Innovate: Issue 11, Summer 2011

Summer 2011

™

Als o in th is is s ue:

■ New Clinic Treats Rare Neurological Disorder ■ Flights for Patients with Transportation Needs

Innovate

a l e t t e r f r o m R I C H AR D L I E K W E G

B A R N E S - J E W I S H H O S P I TA L ,

Photo by Tim Mudrovic

a nonprofit academic institution, is the largest hospital in Missouri and is consistently ranked among the Honor Roll of America’s best hospitals by U.S. News & World Report. The adult teaching hospital of Washington University School of Medicine, Barnes-Jewish was the first adult hospital in Missouri to be certified as a Magnet hospital for its nursing excellence.

Dear Friends, Barnes-Jewish Hospital is a member of BJC HealthCare, one of the largest nonprofit health care organizations in the United States.

The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine is the only cancer center within a 240-mile radius of St. Louis to hold the Comprehensive Cancer Center designation from the National Cancer Institute and membership in the National Comprehensive Cancer Network.

WA S H I N G TO N U N I V E R S I T Y P H YS I C I A N S

are the medical staff of Barnes-Jewish Hospital and the Siteman Cancer Center.

For more information or to make an appointment, call 314-TOP-DOCS (314-867-3627) or toll-free 866-867-3627.

magine stopping cancer before it can get started. There are many things we cannot control about our health—heredity and many environmental factors to name a few—but in the everevolving world of cancer prevention, we are discovering about half of all cancer cases are preventable.

At the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, we are fortunate to have one of the world’s foremost experts in cancer prevention, Graham Colditz, MD, DrPH, who leads Siteman’s prevention and control program.

In this issue of Innovate, learn how Dr. Colditz and his team are doing exciting research that explores an array of causative factors such as diet, exercise, weight, genetics, family history, exposure to infections and access to health screenings.

The work of Dr. Colditz, who came to us from Harvard University, has helped recruit dozens of prevention and public health experts to Siteman, one of the many ways Barnes-Jewish Hospital and Washington University physicians remain national leaders in medicine and help make medicine better.

Regards,

Innovate is published quarterly by Barnes-Jewish Hospital.

Managing Editor: Laura Thomson Contributing Editors: Jennifer Arvin, Mary Lee, Juli Leistner and Jackie Stack Address Changes: Innovate circulation | Mailstop 90-94-204 600 S. Taylor Ave. | Suite 202 St. Louis, MO 63110

Richard Liekweg President, Barnes-Jewish Hospital and Barnes-Jewish West County Hospital Want to send a message to Richard Liekweg?

Have questions or comments? E-mail: innovate@bjc.org

If you no longer wish to receive Innovate or received multiple copies, please call 314-TOP-DOCS (314-867-3627) or toll-free 866-867-3627, or e-mail innovate@bjc.org.

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News

B Y T H E N U M B ER S

Washin gton U ni v ersit y is

ranked 4th in the nation (among research-oriented medical schools),

according to U.S. News & World Report

$700,000 awarded from The Foundation for Barnes-Jewish Hospital’s Cancer Frontier Fund to WASHINGTON UNIVERSITY RESEARCHERS AT Siteman Cancer in 2011 http://bjhne.ws/cancergiving

1,500

patients, caregivers and team members

B J C D O N ATE D

87,693

$

to the American Red Cross

for relief efforts in Japan. http://bjhne.ws/japanaid

12,469

trauma CARE VISITS in 2010

$25,000 donated 235

to the united way of Greater St. Louis 2-1-1 storm recovery fund

/ the DAILY

ser v ed annually B Y T H E

average number of

Arts + Healthcare Program

emergency department

http://bjhne.ws/givingarts

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News Secondhand Smoke Exposure Exposure to secondhand smoke is an established cause of cancer, heart disease and serious lung ailments, according to the U.S. Surgeon General. In a study of secondhand smoke exposure in St. Louis bars and restaurants, Washington University researchers found that ventilation systems and “voluntary” smoke-free policies do not protect employees and customers from exposure to tobacco smoke in the air.

“Some of the effects of secondhand smoke on the cardiovascular system in nonsmokers are comparable to

the effects of active smoking,” says study author Joaquin Barnoya, MD, an epidemiologist at Washington University. “These effects occur within a half hour of exposure.”

Southwest Airlines: Flights for Life

Median airborne nicotine levels were 31 times higher in venues where smoking is allowed, compared with those that are voluntarily smoke-free.

As the percentage of smoking clients rose, so did nicotine concentrations.

In addition, comparing establishments with similar levels of smoking patrons, restaurants and bars that had ventilation systems actually had higher nicotine concentrations than restaurants that didn’t have them.

Southwest Airlines Medical Transportation Grants Program recently awarded Barnes-Jewish Hospital with 60 round-trip tickets for patients and their family members who need financial assistance to travel great distances for medical services. Reasons for travel range from a patient not being able to receive care in one’s hometown to a patient needing assistance from a loved one who lives far away.

To learn more about the program, visit

Learn more about the study at

http://bjhne.ws/medtransport

http://bjhne.ws/smokingstudy

Gene Mutations Predict Leukemia Patient Outcomes Decoding the DNA of a woman who died of acute myeloid leukemia (AML) has led Washington University researchers to a gene that they found to be commonly altered in many patients who died quickly of the disease.

The findings, if confirmed in larger studies, suggest that a diagnostic test for mutations in the gene could identify AML patients who need more aggressive treatment right from the start. The new discovery also provides a concrete target for developing improved therapies against AML, one of the most common adult leukemias.

Studying nearly 300 AML patients, the researchers found those with a particular mutation in the DNMT3A gene survived for an average of just over one year after their diagnosis, compared with nearly 3.5 years for those without the mutation. Notably, the investigators found the mutations in one-third of the patients whose prognosis would be unclear based on current diagnostic tests. These patients typically receive standard chemotherapy drugs as a first-line treatment.

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“Based on what we found, if a patient has a DNMT3A mutation, it looks like you’re going to want to treat very aggressively, perhaps going straight to bone marrow transplantation or a more intensive chemotherapy regimen,” says senior author Richard Wilson, PhD, director of Washington University’s Genome Institute.

The study was conducted by a large team of scientists at the Genome Institute and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. They are pioneers in using a comprehensive, genome-wide approach to unravel the genetic basis of cancer.

By decoding the genome— all the DNA—of cancer patients and their tumor cells, they can find critical mutations at the root of the disease.

Then, the researchers can look for those errors in other patients.

barnes-jewish hospital and washington university physicians

atest The L ical d in Me s and urce Reso ology n Tech

BREAKTHROUGHS I N N O V AT I V E C ARE

M I N I MALL Y I N V A S I V E S U r G e r y

BREAST

PAT I E N T C A R E U N I T S

3 - D S U R G E RY

A new technology—3-D breast

Patients in the new gynecologic oncology

Washington University surgeons at

tomosynthesis—offers radiologists a 3-D

unit at the Siteman Cancer Center and in

Barnes-Jewish Hospital are sporting the

Right image courtesy of Viking Systems

3 - D S C REE N I N G

Images © Masterfile and Getty Images

Left Image courtesy of Hologic;

at Barnes-Jewish Hospital and Washington University School of Medicine

view of breast tissue after mammography.

the abdominal transplant, liver and

latest eyewear: 3-D polarized shades.

Radiologists take a series of 15 low-dose

pancreas unit at Barnes-Jewish Hospital

The glasses allow surgeons performing

mammograms at one time and then impose

have new technology and safety improve-

minimally invasive surgery to operate in

them together to form a multi-plain view

ments to assist in their daily care.

three dimensions, replacing the bulky,

of the breast. Studies suggest the new

Touch screens in rooms show daily

cumbersome headsets that surgeons

technology helps reduce the rescreening

schedules and videos about care for

had previously used. The new technology

rate and false positives. While breast tomo-

their conditions. The all-inclusive new

improves the visual field for surgeons,

synthesis offers a radiologist enhanced

spaces are designed by the staff to foster

allowing them to see small blood vessels

images, the experience for a patient is no

communication among patients, physicians

and other structures more clearly—

different than traditional mammography.

and the health care team.

a clear benefit for patients, too.

http://bjhne.ws/3Dbreastscreen

http://bjhne.ws/patienttech

Editor’s Note: Gerald Andriole, MD, is an advisor to Viking Systems, maker of the eyewear.

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STOP CANCER

B E F O R E I T S TA R T S written by julia evangelou strait

KNOWING YOUR RISK can help prevent common health problems.

Cancer is a complex and too often devastating disease. Even with modern medicine’s latest techniques and most powerful tools for diagnosis and treatment, nothing compares to preventing it in the first place. The good news is that as many as half of all cancer cases are preventable.

“You don’t have champions who say, ‘Your study prevented my prostate from becoming cancerous,’” says Graham Colditz, MD, DrPH, associate director of prevention and control at Siteman. “It’s one of the bigger challenges of getting people excited about prevention.”

The prescription for cancer prevention, at least for those factors under our control, is familiar: eat fresh fruits and vegetables, exercise daily, maintain a healthy weight, don’t smoke and get the recommended screenings. And the health benefits go beyond preventing cancer.

And Colditz is excited about prevention. When he came from Harvard University in 2006 he was drawn to Washington University and Siteman because of their commitment to supporting the growth of prevention research and community outreach.

“That’s one of the great things about prevention: one lifestyle choice can have a beneficial effect on multiple cancers as well as other chronic diseases,” says Kathleen Wolin, ScD, a behavioral epidemiologist and prevention expert at the Alvin J. Siteman Cancer Center at BarnesJewish Hospital and Washington University School of Medicine.

“Physical activity is going to reduce your risk of colon and breast cancer.

It’s also going to reduce your risk of heart disease, stroke and diabetes.”

8 KEYS TO PREVENTION:

1. MAINTAIN A HEALTHY WEIGHT

He brought with him an interactive website called “Your Disease Risk,” an important part of Siteman Cancer Center’s efforts to get prevention messages to the community. He has helped recruit dozens of prevention and public health experts to Siteman and Washington University.

Genes vs. Lifestyle

A person’s risk of developing cancer involves an array of interacting factors: diet, exercise, weight, genetics, family history, infection exposure and access to screening. Colditz’s team studies all these, searching for causes and ways to prevent cancer of all types, from breast to colon to blood cancers such as leukemia. In addition to prevention, they are working to improve survival and quality of life after cancer diagnosis and treatment.

A look at several projects devoted to prostate cancer illustrates the breadth and cross-disciplinary nature of prevention research at Siteman.

Urologic surgeon Adam Kibel, MD, treats prostate cancer patients and is interested in the genetics of the disease.

But prevention is difficult to measure.

2. EXERCISE REGULARLY

“We’re trying to look at the genetic basis for aggressive prostate cancer,” Kibel says. “The majority of the disease that’s diagnosed is not very aggressive.

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Fish are Friends 3. DON’T SMOKE

To answer some of these questions, Colditz has recruited epidemiologists and public health experts who team up with physicians such as Kibel to tackle problems they might not be able to address on their own.

4. EAT A HEALTHY DIET

So the critical issue is not whether you have prostate cancer but whether you have the kind of prostate cancer that is going to cause you harm.”

Bettina Drake, PhD, a Siteman epidemiologist, is interested in whether vitamin D, which is naturally found in many fish, is protective against prostate cancer. Partnering with Kibel, Drake is looking at the vitamin D levels of prostate cancer patients when they are first diagnosed and their risk for recurrence.

“Vitamin D and prostate cancer is one of those associations in the literature that has been inconsistent,” Because Kibel can draw from a large Drake says. “Some studies find no population of patients treated for association. Other studies have found prostate cancer at Siteman, he can small associations.” Drake notes that gather valuable information about diet, African-American men are known to exercise and even infection exposure be at higher risk of prostate cancer that, along with the genetic data, can than other populations. They also tend provide new insights into disease risk. to have lower vitamin D levels. Other factors such as age and obesity can “Dietary information is useful because affect vitamin D levels as well. we can look at gene-environment interactions,” he says. “It could “How all of these factors be that the right gene in the right biologically work together environment dramatically increases or decreases a man’s risk of getting and how it impacts cancer prostate cancer.” is complex but very More specifically, Colditz says, “Are there subsets of men for whom vegetables are really fantastic at preventing progression of their cancer? Or is it vitamin D or physical activity? Are there subsets of people in Dr. Kibel’s broader clinical population where lifestyle has a substantial impact?”

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interesting,” says Drake.

5. DRINK ALCOHOL IN MODERATION

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Eating tomato-based foods high in the compound lycopene has also been linked to a lower risk of prostate cancer. The literature often disagrees about diet-based studies, but in this case, according to Drake, the evidence tilts in favor of lycopene being protective against prostate cancer.

“If you can use a genetic marker to identify who is at risk for developing aggressive prostate cancer and then make a dietary change that decreases that risk, that’s the kind of prevention we dream about,” Kibel says.

6. PROTECT YOURSELF FROM thE SUN

Run it Off

Beyond diet, Wolin would like to know whether physical activity can prevent problems with urinary function and sexual activity that some men experience after prostate surgery.

“Our preliminary research suggests that men who were active, even if they were overweight or obese, have better urinary function than men who were inactive,” she says.

Kibel thinks these findings make sense.

“It’s a physical act, holding in urine,” he says. “Ultimately, we’d like to be able to give people a more accurate risk assessment of their likelihood of incontinence. If we can tell someone,

Urologic surgeon Adam Kibel, MD

8 WAYS TO PREVENT CANCER

and senior research technician Bill Wu.

‘you’re not likely to be incontinent after surgery,’ they’re going to feel a lot more comfortable proceeding with it.”

Taking a different approach, epidemiologist Siobhan Sutcliffe, PhD, is looking at possible infectious causes of prostate cancer.

“There are quite a few examples of infections that are known to cause cancer,” says Sutcliffe, citing the connection between human papillomavirus and cervical cancer, among others. “People have hypothesized that inflammation may be involved in prostate cancer development. One way you can have inflammation in your prostate is by infection.”

7. PROTECT YOURSELF FROM DISEASE

8. GET SCREENING TESTS

Sutcliffe is working with Kibel to gather and analyze prostate fluid to look for evidence of current or past infection.

Of course, this kind of research requires patients who are willing to participate in studies and donate tissue samples.

Another major project at Siteman is finding ways to encourage people, especially under-represented minorities, to participate in tissue research. Through the Program for the Elimination of Cancer Disparities (PECaD), Drake is conducting focus groups with African-American men to better understand barriers that might exist for participating in health research studies.

“We want to get a sense of what influences their decision and, if possible, how recruitment strategies can provide more information to help promote participation in these types of studies,” she says.

Through these and other multidisciplinary efforts, Colditz and colleagues are dedicated to making significant progress in detecting cancer early, improving quality of life, reducing recurrence and, of course, preventing cancer in the first place.

Eat more fruits and vegetables.

Exercise regularly. Watch your weight. We all know these things make us healthier. But did you know they also reduce your risk for developing cancer?

To help people understand the connection between healthy habits and cancer, the Siteman Cancer Center has launched a yearlong campaign called “8 Ways to Prevent Cancer.”

The campaign is based on a list of behaviors that have been shown through scientific evidence to reduce a person’s risk for cancer.

To learn more about the “8 Ways,” visit 8ways.wustl.edu, where you also will find links to:  Personalized risk assessments

for 12 different types of cancer  Videos and podcasts featuring

Siteman experts discussing cancer prevention topics  Cancer screening guidelines  Calendar of educational events For more information on prevention, visit http://8ways.wustl.edu

For more information and to listen to a podcast, visit http://bjhne.ws/cancerprevention and http://www.yourdiseaserisk.wustl.edu

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It may not be easy or pleasant, but weight loss has more benefits than looking good in a swimsuit. Losing even a little weight can greatly improve heart and vascular health, boosting heart function, lowering blood pressure and improving metabolic measures. A research program at Washington University School of Medicine is dedicated to understanding the complex relationship between weight and heart health; its work shows that weight-loss benefits can last even if some of the weight

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returns, and that the effort can not only prevent but reverse significant health problems.

In recent studies of obese people, Washington University researchers followed patients in a weight-loss program and demonstrated that four key measures of heart and vascular health improved in those who lost weight.

Using advanced heart-imaging tests, they found that the heart’s pumping ability, its ability to relax, the thickness

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Victor Dávila-Román, MD and Lisa de las Fuentes, MD.

A little goes a long way

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of the heart muscle tissue and the thickness of the carotid artery walls all improved. The benefits continued over many months, even after an individual stopped losing weight and regained a few pounds.

Their findings are important to heart health because thickening of the heart muscle and impaired pumping and relaxation functions are predictors of heart failure. Increased arterial wall thickness is a predictor of plaque formation that can contribute to blockages in arteries and eventually lead to heart attack or stroke.

“An obese person requires a heart that is able to pump greater amounts of blood, so the chamber size—the actual cavity of the heart—enlarges, and the muscle gets thicker as well,” says Lisa de las Fuentes, MD, a Washington University cardiologist at Barnes-Jewish Hospital.

“Over time in some individuals, the heart cannot compensate, and after a while, it begins to lose some of its ability to relax or its ability to pump blood to the rest of the body. Both can lead to heart failure.”

De las Fuentes says it was important to evaluate whether moderate weight loss could improve heart health. When the study began, none of the patients enrolled had clinically evident signs of heart failure, such as shortness of breath, coughing or fluid buildup, and none were taking cholesterol-lowering medications.

About one-third were being treated for high blood pressure.

“Hypertension, or high blood pressure, is a huge public-health problem in the United States,” says Barnes-Jewish Hospital cardiologist Victor Dávila-Román, MD, director of the Cardiovascular Imaging and Clinical Research Core Laboratory at Washington University. “Of the 65 million people with hypertension, between 25 percent and 50 percent have some evidence that their heart has been affected, so the presence of high blood pressure in so many of these subjects suggested that we needed to take steps to help them lower their blood pressure if we hoped to make their hearts healthier.”

Study subjects were instructed to eat either low-fat or low-carbohydrate diets— about 1,200 to 1,500 calories per day for women and 1,500 to 1,800 for men.

Both groups experienced similar amounts of weight loss and similar improvements in heart and vascular measurements. Subjects lost an average of 22 pounds, which represented about 10 percent of their body weight, according to de las Fuentes. Interestingly, she says the cardiovascular benefit didn’t appear right away, lagging behind weight loss.

In fact, the greatest improvements in

heart function didn’t come until six to 12 months after the study began, in spite of the fact that beginning at about six months, many of the participants began slowly to regain some of the weight they had lost.

Although the average weight loss was more than 20 pounds, by the time two years had passed, most participants weighed only about nine pounds less than they had at the start of the study.

Even though they regained some weight, they still retained much of the heart and blood vessel benefit related to their weight loss.

“Not only did we catch them at the point of their maximum weight loss, we also continued to monitor people as they regained weight they had lost,” de las Fuentes explains.

“We wanted to assess not only the impact of the initial loss of weight on the cardiovascular system but also the impact of regaining weight.”

The heart benefits persisted, and de las Fuentes says that although it’s possible that those beneficial effects would eventually end if people returned to their previous weight, it is clear from the study that the benefits of losing weight last for a long time.

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particularly high risk for heart disease and diabetes and need to be treated aggressively to help them lose weight, because dropping a few pounds can make a big difference.

But total body weight isn’t the only factor. Other research suggests that when body fat collects in the liver, it usually spells trouble. People whose fat accumulates in the liver experience serious metabolic problems such as insulin resistance, which affects the body’s ability to metabolize sugar. They also have increases in the production of fat particles in the liver that are secreted into the bloodstream and increase the level of blood lipids, such as triglycerides.

But as de las Fuentes and Dávila-Román learned with heart health, many of the metabolic problems associated with fat in the liver also can be slowed, or even reversed, with weight loss.

“It’s completely reversible,” says Samuel Klein, MD, director of Washington University’s Division of Geriatrics and Nutritional Science, Center for Applied Research Studies, as well as its Center for Human Nutrition. “Calorie restriction and minimal weight loss can

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And looking at the big picture, the researchers say losing 10 percent of your body weight may be enough to do the trick. You don’t need to drop 50 pounds or develop “abs of steel” to get healthier, and they say losing 15 or 20 pounds may be difficult, but it’s not impossible. And even those who can’t lose that much weight can still benefit from smaller amounts of sustained weight loss.

markedly reduce fat content in the liver.

In fact, as little as two days of calorie restriction can cause a large reduction in liver fat and improvement in liver “Losing 20 or so pounds might seem insulin sensitivity.” daunting, but we’ve shown that even For years, scientists noticed that where a modest weight loss can yield heart individuals carried body fat influenced and vascular benefits,” de las Fuentes their metabolic and cardiovascular says. “It’s important to realize that you health. Increased fat in the belly, can choose goals that are attainable and known as visceral fat, was associated work towards those goals progressively. with an increased risk of diabetes and A person doesn’t necessarily need to get heart disease. Overweight people who back to his or her ideal body weight to carried weight in their hips and thighs, improve heart function, because even rather than the belly, seemed to have small amounts of weight loss seem less risk for those problems. to improve metabolic function and hypertension, as well as enhance heart “Visceral fat has long been associated pumping and relaxation, while causing with metabolic risk, which has led to the heart tissue and blood vessel the belief that visceral fat might even walls to get thinner. Cholesterol and cause metabolic dysfunction,” Klein triglyceride levels usually improve, too.” says. “However, we’ve learned that visceral fat tracks closely with liver fat, Other studies of weight loss and and it appears that fat in the liver is a its effects on metabolism and better marker of metabolic dysfunction cardiovascular function currently are and cardiovascular risk.” under way. For more information, call Volunteer for Health at (314) 362-1000.

Klein says people who are obese but For healthy tips everyday, visit our blog at don’t have high levels of fat in the liver http://bjhne.ws/healthblog should be encouraged to lose weight, but those with elevated liver fat are at

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R e sid e n t s ta k e c a r e o f

community and beyond In addition to his role as Barnes-Jewish Hospital’s chief resident at the St. Louis VA Medical Center, Henish Bhansali, MD, a third-year resident, regularly visits with underinsured, elderly men and women to talk about chronic diseases.

He explains the complications and prevention tactics related to high blood pressure, diabetes and kidney disease, through the hospital’s Residents and Fellows Diversity Initiative.

Photo courtesy Henish Bhansali

As part of the Scholars in Global Health program at Washington University School of Medicine, Bhansali spent a month working in a hospital in Bhutan, near his home country of India, in the Himalaya Mountains.

H E N I S H B H A N S AL I , M D why do you feel it’s important to volunteer?

I believe ‘from those who have been given much, much will be expected.’ And, I have been very blessed. I give back to others because I had the most incredible parents, and I have a lovely wife. I am clearly loved by God, and this is my one small way to continue giving his love. how do you support the st. louis community?

I am currently working on a course in health literacy to be taught at Goldfarb School of Nursing at Barnes-Jewish College. The plan is to help nursing students better relate to their patients by visiting the homeless shelters and churches. I’m also on the board and program committee at Gateway Homeless Shelter, where we specifically address health issues of the women and children there.

why go to bhutan?

I chose the Bhutan location because it has been minimally influenced by modern technology, and because of the culture. It’s a happy group of people, so much so that it’s a law to be happy—not just to pursue happiness. The culture in general was like traveling back in time 50 years.

How does the hospital compare to Barnes-Jewish?

The patients in Bhutan have zero privacy and limited access to specialized care. For example, instead of one or two patients in a room, there are six to seven patients in a room.

We did not have a variety of medications or specialized physicians. The hospital that I worked at had many resources—X-ray machines, MRI machines, labs, etc— just not many specialized physicians like a cardiologist or a gastroenterologist. Most things were done by the general surgeon.

To learn more about physicians who volunteer in the community and beyond visit http://bjhne.ws/outreach

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FYI Breathing Better with Emphysema Treatment

emphysema who are not candidates for lung transplantation and for those who have not responded to medical therapy, respiratory care or medications.

Emphysema—a chronic, progressive lung disease characterized by physical destruction of lung tissue and loss of lung elasticity—affects millions of Americans and is a leading cause of death in the United States. For many people with the disease, the simple act of breathing becomes a difficult chore.

The lungs become overstretched, leaving a decreased surface area for oxygen exchange.

LVRS, in which 20 percent to 30 percent of the most diseased portions of the lung are removed, allows increased airspace for the remaining lung to inflate. Although not a cure for emphysema, nor an option for all patients, the surgery can give many people the chance to live healthier and more active lives.

A procedure called lung volume reduction surgery (LVRS) can increase lung function, relieve shortness of breath and improve quality and length of life for individuals with severe emphysema. The surgery also provides an alternative for patients with severe

Since the first LVRS was performed at Barnes-Jewish Hospital in 1993, Washington University thoracic surgeons have completed hundreds of the procedures, and Barnes-Jewish Hospital’s LVRS program remains a Lung Volume Reduction Center of Excellence, a designation that

(L to R) Roger Yusen, MD, MPH, Bryan Meyers, MD, MPH, and Marsha Johnson, ACNP, specialize in the diagnosis and treatment of emphysema.

recognizes its outstanding patient care and leadership in thoracic surgery.

The LVRS program utilizes teamwork among surgeons, pulmonologists, radiologists, anesthesiologists, respiratory therapists, nurses and nurse practitioners, all of whom have extensive experience working with, and caring for, LVRS and lung transplant patients.

To learn more about lung volume reduction surgery, visit http://bjhne.ws/lvr or call (800) 851-9479

New Clinic Treats Rare Neurological Disorder Individuals with neurofibromatosis type 2 (NF2) can now benefit from the Midwest’s only program specializing in the clinical care of children and adults with NF2—a genetic disorder that affects one in 40,000 individuals worldwide. The NF2 Clinical Program is a joint project of Barnes-Jewish Hospital, the Siteman Cancer Center and the Washington University NF Center.

One of the most frustrating aspects of NF2 is its variation among individuals, even in members of the same family. In general, most individuals with NF2 experience their first symptoms —hearing loss, ringing in the ears (tinnitus) and balance problems— during the late teenage years or early 20s.

Individuals with NF2 develop tumors in the cranial nervous system.

Because the tumors grow slowly, they may be present for many years before causing symptoms.

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The NF2 Clinical Program is codirected by Washington University neurosurgeon Michael Chicoine, MD, and Washington University otolaryngologist Timothy Hullar, MD. Their collective experience in treating large numbers of patients with this uncommon disease stimulated the assembly of a dedicated, multidisciplinary group of physicians and other health care professionals to coordinate patient assessment and treatment using a comprehensive approach.

To hear podcasts from the physicians or to learn more about NF2, visit http://nfcenter.wustl.edu

AT a glance

Culturally Sensitive Breast Cancer Screening St. Louis is home to more than 25,000 female refugees from around the world. Many have never had the opportunity to receive a mammogram or learn about breast health.

observant Muslim women take advantage of Daylight’s “Behind the Veil” screening each fall.

Many cultural and religious beliefs play a role in Muslim women not obtaining necessary health screenings.

Since 2002, with funding from the St. Louis affiliate

For this reason, the “Behind the Veil” breast health

of the Susan G. Komen for the Cure foundation and

screening tries to address this community’s needs by

technical support and guidance in securing the grant

providing transportation, an all-female staff, covering

from The Foundation for Barnes-Jewish Hospital,

gowns, and interpreters fluent in Bosnian, Farsi,

Barnes-Jewish Hospital’s Daylight Project has focused

Arabic and Kurdish. The Daylight Project is administered

on bridging cultural and language barriers to screening

by staff of the Barnes-Jewish Hospital Center for

and breast cancer services. For example, many

Diversity and Cultural Competence.

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