April 2006

A Newsletter for the Medical Staff of Gwinnett Hospital System

Doctors’ DialogueGMC has introduced a new element of care for

patients at high risk for stroke. A new procedure at GMCis intended to prevent stroke by treating blockages inthe carotid artery, the main blood vessel leading to thebrain.

This procedure atGMC is a collaboration ofcardiologist Louis Heller,MD, interventionalradiologist James A. York,MD, and vascular surgeonCharles Moomey, MD. Thenew carotid artery stent, theRX ACCULINK CarotidStent, is for use in patientswho have had symptoms ofa stroke, whose carotidartery is at least 70 percentblocked, and who are notgood candidates for thesurgical alternative.

Stents, which aresmall, metal mesh tubes,have been used in heartarteries for several years.The standard carotid arteryprocedure, carotidendarterectomy, involves

GMC Introduces Stroke-Prevention Stent Processsurgeons cutting into the neck artery to remove theblockage. Most patients require general anesthesia forthis procedure. RX ACCULINK Carotid Stent is insertedduring angioplasty, a less invasive procedure in which

the stent is threaded up tothe neck artery via acatheter inserted in thegroin. This procedure isnow available as an optionfor patients who are notcandidates for standardsurgery. Patients of thenew stent procedureusually require only localanesthesia.

Studies have shown thenew stent system tosuccessfully openblockages in 92 percent ofpatients. In addition, thestent still allowed blood flowto the brain more than twoyears after the procedure.GMC successfullyperformed its first RXACCULINK Carotid Stentprocedure in early March2006.

GMC - DuluthGMC - DuluthGMC - DuluthGMC - DuluthGMC - DuluthHospital UpdateHospital UpdateHospital UpdateHospital UpdateHospital UpdateBy Lea Bay, VP/Operations

One of the newest sites is the main entrance canopy that looks reallybeautiful..stacked stone and wood!

Ceiling tile to be installed in May. Loading dock concrete is complete. Landscaping is scheduled for June.

Light fixtures are installed on Ground & Terrace Floors.Questions? Call Lea at 678-584-7300.

(Left to right) Vascular surgeon Charles Moomey, MD,interventional radiologist James A. York, MD, andcardiologist Louis Heller, MD, team together to performGwinnett Medical Center’s first RX ACCULINK carotidstent procedure on a patient at high risk for stroke.

Need an order set? Everything you need isas close as your computer keyboard. From theGwinnettMD homepage, click on Forms in the Toolsmenu on the left side of the page. The center part ofthe screen will display a Physician Forms heading.Click on Physician_Order_Sets and select from thedisplayed list.

To print an order set: 1) Select the appropriate category, e.g., Surgery,Medicine, etc.

- Orders that are often used in multiple areasare also listed under Most Common Orders.

- If uncertain where the order set resides, selectAlphabetized Table of Contents to find theappropriate category. 2) Select the order set to open it. 3) Select the Print Button at the top to generate acopy.

Search Out and Print the OrderSet You Need on GwinnettMD

TIME THOSE ORDERS!Please remember to time your orders,

especially for discharge orders. The Flow Collaborative evaluates delays in discharges.

Without a timed order, it’s impossible toidentify a delayed discharge.

Thanks!

Physician Hotline:678-442-3455

Grapevine e-mail:grapevine@ghsnet.org

GHS Stroke ProgramGHS Stroke ProgramGHS Stroke ProgramGHS Stroke ProgramGHS Stroke ProgramEarns RecognitionsEarns RecognitionsEarns RecognitionsEarns RecognitionsEarns Recognitions

Glancy Rehabilitation Center’s treatmentteam recently acquired new equipment to providestate-of-the-art services for patients with gaitdisorders. Last year, team members researchedcurrent trends in gait treatment and identified theMobility Research Lite Gait body-weightsupported system. This gait-training device cansimultaneously control weight-bearing, posture andbalance over a treadmill or on the ground. It can beused with a wide range of impairments and variedlevels of severity affecting ambulation to provideproper posture, reduce weight-bearing whilestabilizing balance, and facilitating the training ofcoordinated lowerextremity movement.Lite Gait uses aharness system toprovide unilateral orbilateral support forprogression fromnon-weight-bearingto full weight-bearing. In addition,it allows a physicaltherapist to manuallyassist a patient’slegs and pelvis fortraining appropriategait patterns.

During thelast two months, thecenter ’s physicaltherapists have usedthe Lite Gait equipment successfully with manypatients and documented excellent results. “Itprovides us with a better opportunity to establish anormal gait pattern,” reports Margaret Hogan, RPT.“We are thrilled by the opportunity to have the latesttechnology to help progress our patients,” says TracySeymour, PTA.

Glancy Rehabilitation Center is a 30-bedCARF accredited inpatient program that specializesin treating neurologically impaired adults, patientswith orthopedic diagnoses, spinal cord injuries,amputations and low functioning-level patients. Formore information, call 678-584-6789.

Partial Weight-BearingGait Therapy at

Glancy Rehab Center

Margaret Hogan, RPT, (left) andTracy Seymour, PTA, work witha client.

The award-winning Stroke Program atGHS has earned more kudos. At the InternationalStroke Conference in February 2006, we wereawarded the Initial Performance AchievementAward for the Get With the Guidelines program.This month, we began the NovoSeven (activatedfactor VII) trial for Hemorrhagic Stroke.

The American Heart Association HeartWalk on March 18, 2006, raised $14,297.20.Walkers from GHS numbered 86, helping our or-ganization win third-place recognition in the MostMost Money Raised competition.

Gwinnett Hospital System is accredited by the Medi-cal Association of Georgia to offer continuing medi-cal education to physicians. Gwinnett Hospital Sys-tem designates each of these educational activitiesfor the specified hours in AMA PRA Category I Cred-its™. Physicians should only claim credit commen-surate with the extent of their participation in the ac-tivity.

CME Program Information Online!To view specific CME program information, log on toGwinnett Hospital System’s online physician Web siteat http://gwinnettmd.org and click on “CME Offerings.”This site also features links to the “Results CIS” (Clini-cal Information System) and the Medical Library Webpage with links to many online text books, full-text da-tabases and nearly 3,000 full-text medical journals.For additional information, contact Anne Kramer, RN,BC, MN, Director, Medical Education/Medical Library,at 678-442-4341.

Tues., April 18, 12:30 p.m. Diabetes/EndocrinologyEvaluation of Vascular Disease in the Diabetic PatientKhusrow A. K. Niazi, MD, FACC, FSCAI, Assistant Professor,Department of Cardiovascular Diseases; Director, PeripheralInterventions, Emory Crawford Long Hospital, Emory Univer-sity School of MedicineApproved for 1.0 CME credit Education Center, GMCTo register, call Andrea MacDonald at 678-442-4644.Registration required for all associates.

Wed., April 19, 12:30 p.m. Infectious DiseasesInfectious Diseases Grand Rounds-- Update on Community Acquired MRSAPaul D. Martin, MD, Infectious DiseasesApproved for 1.0 CME credit Education Center, GMCTo register, call Kenyana Hutchinson at 678-442-2453.Registration required for all associates.

Friday, April 21, 7:30 a.m. Vascular Surgery, Cardiology &Interventional RadiologyVascular Case ConferenceGregory P. Schlegel, MD, Moderator; Medical Director, WoundTreatment CenterApproved for 1.0 CME credit Education Center, GMCTo register, call Patty Perez at 678-442-4483.* NOTE: Date & Time Change

Mon., April 24, 7 a.m. Department of AnesthesiaNew Therapies in Pain ManagementStephanie J. Smith, MD, AnesthesiologyJorge R. Alvear, MD, AnesthesiologyApproved for 1.0 CME credit New Private Dining Room, GMCTo register, call Patty Key at 678-442-4700.

Wed., April 26, 12 noon Department of PathologyBone Marrow Biopsy in Chronic MyeloproliferativeDisordersRobert J. Siegel, MD, PathologyApproved for 1.0 CME credit Education Center, GMCTo register, call Donna Smith at 678-442-4206. Registrationrequired for all associates.

Wed., April 26, 4 p.m. Department of Emergency MedicineUpdate on Cardiac PacingDavid A. Wilson, MD, CardiologyApproved for 1.0 CME credit GHS Resource Center, 665Duluth Hwy., LawrencevilleTo register, call Nellie Awbrey at 678-442-3317.Registration required for all associates.

Thurs., May 4, 8 a.m. Trauma ServicesTrauma Rounds -- Update on the Las Vegas Trauma Con-ference 2006Thomas K. Duncan, DO, Trauma Surgery

Approved for 1.0 CME credit Education Center, GMCFor more information, call Deb Battle at 678-442-3742.

Thurs., May 4, 5:30 p.m. Inpatient Medical GroupCOPD: A Preventable and Treatable DiseaseGerald W. Staton, Jr., MD, Professor of Medicine, Emory Uni-versity School of Medicine; Medical Director, Chief, Pulmonary/Critical Care, Wesley Woods Long Term HospitalApproved for 1.0 CME credit Administrative Board Room, 2ndFloor, GMCSupported by an educational grant from GlaxoSmithKlineTo register, call Karan Jones at 678-442-3273.

Fri., May 5, 12:30 - 1:30 p.m. Gwinnett Hospital SystemNew Paradigm for Weight Management in Obese Patients:From Dietary Composition to IncretinsOsama Hamdy, MD, PhD, FACE, Director, Clinical ObesityProgram; Assistant Medical Director, Professional Education,Joslin Diabetes Center, Harvard Medical SchoolApproved for 1.0 CME credit GHS Resource Center, 665Duluth Hwy., LawrencevilleSupported by an educational grant from AmylinPharmaceuticals, Inc.To register, call Ellen Roberson at 678-442-7662.Registration required.

Sat., May 6, 8:30 a.m. - 1:30 p.m. Organizational Improve-mentPhysicians Only -- Advanced Cardiac Life SupportRecertificationWilliam McMahon, MD, Instructor; Emergency MedicineApproved for 5.0 CME credits Education Center, GMCTo register, call Tina Gavorsky at 678-442-4338. Registrationrequired.* PLEASE NOTE: Physicians Only

Diabetes CareCommittee News

February 1, 2006 -- The American Association ofClinical Endocrinologists, American College ofEndocrinology and the American Diabetes Asso-ciation joined forces to develop strategies for themanagement of adult patients with high blood glucosein hospitals. The following are some of the recom-mendations made and how GHS is addressing them:

0 Identify elevated blood glucose in all hospitalizedpatients.0 Establish a multidisciplinary team approach to dia-betes management in all hospitals. (Diabetes CareCommittee formed in 2003.)0 Implement structured protocols for aggressive con-trol of blood glucose in both intensive care units andother hospital settings (order sets and protocols be-ing revised).0 Create educational programs for all hospital per-sonnel caring for people with diabetes (5th Floor gly-cemic education initiative currently in process).0 Plan for a smooth transition to outpatient care withappropriate diabetes management.For additional information: www.aace.com orwww.diabetes.org.

The GMC Perioperative Task Force, under theleadership of Reg Gilbreath, MD, has been piloting aprogram designed to decrease post-operativecomplications through risk assessment and riskreduction strategies preoperatively. Patients identifiedat risk for postoperative complications will undergo athorough preoperative evaluation by the GMC HospitalistTeam, which is geared toward risk assessment and

implementationof risk reductiontherapies thatwill decreaseper ioperat ivemorbidity andm o r t a l i t y .P reopera t i veM a n a g e m e n tProtocols havebeen developedfor pre-existing

cardiac disease, pulmonary disease, diabetes, nicotineand substance abuse and steroid use.

The IMPACT (Internal Medicine PreoperativeAssessment Consultation and Treatment) Program,patterned after the Cleveland Clinic Foundation, will beopened full-time beginning in July 2007, in the SurgicalInterview Department. Each patient referred by thesurgeon to the IMPACT Program undergoes a thoroughbut focused history and physical aimed at medical riskassessment, perioperative medication management,implementation of prophylactic therapies such as beta-blockers, optimization of existing chronic medicalcondition and further testing, if necessary.

The GHS SCIP (Surgical Care ImprovementProject) initiatives are incorporated in the preoperativeplanning. The goal of this program during thepreoperative evaluation is to not only clear patients forsurgery, but also to prepare them for surgery. The teamprovides postoperative follow-up to high-risk patientsand continuity of medical care. Lower-risk patients whodevelop unforeseen medical complications are alsoseen postoperatively.

For additional information about the IMPACTProgram, contact Dr. Gilbreath at 678-442-3280 orPriscilla Stockwell, MS, FNP-C, at 678-442-3589.

We currently have six time frames per weekbetween now and July 1, 2006, to evaluate patients. Toschedule a patient for the IMPACT Program, contactGayle Hayes BSN, RN, at 678-442-3351.

IMPACT ProgramComes to GMC

PERIOPERATIVEPHYSICIANS include RegGilbreath, MD; Lance Wiist,MD; Mary Jo Albert, MD;Miles Mason III, MD; MartinAustin, MD; Chris Hosfeld,MD; Gaston Garcia, MD;and Sean Keem, MD.

To provide the best experience possible for ACLSProviders and Recerts, we are rescheduling Recert Classesfor 2006. There will be monthly Recert classes for the rest of2006, and separate learning environments will be offered forProviders and Recerts. Classes will be held at the GHSResource Center.

IF YOU HAVE PRE-REGISTERED for ACLS RECERTin 2006, the DATES HAVE BEEN CHANGED and YOU MUSTPRE-REGISTER AGAIN.

All classes begin promptly at 8:30 a.m. Those arrivingmore than 15 minutes late must reschedule. Proper attire isrequired. Students must present a current ACLS card ortranscript showing current ACLS Provider status prior to classattendance.

The NEW DATES FOR ACLS RECERTS are:Thursday, May 18

Wednesday, June 21Thursday, July 13

Thursday, August 24Thursday, September 21Wednesday, October 18Tuesday, November 7Friday, December 8

For more information, contact Joanie Blaney, RN, at 678-442-3745 or Kim Smith, BSN, at 678-442-4338.

Time to Recert in ACLS