, and present their research findings. The NKF Spring Clinical Meetings are designed for meaningful change in the multidisciplinary healthcare teams' skills, performance, and patient health outcomes. It is the only conference of its kind that focuses on translating science into practice for the entire healthcare team. 1 in 3 American adults is at risk for kidney disease. 26 million American adults have kidney disease—and most aren't aware of it. Risk factors for kidney disease include diabetes, high blood pressure, family history, and age 60+. People of African American; Hispanic; Native American; Asian; or Pacific Islander descent are at increased risk for developing the disease. African Americans are 3 ½ times more likely, and Hispanics 1 ½ times more likely, to experience kidney failure. The National Kidney Foundation (NKF) is the largest, most comprehensive and longstanding organization dedicated to the awareness, prevention and treatment of kidney disease. For more information about NKF visit www.kidney.org. : Full press releases on each award recipient, including quotes for attribution, are hyperlinked by recipient's name and can also be found in the Newsroom at www.kidney.org. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/national-kidney-foundation-honors-leading-researchers-clinicians-patient-advocates-and-more-at-its-26th-annual-spring-clinical-meetings-300442333.html
News Article | April 17, 2017
Allegheny Health Network (AHN) and VA Pittsburgh Healthcare System (VAPHS) today announced the successful integration of their Electronic Medical Records (EMR) platforms. The two organizations can now exchange veterans’ health records securely and seamlessly for a more connected patient-provider experience. The first records were shared across the AHN and VA EMR platforms last fall, and to date more than 1,700 documents have been exchanged. “The expansion of AHN’s Care Everywhere EMR platform to the VA is a major step forward in providing more effective care for patients,” said Robert White, MD, Chief Medical Information Officer at Allegheny Health Network. “By allowing for a seamless record exchange, patients who visit providers at various facilities are more empowered the moment they walk in the door. A patient’s¬ up-to-date medical history is immediately available for review, and the need for traveling with paper records is eliminated. Patients receive more timely and effective care when their providers are equipped with all the health information they need at all times,” Dr. White said. Connecting with VA’s EMR platform, known as Virtual Lifetime Electronic Record (VLER), affords AHN providers secure electronic access to veterans’ health records stored at any of VA’s 1,233 healthcare facilities nationwide, including VAPHS. Veterans’ participation is strictly voluntary, and requires in-person authorization. Dr. White said AHN was particularly excited to establish a program to help better serve the nation’s veterans. “So many of our patients seek care from both private and VA-based providers that integrating their information is essential to providing optimal care. It’s a real privilege for us to be able to provide this improved level of care to those who have served our country,” Dr. White said. VAPHS Director Karin McGraw agrees the records integration is beneficial to veterans . “It’s absolutely essential for VA, as well, to be able to see all clinical and laboratory records so we can provide optimal care for our patients – especially now, with many veterans receiving healthcare outside the VA through the Veterans Choice Program. The records integration puts this information at our fingertips,” McGraw said. EMR integration with other government agencies is also underway at AHN. In January, AHN began sharing its records with the Social Security Administration and is averaging roughly 1,200 document exchanges a month with the agency. The Department of Defense is in the onboarding process with the network. AHN is currently implementing the Epic EMR across all of its provider sites. The system has already been launched at the network’s Allegheny General, West Penn and Forbes hospitals, as well as at its Wexford Health + Wellness Pavilion and in most of its employed physician practices. When completed, AHN will be the region’s only healthcare system, and one of the country’s largest, to be integrated by a single EMR. ###
Sun H.-Y.,VA Pittsburgh Healthcare System |
Sun H.-Y.,National Taiwan University Hospital |
Singh N.,VA Pittsburgh Healthcare System |
Singh N.,University of Pittsburgh
The Lancet Infectious Diseases | Year: 2011
Several countries have seen rising frequencies of mucormycosis among patients with haematological disorders, malignancies, or diabetes mellitus, and among transplant recipients. Growing numbers of immunocompromised hosts, widespread use of antifungal agents inactive against mucormycosis, or other unidentified factors, could be contributing to this situation. The predominant clinical manifestations of mucormycosis vary from host to host. Additionally, risk factors specific to different subgroups have been identified, such as leukaemia, allogeneic haemopoietic stem-cell transplant, voriconazole prophylaxis, diabetes, and malnutrition. We summarise the current state of knowledge of characteristics and risk factors and discuss topical developments in therapeutic methods and strategies in the management of mucormycosis. © 2011 Elsevier Ltd.
Reinkensmeyer D.J.,University of California at Irvine |
Boninger M.L.,University of Pittsburgh |
Boninger M.L.,VA Pittsburgh Healthcare System
Journal of NeuroEngineering and Rehabilitation | Year: 2012
There has been a dramatic increase over the last decade in research on technologies for enhancing movement training and exercise for people with a disability. This paper reviews some of the recent developments in this area, using examples from a National Science Foundation initiated study of mobility research projects in Europe to illustrate important themes and key directions for future research. This paper also reviews several recent studies aimed at combining movement training with plasticity or regeneration therapies, again drawing in part from European research examples. Such combination therapies will likely involve complex interactions with motor training that must be understood in order to achieve the goal of eliminating severe motor impairment. © 2012 Reinkensmeyer and Boninger; licensee BioMed Central Ltd.
Hawkins K.,VA Pittsburgh Healthcare System |
Donihi A.C.,University of Pittsburgh |
Korytkowski M.T.,University of Pittsburgh
Current Diabetes Reports | Year: 2013
Hyperglycemia is commonly observed in hospitalized patients with and without previously known diabetes and is associated with adverse outcomes. For this reason, measurement of blood glucose (BG) is recommended for all patients at admission. Measurement of an A1C identifies patients with either newly recognized diabetes or uncontrolled diabetes. Current guidelines advise fasting and premeal BG <140 mg/dl, with maximal random BG <180 mg/dl for the majority of noncritically ill patients. Rational use of basal bolus insulin (BBI) regimens is effective in achieving these glycemic goals, with low risk for hypoglycemia. The safety of BBI relies upon provider knowledge for initiation and adjustment of insulin doses for changes in nutritional status or use of medications affecting glucose metabolism. Smooth transition of care to the outpatient setting is facilitated by providing oral and written instructions regarding timing and dosing of insulin, as well as education in basic skills for home management. © 2012 Springer Science+Business Media New York.
Ma Y.,University of Pittsburgh |
Shurin G.V.,University of Pittsburgh |
Gutkin D.W.,VA Pittsburgh Healthcare System |
Shurin M.R.,University of Pittsburgh
Seminars in Cancer Biology | Year: 2012
Immune effector and regulatory cells in the tumor microenvironment are key factors in tumor development and progression as the pathogenesis of cancer vitally depends on the multifaceted interactions between various microenvironmental stimuli provided by tumor-associated immune cells. Immune regulatory cells participate in all stages of cancer development from the induction of genomic instability to the maintenance of intratumoral angiogenesis, proliferation and spreading of malignant cells, and formation of premetastatic niches in distal tissues. Dendritic cells in the tumor microenvironment serve as a double-edged sword and, in addition to initiating potent anti-tumor immune responses, may mediate genomic damage, support neovascularization, block anti-tumor immunity and stimulate cancerous cell growth and spreading. Regulatory dendritic cells in cancer may directly and indirectly maintain antigen-specific and non-specific T cell unresponsiveness by controlling T cell polarization, MDSC and Treg differentiation and activity, and affecting specific microenvironmental conditions in premalignant niches. Understanding the mechanisms involved in regulatory dendritic cell polarization and operation and revealing pharmacological means for harnessing these pathways will provide additional opportunities for modifying the tumor microenvironment and improving the efficacy of different therapeutic approaches to cancer. © 2012 Elsevier Ltd.
Clancy C.J.,VA Pittsburgh Healthcare System |
Clancy C.J.,University of Pittsburgh |
Nguyen M.H.,University of Pittsburgh
Clinical Infectious Diseases | Year: 2013
Blood cultures are limited for diagnosing invasive candidiasis by poor sensitivity and slow turn-around time. New diagnostics are needed to complement cultures, in particular to identify the missing 50% of patients who are blood culture-negative. Mannan/anti-mannan immunoglobulin G, β-D-glucan (BDG) and polymerase chain reaction (PCR) assays can diagnose candidemia before blood cultures and show promising sensitivity/specificity, but they are not widely investigated in blood culture-negative, deep-seated candidiasis. In a recent study, BDG and PCR were superior to blood cultures in deep-seated candidiasis, suggesting they may identify currently undiagnosed patients and expand our understanding of disease spectrum. Positive predictive values of nonculture tests are limited by the low prevalence of invasive candidiasis, which mandates that results be interpreted judiciously. When used as biomarkers that assess a patient's risk of having invasive candidiasis, tests will facilitate preemptive antifungal strategies. Because negative predictive values are excellent, tests will also be useful for ruling out invasive candidiasis and discontinuing unnecessary antifungal therapy. © 2012 The Author.
Nashar K.,Allegheny General Hospital |
Fried L.F.,VA Pittsburgh Healthcare System
Advances in Chronic Kidney Disease | Year: 2012
Hyperuricemia is seen when kidney function declines. Whether elevated uric acid (UA) levels play a role in the initiation and progression of kidney disease is a subject of a great debate. Animal studies demonstrate that elevated UA level is a risk factor for kidney disease. In humans, the relationship between UA and kidney disease is more complicated. Cross-sectional studies show an association of hyperuricemia with the presence of CKD; however, from cross-sectional studies, one cannot determine which came first-the elevated UA level or the kidney disease. UA levels are also associated with other risk factors for kidney disease, including hypertension, metabolic syndrome, and microalbuminuria, but it is not clear whether these are mediators or confounders of a relationship. Observational studies suggest a relationship of UA level with incident CKD, but studies evaluating the relationship with decline in kidney function in established CKD are conflicting. Finally, small clinical trials using allopurinol to lower UA levels provide weak, but potentially promising, evidence that lowering UA levels may retard the progression of CKD. In this article, we will review the evidence of the association of hyperuricemia and CKD. © 2012 National Kidney Foundation, Inc.
Vijayan A.,Washington University in St. Louis |
Palevsky P.M.,VA Pittsburgh Healthcare System |
Palevsky P.M.,University of Pittsburgh
American Journal of Kidney Diseases | Year: 2012
The impact of the intensity of renal replacement therapy on outcomes in patients with acute kidney injury has been studied intensively during the past decade. In this review, we consider the concept of dose of renal replacement therapy in acute kidney injury and summarize the recent clinical trials addressing this topic. Although several single-center trials suggest that more intensive therapy is associated with improved outcomes, 2 large multicenter randomized trials do not find a benefit with higher doses of therapy. Based on these studies, we provide recommendations for the delivered intensity of renal replacement therapy in acute kidney injury.
Gandhi C.R.,VA Pittsburgh Healthcare System |
Gandhi C.R.,University of Pittsburgh
Fibrogenesis and Tissue Repair | Year: 2012
'Augmenter of liver regeneration' (ALR) (also known as hepatic stimulatory substance or hepatopoietin) was originally found to promote growth of hepatocytes in the regenerating or injured liver. ALR is expressed ubiquitously in all organs, and exclusively in hepatocytes in the liver. ALR, a survival factor for hepatocytes, exhibits significant homology with ERV1 (essential for respiration and viability) protein that is essential for the survival of the yeast, Saccharomyces cerevisiae. ALR comprises 198 to 205 amino acids (approximately 22 kDa), but is post-translationally modified to three high molecular weight species (approximately 38 to 42 kDa) found in hepatocytes. ALR is present in mitochondria, cytosol, endoplasmic reticulum, and nucleus. Mitochondrial ALR may be involved in oxidative phosphorylation, but also functions as sulfhydryl oxidase and cytochrome c reductase, and causes Fe/S maturation of proteins. ALR, secreted by hepatocytes, stimulates synthesis of TNF-α, IL-6, and nitric oxide in Kupffer cells via a G-protein coupled receptor. While the 22 kDa rat recombinant ALR does not stimulate DNA synthesis in hepatocytes, the short form (15 kDa) of human recombinant ALR was reported to be equipotent as or even stronger than TGF-α or HGF as a mitogen for hepatocytes. Altered serum ALR levels in certain pathological conditions suggest that it may be a diagnostic marker for liver injury/disease. Although ALR appears to have multiple functions, the knowledge of its role in various organs, including the liver, is extremely inadequate, and it is not known whether different ALR species have distinct functions. Future research should provide better understanding of the expression and functions of this enigmatic molecule. © 2012 Gandhi; licensee BioMed Central Ltd.