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M E D I C A L S TA F FGrandRoundsMARCH 23: “Optimizing Protection for the NSTE-ACS Patients with Antiplatelet Therapy”Ron Waksman, M.D., Cardiologist
MARCH 30: TBARandy Cole, M.D., Critical Care, HNMC
APRIL 6: “Panic Disorder”Jon Rosenfi eld, M.D., Columbia University
APRIL 13: TBARobert McConnell, M.D., Columbia Presbyterian Medical Center
Location: Marian Hall • Time: 9:00 - 10:00 a.m.
medical staff offi cersPresident: Patricia Burke, M.D.Vice President: Thomas Birch, M.D.Secretary: Mihran Seferian, M.D.Treasurer: Ronald White, M.D.
members-At-Large:Medical Chiefs Representative: Joel Goldfarb, M.D.Surgical Chiefs Representative: Harris Sterman, M.D. Member At Large: Giuseppe Condemi, M.D.Member At Large: Rosanna Modesto, M.D.
medical staff department directors and division ChiefsDept. of Anesthesiology: Alan Gwertzman, M.D. Dept. of Emergency Medicine: Richard Schwab, M.D.Dept. of Family Practice: Joseph Cassotta, M.D.Dept. of Medicine: Joseph Schuster, M.D. Allergy: Patrick Perin, M.D. Cardiology: Stephen Angeli, M.D. Dermatology: Jeffrey Rapaport, M.D. Endocrinology: Mark Wiesen, M.D. Gastroenterology: Joel Goldfarb, M.D. Infectious Disease: Thomas Birch, M.D. Internal Medicine: Lewis Attas, M.D. Nephrology: David Levin, M.D. Neurology: David VanSlooten, M.D. Oncology: Beata Pieczara, M.D. Psychiatry: Sharad Wagle, M.D. Pulmonary Medicine: Stuart Silberstein, M.D. Radiation Oncology: Charles Vialotti, M.D. Rehabilitative Medicine: George Gombas, M.D. Rheumatology: Ralph Marcus, M.D.Dept. of Obstetrics & Gynecology: Christopher Englert, M.D.Dept. of Pathology: Drew Olsen, M.D. Dept. of Pediatrics: Harry Banschick, M.D. Dept. of Radiology: Jacqueline Brunetti, M.D.Dept. of Surgery: John Poole, M.D. Dentistry: Steven Haber, D.D.S. General Surgery: Joseph Manno, M.D. Neurosurgery: Patrick Roth, M.D. Ophthalmology: Christopher Brown, M.D. Orthopedics: Jeffrey Steuer, M.D. Otolaryngology: John Poole, M.D. Podiatry: Ritchard Rosen, D.P.M. Plastic Surgery: Harris Sterman, M.D. Thoracic Surgery: Ignatios Zairis, M.D. Urology: George Klafter, M.D. Vascular Surgery: Kenneth Fried, M.D.
md360ºNews from and for Holy Name Medical Center’s
Medical Staff
Also available online at:www.holyname.org
January/February 2010
holy name Gets a new name HolyNamehasbecomethecenterofanet-workofphysicianpractices,culturally-focusedmedicalprogramsandotheron-andoff-sitecoordinatedservicesthatfosteracontinuumofcarefrompre-conceptionthroughend-of-life.Mostpeoplewhocometothecentralcampuseachweekforhealthcaredonotcomeforhospitalization.Th eycomeforawiderangeofsophisticatedtechnologicalexpertiserangingfromRadiologytotheMSCenter. Assuch,itisentirelyappropriatethatourhospitalberecognizedasHolyNameMedicalCenter.Althoughself-conferredbytheBoardofTrusteesandtheSistersofSt.JosephofPeace,thisrecognitionisconsistentwiththemanyformsofrecognitionearnedinrecentyearsbyHolyName:theprestigiousMagnetawardforoutstandingnursingandpatientcare,andthird-partyendorsementsfromnationalbenchmarkingorganizationsforclinicalexcellence,includingthosefromJ.D.PowerandAssociates,HealthGrades®andDataAdvantage,LLC. Butwhataboutthepartofthenamethatstaysthesame?WhenIfirstcametoHoly
A quilt celebrating plurality hangs in the waiting room of Holy Name’s Emergency Care Center.
Name,Iwondered“Whichholyname?”SinceitisaCatholichospital,IfiguredthatthisnamereferredtothenameofJesusorChristorGodtheFatherortheHolySpiritorperhapsalloftheaboveandadditionally,thenamesofsaints.AsIbecamemoreinvolvedwiththehospitalandsomanycaringpeople,IrealizedthatthenamesimplymeanstheHolyNameofGod. Allthemajorreligionshaverecognizedthefundamentalproblemofrememberingourrelationshipwiththeinfinite,omnipresentcreator.MysticsofeachreligionhavefoundthatconstantrepetitionofthenameofGodinvokesGod’spresenceinourlivesandbringsthepowerofcreationandcompassionandhealingintoourwork.ChristiansmayrepeatJesusChristorAveMaria.JewsmeditateBa-rukhattahAdoni,“Blessedartthou,OLord.”MuslimscallAllahbutknow100namesofGod,eachrecognizingoneofhischaracteris-tics.HindususeKrishnaorRamaoranyoneofmanyincarnationstoapproachasingle,almostunknowableGod.BuddhistsoftenrememberOmmanipadmehum,“thejewel
inthelotusoftheheart.” Howeverwebegintorecognizethedivinerelationship,theHolyNameistheidealtooltoquicklyorientourselvestogivingourbestinlifeandatourMedicalCenter.
—Adapted from Eknath Easwaran by Tom Birch.
Weliveinaninstantworld–instantcoffee,instantoatmeal,instantcupofsoupandeveninstantmashedpotatoes.Th roughtheadventoftheInternetanddigitaltechnology,weobtaininstantcommunicationandinstantimagery.Wewantinstantgratification.Inourworld,thingscanchangeinaninstant,someforthegood,butsomewithcatastrophicconsequences. Januarywasanexampleofuniqueinstantaneouseventsoccurringonaninternational,nationalandpersonallevel. Th ehorrificearthquakethatrockedHaitioccurredinaninstant,withoutwarning,wreakinghavoconanimpoverished,unpreparednation.WhetherornotHaiticanrecoverfromthisnaturaldisasterremainstobeseen.Butwhatisofconsequenceisthetremendousoutpouringofaid,monetaryandprofessional,generatedprimarilybyasenseofsocialconsciousnessandwithoutregardtopolitics.Th reeofourmedicalstaffmembers,Drs.Butler,FinleyandGwertzman,havegivenofthemselvesandvolunteeredtheirservicesandexpertiseatouraffiliateinHaiti,HôpitalSacreCoeur,locatedinMilot,70milesnorthofPortauPrince.Foundedover50yearsagobyDr.LarryMellon,HôpitalAlbertSchweitzer(HAS),located40milesnorthwestofPortauPrince,hasalsobeeninundatedwithhundredsofsickandwounded.Bothfacilitiesareingreatneedofmedicalprofessionalsandsupplies.InHAS,ithasbeenreportedthatonemonthofreserves
wereusedinoneday!OnecanonlyhopethattheWorldwillnotabandonHaitianditsneedsinaninstant. Nationally,Massachusettswasrockedinstantlybyanotherkindofearthquake,albeitmetaphorical,theelectionofaRepublican,ScottBrown,totheUnitedStatesSenateseatpreviouslyheldbytheDemocraticSenator,TeddyKennedy.Th iselectionsignaledtherebuketoandtherepudiationofthepowersthatbeinWashington.Th evotersrefusedtofollowblindlythe“politicsasusual”machinerytryingtoforceitsagendaandmandatesuponthemwithoutregardtotheirpersonalconsequences.Alreadyfinanciallyburdenedbyanout-of-controlCommonwealthhealthcaresystem,votersrefusedtoacceptthe“NebraskaCornHuskers”dealandthe“LouisianaPurchase.”Th equestionremainsastowhetherornothealthcareasoriginallycraftedandjammedthroughtheSenateonChristmasEveisviableinitspresentform. Onapersonalnote,Iwouldliketosharetwostoriesrelatedtohealthcare,bothofwhichoccurredinaninstant.First,oneofmyclosestfriendswasareluctantrecipientoftheCanadiannationalhealthcaresystem.Ageologistbytraining,andincidentallyDr.LarryMellon’sdaughter-in-law,myfriendwashikingintheProvinceofNewfoundlandandLabradorlastsummer,whenshefelland,inaninstant,fracturedherwrist.Shehaditreducedemergently.Allseemedsatisfactoryandcorrectuntilthefollow-upcarecame.
Patricia A. Burke, M.D., Ph.D., is President of the Medical Staff and an ophthalmologist on staff at Holy Name Medical Center.
from the president of the mediCAL stAff
In an InstantOnfourseparateoccasions,subsequentfilmswereorderedtoassesshealing.Eachtimeittookeight,yes,eighthourstoobtainonefilminthelocalclinic.NowoneneednotwonderwhytheirPremier,DannyWilliams,decidedtocometotheUnitedStatesforcardiacsurgery,tohaveaprocedurewhichisobviouslynecessary,butwasnotofferedtohiminhisownProvince.Luckyforhim,heispurportedlyindependentlywealthy. Secondly,ayoungladyonmydaughter’shockeyteamatHolyCrosshasbeendiagnosedwithasepticnecrosisofhertalus.HailingfromBritishColumbia,herdoctorsplacedherinawalkingboot,adoptingawaitandseeposition.Now,fourmonthslater,shehadhopedforsurgeryinJanuarytobehealthyfornextyear’shockeyseason.Ifsheisnotclearedtoplay,shecannotreturntoHolyCrosstofinishhersenioryearasshelosesherfinancialpackage.Inaninstant,arbitrarilyandwithoutconsiderationorcompassion,shehasbeenrescheduledforSeptember.ItisironicthataProvincePremiercanexercisethefreedomtoobtainhealthcarewhenandwherehewishes,buttheordinarycitizencannot.Whereistheirsocialconscience?Forher,Iimploreyours.
APRIL 20: Annual Allergy Conference: “Guidelines for Differential Diagnosis of Chronic Coughing, Asthma and Allergies”John Oppenheimer, M.D., University of Medicine and Dentistry of New Jersey
APRIL 27: “The Spectrums of Epilepsy and Seizures” Evan Fertig, M.D., Neurologist, HNMC
Service AnniversariesThe Holy Name family extends its congratulations and gratitude to the following members of the medical staff for their association with our Medical Center. This list recognizes anniversaries during Januaryand February, 2010.
25 Years Rosendito Largoza, M.D., Internal Medicine
20 YearsZachary Adler, M.D., Physical Medicine & Rehabilitation 15 YearsFrank C. Arturi, M.D., OphthalmologyHoward M. Friedman, M.D., PediatricsMargarite E. Remsey, P.A., Emergency Medicine
10 YearsVincent Carrao, D.D.S., Oral & Maxillofacial SurgeryChong Hyo T. Park, M.D., Pediatrics
5 YearsMohammad A. Chaudhry, M.D., Internal MedicineConrado A. Boja, M.D., Family PracticeSharon R. Maza, M.D., Internal MedicineElizabeth Falco, R.N.F.A., Orthopedics
Wearewitnessingthedemise(ornear-de-mise)ofmanyhospitals,facilitiesthathaveimmeasurablevaluetotheircommunities.St.Vincent’sinManhattanisthelatestcasualty.Whatwerethefactorsthatcontributedtofailure?Werepatientoutcomespoor?Wasfinancialmanagementatfault?Regulatorydemands?Ill-definedpriorities?Alackofvisionandunwillingnesstoevolvewiththetimes? Aswitheverysuccessorfailure,it’snotaboutonething.It’sabouteverything.It’saboutbalance.It’saboutreconcilingthecallofourmissionwiththerealitiesoftoday’shealthcareenvironment.Inthe85yearssince1925,we’vesurvivedandthrivedthroughgenerations,bal-ancingfidelitytoourfoundingprincipleswithchangeasneeded. Complacencyandinertiahavenoroleinaplaceofprogress.Eachofusneedstobeavision-aryinourownright,understandinghowthewaywefunctionasindividualshereatHolyNamehasadirecteffectontheMedicalCenter’sviability. Fortheyear2010,weestablishedinstitu-tion-widegoalsinfourstrategiccategories:quality, operational effectiveness, workplace excellenceandfinancial performance.Ihavesharedthesegoalswiththehospitalstaff,andhaveaskedfortheirattentionandcooperation.Theseareourpriorities,andIaskyoutomakethemyours,aswell. QualityisthecornerstoneonwhichpatientsatisfactionandpublicperceptionofHolyNamearefounded.Asprodigiousastherewardsforhighqualitymaybe,inattentiontoqualityindicatorscarriesconsiderableliability.Reducinginfectionratesandpreventableadverseevents,loweringreadmissionrates,andenhancingpatientsafetythroughsuchinitiativesasmedicationmanagementand
computerizedphysicianorderentryarekeytooutstandingqualityperformance. Enhancingoperationaleffectivenessisthekeytobalancingpatientcarewithbusinessdemands.Ouremphasishereisonreducingaveragelength-of-staytounder4.5days,keepinginmindthatatpresent,thesecondhighestLOScategory,Medicare,constitutesthehighestproportionofourbusinessbutcarriestheleastlucrativepay-ment.Conversely,oneofthelessfrequentpayorcategories,commercialinsurance,enjoysthehighestreimbursementratesbutthebriefestLOS. Asyouarewellaware,attentiontotheseis-suesimpactsmorethanourJointCommissionsurvey—onwhichweaimforhighlyfavorableresultsduringtheJC’snextvisit.Astheconceptofgainsharingtakeshold,andincentivesaretiedtoperformanceimprovement(anddisincentivesaretakenforlessthanoptimalperformance),itbehoovesustoalignourthink-ingwiththeseconcepts,astheyarethewayofthefuture. AtHolyName,thereishugeemphasisongrowingvolume,asitdrivessuccess.Thisyear’sgoalsaretosecureover19,000inpatientadmis-sionsandmorethan60,000EmergencyCareCentervisits.We’reaimingforasizableincreaseinsurgicalcases,withthegoalofover9,000,includingsame-day.Ilooktoyouasfundamen-taldriversofourpatientvolume,andaskyoutotakeappropriateopportunitiestoreferyourpatientstoHolyNameandperformyourpro-ceduresatourmedicalcenter.Westandreadytoworkwithyoutomakethisprocessefficientandsatisfyingforbothyouandyourpatients. Workplaceexcellenceandstaff/physiciansatisfactionalsoimpactourlong-termsuccess.Yourinputisinvaluablehere,forexample,whencommunicatingwiththenursingandtechnical
from the president/Ceo
Keeping an Eye on What Matters
Michael Maron is President/CEO of Holy Name Medical Center.
Key healthcare issues for nJ hospitals and patients This column appears in the March issue of Commerce magazine.
WhatarethekeyhealthcareissuesandhowwilltheyaffectpatientsatNewJerseyhospitals?Whatcanbedonetoachievethebestoutcome-basedmedicineinahospitalsetting?
ThemostcompellingchallengefacingNJhospitalstodayishowtoconsistentlydeliverthehighestlevelsofquality,access,andsatisfactiontoconsumersofhealthcare,inthefaceofgrowingregulatoryandfinancialpressures.Theseissuesareinterconnected,andareessentialtoahospital’ssuccess. Noneofusknowexactlyhowthepro-posedhealthcarereformwillultimatelyimpactthemedicaldeliverysystem.Wedoknow,however,thatqualitymustbemain-tained.Manythingscanaffectthequalityofcareprovided:theexpertiseoftalentedcaregivers,theavailabilityofadequatefinancialresources,andthestrengthofanorganization’sstructureandprocesses. Fromthevantagepointofsome,thehealth-carefieldasacareerchoicehasbeenmadesomewhatlessattractivebybureaucratic
interferencethathinderswhatusedtobethesacrosanctrelationshipbetweenphysicianandpatient.Reimbursementwoesmakeitdifficulttoadminister,staffandsupplyaprivatepracticewithoutconsiderablepersonalliability.Asaresult,someareasofthecountryareseeingshortagesofcertainhealthcareprofessionals.Inaddition,practicingdefensivemedicinehasbecomeroutineforsomephysi-ciansbecauseitprovidesacertainmeasureofprotectioninourlitigioussociety. Ouragingpopulationposesanotherchal-lenge.Withlongerlifecomesmoreadvanced,complexillness.Thebroadscopeofservicesneededbytheelderlycantaxresources(bud-gets,caregivers,space)andisposingunprec-edentedethicalissuesforourgeneration. Alloftheseissuescreatepotentialaccessproblems—delaysandrestrictions—forbothinsuredanduninsuredpersons.Wetalkabouthealthcareforall,butwillitreallybeforall?Thatquestionloomsforus,ashealth-careadministrators. Whatcanwedo?Practiceevidence-basedmedicine,whichappliesthescientificmethod
Craig Hersh, M.D. is Assistant Vice President of Medical Affairs at Holy Name Medical Center.
dr. sharad Wagle honoredBergen County Executive Dennis McNerney (left) with Lalita Wagle, M.D., Medical Director of Physician Services, and Sharad Wagle, M.D., Medical Director of Behavioral Health and Chief of the Department of Psychiatry. Dr. Sharad Wagle and six other prominent Bergen County residents of Indian descent were honored with commendations from the County Executive and the Board of Chosen Freeholders at the Bergen County Indian Flag Raising Ceremony and Celebration commemorating the 60th Anniversary of the Republic of India on January 26.
tohealthcaredecision-making.Emphasizeresults;weknowtherewillbeanincreasinglygreaterconcentrationonoutcomes,withrewardsforhospitalsthatexcelanddisincen-tivesforthosewhodon’t.Createacultureofsafety,inwhichcompliancewithmeasuresdesignedtoprotectpatientsfrominfectionandinjuryisapriority.Promotephysicianandstaffaccountability.Increaseefficiencywhiledecreasingcoststhroughsuchinitiativesastheelectronicmedicalrecord.Tiedecisionsaboutprogram-buildingtorealcommunityneed,ratherthanfleetingtrends. Andattheendoftheday,keepingthecompassioncommensuratewiththetech-nology,focusingonourmissionashealth-careproviders,andmaintainingtheintegrityoftheoathareparamounttohospitals’
successandourpatients’well-being.
2
Jane Ellis is Vice President for Marketing and Public Relations at Holy Name Medical Center.
AsofMarch9,HolyNameHospitalofficiallychangeditsnametoHolyNameMedicalCenter.Thismilestoneisconcurrentwiththe85thanniversaryofourfoundingbytheCongregationoftheSistersofSt.JosephofPeacein1925. HolyNamehasevolvedinsomanywaysastomaketheterm“hospital”—whichoftenconnotesasmallandsomewhatlimitedfacility—nolongerapplicabletowhoweareandwhatwedo.Ourscopeofserviceshasincreasedconsiderably,weofferleading-edgetechnologyandprocedures,we’veaddedoff-sitelocationsthroughoutBergenCounty
andbeyond,andourmedicalstaffhasalmostdoubledinfiveyears.Andthankstoyourskillsanddedication,we’vegarneredanimpressivearrayofawardsforpatientcareandworkplaceexcellence. Ournewbrand,Holy Name Medical Center,isnotjustalogowithafreshlook—it’smuchmorethanthat.It’saboutthetotalexperiencethatisHolyName.Ournameinfluencesperception.Perception,inturn,affectschoice.ItiscriticaltoHolyName’scontinuedsuccessandtoourpatients’understandingofwhatourorganizationhastooffer,thatweareperceivedastheleading-edge
holy name hospital is now...healthcarechoiceinourmarket.Furthermore,itisimportantthateveryoneassociatedwithourmedicalcenterknowsthatalthoughwehaveanewname,itdoesnotaffectHolyName’smission,whichremainssteadfast. PleaseusetheHoly Name Medical Centernamewithpride…you’veearnedit!
2010 General medical staff meetings
You are invited to attend the General Medical
Staff Meetings. These Meetings are held at
12 noon in the Marian Hall Conference Center.
Find out what’s happening at Holy Name and in
the medical community. Enjoy lunch.
Wednesdays:June 9
September 8December 8
staff,andfosteringateamapproachtoachiev-ingcommongoals. Ourmedicalstaffhasalmostdoubledinthelastseveralyears,andwe’recontinuingthateffort,rampingupphysicianrecruitmentandpracticedevelopment,andtargetingspecificgeographicandpatientpopulationstospurgrowth.Wearedevelopinginnovativeanddifferentiatingcaremodelsinspecificspecialtyareas,andwritingITprogramstoenhanceefficiencythroughouttheMedicalCenter.Andalldepartmentsarechargedwithimprovingoverallprocessestomaximizeeffectivenesswithoutsacrificingquality. Alloftheabovetiesdirectlyorindirectlytofinancialperformance.AtHolyName,we’reworkingtoincreaseourcashonhand,increas-ingouroperatingmargin,workingonstaffingschedulingissuesandencouragingbudgetcompliance.Iaskyoutonoteyourownroleintherevenuecycleandbeattentivetohowyoucanachievetheseobjectives. Toparaphrasethesmallprintfromfinancialinvestmentprospectuses,pastperformanceisnotapredictoroffuturesuccess.Still,Iamconfidentthat,withyourhelp,HolyNamewillbeabletomaintainfiscalstabilitywhilefulfillingbothourmissionandnavigatingthisever-evolvingandcomplexhealthcareenvironment. Asalways,yourfeedbackandinsightsareappreciated,andIthankyouforsharingyourexpertisewithHolyName.
Welcome to the medical staffAppointments approved in January and february, 2010
Alice Chu, M.D.Medicine/Rheumatology
Medical School: Korea University of Medicine Internship: Long Island Jewish Medical Center (Medicine)Residency: Washington Hospital Center (Medicine)Fellowship: Presbyterian Hospital (Rheumatology)Practice: 889 Allwood Rd., Clifton, NJ 07012Phone: 973-778-6800
Jeff Chung, M.D.Medicine/Rheumatology
Medical School: SUNY Health Science Center at Brooklyn Internship: Yale-New Haven Hospital (Medicine)Residency: Yale-New Haven Hospital (Medicine)Fellowship: Yale-New Haven Hospital (Rheumatology)Practice: 889 Allwood Road, Clifton, NJ 07012Phone: 973-778-6800
Jason Gallina, M.D.Surgery/Orthopedics
Medical School: UMDNJ-Robert Wood Johnson Medical School Internship: St. Luke’s-Roosevelt Hospital (Orthopedics)Residency: St. Luke’s-Roosevelt Hospital (Orthopedics)Fellowship: Spine Institute at Saint John’s Health Center (Spine Surgery)Practice: 541 Cedar Hill Avenue, Wyckoff, NJ 07481Phone: 201-447-0550
Harlan Levine, M.D.Surgery/Orthopedics
Medical School: Cornell University Fellowship: Rush-Presbyterian-St.Luke’s Medical Center (Adult Reconstructive)Internship: Hospital for Joint Diseases and Medical Center (Orthopedics)Residency: Hospital for Joint Diseases and Medical Center (Orthopedic Surgery)Practice: 10 Prospect Avenue, Paramus, NJ 07652Phone: 201-291-4040
Elijah Owens, M.D.Medicine/Neurology
Medical School: Columbia University College of Physicians and Surgeons Internship: Beth Israel Hospital (Medicine)Residency: Beth Israel Hospital (Neurology)Practice: 680 Kinderkamack Rd., Oradell, NJ 07649Phone: 201-261-6222
holy name doctors dispense skill and mercy in haiti Intheaftermathofthedevastatingearth-quakeinHaiti,HolyNameMedicalCenter’sDavidButler,obstetrician/gynecologistandanesthesiologistsAlanGwertzman,M.D.andTimothyFinley,D.O.participatedinahumanitarianmedicalmissiononbehalfoftheCenterfortheRuralDevelopmentofMilot(CRUDEM)Foundation.Upontheirreturn,thephysicianspresentedamovingslideshowandcommentaryabouttheirexperiencesinHaitiataHolyNamepressconferenceonFebruary4andatMedicalGrandRoundsonFebruary23. During10daysattheHôpitalSacreCoeur,whichislocatedabout65milesnorthofPortAuPrinceinMilot,Drs.Butler,Gwertz-manandFinleymadeatremendousimpact,convertinga66-bedhospitalintoatraumacentertreatingmorethan420patients—mostlyamputations—andexpandingfromtwooperatingroomsintofive.“Wehadtoadjustaccordingly,”explainsDr.Butler,whoisVicePresidentoftheCRUDEMFounda-tionandhasservedtheHôpitalSacreCouerfor18yearsonabiannualbasis.“Weneededtotreattheearthquakevictimswhilecon-tinuingtoservethepatientsforwhomwetypicallyprovidecare.” “Weseizedthemissiontorebuildthishospital,”saysDr.Finley,whohadbeenonsevenpreviousmissionstoHaiti.However,henotesthatneverhasitbeenas“chaotic”asthis.“Dr.GwertzmanandItookchargeanddecidedtorunitlikeHolyNamebycollec-tivelycreatinganeffectivesystemtomanagetheoperatingrooms.”
A life-altering experience WhileinHaiti,thedoctorswitnessedex-traordinaryactsbycolleagues.“IwasproudtobeanAmerican,proudtobeaphysician,andproudtobeaHolyNamephysician,”declaresDr.Gwertzman,DirectoroftheDe-partmentofAnesthesiology.Bothphysiciansspokeofanalreadyimpoverishedcountryrisingtotheoccasion,theoutpouringofloveandcamaraderieofphysicians,andtheselflessactsofkindness.“Wegavealot,”saysDr.Gwertzman.“Butthespecialmagic,thepositivemessageandspiritualitythatwegotbackfromthepeopleofHaitihasbeenalife-alteringexperience.” Dr.Finleytellsthestoryofaboywhocaughthisattention.“Everydaywewouldmakeeyecontact,”herecalls,“andIwouldstopandgivehimalittlefistpump.”Sincetheyoungsterwasalone,thewhereaboutsofhisfamilyunknown,Dr.Finleylearnedthechild’sname.Thenextday,thedoctornoticedthenameonthesurgicalscheduleforanamputa-tion.“IknewIneededtobetheonetoexplaintohimwhatwasabouttohappen,”saysDr.Finley.“Sowiththehelpofaninterpreter,I
explainedtohimthathewouldneedtohavehislegamputated.”Butattheeleventhhour,anorthopedicsurgeonwhohadjustarrivedattheHôpitalSacreCoeurapproachedDr.Finley,sayinghebelievedhecouldavoidamputatingtheboy’sleg.Afternumeroussurgeriestocleantheinfectedwounds,thephysicianswereabletosalvagethelimb. “Manychildrenwerecryingoragitated,”saysDr.Gwertzman“Itwasnotnecessarilybecausetheywereinpain;itwasbecausetheyhadseensomanypatientsgointotheoperatingroomwithallfourlimbsandcomeoutwithfewer.”ApatientofDr.Gwertzman’s,anotheryoungboy,wasonhiswaytosurgeryforsevereburnsonhisleg.Clearly,thechildwasanxious.Dr.Gwertz-manpromisedhimthathewouldcomeoutwithallfourlimbs.“Ihadpurchasedbrightyellowworkbootsforthemission,”explainsDr.Gwertzman.“SoItoldhimthatafterhissurgery,thebootswouldbehistosolidifymypromise—nowhehasnewboots.”
More help on the way AccordingtoDr.Butler,themajorityof
Alan Gwertzman, M.D., David Butler, M.D. and Timothy Finley, D.O. in Haiti.
theearthquakevictimshavebeentreatedfortheirinitialacutewounds.“Thiscreatesanewsetofchallenges,”heexplains.“Wemustbesurethatthesepatientsreceivefollow-upcareandwell-madeprosthesessotheymaylivelifetothefullestpotential.” “Itissoimportanttohaveagivinghearteveryday,”saysDr.Finley.“EverydayIthinkaboutwhatIcandotomaketheworldabet-terplace.” ThroughacollaborationbetweenHolyNameandBergenAnesthesia,monieshavebeenraisedtosupporttheHaitiCrisisFundandTheCRUDEMFoundation’sgoaltorebuildtheHôpitalSacreCoeur.Inaddition,HolyNamehasdonatedmedicalsuppliesforbothpediatricandadultpatientsincludinganesthesiasupplies,painmedications,andantibiotics.Mostrecently,throughthecom-binedeffortsandresourcesofHolyNameanditsemployees,BergenAnesthesiaAssociates,medicalequipmentcompanyOGSI(OxygenGeneratingSystemsIntl.),BurnAdvocates,andRoyalCaribbeanInternational,anoxygengeneratorhasbeenmanufacturedand,atpresstime,wasintransittoHaiti.
3
report from the Chief nursinG offiCer
Healthy Heart Initiative: Good News for Patients,Good News for Bottom LineHeartfailure(HF)isamajorpublichealthproblemassociatedwithhighmedicalresourceconsumption,frequentandcostlyhospitaladmissions,andhighmortalityrates.Medicarereimbursementforheartfailurehasdecreasedwellbelowtheaverageinpa-tientcost,andcurrentguidelinesprecludeanyreimbursementforhospitalreadmissionswithin30daysofdischarge.AtHolyName,we’reworkingtodecreaseourHF30-dayreadmissionratetoimproveourpatients’qualityoflife,aswellasourownfiscalhealth. Dataindicatesthatapproximately50percentofHFreadmissionsarepreventable.Wealsoknowthatreadmissionsareusuallyduetolackofdiseaseself-management,includingnoncompliancewithmedicationanddiet,andpatientinabilitytoidentifyearlywarningsignsofHFexacerbations. Isn’tthereaneffectivewaytoreduceriskandreturnfunctionalitytoourHFpatients,toelevatethequalityofcarewithoutaddedchallengestothetimeandfinancesofpatientsandphysicians?Thereis,andit’scalledtheHealthyHeartInitiative. HolyName’sHealthyHeartInitiative
(HHI)isaone-of-a-kindprograminBergenCountythatnotonlymeetsourorganiza-tion’sobjectivesofreducingHFadmissions,decreasingcostpercaseofeachchronicHFpatient,andreducinglength-of-stayforre-admittedpatients,italsoenhancesthehealthstatusandqualityoflifeforHFpatientsbyempoweringthemtotakeanactiveroleinmanagingtheirdiseasethroughself-care. DevelopedanddirectedbyJudithKutzleb,D.N.P.,R.N.,CCRN,APN-C,theHealthyHeartInitiativehelpsphysiciansmanagetheirchronicheartfailurepatientspost-dischargethroughpersonalizededuca-tionaboutdiet,exercise,smokingcessationandmedicationmanagement,andregularweeklyfollow-up.Conductedbyadvancedpracticenursestrainedincardiology,thedifferencebetweenHolyName’sinitiativeandsimilarprogramselsewhere,isthatthephysiciansremainincontroloftheirownpatients.HHItakesplaceincooperationwiththeprimarycarerenderedbyphysi-cians—itdoesn’tsubstituteforit. Priortodischargefromthemedicalcenter,patientsarescreenedformajorrisk
factors(myocardialinfarction,diabetes,obesity)andminorriskfactors(dislipe-demia,sleepdisorders).Theyareevaluatedfortheirexercisecapacity,andsubsequentlyreferredtoexerciseprogramswitheitherHolyName’sCardiacRehabilitationPro-gramorHNHFitnessinOradell,dependingontheirNYHAheartfailureclassification.Patientsreceiveregularfollow-upthroughtelephonemonitoring—somethingforwhichprimarycarephysiciansgenerallydonothavethetimeorresources. IencourageyoutoreferyourHFpatientstotheHealthyHeartInitiative.Inonlythreemonthssincetheprogram’sinception,therehavebeen26patientswhohaveparticipated
intheHHI,withzeroreadmissionswithin30daysofdischarge. For more information contact Judith Kutzleb, D.N.P., (201) 833-7183.
Steps for Physicians:1. WriteanorderforaCHFpatient educationconsult.2. TheHealthyHeartInitiativeAPNwill benotified.3. Apatientconsultwillbecompleted within24hoursofsubmittingtheorder.4. Consultincludes:patienteducation, documentationofejectionfraction,daily weight,treatmentplanforpatient’s diseaseself-managementandhomecare referrals.5. Ifthepatienthasnoscale,onewillbe providedfreeofcharge,aswellasan educationbookletwithpersonalized guidelinesfordiet,physicalactivity, symptomsofexacerbationthatwarrant physicianintervention,etc.
Sheryl Slonim, RNC, M.Ed., CNAA is Executive Vice President for Patient Care Services at Holy Name Medical Center
Thisisthefaceoftheexpandingcohortofmetabolicsyndromeanditsurologicmani-festations.Moreandmore,youngerpatientsareexperiencingerectiledysfunction(ED)andlowerurinarytractsymptoms(LUTS).Metabolicsyndromeisclearlyoneoftheculprits,causing40%ofmenintheirfourthdecadetoexperiencesomedegreeofED. Themetabolicsyndromeischaracterizedbyagroupofmetabolicriskfactorsinoneperson.Theyinclude: • Abdominalobesity(excessivefattissue inandaroundtheabdomen) • Atherogenicdyslipidemia(bloodfat disorders[hightriglycerides,lowHDL cholesterolandhighLDLcholesterol] thatfosterplaquebuildupsinartery walls) • Elevatedbloodpressure • Insulinresistanceorglucose intolerance(thebodycan’tproperly useinsulinorbloodsugar) • Prothromboticstate(e.g.,high fibrinogenorplasminogenactivator inhibitor–1intheblood) • Proinflammatorystate(e.g.,elevated C-reactiveproteinintheblood)
Peoplewiththemetabolicsyndromeareatincreasedriskofcoronaryheartdisease,type2diabetes,andotherdiseasesrelatedtoplaquebuildupsinarterywalls,suchasstrokeandperipheralvasculardisease.Metabolicsyndromehasbecomeincreas-inglycommonintheUnitedStates.It’sestimatedthatover50millionAmericanshaveit. Accordingtoanewstudythataddstothegrowingevidenceofalinkbetweenurinaryproblemsandotherchronicconditions,menwithlowerurinarytractsymptomsaremorelikelytosufferfrommetabolic
syndrome.Thisstudy,intheAugust2009Journal of Urology,foundthatmenunder60yearsofagewhoreportedmoderatetoseverelowerurinarytractsymptomswere1.68timesmorelikely(95%CI1.21to2.35)tosufferfrommetabolicsyndrome.Sexualdysfunctionsymptoms,particularlyerectiledysfunction,aresimilarlyreportedbythemajorityofmenwithmetabolicsyndromeandshouldberoutinelyevaluated. Thesefindingshaveimportantimplica-tionsforthediagnosisandmanagementofurologicconditionsinthispopulationofpatients. Patientswhopresentwithcomponentsofmetabolicsyndromeshouldberoutinelyquestionedwithrespecttourologicalfunc-tion,particularlyvoidingsymptomssuchasintermittency,incompleteemptying,andnocturia.Additionally,thoroughsexualhis-toryanddietaryhabitsshouldbeobtained. InadditiontotreatingthesesymptomswithalphablockersorPDE-5inhibitors,westronglycounselourpatientsonappropri-atelifestylechanges,includingweightlossandconsistentphysicalexercise.Anylossofsexualfunctionintheserelativelyyoungmencanprovideapotentmotivationaltool.Itshouldbenotedthattheroleoftheselifestylechanges,suchasweightlossandincreasedphysicalactivity,inthemanage-mentofurologicalsymptomshavenotbeenthoroughlystudied. Severaltheorieshelpexplaintheassocia-tionofmetabolicsyndromeandurologicalconditions.Oneprevailingthoughtisthattheincreasedglucoselevelsareaccompa-niedbyhyperinsulinemia,resultinginanincreaseintheinsulin-likegrowthfactor,whichisaknownprostaticmitogen,andinducesareductioninapoptosispathwaysintheprostate.Thismayalsoexplainthe
metabolic syndrome and Luts
Robert Simon, M.D. is a urologist on staff at Holy Name Medical Center.
Eric Margolis, M.D. is a urologist on staff at Holy Name Medical Center.
A 46-year-old obese man with hypertension and hyperlipidemia complains of erectile dysfunction and waking up two times per night to urinate. This presentation is being noted with increasing frequency in our practice. It is not uncommon that these young men are hesitant to start adding alpha blockers and PDE-5 inhibitors to their already expanding list of medications. They feel that Flomax, Avodart and Viagra or Levitra are not for them but rather their fathers and are therefore apt to try lifestyle changes as an effective treatment modality.
it innovAtions
Use WebNOTES for Better Progress Notes HolyNameMedicalCenterhasbeenaninnovatorinelectronicmedicalrecorddevelopmentandimplementationformanyyears.WebHIS,HolyName’sclinicalinformationsystem,hasbecomeaninvaluabletoolforyoutoaccessandmanageyourpatients’informationandcare.ThroughWebHIS,youhavealsobeenabletoaccessWebSIG,therobustapplicationthatallowsyoutoread,editandsignyourmedicalrecorddocuments.Completingthephysicians’medicalrecordistherecentlyreleasedWebNOTES,anelectronicprogressnotesapplication. WebNOTESallowsyoutodictateprogressnotesutilizingstate-of-the-artvoicerecognitiontechnology(Dragon-10Medical).Theseprogressnotes,utilizingtheSOAPformat(subjective,objective,assessmentandplan)areavailableinstantaneouslyasyoudictate,andappearintheWebHISimmediately,oncethenoteissaved.Ifyouprefer,WebNOTEScanbecreatedutilizingkeyboardinginsteadofdictation. WebNOTESallowsyoutoeasilyimportkeylaboratoryvalues,radiologyreportsandotherclinicaldataalreadypresentinthepatient’sWebHISmedicalrecord.Thesystemallowsforthecustomizationoftemplatesand‘normals’allowingyoutocreateyournotesconsistentlyandexpeditiously. WebNOTEShasbeenlivefortwomonths,withover2,000notesalreadycreatedandstored.WeneedeachofyoutobecometrainedandsavvyintheuseoftheWebNOTESprogramassoonaspossible.DictationtrainingcanbescheduledbycontactingDeb Ross at ext. 7114orviaemailatdebross@holyname.org.Ascheduleofgroupclasseswillbedistributedonaregularbasis,aswell.
Benefits to Physicians • Patient is monitored weekly • Promotes quality outcomes • Decreased readmission rates • Physician receives fewer phone calls • No charge or financial disincentive for physician or patient
since the program’s inception, there have been 26 patients who have participated in the hhi, with zero readmissions
within 30 days of discharge.
associationbetweenobesityandpros-tatecancer.Anincreaseinthesizeoftheprostatethenleadstoworseningoflowerurinarytractsymptoms. Additionally,sustainedhyperglycemiamayhaveanadverseeffectonparasympa-theticnervefunction,leadingtosympa-thetichyperactivity.Thismayresultinhighbladdernecktonewithsubsequenturinarysymptoms.Sympathetichyperactivitywillalsoleadtoerectiledysfunctionbydecreas-ingbloodflowthroughthecavernosalarteries.This,inturn,reducesengorgementofthesinusoidswithintheerectilebodies. Consideringthegrowingpopulationofourpatientswithmetabolicsyndrome,itiscertainlyimportanttounderstanditsrelationshiptolowerurinarytractsymptomsanderectiledysfunction.Whilethepossibil-ityofspecificpharmacologicalinterventionstotreaturologicalconditionsinpatientswithmetabolicsyndromemaynotbefaroff,guid-ingthesepatientsonweightlossandexerciseremainsofprimeimportance. Inanefforttotreatthesepatientsinaglobalmanner,insteadofwithamedicinecabinetoverflowingwithcostlydrugsandpotentialsideeffects,itisourgoalattheUrologyCenterofTeanecktoscreenthesepatientsandtoaddressthemetabolicsyndromeratherthanitsendorgancomplaints.
Drs. Simon and Margolis practice at Urology Center of Teaneck, 222 Cedar Lane, Teaneck, NJ, 201-457-1500.
4
StateandnationalqualityinitiativeswillbelookingspecificallyatthosepatientsadmittedtoHolyNamewithadiagnosisofcongestiveheartfailure(CHF)whoarere-admittedtotheMedicalCenterwithin30daysofbeingdischarged. Th e30-daytimewindowincludespatientstransferredtoanotherfacility,i.e.,hospital,short,intermediateorlong-termcarefacility.Ifapatientisre-admittedtoourfacilityoranotherhospitalfacilitywithin30days,HNMCcouldbedeniedpaymentfromMedicareand/oranyotherthirdpartypayorforthepatient’soriginalandsecondadmission. Th erefore,theneedtofollowthesepatientsfromthemomentofadmissiontodischarge,andevenpost-discharge,isessential.Inordertodothis,HNHhascreatedapre-printedPhysician’sOrderFormcoveringallofthevital
aspectsofaCHFpatient’scareduringhisorhertreatmentatHNH.Th eformisavailableontheHospital’sRUMBAsystemandislistedasfollows:CHFCongestiveHrtFailureOrd. Th ePhysician’sOrderFormwascreatedbyamultidisciplinarycommitteeandthefinalformwasreviewedandapprovedbythedepartmentsofCardiologyandFamilyPractice,nursingleadership,thePharmacy&Th erapeuticsCommittee,andMedicalExecutiveCommittee. Welookforwardtoyourassistanceinthisvitalinitiativetoprovidethebestlevelofcaretoourpatientsandprevent,whenfeasible,unnecessaryreadmissions. If you have any comments, concerns, questions and/or suggestion, please do not hesitate to call the Medical Staff Offi ce at 201-833-7273.
from the offiCe of mediCAL AffAirs
Congestive Heart Failure (CHF) Initiative & Orders
phArmACY updAte
Backorders and ChangesBackorders: Propofol (Diprivan) Recently,twoofthethreesuppliersofpropofolhaveexperiencedunrelatedmanufacturingissuesduringtheproductionoftheirrespectiveproduct.Obviously,thishasresultedinextremelylowinventorylevelsofpropofolinthemarketplaceandwearenowfacedwithonemanufacturersupplying100%oftheUSmarket. Wehavestandingordersandgetshipmentsfromourwholesalersanddirectlyfromthemanufacturers.Assuppliesarereleased,wereceiveproduct,butnotalwayswhatweneed.Hence,wearerestrictingthe20mLvialstoplacementintheAnesthesiaTrays.Th e100mLisbeingstockedandusedupinEndo,fornolongerthan4hours,onceopened.Th isisanationwideshortageandinsomeplaces,alternativemedicationsarebeingutilized.
Changes: Colchicine Th ereisachangeinhowcolchicineisdosedforacutegout.Inappropriatecolchicinedosingisleadingtoproblems. Th eoldregimenwastoadminister2tabletsofthe0.6mgcolchicine,followedby1tabeveryhouruntilpainsubsidesorGItoxicityoccurs.Th e new regimen is 2 tablets followed by just 1 tab one
Russ Lazzaro, MS, RP,Director of Pharmacy Services; and the Pharmacy and Th erapeutics Committee at Holy Name Medical Center.
hour later for a gout fl are.Takingmorethan3tabletsisNOTmoreeffectiveanditcausesmoreadverseeffects.About25%ofpatientsonthelowerdosegetGIeffects,comparedtoalmosteveryoneonthehigherdoses. Recommendevenlowerandlessfrequentdosingifcolchicineiscombinedwithdrugsthatinhibititsmetabolism.FormoderateCYP3A4inhibitors(verapamil,etc),havepatientstakejust2colchicinetabsandNOTrepeatforatleast3 days. ForstrongCYP3A4inhibitors(clarithromycin,etc),havepatientstake1colchicinetab,thenHALFatabanhourlaterifneeded,andnotredoseforatleast3days. DoNOTusecolchicinewithstronginhibitorsifpatientshaverenalorhepaticimpairment.Andlimitcolchicinecoursestoevery2weeksforsevereimpairment.Counselpatientstoavoidgrapefruitwhentakingcolchicine.
BacterialresistancecontinuestobeanongoingproblemnationwideandatHolyNameMedicalCenter.Wecontinuetofacedailychallengeswhenprescribingantibi-otics.Ourbiggestchallengehasbecomepatientswithpenicillin(PCN)allergies!Pa-tientswithPCNallergiescanhavedelaysintherapyandmanytimesareadministeredsecondlineagentsfortheirinfection. Th etrueincidenceofallergicreactionstopenicillinisunknown,butitisestimat-edtoinvolve0.7%to10%ofthepopula-tion.Nearly10%ofallergicreactionsarelife-threateningand1%arefatal. PCNisknowntocausetypesI, II, III, IVandidiopathicreactions.Inorderforthosereactionstooccur,thepatientmustbesensitizedtothedrug.Th ereactionsaredefinedas:
TYPE I–anaphylacticandmediatedbyIgE.Generallyoccurringwithin30minutesofexposuretotheallergen.Somemanifestationsincludebronchialasthma,allergicrhinitis,urticaria,angioedemaandanaphylacticshock
TYPE II –antibodymediatedcytotoxicreaction.Th isoccurswithin5-12hours.IgMorIgGareinvolvedinthistypeofhypersensitivityreaction.Manifestationsincludehemolyticanemia,agranulocyto-sis,leucopeniaandthrombocytopenia.
TYPE III–mediatedbyanimmunecomplex.Th ecomplexisformedbetweentheallergenandIgGorIgM,causingdrug-inducedfeverandallergicvasculitis.Th isoccurswithin3-8hours.Serumsick-nesssyndromeisalsocategorizedasTypeIIIandcantake7-14daystoappear.
TYPE IV–delayedreactionmediatedbyT-lymphocytesoftenwithdermatologicmanifestations.Occurswithin24-48hoursfromcontact.Idiopathicimmunologi-calreactionsarebelievedtobeimmunemediatedbutthemechanismofactionisunknown.Exfoliativedermatitis,erythemamultiformeeruptionsandmaculopapular
Penicillin Allergies From the Infectious Disease Physicians and Infectious Disease Pharmacist of Holy Name Medical Center: Th omas Birch, M.D., Amita Desai, M.D., Mihran Seferian, M.D., Suraj Saggar, D.O. and Lori-Ann Iacovino, M.S., R.Ph.
Table 1. 7- Position Side Chains of Penicillins and CephalosporinsSimilar Side Chain Cross Rx Possible
Penicillin G CephalothinCephaloridine
Similar Side ChainCross Rx Possible
Ceftriaxone (Rocephin)Cefotaxime (Claforan)Cefpodoxime (Vantin)Ceftizoxime (Cefi zox)Cefpirome (Cedixin)Cefepime (Maxipime)
Dissimilar Side ChainUnlikely Cross Rx
Cefoxitin (Mefoxin)Cefprozil (Cefzil)CefmetazoleCefi xime (Suprax)Ceftibuten (Cedax)Ceftazidime (Fortaz)
Similar Side ChainCross Rx Possible
AmpicillinAmoxicillinCephalexin (Kefl ex)Cephradine (Velosef)Cefadroxil (Duricef)Cefaclor (Ceclor)
Dissimilar Side ChainUnlikely Cross Rx
Cefazolin (Ancef)Cefotetan (Cefotan)Cefuroxime(Zinacef, Ceftin)Cefdinir (Omnicef)CefoperazoneCefditoren (Spectracef)
rashareindicatorsofPCNhypersensitivity. Itisimperativetoidentifythereactionandassessifthepatientcantakeapenicil-lin-basedantibiotic.AsofJanuary2010,skintestingisnowanoptionasPrePen,askindeterminant,hasbeenbroughtbacktothemarket.Itisimportanttoberemindedthattestresultsdonotappytootherclassesofantibiotics.Th etestas-sessesonlyallergicreactionscausedbyIgEantibodies.Suchadverseaffectsasserumsickness(mostcommonly,hives,pain,andswelling)anddrugfever(ahightempera-tureduetoadrugreaction)maystilloccur,evenifpenicillinskintestisnegative.Analternativeistheprescribingofacephalo-sporin,asevidencenowsuggestscross-re-activitywasoverestimated. Withregardtocephalosporins,earlyworkoncross-sensitivitycitedratesof7%and8.1%whichwereoftenroundedupto10%inmedicaljournals.Itwaslaterdiscoveredthatfirstgenerationcephalosporinswereproducedbythecephalosporiummoldandoftencon-tainedtraceamountsofpenicillin.Also,analysesofearlierstudieswerefoundtocontainasignificantproportionofreportedreactionsthatwerenottrueallergicresponses.Cephalothin(Kefl in)andcephaloridine(Kefl odin)(first-gen-erationcephalosporins)andcefamandole(Mandole)(second-generationcephalo-sporin)didhaveanincreasedfrequencyofallergicresponsesinpatientswith
previousallergicreactionstopenicillin. However,increasedreactionswerenotobservedwithothersecond-generationcephalosporinsoranythird-generationcephalosporin.Apteretalevaluatedallergicreactionsfromcephalosporinsamongpenicillin-allergicpatients.Th eyfounda1.1%increasedriskofreactionsbutalsofoundtherewasa1.6%increasedriskofreactionswhenthesepatientswerechallengedwithsulfonamideantibiotics.Th esefindingsargueagainstcross-reactiv-ityasthemechanismofreportedincreasesinallergicresponsesinthesepatients,asitappearsthatpenicillin-allergicpatientstendtobeallergictomultipleantibiotics,inadditiontoafewcephalosporins. Cross-reactivity of cephalosporins and penicillins due to similarity of side chains: Cephalosporinsandpenicillinsbothpossessabeta-lactamring.Severalcephalosporinshavesidechainsofthebeta-lactamringatthe7-positionsimilartothesidechainofpenicillin(seeTable1).Th erefore,theseantibioticswouldbeexpectedtobeassociatedwithincreasedcross-reactivity.Severalcephalosporinshave7-positionsidechainssimilartoampicillinandamoxicillin(seeTable1).Th eseantibioticswouldhaveagreaterprobabilityofproducingallergicreactionsinpatientsallergictoampicillin.Ontheotherhand,cefdinir(endorsedbytheAAPforpenicillin-allergicpatients)doesnothaveasimilar7-positionsidechain
comparedwithpenicillinorampicillinandwouldunlikelyproduceanallergicreaction.Sastreevaluatedtheclinicalcross-reactivityofamoxicillinandcefadroxil,bothhavingasimilarsidechain.Two(12%)of16amoxicillin-allergicpatientswithgoodtolerancetopenicillindevelopedanallergicreactiontocefadroxil(Duricef).Inanotherstudy,8of21patients(38%)allergictoamoxicillinwerealsoallergictocefadroxil,butnonewereallergictocefamandolewhichhaddissimilarsidechains.Th erefore,inpatientsallergictopenicillin,cross-reactivityisunlikelywithselectivecephalosporins. When a PCN or cephalosporin type antibiotic is prescribed for a patient with a PCN allergy, the Pharmacy will con-tinue to call Prescribers; however, we are encouraging all Pharmacists to discuss the PCN allergy and when appropriate, educate Prescribers on the risks of cross sensitivities among the cephalosporins. To reduce the phone calls, if you are aware that a patient is able to tolerate a PCN or cephalosporin, please indicate on the Physician Order Form that you are aware of the allergy. If you would like the allergy removed from the database, please indicate that on the Physician Order Form and the Pharmacy will remove the allergy from the data base. Referencesareavailableuponrequest.PleasecontactthePharmacyatext.3055or3773.
5
A tribute to a dialysis pioneer: James e. Cimino, m.d.
James(Jack)CiminodiedquietlyathomeonFebruary11,2010.Dr.Ciminoisbestknownforhisconceptionofthearteriovenousfistula(AVF),whichwasoriginallypublishedintheN Engl J Medin1966,alongwithco-authorsDr.MichaelBrescia,Dr.KennethAppelandDr.BaruchHurwich.Today,theAVFiswidelyacceptedthroughouttheworldasthevascularaccessprocedureofchoiceformorethan400,000patientsintheUnitedStatesandmorethantwomillionpatientsthroughouttheworldwithend-stagekidneydiseasewhoneedhemodialysistosurvive. Dr.CiminowasbornGiacomoCiminoin1928inBronx,NewYork.Afterchanginghisnameto“James”(althougheveryonecalledhim“Jack”)andattendingStuyvesantHighSchool,hecompletedtwoyearsintheForestryProgramatSyracuseUniversity,andthentransferredtoNewYorkUniversitytocompletehisundergraduatetraining.HethenattendedtheNewYorkUniversity-BellevueSchoolofMedicine,wherehemetandmarriedgraduatingnursingstudentDorothyNaperkoski.Th eymovedtoBuffalo,NewYorkin1954,whereDr.CiminocompletedaninternshipandresidencyininternalmedicineatMemorialHospital,andafellowshipinphysiologyattheUniversityofBuffalo.WhileinBuffalo,theyhadthefirstthreeoftheirchildren.Dr.CiminothenenlistedintheUnitedStatesAirForceandmovedthefamilytoOrlando,Florida,whereheservedfortwoyearsastheChiefofMedicalServices,attainingtherankofCaptain.Th efamilythenmovedtoValhalla,NewYork,whereDr.Ciminoopenedamedicalpracticewiththeprofessionalassistanceofhiswife.
Robert S. Rigolosi, M.D. is Director of the Department of Hemodialysis at Holy Name Medical Center.
Dr.Cimino’searlyinterestinvascularaccessstartedwhenhewasamedicalstudent-phlebotomistattheNYCBloodBank.Heobservedthatpatientssufferingfromfluidoverloadhadhighbloodflowratesthroughthevenousneedlepuncture,especiallywhenvacuumsuctionwasapplied. Intheearly1960s,Dr.CiminofinishedhistourofdutywiththeUSAFandjoinedtheBronxVAHospitalasDirectoroftheRenalDivision.Atthetime,hemodialysisfacilitieswerelimitedandmostpatientswithchronickidneydiseasediedforlackofavailablefacilities.Th eBronxVAHospitalwasoneofthedominantinstitutionswithdialysiscapabilitiesintheworld.Althoughdialysistechnologywasrudimentarybytoday’sdialysisstandards,theothermostsignificantchallengewasgainingrepeatedaccesstobloodvesselsforthethreetimesweeklylife-sustainingtreatments. Duringthistime,Dr.BeldingScribner,fromSeattle,Washington,devisedaTefloncatheterthatconnectedaperipheralarterytoaveinbywayofabridge.Althoughitwasanimprovementoverotherexternalcannulaedevices,theexternalshunt,or‘ScribnerShunt’waspronetoinfection,clotting,anddisplacementleadingtopotentiallyfatalbloodloss. Dr.Ciminoandhisteamstruggledwiththesefrequentexternalshuntcomplicationswiththeirdialysispatientsonadailybasis.Th emajorbreakthroughfortheBronxVAteamwaswhentheyrecognizedthatanexternalshuntwasanalogoustoaninternalarteriovenousfistula(AVF).Infact,Cimino’sexperienceasaphlebotomistandhisrecollectionthatKoreanWarveteranswithtraumaticAVFsnotonlytoleratedlargeAVFswithoutapparentcardiaccomplications,butwere“easyhits”whendrawingblood.Also,patientstoleratedrepeatedneedlepunctureswithoutclottingorsclerosing. Th earteriovenousfistuladiscoveryrevolutionizedthehemodialysisfieldandwaswidelyaccepted,especiallyinEurope,
followingDr.Cimino’sguestlecturetourofEuropeancountriesin1968.Today,upto90%ofdialysispatientsinsomeEuropeancountriesusetheAVFastheprimaryaccess,incontrasttolessthan60%intheUnitedStates.NumerousstudieshaveproventhattheAVFhasalowerincidenceofinfection,lessclottingandthrombosis,fewerhospitalizations,andsignificantlylesscost. Forthelastseveralyears,theCentersforMedicareandMedicaidServiceshasurgeddialysiscentersacrosstheUnitedStatestoadopttheCiminofistulaastheprocedureofchoiceforend-stagekidneydiseasepatients.“FistulaFirst”campaignshavecompareddialysisfacilitiesagainsttheirpeersinanattempttopromotewideruseacrossthecountry. DuringDr.Cimino’smid-career,helefthispositionattheBronxVAHospitaltomanageanotherchronicdiseaseattheHouseofCalvary,Bronx,NewYork.Underhisleadershipandguidance,CalvarywastransformedintoCalvaryHospital,anaccreditedinstitutionwhereterminalcancerpatientscoulddiewithdignity.In1994,heextendedCalvary’smissiontoincludetheeducationofmedicalstudentsandcancercaretechniciansbycreatingthePalliativeCareInstitute,whereheservedasdirectorforadecadeandcontinuedtoteachuntilshortlybeforehisdeath.Currently,CalvaryHospitalisarevolutionarynewinstitutionthathasinfluencedthehospicemovementsintheUnitedStatesandabroad. Dr.Cimino’spublicationrecordextendsover50years,withhismostrecentpublicationasabookchapterinaforthcomingcompendiumonthehistoryofrenaldialysis.Dr.Ciminohasbeenhonoredinmanywaysthroughouthislife,forhisworkinrenaldialysisandinterminalcancercare.OrganizationshonoringhimhaveincludedtheVeteransAdministration,theNationalKidneyDiseaseFoundation,theAmericanCollegeofPhysicians(twoLaureateAwards),theAmericanDietetic
Association,NewYorkMedicalCollege,theAmericanAssociationofKidneyPatients,theGoldHumanismHonorSociety,AlphaOmegaAlpha,andtheAmericanCancerSociety.Mostrecently,hereceivedtheScribnerTrailblazerAwardfromtheInternationalSocietyforHemodialysisandtheBeldingH.SchribnerAwardfromtheAmericanSocietyofNephrology. Dr.Ciminowaslovedandrespectedbyallthosewhoreallyknewhim.Heledbyexampleinallaspectsofhispersonalandprofessionallives.Th roughhisworks,hehasextendedthelifeandreducedthesufferingofhundredsofthousands,ifnotmillions,ofpeoplethroughouttheworld.Today,andinthefuture,patientssufferingfromterminaldiseaseandthoseundergoinghemodialysiswillbenefitfromDr.Cimino’scontributionstomankind.Hediedashelived,quietlyinhishome,surroundedbyhisfamily,withdignity.HeissurvivedbyDorothy,hiswifeandpartnerfor55years,hissisterCamillaHarrisandherhusband,hissixchildrenandtheirspouses,andhis12grandchildren. After44years,Dr.JackCimino’sinventionofthearteriovenousfistulahasstoodthetestoftimeforthebenefitoftheworld’spatientswhosufferfromend-stagekidneydisease.DuringDr.Cimino’scareer,heinfluencedandguidedmanyphysicianstoenterthefieldofnephrology.Th edialysiscommunityisforeverindebtedtoDr.James(Jack)Ciminoforhislastingcontribution.Hewastherolemodelforallphysicianstoemulatebecauseofhiscompassion,hisdedication,andhiscommitmenttofindingasolutiontoeasepatients’suffering.Hewasthe“doctor’sdoctor”….IamfortunatetohavehadJackasmymentorandclosefriend.
Dr.JamesCiminowasaconsultanttoHolyName’sHemodialysisUnitfromitsestablishmentin1969until1990.Hedidmedicalroundsonourhemodialysispatientstwiceaweek,andwasavailabletoanyHolyNamenephrologistforadviceandasecondopinion.HealsotaughtHNinternsandresidentswhenwehadateachingprogram,andjustlastyear,providedcounselonVillaMarieClaire.Hisson,Jim,nowaprominentprofessorinmedicalinformaticsatJohnsHopkins,helpedintroducecomputertechnologytoHolyName’sLaboratoryDepartmentasapre-medstudentatBrown.JackwasmygoodfriendandmydaughterRebecca’sgodfather.
James Cimino, M.D.
Outpatientcataractsurgeryandintraocularlensimplantscanbeperformedusingatechniquethathasbeeninstrumentalinrevolutionizingcataractsurgery.Th istechniqueiscalledsmall-incisioncataractsurgerywithnostitches. Small-incisioncataractsurgerybeginswithphacoemulsification,amethodofremovingcataractswithanultrasonicallyvibratingprobethatbreaksthecataractupintominutefragmentsandthengentlysuctionsthemoutoftheeye.OphthalmologistsatHolyNameMedicalCenterareabletousethelatesttechnologyforthisprocedure—theAlconINFINITI®VisionSystem,anewphacoemulsificationmachinethatfeaturesOZil®ultrasoundhandpiecesfortorsionalemulsificationanddynamicfluidmanagement. Th isadvancedtechniqueallowsthesmallestincisionofanypriorcataractremovalprocedure.Th euseoftopicalanesthesiaallowsforavirtuallypainlessprocedurewithnoinjectionsneeded.Th isshortsurgery
Mark S. Goldfarb M.D., F.A.C.S. is an ophthalmologist on staff at Holy Name Medical Center and an associate clinical professor of the Department of Ophthalmology at Mount Sinai School of Medicine in New York City. His offi ce is located at 130
Kinderkamack Road, River Edge, N.J., 201-488-2020.
allowsforaquickrecoveryandmayreducethepatient’sdependencyonglasses(thoughitmayvarypatienttopatient).Th elensimplantedduringtheprocedureispermanentanddoesnotwearout. Iobtainedtheoriginalapprovalforintraocularlens(IOL)implantsfromtheInstitutionalReviewBoard(IRB)in1981atHolyNameHospital.Atthetime,lensimplantswereconsideredexperimentalbytheFDA.Today,IOLimplantsarefullyFDA-approved. Th enewestIOLlensesareacrylic,softandfoldable,andthetextureofthenewlensissimilartoasoftcontactlens.Performedthroughamicroscope,theprocedureutilizesaverysmallincisionthat,inmostcases,requiresnosuturesoreyepatches.Th ispermitspatientstoreturntotheirnormalactivitieswithfewrestrictions;visualrecuperationisquick;andthereisminimaltraumatotheeye,withnostitchestoberemoved. Cataractsarethenumberonecauseofpoor
visionamongadultsintheUnitedStates.Morethantwo-thirdsofthepopulationoverage60hasavisionproblemfromcataracts.Acataractiscloudingofthenormallyclearandtransparentlensoftheeye.Itisnotatumor,anewgrowthofskinortissueovertheeye,butafoggingofthelensitself.Whenacataractdevelops,thelensbecomescloudylikeafrostedwindowandmaycauseapainlessblurringofvision.Oncethelensoftheeyehasbecomecloudyenoughtorequireitsremoval,thereisnomedicalornutritionalmethodofclearingupthecataract.Bothnear-andfar-sightedpeoplecanhavecataracts. Whencataractscauseenoughlossofsighttointerferewithaperson’swork,hobbies,orlifestyles,itisprobablytimetoremovethem.Fortunately,cataractsurgeryishighlysuccessfulandmorethan95percentofpatientswhoundergosurgeryregainusefulvision. Small-incisioncataractsurgeryiscoveredbyhealthinsurance.
The Alcon INFINITI® Vision System
Cataract surgery with no stitches
6
it’s Year two for the Kmp
About250physicians,communityleaders,MedicalCentertrustees,donorsandotherfriendsoftheKoreanMedicalProgramcelebratedtheKMP’ssecondanniversaryatHolyNameonJanuary27.Th eeventfeaturedcocktailsandhorsd’oeuvres,buffetdinnerandatalentshowdubbed“KMPIdol,”inwhichphysiciancroonersdisplayedrealaptitudeandflair.JacobChung,M.D.,anophthalmologistwhosangJoshGroban’s“ToWhereYouAre,”earnedthemostkudosfromthepanelofthreejudges—JaneEllis,VicePresident,Marketing,PublicRelationsandCommunityHealth;PatriciaBurke,M.D.,ophthalmologistandPresidentoftheMedicalStaff;andDr.KennethPark,painmanagementspecialist.Dr.ChungandallparticipantswereawardedprizesfromTiffany&Co.AnotherhighlightduringtheeveningwasthepresentationofcommunityserviceawardsbySherylSlonim,RNC,M.Ed.,CNAA,ExecutiveVicePresidentofPatientCareServices,totwodoctors:ChangW.Lee,M.D.,internist,andHeeK.Yang,M.D.,surgeonandMedicalDirectoroftheKMP.
The Alcon INFINITI® Vision System
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January/February 2010 editorialstaff: Jane F. Ellis,VicePresident,MarketingandPublicRelations Barbara Franzese Cron,Manager,MarketingCommunications Patricia A. Burke, M.D., Ph.D.,PresidentoftheMedicalStaff
Please e-mail all comments and contributions to: [email protected] or call Jane Ellis: 201/833-3129
MD360º ispublishedbimonthlybyHolyNameMedicalCenter’sDepartmentofMarketing/PublicRelationsandisintendedforusebythemedicalstaffofHolyNameMedicalCenter.
physicians Called to Advocate for villa marie Claire Lastyear,HolyNameMedicalCenterpresentedmewiththeSpiritofHealingAwardattheirannualFoundersBall,andIwasveryhonoredandhumbledbythisrecognition.Theeveningwasanincrediblemomentforme,asIacceptedthisawardwitnessedbymypersonalandprofessionalfamilies.Thefundsraisedfromthe2009FoundersBallwenttotheCampaignforVillaMarieClaire,anewfree-standinghospicefacilitycurrentlyunderrenovationinSaddleRiver,NJ.WhentheHolyNameHealthCareFoundationapproachedmeandaskedmetobecomeamemberoftheCampaignCabinet,Ididnothesitatetoacceptthepost. AsamemberoftheCampaignCabinet,IproudlysupportandadvocatethedevelopmentofVillaMarieClaireasanewmodelforcomprehensiveandinnovativeend-of-lifecare.Asphysicians,weallknowthathospicecareisessentialwhenacureisnolongerpossible.Itofferscomforttopatientsandsolacetotheirlovedones.Hospicecarealsocarriesasignificantreductioninhealthexpendituresforpatientsandismorecost-effectivethanhospitalization.VillaMarieClaireaffordsanimportantopportunitytodeliverourhighstandardofcaretothoseinthefinalstagesofaterminalillness. BecausethereisnodedicatedresidentialhospicefacilityinBergenCounty,theVillarepresentsacommitmenttofillanunmetneedinourcommunity,onededicatedtopatients,andalsototheirfamiliesandlovedones.TheCampaignforVillaMarieClaireisanopportunitytoraisemuch-neededawarenessandfundstocompletethecontinuumofcareessentialtothemissionofHolyName. TheFoundationisactivelyseekingthoseinterestedinsupportingtheCampaignandisspeakingtoindividuals,privatefoundationsandcorporations.SotakeamomenttoconnectaprospecttotheFoundationoffice. For more information about the Campaign for Villa Marie Claire, or to be part of the Campaign’s fundraising efforts, contact the Foundation’s Executive Director, Kevin McCarthy, at 201-833-3231.
Salvatore Laraia, M.D., Villa Marie Claire Campaign Cabinet; Trustee, Holy Name Medical Center
TheNovember21stCommunityHealthFestivalcosponsoredbytheKoreanMedicalProgramandAKAM(AssociationofKoreanAmericanMedicalGraduates)drew500peopleforavarietyofscreeningsthatdiscoveredundiagnosedhealthissuesinamajorityoftheparticipants. Generalbloodtestsperformedon330individualspriortothefestivalindicatedthat78percenthadLDLcholesterollevelsexceedingthehealthylimit,16%werepre-diabeticordiabetic,and19%hadliverfunctionissues.Patientsreceivedtheirbloodresultsattheevent,whereinternistswereonhandforinformationandguidance.Thyroidscansof150individualsindicatedabnormalitiesin27percentofthesubjects,andhemorrhoidscreenings
Kmp heALth fAir updAte
Health Fair Draws Hundreds, with Notable Results
alsorevealedahighincidenceofthatcondition.Glaucomatestresultswerewithinexpectedranges. Intotal,30physiciansrepresentinginternalmedicine,cardiology,ophthalmology,orthopedics,endocrinology,generalsurgery,dermatology,painmanagement,podiatry,neurology,otolaryngology,obstetrics/gynecology,allergy,dental,psychology,psychiatry,physicalrehabilitationandurologywereavailableforpersonalconsultationsatthefestival.Therewerealso30HolyNamevolunteers,includingRNs,technicians,andotherstaff,aswellas25volunteersfromthecommunity,including15fromtheAsianWomen’sChristianAssociation.
Magnet Recognition From the American Nurses
Credentialing Center. Places us among the top 5% of hospitals
nationwide for excellence in patient care.
J.D. Power and Associates Distinguished Hospital
Awards For Emergency, Inpatient, Outpatient
and Maternity Service Excellence.
Accredited Chest Pain Center From the Society of Chest Pain
Centers for our ability to diagnose chest pain
and acute coronary symptoms.
Primary Stroke Care Center Certification From The Joint
Commission, the nation’s leading health care evaluation and accreditation organization.
HealthGrades® Specialty Excellence Award for Stroke
Care™
Ranked in the top 10% of hospitals nationally for stroke services.
HealthGrades® Distinguished Hospital Awards for Clinical
Excellence™
Among the top 5% of hospitals in the nation for clinical excellence.
Modern Healthcare magazine Ranked fourth in the nation on the
“100 Best Places to Work in Healthcare” list.
NJBIZ magazine Cited Holy Name among the
“Best Places to Work in New Jersey.”
Data Advantage, LLC Awarded for quality, affordability,
efficiency, patient safety and overall experience.
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Write an article for MD360. Share an exciting new
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health-related issue or tell about a recent achievement.
Email your submission to: [email protected].
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