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Winter 2013

New Devices Improve Sleep Apnea Treatment

Continuous positive airway pressure (CPAP) is effective treatment for obstructive sleep apnea, but 46 to 83 percent of patients don't adhere to therapy because of discomfort. New developments, however, are making them more comfortable to use:

  • Humidifier – Air pumped by the CPAP machine may cause dryness in the nasal passages and throat, sore tongue and nose bleeds. The CPAP humidifier helps alleviate these side effects.
  • Nasal Pillow – The CPAP nasal pillow, which is smaller than the conventional mask covering the nose and mouth, plugs into the nostrils, making breathing more comfortable.
  • Pressure Relief – Exhaling against the positive air pressure can be uncomfortable. CPAP pressure automatically adjusts the air presssure when patients inhale and exhale. The device flexes air pressure when the patient starts to exhale, then flexes up to treatment level at the end of exhalation for better comfort.

To refer a patient to the UCSF Sleep Disorders Center, call (415) 885-7886 or visit www.UCSFhealth.org/sleepdisorders. Read more in the Proceedings of the American Thoracic Society (2008 Feb. 15; 5(2):173-8).

Bariatric Surgery Reduces Rate of Type 2 Diabetes

Bariatric surgery is more successful than medical therapy alone to reduce type 2 diabetes in obese patients, according to clinical trials published in the New England Journal of Medicine. One study (NEJM, Aug. 23, 2012) followed 1,658 bariatric surgery patients and 1,771 obese matched controls for up to 15 years. Patients didn't have diabetes at baseline. Nonrandomized, matched, prospective controls received standard care, including medical therapy and lifestyle changes. More control group patients developed type 2 diabetes (392 vs. 110), corresponding to incidence rates of 28.4 cases per 1,000 person-years and 6.8 cases per 1,000 person-years, respectively.

Another study (NEJM, April 26, 2012) evaluated intensive medical therapy for type 2 diabetes alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes. Within a year, diabetes remission rates with bariatric surgery were 40 percent, compared to 12 percent for patients treated with medical therapy alone.

To refer a patient to the UCSF Bariatric Surgery Center, call (415) 353-2804. Referral guidelines are at www.UCSFhealth.org/bariatric. The center is accredited by the Bariatric Surgery Center Network of the American College of Surgeons as a Level 1 center. That means it provides comprehensive bariatric care, has a high volume and manages the most challenging and complex patients. New patients are seen within two weeks of referral. Patient diet and weight loss history is necessary for insurance authorization.

2 Surgeons Better Than 1 in High-Risk Spine Surgery

UCSF research shows that two surgeons operating together at an experienced spine center decreases major complications and reduces operative time and blood loss during pedicle subtraction osteotomy (PSO) to correct fixed sagittal plane deformity. PSO is a common treatment for scoliosis, flatback syndrome and kyphosis and is associated with a high complication rate, significant perioperative morbidity and substantial blood loss. A study, published in the January 2013 issue of Spine Deformity and conducted by UCSF spine surgeons Dr. Christopher Ames and Dr. Vedat Deviren, included 78 cases from 2005 to 2010 divided into single versus two surgeon groups.

Forty-five percent of single surgeon patients compared to 25 percent of two surgeon patients experienced at least one major complication within 30 days. In the single surgeon group, 19 percent had unplanned surgery within 30 days versus 8 percent in the two surgeon group. The UCSF Spine Center is one of a few centers in the country that offers the dual-surgeon approach. To refer a patient, call the UCSF Spine Center at (866) 81-SPINE or (866) 817-7463, or visit www.UCSFhealth.org/spine.

New Diagnosis Criteria for Sjögren's Syndrome

About 4 million Americans have Sjögren's syndrome, the second most common systemic autoimmune disease in the U.S. Because the main symptoms — dry mouth and dry eyes — are common and non-specific, classification criteria were developed to optimize selection of participants for clinical trials. Criteria — provisionally endorsed by the American College of Rheumatology and developed by the UCSF-led Sjögren's International Collaborative Clinical Alliance (SICCA) — use the following tests:

  • Anti-SS-A/B serology measures specific Sjögren's syndrome antibodies in blood.
  • Labial salivary gland biopsy collects a few minor salivary glands from inside the lip to identify inflammation patterns.
  • Staining the eye surface with a specialized dye assesses changes in eye dryness.

Two of the three tests must be positive to meet the classification criteria. Criteria are described in Arthritis Care and Research (Vol. 64, No. 4, April 2012, pp 475–487).

The UCSF Sjögren's Syndrome Clinic is the only one of its kind on the West Coast. To refer a patient, call (415) 476-2045 or visit www.UCSFhealth.org/sjogrens.

New OB/GYN Clinic Opens at Mission Bay

UCSF Women's Health has opened a new clinic — UCSF Obstetrics and Gynecology Services at Mission Bay — at 1500 Owens St., Suite 380 in San Francisco. To make an appointment, call (415) 353-4600. The clinic is part of UCSF's nationally designated Center of Excellence in Women's Health, the only such center in Northern California. For more information, see www.UCSFhealth.org/obgynmb.

Online Recruitment for Clinical Trials

The UCSF Research Participant Registry helps connect research participants to clinical studies. Participants don't have to be ill to join the registry. Healthy participants are needed too. The registry is currently recruiting for:

  • Type 1 Diabetes — UCSF Diabetes Center intervention clinical trials for people with type 1 diabetes and prevention studies for family members of type 1 diabetes patients.
  • Chemotherapy — Chemotherapy Induced Neuropathy Study is investigating nerve damage caused by certain chemotherapy drugs. Seeking participants 18 years or older who have completed chemotherapy for cancer.

For more information, visit https://ucsfregistry.secure.force.com/SiteRegister or call toll-free (855) 855-8273 (UCSF).

Continuing Medical Education

UCSF's Continuing Medical Education Program offers courses throughout the year. Upcoming conferences include:

  • Family Medicine Board Review: Improving Clinical Care Across the Lifespan; March 25 – 28, Hotel Nikko, San Francisco
  • Primary Care Medicine: Update 2013; April 7 – 12, Wailea Beach Marriott, Maui, Hawaii
  • 41st Annual Advances in Internal Medicine; May 20 — 24, Stanford Court Renaissance, San Francisco

For more information, call the CME office at (415) 476-4251 or visit www.cme.ucsf.edu.

Need Help Making a Referral?

UCSF Medical Center

The Physician Liaison Service assists physicians, medical groups and health plans refer patients or arrange consultations.
Phone: (800) 444-2559
Fax: (415) 353-4395
Email: referral.center@ucsfmedctr.org
Website: www.UCSFhealth.org/healthprofessionals

UCSF Benioff Children's Hospital

Our toll-free Access Center is the gateway for all services at UCSF Benioff Children's Hospital.
Phone: (877) 822-4453 (UC-CHILD)
Websites: www.UCSFbenioffchildrens.org/accesscenter and www.UCSFbenioffchildrens.org/healthprofessionals

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