Gel reduced daily tremors in Parkinson’s disease

 An experimental treatment for Parkinson’s disease reduced by nearly two hours on average the period each day when medication failed to control patients’ slowness and shaking, according to results from a double-blind, phase III clinical trial published in December 2013, in Lancet Neurology

The study compared AbbVie’s levodopa-carbidopa intestinal gel against the same medication in pill form in patients with advanced disease. 

The University of Alabama at Birmingham was among the sites for the study, with David G. Standaert, M.D., Ph.D., chair of the UAB Department of Neurology, an author. Led by the Mount Sinai School of Medicine, preliminary results from the study were first presented at the annual meeting of the American Academy of Neurology in April 2012. 

Parkinson’s disease results from the loss of brain cells that make dopamine, which helps to control movement. As dopamine levels fall, patients experience tremors, muscle stiffness and loss of balance. A commonly prescribed treatment, the levodopa-carbidopa combination works as the body converts levodopa into dopamine and carbidopa escorts levodopa to the right part of the brain. The problem is that patients face hours of uncontrolled slowness, freezing and tremors each day — called “off-time” — as the treatment gets into place or wears off.

One reason for the break in treatment coverage is that it comes in a pill, and pills sit in the stomach for up to six hours waiting for it to empty into the small intestine. It is only there that levodopa encounters the proteins capable of transporting it into the bloodstream en route to the brain. Thus, researchers envisioned a system that steadily delivers levodopa gel directly into the small intestine through a surgically placed tube, and with the help of a pump worn on the belt.

“The results are very exciting, considering that other recently approved drugs on the market reduce off-time by, at most, just over an hour,” said Standaert. “In the study, the gel treatment helped patients who had run out of alternatives with current medications. We believe it may be an important new option for patients with severe Parkinson’s, with benefits comparable to more invasive techniques like deep brain stimulation.”

Patients using the gel system saw an average reduction in daily off-time of 1.91 hours, and an increase in “on-time” without troublesome dyskinesia of 1.86 hours compared with the pill form. Nearly all subjects experienced at least one side effect, although most were short-lived and moderate. 

This study was sponsored by AbbVie, with Standaert and other authors receiving compensation from AbbVie for serving as consultants.

(Courtesy of Bob Shepard)

UAB Medicine launches new physician learning site

UAB Medicine, in collaboration with BroadcastMed, Inc., has launched MD Learning Channel, an online resource that enables medical professionals worldwide to tap into the knowledge and expertise of University of Alabama at Birmingham physicians.

The website,, offers free Web-based learning and continuing medical education for physicians and other medical professionals. It includes video presentations from UAB School of Medicine faculty physicians discussing new research findings, new procedures and changes and developments in diagnosis or treatment of disease. The site primarily focuses on cancer, neurosciences, pulmonary medicine, women and infants services and cardiovascular medicine and will expand to include additional medical specialties in the future.

“UAB physicians and scientists are at the forefront of medicine, scientific research and discovery and advancement of treatments and patient-focused care,” said Physician Marketing Manager Whitney McDonald. “This site provides an easy, convenient way for UAB to help disseminate its incredible wealth of expertise to medical professionals around the world.”

McDonald says the site’s on-demand service enables physicians and medical professionals to learn as their schedule permits.

“By making the information readily available, we hope to further the mission, vision and successes of the UAB Medicine team, while sharing techniques, procedures and evidence-based care in use here to help others care for their patients,” said McDonald. “We hope that the MD Learning Channel will serve as a platform to foster many growth and development opportunities for health-care providers.”

UAB Medicine has added continuing medical education credit to cancer, neurosciences, Pulmonary and Women & Infants video libraries presentations on the MD Learning Channel. The addition of CMEs further enhances the site by allowing medical professionals free Web-based learning opportunities at the click of a mouse.

There is no charge to individuals who participate in the online evaluation and claim CME credit. Nurses can also claim credits toward their continuing education unit totals.

Stroke mortality is down, but the reason remains a mystery


By Nicole Wyatt

 A national group of leading scientists, including one University of Alabama at Birmingham expert, says that for more than 100 years fewer people have been dying of stroke, yet it is still unclear why this decline remains constant.

The American Heart Association and American Stroke Association have published a scientific statement, Factors Influencing the Decline in Stroke Mortality, which has also been affirmed by the American Academy of Neurology as an educational tool for neurologists. The statement is published in the AHA journal Stroke.

Stroke is a leading cause of long-term disability and was previously recognized as the third leading cause of death in the United States, according to the National Stroke Association. However, stroke has now fallen to the fourth leading cause of death due to decreases in people dying from it. This has led the Centers for Disease Control and Prevention to acknowledge the decline, and a similar decline in heart disease, as one of the 10 great achievements in public health of the 20th century.

Statement co-author George Howard, Dr.P.H., professor in the Department of Biostatistics in the School of Public Health, explains that, even with these dramatic decreases, there is still more to be done.

“Stroke has been declining since 1900, and this could be a result of changes leading to fewer people having a stroke or because people are less likely to die after they have a stroke,” Howard said. “Nobody really knows why, but several things seem to be contributing to fewer deaths from stroke.”

Perhaps the biggest contributor to the decline, Howard says, are changes leading to lower blood pressure levels, which is the biggest of the stroke risk factors. Other contributors may include reductions in smoking, better treatment of cholesterol, and how people are cared for after having a stroke.

“We don’t know how much all of the sources are contributing,” Howard said. “Certainly, we want it to keep going down; but if we don’t understand why the numbers are decreasing, we can’t work toward that trend.”

Howard says that, in the last 11 years, stroke deaths have declined by 30 percent.

“It’s a big deal, so you could argue that our battle is won,” he said. “But I think we still have a lot to be accomplished in this area.”

Andrei Alexandrov, M.D., professor of Neurology and director of the UAB Comprehensive Stroke Center, was not affiliated with the statement, but says it brings welcome news.

“This likely is attributable not only to better arterial blood pressure control over recent years, but also to a greater number of neurological specialists focused on stroke care across many hospitals in the United States and abroad,” Alexandrov said. “Better early stroke recognition and specialized care can also reduce the risk of dying from stroke.”

Alexandrov pointed out one finding of the statement — the lower death rate among adults younger than 65 years of age — deserves further attention since a large proportion of stroke victims in the southeastern U.S. are young.

“More efforts are needed to reduce mortality and prevent first-ever stroke incidence, as well as to reverse disability following stroke by improving patient access to hospitals providing clot-busting therapy,” Alexandrov stated. 

Howard agrees that, while stroke prevention and care have played a large part in the decline of stroke mortality, more research needs to be done in stroke prevention.

“This brings up an interesting question: Should more research resources go toward areas where we’ve seen success, or should they go where differences haven’t been made yet?” Howard said. “I’d say there’s an argument for both.”

Unit for Neurosciences Nursing demonstrates AMC21 quality pillar goal

UAB Medicine is devoted to becoming the Preferred Academic Medical Center of the 21st Century (AMC21) through the achievement of its pillar goals and commitment to outstanding research, education, and clinical care. One key area of focus at UAB is the quality of care provided to patients.

ccrnWhen it comes to quality, the Unit for Neurosciences Nursing (UNSN) has continued to improve their performance by enacting the Reaching for Excellence principles into their routine. Nurse Manager Elizabeth Toomey (pictured, right) attributes her team's success to their commitment to holding each other accountable to these daily practices, whether it is hourly rounding, hand washing, or other common practices to improve quality for patients.

"I expect people to do their jobs, and we hold each other accountable if they don't," Toomey states.

For example, Toomey's unit took it upon themselves to reduce the number of  patient falls, and began to brainstorm on ways to reduce them. Advanced Nursing Coordinator Dorri Bierley (pictured, left) initiated different practices, such as daily safety huddles, staff education, and documentation audits. The daily safety huddles between Registered Nurses (RNs) and Patient Care Technicians (PCTs) are used to discuss which patients are at risk for falling and those who have particular issues the staff needs to be aware of in order to best serve the patient. Bierley states that maintaining a high level of quality care begins with staff awareness of quality issues that need to be addressed daily.

"Everything is incorporated into the safety huddles every morning because good quality is what our patients expect of us," explains Toomey.

UNSN also began hourly rounding with patients, as recommended by Reaching for Excellence, as evidence demonstrates that this practice reduces the number of times patients call for assistance with their ‘call lights.' Since hardwiring this behavior into their routine, UNSN has seen a decrease in these calls and a significant decrease in their patient fall rate.

Bierley adds that Toomey always stresses to their team to treat patients as if they are family members in the hospital. "There is a direct correlation to quality when you treat patients like family members, everything goes up from there."

Toomey attributes their success to the staff's longevity and dedication to the unit; little staff turnover makes it easier to create a stable environment. Plus, they maintain a sense of team, always willing to help if someone needs it. Bierley acknowledges that the recognition of staff members' performance is a contributing factor to the lack of turnover, praising Toomey for her dedication to acknowledge a nurse who goes above and beyond.

"If a patient tells me someone has done a great job, I will call their names out in staff meetings and give them a ‘Fantastic Five' card to reward them," says Toomey.

Fantastic Five cards are $5 cards that can be used in cafeterias and coffee shops throughout UAB. Toomey noted that residents and unit secretaries are also honored for going above and beyond the call of duty.

The main challenges facing UNSN now are the changes in health care and keeping nurses educated about new policies. It is a test for their unit because they experienced positive results from the old policies, but Toomey assures that her team will maintain their devotion to the highest quality.

"Our staff is very open to changing and adapting to handle things," says Toomey.

Chief Quality Officer for Inpatient Services, Ben Taylor, M.D., M.P.H., reiterates this dedication to quality throughout UAB and points out that UAB's quality measures are the highest they've ever been, in the context of a continually changing health care environment. UAB has to continue to work and evaluate practices in order to keep quality results high. "The whole point is to do more of what works and less of what doesn't, which sounds simple, but can be really hard in a big complex place like ours." 

Toomey cannot give her team enough praise for their hard work over the last 3 years to improve quality. She praises their devotion to their patients and teamwork as their keys to success and states it best: quality and patient satisfaction go hand in hand.

Click here for more information on how to improve quality metrics with UAB's Reaching for Excellence.