DiscoveryCME :: Physician Education

Cancer
	Advances in Immunotherapy for the Treatment of Metastatic Melanoma It used to be that patients diagnosed with advanced melanoma had few treatment options and little hope for a cure. But that is changing, thanks in part to immunotherapy drugs such as Interferon, Interleukin 2, and a new drug called Ipilimumab. Dr. John Kirkwood, director of the Melanoma Program at UPMC Cancer Center, says these immunotherapeutic agents give patients diagnosed with advanced melanoma promise for a reduction in recurrence and in some cases, remission.
	Using Gene Therapy to Prevent Esophagitis in Lung Cancer Patients Using chemotherapy and radiation to treat non-small cell lung cancer is one of the most significant advancements in oncology over the last 30 years. But there are some potentially debilitating side effects to these therapies, including esophagitis. Dr. Joel Greenberger, co-director of the lung and esophageal cancer program at the UPMC Cancer Centers explains how doctors have developed a new treatment that protects the esophagus from the damaging effects of radiation and chemotherapy, without protecting the cancer.
	Radiosurgery Treatments and Technology Radiation oncologists and neurosurgeons at UPMC believe the best care for patients diagnosed with tumors of the brain and spine is care that is delivered in a multidisciplinary setting, in which physicians work as partners. Treatment often includes stereotactic radiosurgery using technology such as the Gamma Knife and LINAC-based platforms such as the Cyberknife, Trilogy, and True Beam. Drs. Dwight Heron and Arlan Mintz explain how this unique combination of radiosurgical tools and unprecedented access to physicians assures patients of innovative, comprehensive care.
	Whipple Procedure for Pancreatic Surgery For patients diagnosed with pancreatic cancer, surgery is often the best treatment option. In just the last few years, robotics is making this surgery, known as a pancreaticoduodenectomy or Whipple, less invasive for those diagnosed with pancreatic cancer.

Cardiology
	A New Model for Treating Pulmonary Hypertension Idiopathic pulmonary arterial hypertension (IPAH) is a challenging disease to treat. For this reason, patients diagnosed with pulmonary hypertension often find themselves bounced between cardiologists and pulmonologists. At UPMC's Comprehensive Pulmonary Hypertension Program, one of the largest in the country, patients are seen by these specialists at the same time, helping them receive an accurate diagnose faster and treatment quicker.
	Myocardial Recovery in Patients with Peripartum Cardiomyopathy Peripartum cardiomyopathy is a rare but serious disorder that affects mothers late in their pregnancy or shortly after delivery. It is a major cause of maternal morbidity and mortality. Dr. Dennis McNamara, director of UPMC's Heart Failure/Heart Transplantation program, says it is important for physicians to know this disorder exists and to consider the possibility of peripartum cardiomyopathy when pregnant women or new mothers mention symptoms such as fatigue, shortness of breath, and others.
	Exploring Options for Myocardial Perfusion Imaging Microbubbles are gas-filled particles that have the ability to trace the path of red blood cells throughout the body. This is important because until now, ultrasound was not an option for myocardial perfusion testing. Now, they are being used as ultrasound contrast agents, allowing physicians to see blood flow through the heart. Dr. Liza Villanueva of UPMC provides insight into why the time is right to consider ultrasound imaging for myocardial perfusion testing in lieu of conventional nuclear imaging.
	The Ventricular Assist Device (VAD) A ventricular assist device (VAD) can be a life-saver for patients diagnosed with end-stage heart failure. For these patients, the VAD has three potential uses - a bridge to transplant, a temporary tool that enables the patient's own heart to rest and recover, or for those patients for which transplant is not an option, the VAD becomes a destination device. Dr. Robert Kormos, MD, director of UPMC's Artificial Heart Program, discusses how his program, one of the longest running in the country, is advancing new uses for the VAD and giving hope to patients where before there was none.

Gastroenterology
	Personalized Care: A New Approach to Diagnosing and Treating Pancreatic Disease At UPMC, physician researchers have learned that the most effective treatment for pancreatic disease is a personalized approach for each patient. Dr. David Whitcomb and Dr. Adam Slivka explain how tools such as genetics, molecular analysis and others help identify the cause of pancreatitis, ensuring patients receive the right treatment as quickly as possible.
	Crohn's disease: A New Paradigm for Patient Care Despite medications, about two-thirds of all patients with Crohn's disease will require surgery and in some, Crohn's will recur. Doctors at UPMC are finding that the initiation of certain medications immediately following surgery may change the course of postoperative Crohn's, essentially preventing a recurrence.
	Minimally Invasive Liver Cancer Surgery Patients diagnosed with liver cancer or benign liver tumors now have a surgical option, called a laparoscopic liver resection, that can offer less pain and blood loss and a shorter recovery time.

Endocrinology
	Innovative Approaches to Osteoporosis Research Doctors at UPMC are researching novel treatments, studying new populations, and using new diagnostic tools to help patients diagnosed with osteoporosis lead fuller more active lives. Endocrinologists and metabolic bone specialists are among a large number of doctors at UPMC doing metabolic bone research to help those diagnosed with osteoporosis to live a higher quality of life.
	The Role of Bariatric Surgery in Diabetes Care More than two-thirds of all Americans are overweight or obese. And with obesity comes a host of co-morbid conditions, including Type 2 diabetes. Endocrinologists and bariatric surgeons at UPMC are finding that bariatric surgery now offers obese patients with Type 2 diabetes the possibility that their condition will diminish or in some cases, even disappear. Drs. Erin Kershaw and Anita Courcoulas discuss the importance of early referral and the role bariatric surgery plays in diabetes management.
	Multidisciplinary Thyroid Center - An Innovative Approach to Diagnosis and Care Doctors at UPMC believe that thyroid cancer care is improved when delivered in a multidisciplinary setting. Here, patients have access to a variety of medical experts and a complete array of diagnostic tools in real time, under one roof, and often in a single visit. Dr. Steven Hodak, co-director of UPMC's Multidisciplinary Thyroid Center, explains how specialists at this center diagnose and treat a large volume of thyroid cancer cases each year, and develop a custom treatment plan using advanced tools and procedures such as molecular diagnostic testing and scarless robotic thyroidectomy.

ENT
	Upper Airway Stimulation for Sleep Apnea Dr. Ryan Soose, an otolaryngologist and sleep specialist at UPMC, discusses his experience with an implantable pacemaker that delivers gentle stimulation to the hypoglossal nerve, causing the base of the tongue to contract and advance, similar to how it functions when the patient is awake. By using this device, patients' sleep apnea may better controlled.
	Sialoendoscopy - A Minimally Invasive Option for Treating Salivary Stones UPMC is among a small group of hospitals in the country using this minimally invasive approach in salivary gland surgery. It's often used to treat diseases such as salivary stones, Sjogren's syndrome, and the effects of radiation therapy for patients with thyroid cancer. In most cases, sialoendoscopy leaves no external scarring and requires no hospital stay.
	In Office Vocal Fold Injection When the vocal cords become weakened or paralyzed due to age, injury, medical condition, or overuse, there is help for patients. Dr. Clark Rosen of UPMC was one of the first surgeons in the country to perform in-office vocal fold injections using specialized endoscopic visualization equipment and local anesthesia, improving the quality of life for his patients, with minimal side effects.
	Multidisciplinary Concussion Care For years, it was believed that a small amount of rest was all that was needed to treat a concussion, but physicians are now aware this is not the case. Concussion specialists at UPMC discuss how concussions need to be treated from a variety of perspectives. This is most effective when done in a multidisciplinary setting. Concussion care at UPMC offers patients individualized treatment and access to a variety of medical specialties under one roof, helping them to meet their maximum potential as quickly as possible.

Geriatrics

Gait Speed As A Measure of Patient Health
Physicians at UPMC have long theorized that mobility can be used as a marker of an older person's health. After analyzing data from nine of the largest aging studies in the country, they now have the facts to prove it. With just a stopwatch and 13 feet of hallway, Dr. Stephanie Studenski, director of research in the division of geriatric medicine at UPMC, explains how doctors now have a quick measure of their patients' longevity or a measure of their health from visit to visit.

Gynecology
	A Unique Approach to the Treatment of Fibroids The Uterine Fibroid Clinic at Magee-Womens Hospital of UPMC is helping women diagnosed with fibroids receive diagnostic testing and treatment faster. In one visit, patients are seen by a multidisciplinary team comprised of an interventional radiologist and an OB-GYN. Only after extensive consultation and completion of a series of minimally invasive and radiological procedures is a treatment plan developed. Should surgery be necessary, patients will receive information on a number of options including hysterectomy and myomectomy.
	Minimally Invasive Gynecologic Surgery Minimally invasive gynecologic surgery is now an option for many women, eliminating the presence of large, abdominal incisions and offering a quicker recovery time. Dr. Suketu Mansuria of the Center for Minimally Invasive Gynecologic Surgery at Magee Women's Hospital of UPMC performs 99% of all hysterectomies with this minimally-invasive approach and explains how the procedure can work for even the most complicated cases.

Nephrology
	Advances in the Diagnosis and Treatment of Calciphylaxis The best treatment for calciphylaxis, a disease often seen in patients with advanced chronic kidney disease, is one that is customized for each patient, using a variety of therapeutic approaches. Dr. Nirav Shah, a nephrologist at UPMC explains that in addition to earlier diagnosis and referral to a high volume nephrology program, a multidisciplinary approach may improve the prognosis for patients diagnosed with this rare but serious condition.
	Referring To A Nephrologist Many labs are now reporting the estimated glomerular filtration rate (eGFR) in conjunction with serum creatinine levels for kidney function test results, which may help physicians determine when to refer a patient to a nephrologist. This may result in an earlier diagnosis of chronic kidney disease.

Neurology/Neurosurgery
	Using Telemedicine to Evaluate Patients In Need Of Acute Stroke Care Telemedicine enables patients in outlying hospitals to be evaluated quickly by stroke experts at UPMC to determine if they are candidates for IV TPA administration. TPA is often effective in treating stroke if administered within the first 3-4 and a half hours of stroke onset. This partnership gives patients in outlying hospitals access to stroke experts with the press of a button, 24/7, 365 days a year. Think of it as a virtual consult.
	Deep Brain Stimulation for Movement Disorders There is now help for patients with movement disorders, such as Parkinson's disease and dystonia, through a procedure called deep brain stimulation that uses small electrodes to send steady pulses of electrical current to brain tissue.
	Minimally Invasive Scoliosis Surgery UPMC neurosurgeons, Adam Kanter, MD and David Okonkwo, MD, are among a small group of surgeons in the country to adopt a new approach to spinal surgery for patients diagnosed with complex scoliosis. This new, minimally invasive procedure known as an XLIF, accesses the spine from the side of the body instead of the front or back. Patients may experience less postoperative pain, a shorter recovery time and lower likelihood of long-term complications. The XLIF procedure is also effective in treating a variety of other spinal pathologies including spondylolisthesis, vertebral body injuries, degenerative disc disease, trauma and tumors.
	The Unruptured Aneurysm - Treatment Decisions Unruptured aneurysms are usually found by chance and are completely asymptomatic. With the likelihood of rupture ranging from .1 to 3 percent each year, the question becomes: what is the risk of doing nothing versus the risk of surgery? Neurosurgeons must consider a variety of factors and, after weighing the options and having meaningful discussion on the likelihood of rupture, decide along with the patient how to proceed. Dr. Robert Friedlander, Chairman, UPMC Department of Neurological Surgery, explains the factors that should be considered when counseling a patient diagnosed with an unruptured aneurysm.
	Multidisciplinary Concussion Care For years, it was believed that a small amount of rest was all that was needed to treat a concussion, but physicians are now aware this is not the case. Concussion specialists at UPMC discuss how concussions need to be treated from a variety of perspectives. This is most effective when done in a multidisciplinary setting. Concussion care at UPMC offers patients individualized treatment and access to a variety of medical specialties under one roof, helping them to meet their maximum potential as quickly as possible.

Ophthalmology
	New Approaches in Corneal Transplant For years, penetrating keratoplasty has been the gold standard of treatment when it comes to corneal transplantation. Dr. Deepinder Dhaliwal, director of the cornea service at the UPMC Eye Center, explains that new techniques are revolutionizing the field of corneal transplantation. These new approaches may improve patient care and surgical outcome, while increasing the donor pool.
	Minimally Invasive Glaucoma Surgery Glaucoma surgery is safer now than ever before and offers new techniques that enable millions to maintain or improve their sight. These new minimally invasive surgical procedures for glaucoma use natural pathways in the eye to relieve pressure. Dr. Joel Schuman of UPMC explains how he incorporates minimally invasive glaucoma surgery into his practice regularly.

Orthopaedics
	Benefits of an Inpatient Diabetic Foot Service Treatment for a diabetic foot infection can be as simple as oral antibiotic. Too many times, however, a diabetic foot infection results in a hospital stay, IV antibiotics, and surgery, which may include amputation. UPMC is among the first hospitals in the country to establish an inpatient diabetic foot service. Here, patients with diabetic foot infections are evaluated upon admission by orthopaedic surgeons. This prototype allows surgeons to evaluate patients sooner and should an infection be present, treat it earlier, possibly preventing amputations and reducing hospital length of stay.
	Diagnosing Cartilage Damage Early to Prevent Osteoarthritis Osteoarthritis is not just a disease that affects older people. Orthopaedic surgeons at UPMC are finding osteoarthritis in patients in their 20's and 30's who damaged cartilage years before and didn't know it. Dr. Constance Chu from UPMC explains how new imaging technologies help physicians see cartilage damage at the time of joint injuries, helping them to address it early and hopefully prevent the development of osteoarthritis later in life.
	Multidisciplinary Concussion Care For years, it was believed that a small amount of rest was all that was needed to treat a concussion, but physicians are now aware this is not the case. Concussion specialists at UPMC discuss how concussions need to be treated from a variety of perspectives. This is most effective when done in a multidisciplinary setting. Concussion care at UPMC offers patients individualized treatment and access to a variety of medical specialties under one roof, helping them to meet their maximum potential as quickly as possible.

Pediatrics
	The Importance of Long Term Follow-Up of Pediatric Cancer Survivors Because there are so many pediatric cancer survivors today, it is more important now than ever before that survival clinics exist. Doctors at Children's Hospital believe they have an obligation to educate survivors about their future so they can be armed with the necessary information to take charge of their health.
	Using the Endoscopic Endonasal Approach (EEA) in Children with Brain Tumors EEA is a minimally invasive procedure in which neurosurgeons reach and remove lesions of the skull base through a natural pathway, the nose. Doctors at the Brain Care Institute of Children's Hospital of Pittsburgh of UPMC often use this approach to excise skull-based tumors in children as young as two years old. This multidisciplinary team of specialists has translated its knowledge and expertise in adult EEA into a model that can now benefit the pediatric population.
	New Studies to Enhance Medical Management of Liver Disease Doctors at Children's Hospital of Pittsburgh of UPMC believe that the proper combination of medical and surgical therapy is the key to a successful outcome for children diagnosed with liver disease. They have recently launched two new clinical studies that may help combat the effects of liver disease. One studies ursodeoxycholic acid (URSO) for the treatment of primary sclerosing cholangitis and the other investigates the efficacy of carbamazepine in the treatment of A1AT deficiency.
	Robotic-Assisted Pediatric Urology Surgery Surgeons at Children's Hospital of Pittsburgh of UPMC are now routinely using a robot to assist in complicated bladder and renal reconstructive procedures. This robotic-assisted approach often results in less blood loss, less pain, and shorter recovery times.
	A Viable Option For Treating Epilepsy Epilepsy in children can be debilitating and take a toll on a child's mental growth and social development. However, epilepsy surgery can offer a cure. Dr. Deborah Holder of Children's Hospital of Pittsburgh of UPMC discusses the importance of considering surgery as an early option for children diagnosed with epilepsy as opposed to a last resort. Learn how referring children with epilepsy for surgery earlier can help eliminate seizures sooner and alleviate the emotional and social challenges of epilepsy.
	Use of the VAD in Pediatric Heart Failure Children in heart failure have very few options and very little time. In the past, transplantation was the only alternative. Doctors at Children's Hospital of Pittsburgh of UPMC have found that children placed on a ventricular assist device or VAD can either recover their own heart functions, eliminating the need for a transplant, or have more time to wait, should a transplant be needed. When a pediatric VAD is developed and approved, it's possible that this will become a destination therapy device for the management of heart failure in children.

Psychiatry
	A Primer on Autism in Children Autism Spectrum Disorder causes impairment in three areas of childhood development and crosses all racial, economic, and ethnic groups. Although there may be concerns about labeling a young child as having an autism spectrum disorder, it is widely accepted that an earlier diagnosis will lead to a better outcome. Dr. Martin Lubetsky, director of the Center for Autism and Developmental Disorders and Child and Adolescent Psychiatry at Western Psychiatric Institute and Clinic of UPMC says it is important to be aware of the indicators of autism spectrum disorder and that intervention begin as soon as possible.
	Diagnosing and Treating Sleep Disorders Experts at the Western Psychiatric Institute and Clinic of UPMC are leaders in the fields of sleep disorders and autism. Dr. Daniel Buysse, Co-Director of the UPMC Sleep Medicine Center at Western Psychiatric Institute and Clinic of UPMC discusses why it's important for physicians to engage patients in meaningful dialogue about sleep patterns and how patients diagnosed with insomnia may be able to address this condition through behavior modification.
	The Challenge of Diagnosing Bipolar Disorder in Children and Adolescents Until recently, bipolar disorder was not associated with children. However, pioneering studies have identified that this disorder may have its onset in young adults. It's also believed that bipolar disorder manifests itself differently in youth than in adults. The concerns for today's psychiatrists include overdiagnosing, misdiagnosing, or underdiagnosing bipolar disease in children. Dr. David Axelson of UPMC explains the importance of accurate diagnosis for bipolar disorder in children, because it has prominent implications for treatment, especially with regard to medications.

Pulmonology
	NEJM Study Indicates Bronchial Valves Are Viable Option For Lung Volume Reduction Some patients with chronic emphysema or COPD may soon have a minimally invasive option to help make breathing easier. Physician researchers from UPMC, a long-time leader in lung volume reduction surgery, recently published an article in the New England Journal of Medicine that reviewed the use of the VENT valve for bronchoscopic lung reduction surgery. In the study, the bronchial valve showed promise as a viable option for lung volume reduction surgery, improving lung function and walking distance.
	A New Model for Treating Pulmonary Hypertension Idiopathic pulmonary arterial hypertension (IPAH) is a challenging disease to treat. For this reason, patients diagnosed with pulmonary hypertension often find themselves bounced between cardiologists and pulmonologists. At UPMC's Comprehensive Pulmonary Hypertension Program, one of the largest in the country, patients are seen by these specialists at the same time, helping them receive an accurate diagnose faster and treatment quicker.
	Acute Lung Injury and Pneumonia Acute lung injury is a severe disease, affecting over 200,000 people annually. With a mortality rate of 40 to 50 percent, supportive care is the only option for many of these patients. Dr. Rama Mallampalli and his team at UPMC are conducting research that may lead to the development of new, non-antibiotic therapies for pneumonia and sepsis. By identifying the causes of pneumonia and other acute lung injuries, doctors at UPMC are devising novel treatments that are improving the quality of life for many patients.

Rehabilitation
	Specialty Medical Homes for Patients with Spina Bifida Today, because of advancements in medical care, those with spina bifida are living into their 70s and 80s. This has demonstrated the need for a new field of medicine - wellness care for adults with spina bifida. Dr. Brad Dicianno, of UPMC's Department of Physical Medicine and Rehabilitation, says it is important to proactively manage patients' health by establishing specialty medical homes. By doing so, hospitalizations may be reduced and the patients' quality of life may be enhanced.
	Anabolic Rehabilitation It used to be that doctors used a highly focused approach to healing, when it came to musculoskeletal rehabilitation. This often involved anti-catabolic agents that fought the body's natural inflammatory response. Learn from Dr. Gary Chimes of the UPMC Rehabilitation how doctors at UPMC are among the first in the country to combine the tools of anabolic therapy in an integrated approach to rehabilitation. The anabolic approach is a significant paradigm shift in musculoskeletal rehab since it uses the body's natural inflammatory response to help the body heal itself.
	Robotic Rehabilitation Rehabilitation physicians on the forefront of advanced technology are using robotics daily in clinical and research settings to help patients recover more quickly and with less emotional and physical strain.
	Multidisciplinary Concussion Care For years, it was believed that a small amount of rest was all that was needed to treat a concussion, but physicians are now aware this is not the case. Concussion specialists at UPMC discuss how concussions need to be treated from a variety of perspectives. This is most effective when done in a multidisciplinary setting. Concussion care at UPMC offers patients individualized treatment and access to a variety of medical specialties under one roof, helping them to meet their maximum potential as quickly as possible.

Rheumatology
	Using Treat to Target in Rheumatoid Arthritis It's a common practice for hypertension and diabetes but a relatively new idea in the treatment of rheumatoid arthritis. Using a treat to target approach, doctors use quantifiable measures such as joint counts, blood work, and health assessment questionnaires to assess the progression of a disease. Based on these scores, a patient's disease is deemed active, low active or in remission and a treatment plan will be developed accordingly.
	New Research Attacks Vasculitis Doctors treating patients diagnosed with vasculitis often find themselves doing a balancing act. They must suppress the immune system enough to control the vasculitis but not to the point where patients are susceptible to infection. Doctors at UPMC are piloting T cell research that may break this cycle. Their goals is to assess immunocompetence and personalize immunosuppression for vasculitis patients.
	The Challenge of Diagnosing and Treating Lupus Systemic Lupus Erythematosus - or SLE - is a disease that affects millions worldwide and is sometimes difficult to diagnose. And even once a diagnosis is made, it's equally difficult to treat. Marc Levesque, MD, PhD, of UPMC discusses new medications that are being studied to modify the body's immune response and to treat lupus. When diagnosed early and treated with the right combination of drugs, the progression of SLE can usually be slowed, improving patients' quality of life.

Urology
	The Role of Surveillance in the Management of Kidney Cancer Active surveillance, also known as watchful waiting, is the least invasive treatment option for patients with small renal masses but for some, it may be one of the most effective. Active surveillance may eliminate over diagnosis and over treatment of indolent kidney cancers. By reviewing test results and having quality discussions, patients and physicians work together to identify the right treatments at the right time.
	Managing Congenital Urologic Disease in Adults Many congenital urologic problems are identified and treated in infancy or childhood. In some instances, however, congenital urologic disease can present in adulthood. In these cases, it's important for physicians to know there are urologists trained in pediatric and adult urology who can help. Dr. Michael Ost, an endourologist specialized in adult and pediatric urology at UPMC explains why physicians such as himself are best suited to manage these diagnoses.
	Prostate Cancer Screening and Treatment Presently, there is much debate about whether current screening practices have led to over diagnosis and over-treatment of prostate cancer. Some physicians believe that decisions about screening and treatment should be made on a case-by-case basis.
	Robotic-Assisted Pediatric Urology Surgery Surgeons at Children's Hospital of Pittsburgh of UPMC are now routinely using a robot to assist in complicated bladder and renal reconstructive procedures. This robotic-assisted approach often results in less blood loss, less pain, and shorter recovery times.