Keck Medicine of USC in Los Angeles
Beginning this fall, the program will help people living near the Health Sciences Campus to maximize their chances of surviving cancer by getting them to the right doctors. It will also help them in understanding treatment options, clarifying insurance benefits and finding additional resources.Before Ronnie Lippin developed a rare form of breast cancer, the couple had high-flying careers in the entertainment industry. Ronnie Lippin represented top names in music such as Eric Clapton, Prince, Brian Wilson and the Bee Gees. Dick Lippin represented major Hollywood companies as clients of his public relations firm, the Lippin Group.
Despite their success in business, dealing with Ronnie Lippin’s cancer made Dick Lippin feel “like a babe in the woods.”
“I was so sure of decisions I made in business, but when it came to complex medical information, I felt like I didn’t know what I was doing,” Dick Lippin said. “I remember thinking that if I was going through all this, I couldn’t imagine what people who couldn’t afford great care were going through.”
After Ronnie’s death, Dick Lippin partnered with Tower Cancer Research Foundation. He explained the type of program he envisioned to honor his wife’s memory and they steered him toward a $300,000 donation to establish the program at USC Norris.
Linda David, executive director of Tower Cancer Research Foundation, explained that the organization works with its donors to find the right institution in Southern California for the kind of donation they want to make.
“He is passionate about getting help for people who don’t have access to the best care or the understanding of the system to get the help they need,” explained David.
Lippin came to her unsure where his money would do the most good. She knew that Keck Medicine physicians do free cancer screenings in the communities around the campus, where there are high instances of late-stage cancer diagnoses, and she saw an immediate fit.
“A lot of those people who get a cancer diagnosis will benefit from someone stepping in to help them navigate their next steps,” she said.
Zul Surani, executive director of HSC Community Partnerships, said that it was, indeed, a timely and perfect fit. He explained that USC Norris had identified a need to bridge the gap between doing free cancer screenings in the nearby neighborhoods and making sure those people get the help they need.
“We don’t want the people we screen and who need follow up services to fall through the cracks,” Surani said. “We are so grateful for this gift because we think it is will help us fulfill our mission of promoting better health in the community we serve.”
by Hope Hamashige]]>
Benjamin Emanuel, DO, and May Kim-Tenser, MD, launched an effort to optimize their documentation about a year ago after discovering that the existing process did not reflect the actual severity of illnesses and mortality risks of their patients, affecting their quality indicators.
“We asked ourselves: How can we improve our documentation to reflect how sick our patients actually are?” Emanuel said. “We found that accurately documenting how the patient is actively being treated had a huge impact.”
Their work has paid off. The neurology team has improved all measurable indicators of quality, complications rate, severity of illness, risk-adjusted mortality, case mix index and the respective proper reimbursement for the hospital.
Proper documentation is a narrative, Kim-Tenser said.
“You’re describing everything that’s happening with the patient in real time and documenting what is actively being treated,” she said. “I changed my wording to reflect the severity of their current condition and documented how their problems would be treated.”
The neurology team’s improved documentation has led to an additional billing reimbursement of as much as $600,000 per month.
But the importance of proper documentation is not just financial, said Jeyson Flores, senior clinical documentation specialist for Keck Hospital of USC and USC Norris Cancer Hospital. Accurate documentation in the medical record will translate into proper coding and reporting that will produce meaningful clinical data that will truly represent the severity of illness, risk of mortality and complications rate of patients. It will also support decisions about the medical necessity and length of stay in the hospital, he said.
Clinical data is analyzed by entities that make the information publicly available to help consumers make decisions when choosing hospitals, physicians and health plans, Flores said. Additionally, properly reflecting a patient’s condition and the care they receive can protect physicians from lawsuits.
“Documentation drives everything,” Flores said. “If you already have good documentation, you won’t be affected by the ICD-10 transition.”
The focus on documentation comes as Keck Medicine of USC and other medical facilities across the nation prepare for the Oct. 1 implementation deadline of ICD-10, the latest edition of the International Classification of Diseases published by the World Health Organization as the standard diagnostic tool for epidemiology, health management and clinical purposes. ICD-10 will be used to report diagnoses in all clinical settings.
Keck Medicine of USC has begun information and training sessions. Under the old system, physicians may have been providing the patient with optimal care but that care was not accurately reflected in the patient’s medical record, Flores said.
The work in the Department of Neurology highlights the success of the Clinical Documentation Improvement Program and shows what can be achieved when physicians and other staff members commit to accurately reflecting patient conditions and care in the medical record, Flores said.
“Emanual and Kim-Tenser understood what needed to be done,” Flores said. “They were receptive. Having the support of administration and department leaders is crucial to documentation success.”
Keck Hospital of USC treats some of the most severely ill patients, making accurate documentation critical for patient care and accurate billing, said Katy Sullivan, clinical information manager.
“In the current health care climate, it is vitally important that our physicians, nurse practitioners and physician assistants accurately represent that severity of illness in their documentation so that we are able to be reimbursed fully for the care we provided,” Sullivan said. “Additionally, we need to ensure that our complication rate is not artificially high due to unclear documentation.”
by Douglas Morino]]>
Based on a survey of 2,530 14-year-olds at 10 public high schools in Los Angeles, the team found that teens who use e-cigarettes were more likely to transition to smokeable tobacco products. However, researchers cautioned that additional studies are needed to determine whether the association is causal.
The findings were published on Aug. 18 in the peer-reviewed Journal of the American Medical Association.
“E-cigarettes may be drawing a new generation of teens into recreational nicotine use because they are high-tech, can be purchased somewhat easily, come in enticing flavors and have a perception that they’re not harmful,” said Adam Leventhal, PhD, associate professor and director of the USC Health, Emotion, & Addiction Laboratory (USC-HEAL) at the Keck School of Medicine. “Some e-cigarette devices appear to be very efficient at delivering nicotine to the lungs and brain. If you enjoy the experience of inhaling nicotine in e-cigarettes, it makes sense that you would be open to trying other nicotine products, like cigarettes, hookah and cigars.”
The research is among the first to be released by a Tobacco Center of Regulatory Science (TCORS), funded by the federal Food and Drug Administration through the National Institutes of Health (NIH). One of 14 TCORS was established in 2013 at the Department of Preventive Medicine at the Keck School of Medicine.
The longitudinal study included 2,530 students who had never smoked tobacco when they were first surveyed at the start of ninth grade. Of these students, at the first survey, 222 had used e-cigarettes (also known as “vaping”) and 2,308 had never vaped. The students were surveyed again in six months and 12 months. By the six-month mark, 30.7 percent of the e-cigarette users had started smoking one or more combustible tobacco products including cigarettes, cigars and hookahs, as compared with 8.1 percent who had never used e-cigarettes. At the 12-month mark, as the students were heading into 10th grade, differences in rates of tobacco smoking persisted between students who had used e-cigarettes versus those who had not.
Leventhal’s research team conducted the e-cigarette study as part of a larger substance abuse and mental health study funded by the National Institute on Drug Abuse (NIDA).
The research team includes Matthew Kirkpatrick, PhD, Jennifer Unger, PhD, Steve Sussman, PhD, Matthew Stone, BA, Rubin Khoddam, MA and Jonathan Samet, MD, MS (USC); Janet Audrain-McGovern, PhD (University of Pennsylvania), David Strong, PhD (University of California, San Diego) and Nathaniel Riggs, PhD (Colorado State University).
The research, “Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence,” was published online ahead of print in JAMA on Aug. 18, 2015. The study was funded by the NIH, through NIDA under R01-DA033296 and the National Cancer Institute under P50-CA180905.
by Leslie Ridgeway]]>
The Keck School of Medicine of the University of Southern California (USC) Department of Family Medicine has been awarded a $2.5 million Health Resources and Services Administration (HRSA) grant to create a primary care workforce with interdisciplinary competency in treating health issues faced by elderly patients, helping solve a longtime challenge faced by primary care doctors.
Principal investigator Laura Mosqueda, MD, chair of the Department of Family Medicine, is an expert in geriatric medicine and has been charged with developing and implementing the groundbreaking program, called the USC-Los Angeles County Training a Workforce in Interprofessional Geriatrics (USC-LAC TWIG). The three-year grant will fund the team’s effort to develop comprehensive primary care-based assessment for the elderly, as well as training programs that emphasize interprofessional and team-based medical care. Along with the development of a new geriatric primary care assessment clinic at the USC Health Sciences Campus, the program looks to the future by training and educating the next generation of medical students so they are better equipped to care for the elderly.
“People over the age of 85 comprise the fastest growing segment of the U.S. population, and the problem is that they experience issues that interfere with their quality of life,” said Mosqueda, who also serves as associate dean of primary care at the Keck School of Medicine and is a professor of family medicine and geriatrics. “In order to address this problem, we need more than well-trained primary care physicians; we need teams of people from many disciplines working together to focus on patients’ health care needs as a whole.”
The program will go beyond the school of medicine, extending across disciplines by working in partnership with specialties including pharmacy, dentistry, occupational therapy, physical therapy and more.
“We’re looking forward to working with others within Keck and USC, as well as with our community partners, in establishing successful educational and clinical systems,” said Mosqueda.
Mosqueda’s goal with this program is to focus on person-centered care, giving more attention and consideration to patients and their families. Additionally, there will be greater emphasis on improving diagnosis and care for patients with cognitive impairment or dementia, who also have other medical problems.
“USC-LAC TWIG has the potential make an important difference in medical care for the elderly,” said Carmen A. Puliafito, MD, MBA, dean of the Keck School of Medicine of USC.
“With our rapidly aging population, USC-LAC TWIG is an idea whose time has come,” Puliafito said. “Dr. Mosqueda and her team are poised to create a compassionate, competent health care ‘safety net’ to meet the substantial needs of our elderly patients.”
Leading the USC-LAC TWIG team is Bonnie Olsen, PhD, clinical professor of family medicine and vice chair of academic affairs, Department of Family Medicine. Other team members include, Diana Homeier, MD, director of the Geriatric Medicine Fellowship Training Program and associate professor of clinical family medicine; Brad Williams, PharmD, professor of clinical pharmacy and clinical gerontology; Freddi Segal-Gidan, PA, PhD, director of the USC-Rancho California Alzheimer’s Disease Center (CADC) and assistant clinical professor of neurology and family medicine; Christopher Forest, MSHS, DFAAPA, PA-C, director of research in the physician assistant program and assistant professor of clinical family medicine; and Michael Cousineau, DrPH., professor in the departments of family medicine and preventive medicine at the Keck School of Medicine of USC and the USC Price School of Public Policy.
by Margaret Trtryan]]>
The campaign is an ambitious effort to fund academic priorities and expand the university’s impact on the community and world.
The extraordinary generosity of these individual, family and foundation donors to the Keck School of Medicine has spurred the university’s contributions to a global health revolution now transforming the practice of medicine.
Gifts support a wide range of USC’s medical education, research and patient care efforts, from fighting leukemia to improving hearing to mapping the brain. As part of the Campaign for USC, the Keck Medicine Initiative aims to improve the quality of life of people in Southern California and around the world by bringing cutting-edge science and medicine together.
“These six major gifts, along with the collective contributions of so many other donors, are a concrete endorsement of the vision for USC to invest in the promise and potential of biomedical research,” said Carmen A. Puliafito, dean of the Keck School of Medicine. “Through their philanthropy, all of our donors help us to advance our tri-part mission: providing the best in patient care, finding new treatments and cures for disease and educating the next generation of physicians.”
One of the major centers endowed is the USC Mark and Mary Stevens Neuroimaging and Informatics Institute. It brings together scientists from around the world to further understanding of the brain. Longtime benefactors Mark and Mary Stevens’ $50 million gift will accelerate the institute’s already dramatic progress toward mapping the healthy brain and illuminating neurologic diseases such as Alzheimer’s and schizophrenia. Mark Stevens ’81, MS ’84 is a USC alumnus and member of the USC Board of Trustees and the USC Health System Board. The Stevenses are among the university’s most generous donors.
Another gift recognized the school’s fast-growing program of clinical expertise and research of ear, nose, throat and related diseases of the head and neck. The Caruso Family Foundation’s transformational gift of $25 million will endow and name the USC Caruso Department of Otolaryngology – Head and Neck Surgery. Of this endowment, $5 million will help diagnose, test and treat hearing-impaired children through the USC Caruso Family Center for Childhood Communication. Rick Caruso ’80, founder and CEO of Caruso Affiliated, is a member of the USC Board of Trustees.
Donors’ giving also provided significant support to cancer research. Entrepreneur and industrialist Norbert Gehr lost his battle with leukemia in March, but his family foundation’s $20 million gift to support USC Norris Comprehensive Cancer Center will help others fighting the disease.
The funding advances research into diseases that precede leukemia, such as myelodysplastic syndromes and myeloproliferative neoplasms, as well as for acute myeloid leukemia. Gehr, founder and CEO of The Gehr Group, was a longtime patient of Keck School of Medicine hematologists Donald Feinstein and Casey O’Connell, as well as David Goldstein, associate professor of medicine and chief of the Division of Geriatric, Hospital, Palliative & General Internal Medicine.
While alumni have made big contributions to the Keck School of Medicine’s initiatives, so have faculty. The late Norman Levan MD ’40, USC professor emeritus and former chief of the Department of Dermatology, led the way among faculty donors. His $12 million bequest to USC, announced in May, will fund scholarships and an endowed chair in medical ethics.
Levan created the medical school’s first class in bioethics, which led to required ethics classes for medical students. An alumnus who graduated from the medical school in 1940, Levan supported USC for decades. His gifts to the university, including this bequest, total $20 million.
Another transformative gift came from the Stephenson family: husband-and-wife entrepreneurs and investors Emmet and Toni Stephenson and their daughter, Tessa Stephenson Brand ’02.
The Stephensons’ $10 million gift establishes the Stephenson Family Personalized Medicine Center at the Center for Applied Molecular Medicine at the Keck School of Medicine. The center will be a focal point for applying new technologies toward creation of a whole new classification system for cancer based on the biology of a tumor and the cellular microenvironment surrounding it — instead of the location where a tumor begins. Inspired by the personalized and experimental treatment of Toni Stephenson’s lymphoma, the family’s gift backs the work of David Agus, a professor of medicine and engineering at USC, and one of the world’s leading cancer doctors and pioneering biomedical researchers.
Finally, a $7.5 million gift from the Hastings Foundation establishes the new Hastings Center for Pulmonary Research. The center will advance research on lung injury, repair and regeneration to discover new treatments and cures for pulmonary diseases such as cystic fibrosis and chronic obstructive pulmonary disease. The Hastings Foundation has a long history of supporting research and programs at USC, providing more than $30 million to the university since 1975.
by Lynn Lipinski]]>
The study, published July 27, 2015 in the peer-reviewed journal Pediatrics, surveyed more than 2,000 Southern California 11th and 12th graders and discovered that psychosocial factors including attitudes of family and friends toward e-cigarettes, as well as a belief that e-cigarettes pose no health risks, may be “renormalizing” tobacco use among adolescents. The researchers also found that 40 percent of the adolescents using e-cigarettes had never smoked a cigarette.
“Almost half of the current e-cigarette users in the survey reported they didn’t believe there were health risks associated with e-cigarette use,” said Jessica Barrington-Trimis, PhD, postdoctoral scholar and research associate at the Keck School of Medicine and lead author on the study. “However, in spite of the huge increase in e-cigarette use among adolescents, there has been limited study of the health risk. E-cigarettes may be less harmful than cigarettes but they’re probably not harmless.”
There is also concern that e-cigarettes could become the new “gateway” to tobacco use for adolescents, undoing years of education that turned teenagers away from tobacco. The study found that friends’ attitudes and others’ use of e-cigarettes in the home were associated both with e-cigarette and with cigarette use among adolescents. Additional studies are needed to determine if e-cigarettes are leading teens to regular cigarettes, Barrington-Trimis said.
The researchers obtained their data from the Children’s Health Study, an ongoing survey launched in 1993 by USC. The study follows more than 11,000 schoolchildren in Southern California, focusing on the long-term effects of air pollution on their respiratory health.
The study was conducted and funded by the Tobacco Centers of Regulatory Science (TCORS), a $20 million grant funded program in the Department of Preventive Health, Keck School of Medicine. The Keck School of Medicine was one of 14 TCORS established nationwide in 2014 by the federal Food and Drug Administration to help the agency develop a scientific base for decisions about the manufacturing, marketing and distribution of tobacco products to the public.
by Leslie Ridgeway]]>
Steve, a wine and spirits division manager in the San Gabriel Valley, first noticed a lump on his neck about the size of a pea in May of 2010.
An emergency tonsillectomy and biopsy revealed stage 4 squamous cell cancer. Stunned and unsure what to do, Steve followed the recommendation of his doctor to see Niels Kokot, MD. Rattled by the diagnosis, Steve was put at ease by Kokot’s caring approach: “Dr. Kokot was so easy to talk to and make it very understandable to me.” Together, they elected to proceed with surgery and radiation treatment.
Beginning in July 2010, Kokot performed a series of robotic surgeries using the daVinci® robot to remove Steve’s tonsil, the affected area around it and the lymph nodes in his throat. Thankfully, only one other lymph node had been infected and the cancer hadn’t spread further. With the help of Kokot and his staff, Steve began to recover.
“I had a great experience at the hospital. The staff made me very comfortable and pain management was great.” Radiation treatment caused Steve to temporarily lose his sense of taste. He also had difficulty opening his mouth and swallowing. He worked with a speech therapist and a rehabilitation specialist to improve his muscle strength and began swallowing very soon.
Faced with a long recovery, Steve was grateful for the unwavering support of his wife, but became withdrawn. Kokot and his wife suggested he attend the Head and Neck Surgery Support Group. Though not typically something he would try, Steve gave the group a shot.
“It was a very positive experience; everyone was very open.”
With past and present patients and their families in attendance, as well as Kokot and Uttam Sinha, of Keck Medicine of USC, Steve found himself among a community of peers who opened his eyes. “It was good to hear from people who had gone through the same thing [as me]. Some had been coming to the support group for eight years and are now living full and complete lives. I could see the light at the end of the tunnel.” Steve began attending the support group on a regular basis and continued speech and swallowing therapy. His taste returned about eight months later — “well enough to know what a good wine tastes like,” he jokes. And now, he’s working with Dr. Kokot to help others facing head and neck cancer on an individual basis.
Steve says the experience has changed his life. “Every day is a good day. I couldn’t have asked for a more caring and thoughtful staff, and I can always talk to Dr. Kokot. I’m so lucky to end up where I am.”
Visit the Head and Neck Cancer program at the Caruso Department of Otolaryngology – Head and Neck Surgery for more information.]]>
In the classic fairy tale, Snow White bites into an apple and slips into a state of suspended animation. For her fellow figment of fiction, man-about-the-Catskills character Rip Van Winkle, a sip of moonshine affords the luxury of sleeping through the American Revolutionary War. Sleep has long featured in our collective storybook as an enigmatic netherworld, a far away place where strange things happen and then are forgotten upon our return to reality.
Turns out there’s a reason for the mythology. Left to investigate why humans spend nearly a third of our lives in slumber — and what sleep is — scientists don’t have a simple answer.
“Why we sleep is still one of the greatest unsolved mysteries of science,” says Terese Hammond, Keck Medicine of USC pulmonary critical care physician and director of the USC Sleep Disorders Center. “No one yet knows the true purpose and nature of the state of sleep.”
We may not know the reasons behind it, but here’s what’s clear: Many of us don’t get enough of it.
More than a third of Americans get less than the needed seven hours of snoozing a day, according to the U.S. Centers for Disease Control and Prevention. Over time, lack of sleep takes a toll on our well-being—so much so that the CDC calls it a public health epidemic. That makes the field a formidable frontier for scientists and physicians.
“This is a very exciting time for sleep research,” says Steve Kay, dean of the USC Dornsife College of Letters, Arts and Sciences and a biologist who has long studied the sleep-wake cycle. It’s also a growing area for USC physicians and other health care professionals who see the wider effects of poor sleep among the patients in their clinics and exam rooms.
What happens to us in those wee hours as we lie unconscious in our beds? Quite a lot.
After drifting off, we go through several cycles of what’s called non-rapid eye movement (non-REM) sleep, followed by cycles of rapid eye movement (REM) sleep. During non-REM sleep, the body repairs and restores itself—building bone and muscle, healing wounds and bolstering immune defenses. In REM sleep, body temperature drops and blood thickens. Blood pressure and pulse become erratic. Muscles turn off.
The brain, however, buzzes with activity. Cholinergic neurons, which help store memories, fire during REM, says Julie Dopheide, a professor of clinical pharmacy, psychiatry and the behavioral sciences at the USC School of Pharmacy and Keck School of Medicine. REM is when dreams occur. And it may be during this time that the brain tries to interpret and organize information.
USC Dornsife neuroscientists and USC Viterbi engineers are trying to uncover what happens in the brain during sleep. Thanks to leaps in imaging technology and a $9.7 million National Institutes of Health grant, the USC research team is mapping neurons in the brains of live zebrafish to see how their activity patterns change as the animals sleep or form new memories. “Brain circuitry underlies the complexity of human consciousness,” Kay says, so breaking through imaging barriers will be critical to “seeing” sleep.
Research by Kay and others has improved our understanding of the natural timing system that regulates when we fall asleep and when we wake. Known as the circadian system, this internal clock maintains 24-hour sleep-wake cycles through signals from the brain’s hypothalamus. Our circadian system responds to environmental cues such as darkness and light, using hormones to spur drowsiness or wake us up. If circadian rhythms fall out of sync with day-night cycles—after an overseas flight or a graveyard shift, for example—the system usually realigns in a few days. Sometimes life gets in the way of biology, though, and systems go awry.
TOO BUSY TO SLEEP
With mobile devices that allow 24/7 communication and unlimited movies and shows available digitally at the touch of a button, it’s easy to stay up late binge watching a series or updating a report for the boss. It’s no wonder that so many of us fail to get the recommended seven to nine hours of sleep a night. Among teens, snooze time dropped steadily between 1991 and 2012, with 10 percent of high school students claiming they get only five hours of sleep per night.
“We wear our lack of sleep like a badge of honor,” says Keck Medicine sleep specialist Raj Dasgupta.
As a nation, we’re not just losing sleep time — we’re missing the health benefits that sleep brings. Inadequate sleep is linked to nearly a fifth of serious car crashes. It also seems to weaken a person’s willpower to eat normal portions and choose healthful food instead of junk, according to research.
If scant sleep becomes the norm, consequences can mount. Long-term sleep-wake cycle troubles can disrupt the activity of genes that govern metabolism and immunity, leading to potential trouble by spurring diseases like Type 2 diabetes.
Several years ago, Kay and his colleagues found a key biochemical link between circadian rhythms and diabetes. In their studies with mice, they discovered that the same protein that regulates the circadian clock also controls the liver’s production of glucose. Too much glucose in the blood is a serious complication of diabetes. Kay’s team found a way to harness that clock protein to slow glucose production, making diabetic mice healthier.
But there’s more to it than diabetes. “Chronic disruption of sleep patterns is strongly linked to cardiovascular disease and to a sharp increase in the incidence of breast cancer,” Kay says, citing findings from large studies in the United States and Japan.
Other studies done in the lab suggest that staying awake too long can kill brain cells and impair clearance of toxic proteins — including amyloid beta, which builds up in the brains of people with Alzheimer’s disease.
Many people come to the USC Sleep Disorders Center after years, often decades, of struggle, Hammond says. Indeed, about 50 million to 70 million U.S. adults suffer chronic sleep disorders.
Typically, it should take less than 15 minutes to fall asleep. “If it takes longer than a half hour and impairs your function the next day, it’s considered insomnia,” Dopheide explains. People with insomnia not only struggle to drift off, but also wake up repeatedly.
If tossing and turning is part of your nightly routine, don’t just dismiss it, Dopheide warns. Causes range from simple factors like room temperature to serious issues like sleep apnea or depression. “One of the first things to go wrong when you’re having a psychological or physical problem is your sleep,” she says. “Insomnia is a marker for poor health.”
Just ask Jennifer Ailshire, a sociologist at the USC Davis School of Gerontology and Ethel Percy Andrus Gerontology Center. She studies how family relationships affect health, including sleep quality. In a 2012 study, she found that demanding relationships with family members can hurt sleep — and it’s about more than just having a fight with your spouse before bed. Even regular contact with a challenging parent or child living outside the home can cause sleep trouble.
There’s another modern-day culprit for sleeplessness: artificial light. Nighttime light suppresses the body’s production of melatonin, a hormone that promotes sleep, and the blue light emanating from computers and other electronic devices is particularly harmful.
A recent study conducted at Brigham and Women’s Hospital in Boston bore this out. It showed that young adults who read on a tablet for four hours before bedtime took longer to fall asleep, spent less time in REM cycles and woke the next day feeling groggier than those who read a printed book. Scientists who analyzed the volunteers’ blood samples found that the tablet group had lower levels of melatonin.
“This work is really solid,” Kay says. “My kids aren’t allowed to use iPads after 6 p.m. now.”
Some 20 million U.S. adults can blame another problem for their sleeplessness: sleep apnea. Every night, they snore, wake up and gasp for air over and over again, notes Eric Kezirian, an otolaryngologist with Keck Medicine and an international expert in treating snoring and obstructive sleep apnea.
“Your throat is basically a tube surrounded by muscle,” Kezirian says. “It can collapse during deep sleep and block your breathing.” People with severe sleep apnea may wake 30 or more times per hour, increasing their risk for heart attack and stroke.SNOOZE SOLUTIONS
Fortunately, innovations are helping doctors like Kezirian treat sleep apnea. While many patients breathe better by using what’s called a continuous positive airway pressure device, or CPAP, others can’t sleep comfortably while wearing one. Some have found relief from a new sleep apnea treatment approved by the Food and Drug Administration last year. Called the Inspire® Upper Airway Stimulation™, this surgically implantable device keeps the airway open by electrically stimulating thenerve that controls tongue movement. Keck Medicine was the first group in Los Angeles (and one of the relatively few around the world) to offer the Inspire treatment.
Sometimes apnea is mysterious. Kezirian is an international leader in a test called drug-induced sleep endoscopy, which allows him to use a tiny camera to observe nasal cavity positioning during sleep. “If we can figure out what’s causing the blockage of breathing, we can hopefully give more targeted and effective treatment,” he says.
That’s also why a trio of USC investigators recently developed a new imaging tool for children with sleep apnea. Patients undergo specialized MRI scans that produce a real-time video of the airway opening and closing during natural sleep, and that can help doctors pinpoint the source of breathing problems, says Krishna Nayak, a professor in USC Viterbi’s Ming Hsieh Department of Electrical Engineering. He worked with Children’s Hospital Los Angeles and Keck Medicine pediatric pulmonologist Sally Ward and USC Viterbi biomedical engineer Michael Khoo to develop and test the new technique. About 50 people have received the procedure so far, Nayak says.
Khoo and others are also studying how a tool called electroencephalography (EEG) can illuminate the quality of sleep. Electrodes placed on the head can record brain wave patterns, while other sensors detect eye movements, limb movements, heart rate and breathing patterns while a person sleeps. These measurements reveal sleep patterns and arousals, which can help clinicians diagnose sleep disorders and gain insight into potential causes.
The USC Sleep Disorders Center treats rare conditions as well, including narcolepsy, sleep walking, sleep talking and sleep-associated movement disorders such as restless legs syndrome. “A thorough sleep evaluation can be very good for patients, especially those with long standing sleep complaints, because it may well identify targets for therapy that will improve daytime functioning and well-being,” Hammond says.
Outside the sleep clinic, there may be a much cheaper, albeit lower-resolution, way to measure sleep: using off-the-shelf wearable monitors and mobile health apps you can download on your smartphone. “We’re going to go through a ‘big data’ era for collecting sleep-wake patterns,” Kay says. He notes, however, that “while this allows us to go ‘wide’ on understanding sleep behaviors, it does not go ‘deep’ in the same way an EEG collects interesting data on much smaller numbers of individuals. So one does not replace the other.”
Ultimately, you don’t need the latest wearables or phone apps to prioritize sleep. “Treat it like you treat exercise and diet,” Kezirian says. “It’s important for your health and for getting the most out of life.”
By Esther Landhuis
Illustrations by Oscar Bolton Green
Learn more about the sleep medicine program within the USC Tina and Rick Caruso Department of Otolaryngology – Head and Neck Surgery and the USC Sleep Disorders Center at Keck Medicine of USC.]]>
The honorees on this year’s list have achieved great professional heights in the health care industry at a young age, and these “rising stars” are poised for continued growth throughout the rest of their careers, according to a news release from Becker’s Hospital Review.
Becker’s selected leaders through an editorial review process that included peer nominations. All leaders were under 40 years old at the time of their nomination earlier this year. Becker’s has published a version of this list annually since 2012.
Recipients work at hospitals all over the United States, and Desai is one of four from California. He joined Keck Medicine of USC on Aug. 1, 2014, as chief executive officer of USC Care and Ambulatory Care Services. Previously, he had worked at DaVita Healthcare Partners Inc., as well as McKinsey & Company, where he led engagements with hospitals, integrated health systems, governments, and medical technology companies.
He has had experience working in other leading academic health centers across the country, including the University of California San Francisco Medical Center and San Francisco General Hospital. Desai has held faculty appointments at the Stanford School of Medicine and the David Geffen School of Medicine at UCLA. He holds a bachelor’s degree in public policy from Brown University, a medical degree from Brown Medical School and a master’s degree in public health from the Harvard School of Public Health. He is board certified in internal medicine and nephrology, and is broadly published in health services and outcomes research.]]>
Dr. Colquhoun is a renowned expert in transplant surgery, specializing in liver transplantation and hepatobiliary surgery. Here’s what you won’t find on his resume:
Transplant surgery found him.
“When finishing medical school, there’re an amazing number of directions one can go in for further training. Even choosing general surgery is a bit like putting off a decision because there are so many different subspecialties. When I was first making those choices, I couldn’t have picked liver surgery and transplantation — because the field didn’t really exist yet. I discovered it in the earliest days of its evolution. I suppose if there’s been a theme in my professional life, it’s been to be flexible and to follow the path that’s most interesting and exciting. Transplantation is a specialty that definitely allows one to satisfy the need for a ‘purpose driven life’.”
He found liver transplantation was an exciting new frontier.
“I completed a fellowship in surgical oncology and initially went into transplant for additional training. A surgeon mentor told me, ‘if you can perform a liver transplant, you’ll be a better surgeon.’” I took his advice. At that time, transplant was a little like the ‘Wild West’ in a way because it was such a new frontier in surgery.”
He has seen a dramatic change in the field in the last 20 years.
“In the earliest years, a liver transplant was an almost heroic undertaking. Thankfully, over time, the technical aspects of the operation have evolved dramatically. Significant improvements in anesthesia, intensive care and pharmacy have also contributed to transplant success rates. Liver transplantation will never become “routine”, due to organ shortage and how ill patients can become while waiting, but results today are astoundingly good.”
When he’s not performing surgery, you can find him among the clouds.
“I try to be very active. A few years ago, my wife and I took up running quite a lot – mostly half marathons. Perhaps someday we’ll run a full marathon. We go skiing every year and wakeboarding every summer with our son. Recently, I took up flying. I bought a small airplane in Anchorage and flew it down to Los Angeles.”
He raises chickens in his backyard.
“At my son’s urging, we built a chicken coop together in the backyard as a little father-son project several years ago. Although he’s now off in college, we still have five to six chickens at a time, and they produce about an egg a day. We’re always giving them away!”
The surgeons, nurses and staff drew him to Keck Medicine of USC.
“The transplant program at Keck Medical Center of USC is emerging as one of the largest and highest quality transplant programs in the country — this is a direct result of the amazingly talented physicians, nurses, administrators and supportive staff in the program. The potential here is already being realized, and the expertise exists to make this the premier program on the West Coast. It’s already happening. I came here to be a part of it.”
Dr. Colquhoun’s research interests include surgical oncology as it relates to the liver and the pancreas. Visit the Liver Transplant Program for more information.