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Anthony Wahl 

A man walks his bicycle past a wanted sign for Joseph Jakubowski on Court Street in Janesville on April 10.


Angela Major 

An FBI agent in tactical gear tears down a sheet of plywood covering the doorway of an apparently empty house at 426 Eisenhower Avenue in Janesville on April 7 while searching for Joseph Jakubowski. FBI and sheriff’s deputies also searched two blocks away, on Glen Street, where Jakubowski once lived.


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Telemedicine to be offered in Edgerton nursing home come February

EDGERTON

Patients at Edgerton Care Center soon won’t have to leave the facility to receive specialty health care thanks to the addition in February of telemedicine for all its patients.

Telemedicine is a virtual health care service that allows physicians to consult with and treat patients via video chat during hours when physicians often are not available, such as nights, holidays and weekends.

Many nursing homes in the state have started to explore the technology, but the Edgerton facility will be one of the first to implement it, said Bob Siebel, CEO of Carriage Healthcare Companies, which operates Edgerton Care Center.

He hopes telemedicine will reduce the number of readmissions to emergency rooms for nursing home residents, he said.

“Any time you (take) someone who has a number of chronic conditions and relocate them, even for a couple of hours, that’s not necessarily good for that person,” Siebel said.

Residents will not pay additional costs for telemedicine services, Siebel said. The service is an expense exclusively for the nursing home.

The preventive care telemedicine provides outweighs the cost and could save the company in the long run, Siebel said.

New York-based TripleCare will provide Edgerton Care Center with its telemedicine technology and doctors, according to a news release.

TripleCare CEO Mary Jo Gorman said 80 percent of patients who use their telemedicine services are treated and cared for in their nursing homes without a trip to the emergency room.

About half the patients who use the service likely would have been sent to an emergency room if not for the technology, Gorman said.

Physicians can treat Edgerton Care Center residents from anywhere in the country with telemedicine, so long as the doctors are licensed to provide treatment in Wisconsin, Gorman said.

Telemedicine physicians commonly address conditions such as shortness of breath, low-grade fever and early bladder infection, Gorman said.

“The ability to help that patient be evaluated and treated right in facility is a tremendous benefit to the patient,” Gorman said.

Telemedicine elsewhere

SSM Health St. Mary’s Hospital-Janesville has used telemedicine in its intensive care unit and emergency neurological department since the hospital opened in 2012, said Jason Steinke, the hospital’s director of emergency medical services.

Telemedicine physicians use high-definition cameras to exam the patient externally and monitor IV pumps and vital sign monitors, Steinke said. Physicians have access to patients’ electronic medical records to ensure continuity of care.

Strokes are time-sensitive emergencies, said Andrea Hughes, chest pain coordinator at St. Mary’s. Receiving expert consultation in a timely manner is crucial for stroke patients.

“One of the biggest benefits is it gives us an additional expert consultation,” Hughes said.

Patients in the intensive care unit can receive care immediately from a telemedicine doctor in the event an on-site doctor is with another patient or is unavailable, Steinke said.

Some patients are concerned about having a camera in their room at all times, but cameras are only activated with notice and are turned off when not in use, Steinke said.

St. Mary’s is considering expanding its neurological telemedicine to inpatient services, not just the emergency department, Steinke said.


Joseph A. Jakubowski


In a milestone year, gene therapy finds a place in medicine

After decades of hope and high promise, this was the year scientists really showed they could doctor DNA to successfully treat diseases.

Gene therapies to treat cancer and even pull off the biblical-sounding feat of helping the blind to see were approved by U.S. regulators, establishing gene manipulation as a new mode of medicine.

Almost 20 years ago, a teen’s death in a gene experiment put a chill on what had been a field full of outsized expectations. Now, a series of jaw-dropping successes have renewed hopes that some one-time fixes of DNA, the chemical code that governs life, might turn out to be cures.

“I am totally willing to use the ‘C’ word,” said the National Institutes of Health’s director, Dr. Francis Collins.

Gene therapy aims to treat the root cause of a problem by deleting, adding or altering DNA, rather than just treating symptoms that result from the genetic flaw.

The advent of gene editing—a more precise and long-lasting way to do gene therapy—could expand the number and types of diseases that can be treated.

In November, California scientists tried editing a gene inside someone’s body for the first time, using a tool called zinc finger nucleases for a man with a metabolic disease. It’s like a cut-and-paste operation to place a new gene in a specific spot. Tests of another editing tool called CRISPR, to genetically alter human cells in the lab, could start next year.

“There are a few times in our lives when science astonishes us. This is one of those times,” Dr. Matthew Porteus, a Stanford University gene editing expert, told a Senate panel discussing this technology last month.

It’s a common path for trail-blazing science—success initially seems within reach, setbacks send researchers back to the lab, new understandings emerge over years and studies ultimately reveal what is safe and effective.

Here is a look at what’s been achieved and what lies ahead.

A string of firsts

The year started with no gene therapies sold in the U.S. and only a couple elsewhere. Then the Food and Drug Administration approved the first CAR-T cell therapies, which alter a patient’s own blood cells to turn them into specialized cancer killers. They’re only for certain types of leukemia and lymphoma now, but more are in the works for other blood cancers.

Last week, the FDA approved Luxturna, the first gene therapy for an inherited disease, a form of blindness. People with it can’t make a protein needed by the retina, tissue at the back of the eye that converts light into signals to the brain, enabling sight. The therapy injects a modified virus containing a corrective gene into the retina so the cells can make the protein.

Children who received the treatment told what it was like to gain vision.

“Oh yikes, colors. Colors are super fun,” said 13-year-old Caroline Carper of Little Rock, Arkansas. “And the sunshine is blinding.”

Gene therapies also showed some promise against a variety of diseases including hemophilia, a blood clotting problem; “bubble boy” disease, where a flawed immune system leaves patients vulnerable to fatal infections; and sickle-cell disease, a serious and painful blood disorder common among black people.

It’s not all good news, though. The therapies don’t work for everyone, they’re shockingly expensive, and no one knows how long some results will last, though scientists say the aim is a one-time repair that gets at the root cause.

“The whole promise ... is to cure diseases. It’s based on the rationale of fixing the problem,” not just improving treatment, said Dr. Carl June, a University of Pennsylvania scientist who pioneered CAR-T therapy.

A new frontier: gene editing

In mid-November, Brian Madeux, a 44-year-old Phoenix man with a metabolic disease called Hunter syndrome, had just become the first person to try an experimental gene editing treatment.

“I believe in science,” he texted The Associated Press after doctors sent viruses containing a corrective gene and an editing tool through an IV into his body. The hope is that the gene and the editing tool would enter some of his liver cells and insert the instructions needed to start making an enzyme he lacks.

It’s not known yet if it worked. Sangamo Therapeutics is testing its therapy in several studies, and independent monitors will help decide when results are released.

“It’s a pretty exciting milestone,” Collins said, because it shows a way to treat more diseases than ones that can be addressed now by altering blood cells in the lab or injecting genes into the eye.

What’s next

Top of Collins’ list: muscular dystrophy and sickle cell.

There’s been so much progress that the NIH has modified an oversight panel that just a few years ago reviewed every gene therapy experiment in the U.S. Most are considered safe enough to go ahead without the Recombinant DNA Advisory Committee’s review. The panel hasn’t even met for a year.

When the panel was formed decades ago, “there was a lot of concern that a graduate student could take some of this home and create a monster in his basement,” said one panel member, Boston scientist Dr. Howard Kaufman.

Those fears have eased, he said.

“There’s no monsters that have materialized from this.”