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live well SISTER TO SISTER The gift of a healthy kidney gives sibling another chance at life SMARTER HEALTHCARE FOR SOUTHERN CALIFORNIA

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A CLINICAL TRIAL FOR PATIENTS WITH LOU GEHRIG S DISEASE PROBING THE IMPACTS OF LEGALIZED MARIJUANA SUMMER 2018 live well SMARTER HEALTHCARE FOR SOUTHERN CALIFORNIA SISTER TO SISTER The gift of a healthy kidney gives sibling another chance at life NOTES 2 FROM RESEARCH TO CLINICAL CARE, WE HAVE IT COVERED A s Orange County s only academic medical center, we play a unique role in meeting the health needs of our community. Our combination of high-value complex care provided by leading clinicians and UCI s cuttingedge research right here in our backyard means residents don t have to travel far for expert medical care. Our growing program in kidney transplantation is a case in point. People in need of a transplant no longer have to head to Los Angeles or beyond for this complex procedure. Our highly skilled transplant team can perform this operation whenever matching kidneys are available. On page 6 of this issue of Live Well, the story about kidney transplant patients Xenia and Delia Morales underscores the devotion of our transplant team and the importance of our living donor program to helping others who are awaiting this life-saving procedure. From our kidney transplant program to our National Cancer Institutedesignated comprehensive cancer center and our neurosciences and digestive disease programs, UCI Health offers care and treatment that far exceed what community hospitals can provide. This is due in large part to our academic and clinical research that has far-reaching implications for public health. For example, on page 3, infectious disease expert Dr. Susan S. Huang discusses work that is reducing the spread of dangerous superbugs in nursing homes. Huang, a national leader in this arena, is spearheading research that may change how communities across the country respond to outbreaks. On page 10, learn about UCI neuroscientist Daniele Piomelli and his quest to better understand the medical properties and health impacts of cannabis. With the legalization of marijuana, he explains why Californians need unbiased research to clarify how marijuana use may impact lives. As we grow our network of convenient, ambulatory care centers to improve access to our expert primary care physicians and specialists, we also strive to protect our patients. That s why we are proud of our eighth consecutive A hospital safety grade from the nation s leading safety watchdog group. Each day, our physicians many of whom have been named Best Doctors in America our nurses and other healthcare professionals work tirelessly to keep you at the pinnacle of good health. Even with something as basic as advising you on how to protect your feet this summer (don t miss the story on page 5 on flip-flops!), our goal is to help you keep small ailments from becoming chronic problems. Kind regards, Richard J. Gannotta, DHA, FACHE Interim CEO and Chief Operating Officer, UCI Health LIVE WELL CHIEF EXECUTIVE OFFICER (INTERIM) CHIEF OPERATING OFFICER Richard J. Gannotta, DHA, FACHE CHIEF STRATEGY OFFICER Teresa Conk ASSISTANT MARKETING DIRECTOR Daphne Tam PUBLIC INFORMATION OFFICER John Murray MANAGING EDITOR Kristina Lindgren DESIGN, EDITORIAL & CONTRIBUTORS Moon Tide Media ART DIRECTOR Angela Akers EDITOR Shari Roan DESIGNER Kelsey Elliott BRAND PUBLISHER Hannah Lee If you have comments or questions, please contact: UCI Health Marketing & Communications 333 City Blvd. West, Suite 1250, Orange, CA The information contained in this magazine is not meant to replace the advice of your physician. YOU MAKE THE DIFFERENCE Few things in life matter more than your health. If you or someone close to you has experienced UCI Health s personalized, researchdriven care, then you know how Orange County s only academic medical center is improving the lives of people in our community and beyond. We couldn t do it without you. Your philanthropic support drives clinical innovations like the ones you ll read about in the following pages. If you would like to make a gift to thank a provider, honor the memory of a loved one or establish a lasting legacy, call or visit ucirvinehealth.org/giving DISCOVERIES PREVENTING THE SPREAD OF SUPERBUGS TO THE MOST VULNERABLE WRITTEN BY LAUREL DIGANGI In the fight against multidrug-resistant organisms, or superbugs, UCI Health infectious diseases expert Dr. Susan S. Huang has long been a superwoman. Her groundbreaking clinical trial, published in the New England Journal of Medicine in 2013, demonstrated that a simple protocol known as decolonization could dramatically decrease superbugs in intensive care units. The protocol involves cleaning patients skin and swabbing their nostrils with an antibacterial agent before admitting them to an intensive care unit. With decolonization, we reduced the superbug MRSA (methicillin-resistant Staphylococcus aureus) by 37 percent and reduced all bloodstream infections by 44 percent, says Huang, director of epidemiology and infection prevention at UC Irvine Medical Center. Thanks to Huang, decolonization is now considered best practice in all U.S. intensive care units to protect patients from MRSA, one of an alphabet soup of antibioticresistant superbugs. For patients who are elderly, sick or frail, contracting a superbug can be deadly. That s why Huang is involved in two large-scale decolonization projects involving vulnerable patients those in nursing homes, long-term acute care facilities and general medical and surgical units in the hospital. The studies are known as the Protect Trial and the SHIELD Orange County project. The Protect Trial, now underway, involves 28 nursing homes in Orange County and southern Los Angeles County. Half the nursing homes are following routine bathing and hygiene procedures; the others are practicing decolonization. Because non-infected patients can be unwitting carriers of multidrug-resistant organisms, decolonization can reduce the spread of superbugs to others and prevent patient infections. People who carry these organisms are at higher risk for drug-resistant infections later, says Huang, especially if they have breaks in their skin, have undergone surgery or have bedsores. They re also at a higher risk for developing pneumonia. The SHIELD project is a regional collaboration funded by the Centers for Disease Control and Prevention (CDC). Plugging regional data into a mathematical simulation model, Huang and her team identified 17 hospitals, 18 nursing homes and three long-term acute care facilities that together share the most patients. These 38 facilities have adopted a decolonization intervention. The nursing homes and long-term acute care facilities switched to a chlorhexidine bathing soap and are applying an overthe-counter iodine-based swab to the nose. In hospital wards, the project targets patients who are already known to harbor superbugs. In the hospitals ICUs, all patients already receive the chlorhexidine bath and nasal swab as the standard of care. Before we began the SHIELD Project, we sampled people in these facilities and found that 64 percent of residents in nursing homes and 80 percent of the long-term acute-care patients had a multidrug-resistant organism, she says. These numbers are alarming when you consider the number of people we need to protect. The problem, Huang explained, is that people are more likely to get multidrug-resistant organisms when they receive antibiotics that kill off susceptible bacteria. Moreover, patients in hospital, nursing home and long-term care settings require hands-on care, which can spread contagion. Huang expects the Protect and SHIELD studies to show these simple SUPERBUG THREAT 4.1 million Americans reside in nursing homes. Nearly 70 percent of them are prescribed antibiotics each year. However up to 75 percent of these antibiotics are prescribed incorrectly. About 27 percent of U.S. nursing home patients carry a superbug. Sources: Centers for Disease Control and Prevention, American Journal of Infection Control interventions we re implementing can make a big difference. Over time, she believes the studies can actually reduce Orange County s drugresistant organisms. If we can control disease among high-risk patients, then it s possible we will do good for the entire community, she says. To learn more about drug-resistant bacteria and infection control, visit ucirvinehealth.org/infectioncontrol UCIRVINEHEALTH.ORG 3 HEALTH FILES UCI HEALTH GETS HIGH MARKS FOR PATIENT CARE AND SAFETY Top Leapfrog Safety Grade UCI Health received an eighth consecutive A in The Leapfrog group s Hospital Safety Grade, which rates how well hospitals protect patients from errors, injuries and infections. The spring 2018 Hospital Safety Grade is compiled by the nonprofit patient safety watchdog organization. The Leapfrog report is the first and only hospital safety rating to be peer-reviewed in the Journal of Patient Safety. The score is free to the public and designed to give consumers information they can use to protect themselves and their families when facing a hospital stay. Critical-Care Nursing Three intensive care units at UC Irvine Medical Center have received the silver-level Beacon Award for Excellence, a prestigious recognition of caregivers who successfully adhere to the highest standards of acute and critical care nursing. The award from the American Association of Critical- Care Nurses was issued to the neurosciences, cardiac care and medical intensive care units in recognition of exceptional patient care and healthy work environments. Nearly 50 nurses in the three honored UC Irvine Medical Center intensive care units hold advanced specialty certifications. Stroke Care The UCI Health Comprehensive Stroke and Cerebrovascular Center has earned The Joint Commission s Gold Seal of Approval and the American Heart Association/American Stroke Association s Heart-Check mark for Advanced Certification for Comprehensive Stroke Centers. It is the third time UCI Health has earned the designation since the Comprehensive Stroke Centers program was established in To be eligible for advanced certification, hospitals must meet standards as a Primary Stroke Center and provide services such as advanced imaging capabilities, round-theclock availability of specialized treatments and staff who possess the unique education and competencies to care for complex stroke patients. Best Doctors Nearly 90 UCI Health physicians were named Best Doctors in America for The honor, given to just 5 percent of U.S. doctors in a national survey of their peers, means UCI Health has more physicians trusted by other doctors than any other hospital in Orange County and the region. UCI Health honorees represent 30 medical specialties. Best Doctors has a worldwide reputation for reliable, impartial results by remaining independent. Doctors cannot pay to be included in the Best Doctors database. The list is assembled through validated peer review, in which doctors who excel in their specialties are selected by their peers in the profession. The list is audited and certified by the Gallup organization. Learn how we keep patients safe at ucirvinehealth.org/patientsafety 4 LIVE WELL HEALTH FILES THE TROUBLE WITH FLIP-FLOPS STRAWBERRY-ACAI- CHIA SMOOTHIE BOWL Cool as an ocean breeze, a fruit smoothie bowl offers a fast, tasty way to beat the summer heat. This good-for-you smoothie recipe is a favorite of registered dietitian Katie Rankell of the UCI Health Weight Management Program. It features fruit and healthy supplements such as acai berry powder and chia seeds. The suggested toppings further amp up the nutritional benefits and add a fun, artistic touch to your smoothie. Customize each to suit your own tastes, then find a spoon and enjoy! INGREDIENTS 1½ cups halved strawberries, frozen ½ large banana, frozen 1 cup unsweetened hemp milk 1 tablespoon chia seeds 1 teaspoon acai berry powder 1 tablespoon honey OPTIONAL TOPPINGS ½ large banana, not frozen 1 tablespoon chia seeds ¼ cup raspberries Serves 2 DIRECTIONS In blender, add strawberries, ½ frozen banana, hemp milk, chia seeds, acai berry powder and honey. Blend well. Divide into two bowls. Slice unfrozen ½ banana and arrange slices on top of each bowl, then sprinkle on additional chia seeds. Garnish with raspberries and blueberries. NUTRITIONAL INFORMATION Per serving (without toppings): 173 calories 44 calories from fat 5.2 g total fat 73 mg sodium 396 mg potassium 4.1 g protein 18 g sugars 28.9 g carbohydrates 4.7 g dietary fiber The UCI Health Live Well blog has a library of recipes, many with videos, to help you eat healthier. Visit ucirvinehealth.org/eatwell Flip-flops symbolize summer in Southern California. But the ubiquitous footwear can be a flop in some circumstances. These sandals are fine for a short walk to the beach, said Dr. Andrew R. Hsu, a UCI Health orthopaedic surgeon who specializes in foot and ankle conditions. But using flip-flops as your go-to shoe year-round can definitely lead to problems. There are many ways you can get into trouble with them. These casual thong-style sandals often made of rubber or plastic can aggravate foot conditions such as plantar fasciitis, arthritis and tendinitis. Foot and toenail fungi are more easily contracted when wearing flip-flops, especially when wearers are walking in dirty, moist environments or in public places where others germs can flourish. Wearing flip-flops can create problems for people with diabetes, older people with thinning skin and people with rheumatoid arthritis or immunosuppressive disorders, causing blisters and sores. Diabetics, who often cannot feel these types of injuries, may be in particular danger because their small wounds or blisters can more easily become infected. Because feet in flip-flops are largely unprotected, toes can be stubbed or stepped on. Flip-flop wearers can slip on wet surfaces as well as on automobile pedals while driving. Walking too much on concrete while wearing flip-flops may cause stress fractures. Ideal footwear for people with any foot condition is stiff, well-cushioned and has a good arch built in, Hsu said. Unfortunately the vast majority of flip-flops are the complete opposite of that. Hsu recommends wearing sturdier sandals with better traction. To learn more about foot and bone health, visit ucirvinehealth.org/orthopaedics UCIRVINEHEALTH.ORG 5 THE GIFT OF LIFE Nadia Morales gave a healthy kidney to her sister, Xenia, then nursed her back to health and stood beside her on the path to wellness WRITTEN BY NANCY BRANDS WARD PHOTOGRAPHED BY LAUREN PRESSEY Xenia Morales, left, and her older sister, Nadia, are inseparable. Three days after Christmas in 2013, 23-year-old Xenia Morales experienced such severe chills that even layers of blankets couldn t keep her warm in the Huntington Beach home where she lives with her parents. With her pulse barely registering, her family rushed her to the closest emergency room. When they finally let me in, I saw her lying there with all these needles, lines, tubes everywhere, says her sister, Nadia Morales, then 27. The doctor says, Do you know she s dying? and I felt this big crush in my heart. Within months, Xenia sought the help of UCI Health nephrologists and later that year she had a new kidney, thanks to her sister and donor and the expanding UCI Health kidney transplant program. Until the weekend she fell ill, Xenia had been healthy and busy, taking college classes and attending beauty school, plus working to pay tuition. She d recently passed the state test for her cosmetology license and had accepted a job at a beauty salon. But on the Sunday before she was scheduled to start her job, her kidneys quit working. Xenia s kidneys were unable to do their job of filtering waste and extra fluid from her blood, turning her blood the color of pink lemonade. She needed a transfusion of 10 units of blood, which is just about the total amount her body held. Doctors told her family that without emergency care she would have died within a few hours. While there are many causes of kidney failure from diabetes to heart disease to drug abuse in Xenia s case, her kidneys hadn t developed properly after her premature birth at 8 months gestation. Yet no one was aware that her kidneys were much smaller than the normal size of a human fist, and their failure at age 23 came as a complete surprise. As Xenia battled her illness and began kidney dialysis, the sisters became almost inseparable. In the intensive care unit and hospital, at doctor visits and dialysis treatments, Nadia never left her sister s side. Nadia encouraged her whenever Xenia felt like giving up. Nadia also researched the advantages of peritoneal dialysis, which fills the abdomen with a special solution to clean the blood, and she convinced Xenia it would give her greater independence and quality of life. Nadia even acted as her needle-shy sister s caretaker by cleaning and maintaining the dialysis lines. Inseparable before the ordeal, the two sisters are even closer. They tell the story together, both contributing different pieces of it and frequently finishing each other s sentences. Four months after Xenia s collapse, Nadia made the decision to give one of her own kidneys to her sister and it truly became their story. It s one that too few kidney failure patients can claim. In 2016, more than 30,000 U.S. kidney transplants were performed. That s a record high, but more than 100,000 people still languish on the list for a replacement kidney. The problem is a lack of kidneys from both deceased and live donors. In Orange County, the wait for a deceased donor kidney can be as long at 10 years. A live donor is gold, says Dr. Donald C. Dafoe, who is UCI Health s chief of transplant surgery. If someone comes to us with a live donor, we can do that transplant within three to six months once all testing is complete. After Nadia decided to donate one of her healthy kidneys, she turned out to be almost a perfect match, lining up with Xenia on five of six biomarkers. The more biomarkers that match, the less risk there is that the recipient s body will reject the donor kidney. When the transplant team nurse called to give me the good news, Nadia says, I knew that God had his own plan. The sisters went back and forth over the usual questions: Are you sure you want to do this? What if something happens and you need the kidney later on? What about the dietary restrictions you ll have to follow after surgery? But Nadia was committed. On Dec. 14, 2014 just months after learning of the match the sisters headed to UC Irvine Medical Center in Orange for the transplant surgery. The odds of successful transplants have improved greatly in recent years thanks to advances in drugs and aftercare, says Dafoe. These improvements also have expanded the number of candidates who qualify for transplants. Yet the need has also increased because of our aging population along with the soaring rate of type 2 diabetes, which often leads to serious kidney disease. The UCI Health kidney transplant program is expanding to meet this mushrooming need and to ensure that area residents get top-notch care where they live. We re on solid footing to become the face of transplant in Orange County, says nephrologist Dr. Uttam G. Reddy, medical director of the kidney transplant program. Our outcomes are better than the national average on par some of the top transplant programs in the country. That s the gold standard for me. In addition, UCI Health s state-of-the-art outpatient dialysis program helps prolong the lives of people with kidney failure, including those who are waiting for a kidney donor or who aren t candidates for transplantation. The nephrology team also supports home peritoneal dialysis and hemodialysis, and it staffs an inpatient unit for acute dialysis at the medical center. Even with the best care, dialysis isn t as good as a transplant. The five-year survival rate for people on dialysis is only 50 percent, says Dr. Hirohito Ichii, the surgeon who t
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