• Benefi ts of Low-Dose CT Lung Cancer Screening, pg. 3 • Advances in Non-Surgical Facial Rejuvenation, pg 4

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Medical Executive Committee and Positions President: Dr. Thomas BirchVice President: Dr. Ronald WhiteSecretary: Dr. John PooleTreasurer: Dr. Randy TartacoffMedical Chiefs Representative: Dr. Benjamin RosenbluthSurgical Chiefs Representative: Dr. Harris StermanMember At Large: Dr. Patricia BurkeMember At Large: Dr. Giuseppe Condemi

Medical Staff Department Directors and Division ChiefsDept. of Anesthesia: Dr. Alan GwertzmanDept. of Emergency Medicine: Dr. Richard Schwab and Dr. Randy Tartacoff (co-directors)Dept. of Family Practice: Dr. Ohan KaratoprakDept. of Interventional Radiology: Dr. John RundbackDept. of Medicine: Dr. Michael Denker Allergy: Dr. Patrick Perin Cardiology: Dr. Stephen Angeli Dermatology: Dr. Jeffrey Rapaport Endocrinology: Dr. Mark Wiesen Gastroenterology: Dr. Michael Schmidt Infectious Disease: Dr. Mirhan Seferian Internal Medicine: Dr. Lewis Attas Nephrology: Dr. Louis Jan Neurology: Dr. David Van Slooten Oncology: Dr. Yadyra Rivera Psychiatry: Dr. Sharad Wagle Pulmonary Medicine: Dr. Stuart Silberstein Radiation Oncology: Dr. Benjamin Rosenbluth Rehabilitative Medicine: Dr. Michael Denker (Interim) Rheumatology: Dr. Ralph MarcusDept. of Obstetrics & Gynecology: Dr. Christopher EnglertDept. of Pathology: Dr. Drew OlsenDept. of Pediatrics: Dr. Harry BanschickDept. of Radiology: Dr. Jacqueline BrunettiDept. of Surgery: Dr. Joseph Manno Dentistry: Dr. Stephen Haber General Surgery: Dr. Joseph Manno Neurosurgery: Dr. Roy Vingan Ophthalmology: Dr. Joseph Manno (Interim) Orthopedics: Dr. Raphael Longobardi Otolaryngology: Dr. Asmat Quraishi Podiatry: Dr. Ritchard Rosen Plastic Surgery: Dr. Harris Sterman Thoracic Surgery: Dr. Ignatios Zairis Urology: Dr. Vincent Lanteri Vascular Surgery: Dr. Kenneth Fried

News from and for Holy Name Medical Center’s

Medical Staff

Also available online at:www.holyname.org/md360

First Quarter 2012

Iusedto“admit”patientstothehospitalto“observe”them.WhenIwaspracticing,thatmeantthatIdidnotfeelthatitwassafetoallowthemtostayoutofthehospital,and/orIwasunclearofthediagnosisandfeltthepatientneededtobe“observed”untilthediagnosiswasclarified. Th eterm“observation”hasbeenco-optedbytheinsuranceindustry,includingMedicareandMedicaid,andnowreferstoapatient“status”forwhichthehospitalreceivesreducedreimbursement,despiteprovidingthesamelevelofserviceasitdoesforanadmittedpatient.Itseemsobviousthatthisisoneofthereimbursementtechniquesbeingusedbyinsurerstoreducetheircosts.Unfortunately,thesearetherulesofthegamethatwemustplay. Observationisformallydefinedasfollows:Outpatient services furnished in a hospital, including the use of a bed and at least periodic monitoring by its nursing or other staff that are reasonable and necessary to evaluate and treat a patient’s condition or determine the need for inpatient admission.However,ifyoucankeepafewsimplerulesinmind,youwillknowallyouneedtoknowtohelpHolyNamebesuccessful:

1.Typically,patientswhoneedonly24- 48hoursinthehospitalwillmeetthe requirementstobeplacedinobservation.2.If,after48hoursinthehospital,andif medicallyappropriate,apatient’sstatus canbeconvertedtoinpatient.3.Aphysician’sorderisrequiredtoplacea patientinobservation.

Observation: It Doesn’t Mean What It Used To

Adam Jarrett, MD, MS, is Executive Vice President/Chief Medical Offi cer at Holy Name Medical Center. He can be reached at 201-833-7273.

DearColleagues,

IthankyouonbehalfofthemedicalstaffofficersandExecutiveCommitteeforelectingustorepresentyou.Th enexttwoyearsseemlikelytoproducemorechangeinmedicalcarethananypreviousbriefinterval.WeatHolyNameMedicalCenterarelikelytobemoreaffectedthanourcolleaguesinotherpartsofthecountrywhomaybelongtolargehealthcarecorporations.Th eyarepartiallyprotectedfromdisruptivechangebecauseofsystemssupport,bargainingpowerandaccesstocapital.SometimesIfeellikeacobbler,dressmakerorblacksmithonthevergeofindustrialization.Th ingsarenotthatbad,though;inourindustry,onlydoctorsandnursescantakecareofpatients.Evenalliedhealthhasonlyusasallies. Clearly,asmedicalstaff,wearegoingtoneedtoworkverycloselywitheachotherandwiththehospitaladministration,Board,Sistersandthecommunityifwewantourownpersonalizedformofmedicalcaretosurviveinthiscommunity.Previously,servingoncommitteesorothervoluntarycontributionstothehospitalcommunitywereelectiveaccordingtointerestandsenseofduty.Nowitisabsolutelyessentialtohave

ahighlevelofengagementandalignmenttomakethisthehighestqualityandmostefficientproviderinthemetropolitanareaor,forthatmatter,thecountry. Sizeandmoneyarenotthebarrierstobecomingafirst-tier,world-classmedicalcenter.Th eonlybarriersareourabilitytodevelopsharedgoalsandtheambitiontoachievethem.Wemustoffertheverylatestandbestservicesinoursegment.Wemustretainourpatientsforalloftheservicesthatweprovideandnotlosethoracicsurgery,imaging,laboratoryoroncologytoneighboringinstitutions.Weneedbetterinfectioncontrol.Weneedmoredoctorsincorporatingresearchintotheircareers.Wearedevelopingsystemstoreducepreventablere-hospitalizations.Newservicelineslikewoundcarewillbedeveloped.Th emedicalandsurgicalcarereviewcommitteeshavebeenrevitalized.Weneedtomakeourmedicalinformationsystemmoreconducivetoexcellentmedicalreasoningandimplementphysicianorderentry.Th isisbutapartiallistofneedsforthenexttwoyears. Youareundoubtedlybusierthanyouhaveeverbeen,justkeepingworkandfamilyinorder.Nowweareaskingyoutocontributemoretoourcommunity.Pleasecontactany

Become Engaged, Be Ambitious and Make It Happen

Th omas Birch, MD, is an infectious disease specialist and President of the Medical Staff at Holy Name Medical Center. He can be reached at 201-833-7274.

ofusinmedicalleadershipwithyourneedsandconcerns,butpleasebepreparedtoofferpotentialsolutions,timeandenergy.Ifweleaveourfuturetoahandfulofseniorcolleagues,hospitaladministrationandoutsideforces,thereisnoguaranteethatwewillbehappywithorevensurvivetheapproachingtransformation. IthinkofHolyNameasalarge-caratredrubywithmanyfacets.Th erearesomesmallinternalimperfectionsthatproveitsnaturalorigin.Someofthefacetsneedmorepolishingbut…Itisintrinsicallyprecious.Volunteer,findsomethingthatneedsfixing,worktogether,makeitshinebrightlyinourlocalgalaxy.Successonlycomesfromgiving. Th ankyoutosomanyphysicians,nursesandotherstaffwhoarealreadysogenerousinvolunteeringtimeandtalents.Ilookforwardtodeterminingourcommitteemembershipwithallofyouinthecomingmonths.

4.Observationpatientsareconsidered outpatients,butthecaretheyreceive innowaydiffersfromnon-observation patients.5.HNMCwillnotbepaidbyinsurers, includingMedicareandMedicaid,ifthe patientisnotplacedinobservationby theadmittingphysician,evenifthe patient’sconditionmeetsthe requirementsforobservation.6.AtHNMC,wehavecasemanagerswho willassistyouindeterminingwhethera patientmeetsthecriteriaforobservation.7.Th eprofessionalcodesutilizedby physiciansonobservationpatientsdiffer fromthecodesusedoninpatients.

Asmentionedin#7above,thecodesthatphysiciansuseonobservationpatientsaredifferent;however,theactualreimbursementsareverysimilartothe

Medicarereimbursementsyouwouldreceiveoninpatients(seethechartabovefordetails). Th eseinsurancerulesarefrustrating,buttheyaretherulesthatweareobligatedtoliveby,andnotfollowingthemputsHNMCatsignificantfinancialrisk.Keepinmindthat“admitting”apatientwhomeetscriteriafor“observation”willresultinnopaymentforthehospital.Pleaseworkwithusaswestrivetogetthisright,andfeelfreetodiscussthismatterwithmeand/oranyofourcasemanagers.

FROM THE PRESIDENT OF THE MEDICAL STAFF

JOINT MESSAGE FROM THE CHIEF MEDICAL OFFICER

Initial Visit 99221 $106.52 99218 $101.97 99222 $144.17 99219 $140.42 99223 $211.67 99220 $192.77

Follow-up 99231 $41.30 99224 $42.06 99232 $75.65 99225 $76.11 99233 $108.44 99226 $109.30

Discharge 99217 $76.59 99238 $76.23

Discharge on same day as placed inobservation 99334 $142.39 No codes 99335 $178.67 99336 $229.80

INPATIENT OBSERVATION

Inside:

Asorthopedicpractitionersandfamilycarepractitioners,weareallawareoftheprevalenceoflowbackcomplaintsinsociety.Somestudiesreportthat,overall,lowbackpainisthemostcommoncomplaintseeninafamilypracticeoraninternalmedicinesettinginthemusculoskeletalsphere.Often,thesecaseswillresolvewithphysicaltherapyorperhapssomepainmanagementandsteroidalanti-inflammatories.Occasionally,thesecaseswillgoontoneedthehelpof

anorthopedicspinesurgeonforoperativespineconditions. Accordingtosomepublisheddata,upto25%oflowbackcomplaintsmaynotactuallyberelatedtothelumbarspineitselfbutrathertothesacroiliacjoint.Thesacroiliacjointconnectsthebottomofthespine,orthesacrum,totheiliacwing,thelateralaspectofthepelvis.Thisisajointthathasbeenlongrecognizedbyrehabilitationmedicinedoctorsasbeingapotentialsourceofpain.Morerecently,spinalsurgeonsandorthopedicdoctorsarerecognizingthatitmayactuallybethesourceofmanyofthelumbosacralcomplaintsthatareappearingintheirpractices. Inordertodeterminewhetherapatientissufferingfromasacroiliacjointproblemversusalumbarspinalproblem,thepatientneedsafullevaluationofthelumbarspine,aswellasthesacroiliacjoint,andseveraldiagnosticmaneuverstodetermineifthesacroiliacjointisindeedthepainfularea.OnecommontestknownastheFaberexam,

inwhichthepatient’slegisflexed,abductedandexternallyrotated,canoftenspecificallyelicitthepainfulanddegenerativesacroiliacregion.Managementofthisconditionmayincludephysicaltherapy,aswellasdiagnosticandtherapeuticinjectionintothesacroiliacjoint. Whenallelsefails,recentnewtechnologyhasenabledaminimallyinvasivesacroiliacfusionforthisprocedure.AleadcompanyinthisregardisSI-Bone,Inc.,whichisprovidingbothminimallyinvasivetechnology(theiFUSEImplantSystem)aswellassurgeonsupportandeducationtowardtheelucidationofthisdiseaseanditstreatment.Certainly,notallpatientsarecandidatesandagain,thebiggestissueisgoingtobeoneofdiagnosisandappropriatemanagement.However,thetechnologydoesofferthebenefitsofminimalincisionsize,possibilityofimmediatepostoperativestabilization,minimalmusclestrippingand,hopefully,apotentialforquicker

recoveryandreturntoactivitiesofdailyliving. Itshouldalsobenotedthatmoreandmorespinalsurgeonsarerecognizingthatsomeofthefailedbacksurgeriesmayactuallybeduetoacomponentofthepainemanatingnotfromthelumbarspine,butratherfromthesacroiliacjoint. HereattheCenterforSpinalDisorders,weareattemptingtohoneinonthistechnologyanduseitinappropriatecases.Pleasedonothesitatetocontactusabouthowthisadvancementcanenableyourpatientstohavebetterspinalandpelvichealth.

Jonathan D. Lewin, MD, is an orthopedic surgeon on staff at Holy Name Medical Center and Director of the Center for Spinal Disorders, 177 North Dean Street, Suite 100, Englewood, NJ 07631. He can be reached at 201-510-3777.

A New Back Joint Discovered?

•Firstserumtestapprovedtohelp detectriskofrarebraininfectionin Tysabri-treatedpatients.•FirstoraldrugapprovedforMS treatment.•Firstdrugapprovedtohelpimprove walkinginMSpatients.

What do these firsts have in common? TheywereallclinicaltrialsinwhichtheMSCenteratHolyNameMedicalCenterparticipated.

An Historical Perspective TheMSCenterhasbeentakingpartinclinicalresearchsincetheCenter’sinceptionin1985.Atthattime,studiesweresymptommanagement-based,involvingtheuseofantidepressantsandtherapiestohelpoveractivebladder.However,followingtheadventofimmunomodulatingtherapies,suchasBetaseronintheearly1990s,clinicaltrialdesignevolvedtoincludetheuseofBetaserontohelpslowsecondaryprogressiveMS,head-to-headtrialofhighdosevs.lowdoseinterferontherapyforrelapsingMS,andtreatmentswithmonoclonalantibodies,suchasrituximabanddaclizamab,tonameafew. Multiplesclerosisisthemostcommonneurologicdiseaseaffectingyoungadultsworldwide.Itisautoimmune,inflammatoryanddemyelinatinginnature,attackingthemyelinsheathsurroundingaxonsinthebrainandspinalcord.Initially,inabout85percentofpatients,thecourseisrelapsing,withlesionsthatcancauselossofvision,weakness,incoordination,andbladderproblems.Thesesymptomsoftenremit,butuntreatedafteraperiodof10-15years,patientsdevelopprogressivediseasewithpermanentlossoffunction. Priorto1993,therewerenoeffectivetreatmentoptionsforMS.Fortunately,withtheuseofinterferonandnon-interferontherapiessuchascopaxone,decreaseinrelapserateandslowingofdiseaseprogressionisnowpossible.Thelastfiveyearshavebroughtaboutnew,sophisticateddrugs,changinghowthediseaseismanagedandofferingpatientsnewhope.

Studies Have Brought New Drugs to Market Whiletheinitialimmunomodulatingdrugsdecreaserelapseratesbyabout30percent,neweragentslikeGilenya,thefirstoraldrugforMS,candecreaserelapseratesby55percent.Gilenyaworksbysequesteringlymphocytesinlymphnodes,preventinginflammatorycellsfromenteringthecentralnervoussystem.However,patientshavetobemonitoredforadverseeventsinvolvingcardiac,hepaticandocularfunction. TheMSCenterwasalsoinvolvedinstudiesofTysabri,thefirstintravenousmonoclonaltherapytotreatrelapsingMS,whichcandecreaserelapserateby70percent.However,thisisalsoadrugthatrequiressafetymonitoring,particularlybecauseoftheriskofararebraininfection,PML,orprogressivemultifocalleukoencephalopathy.Fortunately,thereisnowanassaythatcandetectpriorexposuretoJCvirus,thevirusthatcancausePML,whichcanhelptostratifyrisk.HolyNameparticipatedinthestudythatbroughtthattesttomarket,aswell. Overthepast20years,theMSCenterhastakenpartinover30researchtrials,manyofwhichhavenotonlyimprovedourunderstandingofthediseaseprocess,buthaveledtotheapprovalofnewdrugs.TwoothertherapiesthathopefullywillbeFDA-approvedbytheendof2012includealemtuzumab,anothertargetedTcelldirectedmonoclonaltherapyadministerednomorethanfivedaysyearly,andanoraldrug,BG12.AlthoughtheMSCenterisnolongerrecruitingpatientsforthealemtuzumabstudy,wecontinuetofollowpatientswhowereenrolledinthetrial.

Research Partners WearefortunatetohaveDr.FrederickFoley,ourneuropsychologist,whohasbeentheprincipalinvestigatoronstudiesoftheincidenceofdepressionandsuicideamongpeoplewithMS,measuringcognitiveoutcomes,andexaminingthelinkbetweenearlycognitivedysfunctionandgaitimpairment.WearealsoveryfortunatetohavehadexcellentpartnersinresearchwithDr.MarkGoldfarb,ophthalmologist;andDrs.Andrew,ChrisandStephenBrown,

ophthalmologists;Dr.EugeneSweeney,dermatologist;Dr.MohammadTehranirad,internalmedicine;Dr.GiuseppeCondemiandDr.LewisAttas,hematologist/oncologists;theoncologynurses,and2Marianinfusionnurses. TheMRItechniciansandDr.VirajParikhhavealsoplayedacriticalrole,sincemostofourstudieshaveanMRIcomponent.SeveralofourresearchstudieshaveinvolvedcollaborationswithKesslerInstituteforRehabilitation,UMDNJ–NJMedicalSchool,andRobertWoodJohnsonUniversityHospital.TheMSCenternurses,CindyOugheltreeandReenaMathew,havebeeninvolvedinperformingcognitiveandupperextremitytestingmeasures.Dr.JulieFortunatohasbeentheblindedevaluatingphysicianassessingneurologicfunction,andFranArmentano,ANP,hasalsobeeninvolvedinevaluatingpatients.

The Future of MS Research ThefutureofMScarewillfocusonboththeinflammatoryandtheneurodegenerativeaspectsofthisdisease.Therapiesarebecomingmoreselectiveandmoretargeted.Newermonoclonalantibodytherapieswithimprovedefficacyanddecreasedfrequencyofusearebeingdeveloped.Biomarkerresearch,whichcanhelpindeterminingwhowillrespondeffectivelytoaparticulartreatment,isalsobeinginvestigated. Currently,theMSCenterisenrolling

patientsinthreephase3trials.Onetrialislookingattheuseofahumanizedversionofrituximab,namely,ocrelizumab,aBcelldirectedtherapytotreatrelapsingMS;andanotherstudyofocrelizumabforpatientswithprimaryprogressiveMS.AthirdtrialinvolvestheuseofTysabriforsecondaryprogressiveMSpatients.Theselattertrials,whicharedouble-blind,randomizedandcontrolled,areofparticularinterestbecause,todate,thetwodiseasetypes—primaryandsecondaryprogressiveMS—havebeenthemostchallengingtotreat. For more information regarding inclusion criteria for these trials, please contact Stacy Melvin, research coordinator, at 201-837-0727, ext. 3762.Evenifapatientdoesnotfittheinclusioncriteriaforthesestudies,s/hemayqualifyforotherfutureclinicalstudies. Thegoalofclinicalresearchistohelpindevelopingnewtherapies,expandourbodyofknowledgeandrefinecurrenttherapies.Hopefully,notonlywillwecontinuetoimprovetheabilityofagentstoslowdiseaseprogression,butwewillbeabletodeveloptherapiesthatcanreverseandrepairaxonaldamage.

Mary Ann Picone, MD, is a neurologist and Medical Director of the MS Center at Holy Name Medical Center. She can be reached at 201-837-0727.

Clinical Trials at HNMC’s MS Center

Mary Ann Picone, MD, with Stacy Melvin, RN, BSN, MSCN, Research Coordinator, MS Center

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Lung Cancer Screening – Significant Benefits, Low Risk Given the mortality benefit shown by the NLST study cited below and the recommendations of the NCCN, Holy Name Medical Center has initiated a lung cancer screening program with low dose CT protocols to minimize radiation exposure to patients. The CT screening studies are not currently covered by insurance, but HNMC will provide the service at a discounted fee of $200, with physician referral.

Lung cancer is the second most common cancer in the US, after prostate cancer in men and breast cancer in women. When it comes to mortality, however, lung cancer is the leading cause of cancer death in both men and women, estimated to be about 160,340 in 2012. By the time patients become symptomatic from lung cancer, they usually present with advanced stage disease, which carries a poor prognosis. Consequently, the overall five-year survival rate for lung cancer remains less than 15%. On the other hand, the five-year survival rate for stage I non-small cell lung cancer can be as high as 70%. Therefore, there has been much interest in developing an effective screening program to detect early disease to improve survival. Since the 1970s, there have been a number of studies evaluating the effectiveness of chest x-ray and sputum cytology on the detection of lung cancer and its effect on mortality. However, none of these studies demonstrated any improvement in mortality. With the advent of multidetector CT technology over the past decade, attention has shifted to low-dose CT (LDCT). As you are all aware, CT provides high resolution images rendering high sensitivity for small nodules. Here in the US, the most notable study to evaluate LDCT as a screening tool for lung cancer was the ELCAP Study (Early Lung Cancer Action Project). A total of 1,000 asymptomatic participants were enrolled and each individual was screened with both LDCT and chest X-ray. They found a total of 27 lung cancers with LDCT screening. Of those 27 cancers, only 7 were seen on chest X-ray. Thus, the yield of CT was four times greater than chest X-ray. In addition, 23 out of 27 (85%) cancers detected by LDCT were stage I disease, compared to 57% for chest x-ray. Several additional studies have shown similar advantages of LDCT in detecting early disease, but they were not designed to determine the impact of LDCT screening on mortality. In light of these findings, the National Cancer Institute funded a large prospective, randomized controlled trial to compare LDCT to chest X-ray. The National Lung Screening Trial (NLST) was launched in 2002 and data was collected through December 2009. A total of 53,454 participants were enrolled who were at high-risk of developing lung cancer, between the ages of 55 to 74, and with at least a 30 pack year smoking history. Former smokers must have quit within the last 15 years prior to screening. The participants were randomized to receive three annual screenings by either LDCT or chest X-ray. On the LDCT arm, about 24 % of participants had a positive

finding (non-calcified nodule ≥4 mm), and about 7% on the chest x-ray arm. The investigators found a total of 1,060 lung cancers on the LDCT arm and 941 cancers on the chest X-ray arm. At the end of the study, there were a total of 356 deaths on the LDCT arm, and 443 deaths on the chest X-ray arm. This equates to a 20% reduction in lung cancer mortality with LDCT screening. This reduction in mortality is comparable to breast cancer screening with mammography. In addition, there was also a 6.7% reduction in mortality from all causes in the LDCT arm. There are several issues related to lung cancer screening with LDCT. First, there is a high rate of false positives. However, most of the positive findings in the study were deemed benign by simply demonstrating stability or resolution over time with follow-up imaging, rather than by invasive procedures. Second, who should be screened? It is clear that high-risk individuals will benefit most from screening, but it is unknown whether people with low or moderate risk will experience similar benefit. As with any screening program, a thorough evaluation of cost-effectiveness will need to be carried out. Third, radiation exposure is always a hot topic in both the media and the medical community. Without a doubt, high doses of radiation are harmful, but the effect of low doses of radiation is less clear. As outlined in Table 1, the average effective dose of LDCT at Holy Name Medical Center is 1.0 mSv, which is much lower than routine chest CT (5 mSv). To put this into perspective, each of us receives about 3 mSv/year from natural background radiation. For every transcontinental flight, we are exposed to an additional 0.03 mSv. Furthermore, each of us has about 20% chance of developing a fatal cancer over our lifetime. With the additional radiation exposure, it has been estimated that the risk of developing cancer is about 0.004% per mSv of exposure. So with a single LDCT exam, our risk would be increased to 20.004%, which translates to a very small increase in risk over our baseline. Currently, the National Comprehensive Cancer Network (NCCN) recommends lung cancer screening with annual LDCT for three years, until age 74. The eligibility criteria for screening (Table 2), is similar to the NLST criteria, but NCCN includes two subcategories of high-risk groups. A complete set of guidelines for management of positive findings on screening studies is available from NCCN. Table 3 highlights the follow-up recommendations for solid nodules found on screening studies.

References:1. Aberle DR, Berg CD, Black WC, et al. National Lung Screening Trial Research Team. The National Lung Screening Trial: overview and study design. Radiology 2011; 258:243–2532. Aberle DR, Adams AM, Berg CD, et al. Reduced lung cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365:395–4093. Henschke CI, McCauley DI, Yankelevitz DF, et al. Early lung cancer action project: overall design and findings from baseline screening. Lancet 1999;354(9173):99–105.

4. NCCN Lung Cancer Screening Guidelines, Version 1.2012. www.NCCN.org5. Patient safety: Radiation exposure in X-ray and CT examinations. www.radiologyinfo.org6. Cancer Facts and Figures, 2012. American Cancer Society. www.cancer.org

James Park, MD, is a radiologist on staff at Holy Name Medical Center.

• Age 55-74, and

• ≥ 30 pack year smoking history; current smoker or quit smoking within

the past 15 years

OR

• Age 50-74, and

• ≥ 20 pack year smoking history, and

• Have one or more of the following risk factors:

- Exposure to radon, silica, cadmium, asbestos, arsenic, beryllium,

chromium, diesel fumes or nickel, or

- A personal history of cancer, or

- COPD or pulmonary fibrosis, or

- A family history of lung cancer

Nodule Size Follow-up

≤ 4 mm Continue annual LDCT screening

5-6 mm LDCT in 6 mos (If no increase in size, LDCT in 12 mos)

7-8 mm LDCT in 3 mos (If no increase in size, LDCT in 6 mos, then 12 mos)

> 8 mm Consider PET/CT (If low suspicion of cancer, then LDCT in 3, 6, and 12 mos)

*All screening and follow-up CT scans should be performed with low dose technique, unless evaluating mediastinal abnormalities or lymph nodes, where standard CT with IV contrast might be appropriate.

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Chest X-ray: 0.1 mSv

Low dose chest CT: 1.5 mSv (1.0 mSv at Holy Name)

Routine chest CT: 7.0 mSv (5.0 mSv at Holy Name)

Mammography: 0.4 mSv

Natural Background Radiation: 3.0 mSv/year (1.5 mSv/year more in Colorado)

Transcontinental Flight: 0.03 mSv

Table 1. Comparison of mean effective radiation dose

Table 2. NCCN Guidelines for Lung Cancer Screening- Eligibility Criteria

Table 3. Management of solid nodules found on screening LDCT

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Hallmarksofagingincludehyperpigmentation,freckling,scars(i.e.,acne),wrinklesandsagging.NewtechnologyliketheDEKASmartXideDOTLaserFractionalResurfacingTreatmentisnowavailabletohelpfacialrejuvenation.Th isisanon-invasivelasertherapy,whichwascreatedtodramaticallyimprovetheappearanceofskin,reducingpigmentation,improvingtextureandtreatingfinelinesandwrinkles,acnescars,surgicalscarsandsundamage.

Laser Options for Skin Rejuvenation Manydevicesforskinrejuvenationexist.SomevarietiesofCO2lasersareablative;theyremovethetoplayeroftheskin,theepidermis,andsomeofthedermallayerbeneath.WhiletheseCO2lasersachievegoodresults,theskinisleftred,raw,andpronetoinfectionforweeksaftertheprocedure.Areassuchastheneckanddécolletagearenottreatablewiththeselasersbecausetheydonothealwell. Th erearelessaggressivedevicesthatusethenon-ablativemethod.Insteadofremovingtheepidermis,theysendpulsesoflightintothedermis,leavingtheskinintact.Withnon-ablativetechniques,resurfacingrecoveryiseasierandquicker.However,sincethelightdoesnotpenetrateallthatfarintothedermis,improvementsintextureandtoneareoftendisappointing. Th eDEKASmartXideDOTLaserofferstheultimateinskinrejuvenationwithminimaldowntime.

How the DEKA SmartXide DOT Laser Works WiththeDEKASmartXideDOT,(photo2)onlyafractionoftheskinsurfaceareareceivesthelaserlight(hence“fractionalskinresurfacing”).Acomputerfiresthelaserina‘dot’patterntocreatethousandsofmicroscopicperforationsintheskin.Th eskinsurroundingeach‘dot’isleftintact.Th epreciselasermicrobeamspenetratedeeplythroughtheepidermisintothedermiswithoutdamagingthesurfaceskin.Th elaserheatsupthecollagen,causingmorecollagentodevelopinthedermis,whilethehealthycellsintheuntouchedspotspromoterapidhealingoftheentiretreatmentarea.Th eresult(photo1)isfasterrecoverytimeandminimalsideeffects.Overall,theprocedureissafer,fasterandmoreefficientthantreatmentwithconventionalablativelasers.WithDEKASmartXideDOT,theentirefacecanbetreatedinapproximately50minutes.

A Historical Perspective Th equestforimprovingtheappearanceofagingskinwithnon-surgicaltechniqueshasbeenpursuedinplasticsurgeryfordecades.Manymodalitieshavebeenexplored,somemoresuccessfulthanothers.Butallthetechniquesshareonecommonprocess:removingtheouterskinlayer,theepidermis,andpartoftheinnerlayer,thedermis.Essentially,thiscreatesasecond-degreeburn,whichremovestheunwantedsurfaceirregularities.Whenthenewepidermisgrowsandre-epithelializes,itcreatesasmoother

complexion,withfewerspots,scars,andtighterskin. Oneofthefirsttechniquesusedwasacid(phenol,TCA)toburnofftheepidermisandsuperficialdermis,removepigmentation,wrinklesandscarring,andtotightenskin.Othermethods,suchasmechanicallyabradingtheskinwithametallicsandingwheel,alsohavebeenusedsuccessfully.However,whatthesetechniqueslack,isprecisioninthedepthofthetissueremoved,whichcanleaveunevenresultsandevenscarring.Furthermore,whilethesemethodsimprovethesurfaceappearance,theydon’taffectnewcollagenproduction. Outofallthemodalitiesdesignedforskinrejuvenation,oneoftheadvantagesofthelaserhasbeenitsdepthofpenetration,whichispreciseandcontrollable,diminishingthechanceofover-ablation,unpredictabilityandscarring.Inaddition,thelaserheatsupthedermalcollagen,thusstimulatingnewcollagenproductionandtherebytighteningtheskin,whilesimultaneouslyimprovingtheskintextureandappearance,andlesseningwrinkles.

Post-Treatment Expectations TreatmentswiththeDEKASmartXideDOTcarryminimalrecoverytime.Resultsareimmediateandprogressive.Immediatelyfollowingtreatment,patientsmayexperiencemildswellingandhaveasunburn-likeappearance.Th eskinisneverraworoozing.Overthefollowingweeksandmonths,thebodyrepairsthedeeperdermaltissuesthathavebeenaffectedbythetreatment,producingbeneficial,longer-termchangesassociatedwithahealthy,youthfulappearance.

Especially For Eyes Th eMadonnalift(photos3&4)isanon-surgicalalternativedesignedtoreduceandimprovedroopingskinoftheupperandlowereyelids,plumpupwrinkles,liftsaggingbrowsand

Advances in Non-Surgical Facial Rejuvenation

Harris Sterman, MD, is Chief of Plastic Surgery at Holy Name Medical Center. His private offi ce is located at 870 Palisade Ave., Suite 304, Teaneck, NJ 07666. He can be reached at 201-836-4111.

On the left pre-op photo, the upper lid’s excess skin almost covers the eyelashes. On the right, seven weeks after one DEKA SmartXide laser treatment, the upper lid skin has shrunk and there is a large reduction in upper eyelid skin. There is clear visibility of the upper lid skin and the lashes. The eyebrow is also elevated, creating an open, softer, less angry expression. Eyelid makeup is more easily applied.

The DEKA SmartXide DOT procedure entails faster recovery and minimal side effects, with excellent results.

With the DEKA SmartXide DOT, only a fraction of the skin surface area receives the laser light (hence “fractional skin resurfacing”).

treatothersignsofagingaroundtheeyes.ItusestheDEKAfractionallasertechnologytotightenandrejuvenatetheskinandimprovetextureforamoreyouthfulappearance–allwithoutsurgicalincisions. Improvementcanbeseenwithasingletreatment,butthreetofivetreatmentswillyieldthebestresults.

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Q: What are the benefi ts of DEKA Dot?

A:DOTTh erapywiththeSmartXideDOTCO2laserofferstheultimateinskinrejuvenationinjustunderanhourformosttreatments.DOTTh erapyisidealforthetreatmentofsundamage,brownspots,finelines,wrinkles,skinlaxity/textureandacnescars.NotonlydoestheDOTofferamazingresults,butitdoessosafelyandquicklywithlittledowntime.

SAVEDATETH

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THURSDAY, JUNE 14, 2012

18TH ANNUALHOLY NAME CLASSICGOLF TOURNAMENTPRESENTED BYHOLY NAME MEDICAL CENTER FOUNDATION

HACKENSACK GOLF CLUB, ORADELL, NJ INVITATION TO FOLLOWPROCEEDS WILL BENEFIT HOLY NAME MEDICAL CENTER

Before After

For more information, call 201-833-7143 or email mcgarrry@holyname.org

Ron White, MD, JD, is a colon and rectal surgeon on staff at Holy Name Medical Center. His private practice has two locations: 216 Engle Street, Englewood, NJ 07631, and 127 Union Street,

Ridgewood, NJ 07450. He can be reached at 201-567-7615 in Englewood and at 201-447-4466 in Ridgewood. Dr. White also practices health-related law with the firm of Philip F. Mattia & Associates.

Expert Witnesses (Part II): So You Want to Be an Expert Witness InthelasteditionofMD 360,IreviewedtheAffidavitofMeritStatute.Ifamedicalmalpracticeactionistoproceedbeyondthispoint,inmostcases,expertwitnesstestimonyisrequiredbothtoprovenegligenceandtodefendagainstsuchallegations.TherequirementstoofferexperttestimonyinNewJerseyaregovernedbyN.J.S.A.2A:53A-41.ThestatuterequirestheexperttobealicensedphysicianorotherhealthcareprofessionalintheUnitedStates.Theexpertmusthavepracticedinthesamespecialtyasthedefendant,atthetimeoftheoccurrence.Ifthedefendantisboardcertified,theexpertmustbeaphysiciancredentialedbyahospitaltotreatforthesameconditionorperformthesameprocedurethatformsthebasisforthenegligenceaction.Intheyearpriortotheoccurrence,theexpertmusthavedevotedthemajorityofhistimetotheactivepracticeofmedicineinthesamespecialtyorinstructedmedicalstudents,residentsorperformedclinicalresearchintheareathatunderliesthecomplaint.Acourtmaywaivetheserequirementsifanypartydemonstratesthatagoodfaitheffortwasmadetofindanexpertthatmeetstheserequirements,nonecouldbefoundandtheexpertbeingofferedinsteadhassufficienttraining,experienceandknowledgetoprovidesatisfactorytestimony.Courtsmaydisqualifyexpertsonunrelatedgrounds,eveniftheymeetthestatutoryrequirements.Expertwitnessesmaynottestifyonacontingencybasis.Inotherwords,feespaidmaynotbebasedupontheoutcomeoftheaction.Civilpenaltiesmaybeenforcedagainstanyonewhothreatensortakesadverseactionagainstapersonin

retaliationforprovidingexperttestimony.Inamedicalmalpracticeaction,thestandardofcaretowhichthedefendantallegedlyfailedtoadhere,mustbeestablishedbyexperttestimony.Thestandardofcareisdefinedasthedutytoexercisethedegreeofcare,knowledgeandskillordinarilypossessedbyanaveragememberoftheprofessionpracticinginthesamefield.Aspecialistisheldtoahigherstandardofcarethanthenon-specialist.Thestandardofcareinmedicalmalpracticeisgenerallyestablishedbynational,notlocalorregional,standards.Itmustbebasedupongenerallyacceptedmedicalstandardsandcannotsimplybetheopinionofthetestifyingexpert.Oncethestandardhasbeenestablished,theexpertmusttestifyastohowthedefendantphysicianbreachedthisstandardandhowthebreachledtoaninjury.Thelatterconceptisreferredtoascausation.

MymothergraduatedfromNYUSchoolofMedicinein1936,wasAOAandwasofferedtoheadthesurgicalresidentsprogram—forpediatricsurgery,ofcourse—atBeekmanDowntownHospitalaftershefinishedatBellevue.ShedeclinedforpersonalreasonsandinsteadbecamethefirstrheumatologyfellowinthecountryunderDr.CurrierMcEwen,thenDeanofNYUSchoolofMedicineandultimately,hisassistant.AfteranotherfellowshipatCambridge,shewasofferedapositionasexecutivevicepresidentofthemedicaldivisionatMONY.EvenaftertheyputherpictureonthecoverofVogue,shequitafteroneday–theywouldnotlethereatintheexecutivediningroom! Mymotherwasnotafeministextremist.Rather,shebelievedthatallthatwasneededtopropelonetothetopwashardwork,academicexcellenceandastrongethic.Shewasnotpoliticalintheslightest.SothequestionremainsinthemonthofMarch,Women’sMonth:Whereareallthestrong,moral,ethicalwomenpoliticalleadersinourcountry,ineitherparty,andwhyaretheynotcelebrated? Awomanhasneverrunourcountry.ThePhilippineshadPresidentCorazonAquino,andover30yearsago,theBritishhadPrimeMinisterMargaretThatcher.Whetheror

notyouagreedwiththeirpolitics,theyweresmartandtheywerestrong. Recently,The New York Times (3/10/12)printedapictureofthetwomostpowerfulindividualsinEuropeonitscoverpage:Ms.ChristianLagarde,DirectoroftheInternationalMonetaryFund,andMs.AngelaMerkel,ChancellorofGermany.Ms.Merkelhasshownusbyausteritymeasuresandretrenchment,thatGermanyhasonceagainemergedasaforceofpowerinEurope.MerkelandGermanyhavecomeupwiththewinninghandandhavesavedtheGreekeconomywhichhadoverspent,wasindolentandself-indulgent.WhoknowsifandwhenItaly,SpainandPortugalaretofollow?Again,whereareourstrongfemalepoliticalleaders,ineitherparty? BushappointedCondoleezzaRiceasthefirstfemaleNationalSecurityAdvisor;inaddition,shewasthefirstAfrican-AmericanfemaleSecretaryofState.RumorhasitfromaBidenfamilyfauxpas,thatHillaryClintonwasmadeSecretaryofStatebyacointoss.BothsheandBidensworeinthe‘08primariesthattheywouldneveracquiescetoaVP-shipunderObama.GuessthingswereironedoutbyJune‘08soObamacouldbethecandidateandHillarycouldkeepherword. Again,wherearethewomenwhodisplaythestrongmoralworkethicthatshouldpropelthemtoapositionofpowerineitherparty?WherearethePresidentAquinos,PrimeMinisterThatchersandtheChancellorMerkels? In1972,some36yearsafterearninghermedicaldegree,mymotherwasthesecondwomanadmittedtotheBellevueAlumni

Patricia A. Burke, MD, PhD, is an ophthalmologist on staff at Holy Name Medical Center, Member-at-Large of the Medical Executive Committee and Past-President of the Medical Staff.

Through the Looking Glass, Slowly

5

Manymalpracticeactionswillresultinabattleoftheexperts.Boththeplaintiffandthedefendantwillhavequalifiedexpertswhosetestimonywillbeacceptabletothecourt.Itislefttothejurytoevaluatethecredibilityoftheexpertsandtodeterminetheweightoftheirtestimony.Noteverycasewillrequireanexpert.Thecommonknowledgedoctrineallowssomecasestoproceedwithoutexperttestimonyiftheexperiencepossessedbylaypersonswouldenableajurytodeterminethatadefendantactedwithoutreasonablecare.Exampleswouldincludeafireintheoperatingroom,wrongsitesurgeryorretainedforeignbodies.Anexpertmaystillberequiredtodeterminetheextentofinjury.Atthispoint,Iamsureyouareexcitedandreadytobecomeanexpertwitness.Attheearlieststages,thelawfirmengagingyourservicesasanexpertwillwantanup-to-date

CV,tomakesureyouaretrulyqualified,andaproposedfeeschedule.Ingeneral,plaintifffirmspaymorethandefensefirms.Thedefensefirmsarelimitedbythemedicalmalpracticeinsurancecompaniesthatarefootingthebill.Onceretained,youwillbeaskedtoreviewrecords,whichcanbevoluminous,authorawrittenopinion,testifyatdepositionand,ifthecasegoestoitsultimateconclusion,testifyincourt.Thereisnovaluetoanexpertwhoisnotwillingtotestifyincourt.Thiscansometimesbeburdensomeascourtproceedingsareoftenrescheduled,delayedoradjourned.Itcanwreakhavoconthebusyphysician’sschedule.Ifthisstillhassomeappealtoyou,youcanmakeyourselfavailableasanexpertinseveralways.Thereareregistries,generallylistingplaintiffexperts,whichcanbejoined.Abetterwayistocontactlawyersinthefieldandmakeitknowntothemthatyouareinterestedintestifying.Mostlawyerswillwelcomeyourinterest,asfindingreliableexpertsisadifficultproposition,particularlyonthedefenseside.

Association.Shewasonlyslightlymiffed,notbecauseshewassecond,buttowhomshewassecond.“Margaretwasalwaysnippingatmyheels.”Shewas,however,morepolitical.Aswedressedtoattendherinductionceremony,Iwashurtandmortifiedforher36-yearhiatus.Shetold

meitdidn’tmatter,asitwasonly“cigarsmokeandoldideas.”Butitdidanditdoes. Andso,another36yearshaspastandmydaughter,unbeknownsttoher,haswrittenapoemforhergrandmother,andforallwomen,tohelpthemthroughthelookingglass,tothesideofpowerandsuccess.

The Business Womanby Amy Déliée Pfund

hidingchildhoodfreckleswithperfecttonedtoner.Thenevenonbothsidessherubsslowly

draggedacrossherhighcheekbonesredsmearedacrossevenonbothsidesshepowdersslowly

eyesbecomewiderandsharpthewetbrushskatesacrossthelidevenonbothsidesshebreathesslowly

plumpingandboldinglipsforboldwordsandlucrativepropositionsevenonbothsidesshelicksslowly

hairpulled,pinnedandpinched;tightthensprayedverylightlyandthinly,likemorningfog

evenonbothsidesshelooksslowly

herreflection.it’sperfectitscaresherandsheisthrilled.

Butthereisonestrandthatleaksfromtherightsideofherface,itsoftensher.soshepushesitback.backawaybehindherear.

thesilverclaspssnapinallhersecretsonwhitepagesthatarefreckledwithorganizedblackletters.it’snotherworld,butshehastofightinit.

battleandswallowcoughscausedbycurlingsluggishsmokefromyellowedbitingteethandfattonguesthatlicktheendsofcigars.

leanlegscrossedanddelicatescarshiddenbynudepantyhoseevenonbothsidesShespeaksstrongly.

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 January, February, March and April 2012.

35 YearsCharles Garbaccio, MD, Plastic Surgery

30 YearsRonny Meier, MD, Obstetrics & Gynecology

25 YearsMichele Deantonio, MD, PediatricsOhan Karatoprak, MD, Family PracticeChun Lowe, MD, General SurgeryJohn Poole, MD, General SurgeryJoseph Schuster, MD, Internal Medicine

20 Years Patricia Burke, MD, PhD, OphthalmologyBruce Rosen, DO, Internal MedicineKaren Weingarten, MD, Radiology

15 YearsBenjamin S. Chouake, MD, Internal MedicineEric J. Margolis, MD, Urology

10 YearsTracy V. Dau, PA, Emergency MedicineSteve R. Fallek, MD, Plastic SurgeryEddie K. Ho, MD, Internal MedicineDaniel Klapper, MD, OphthalmologyKaran Nejad, MD, Internal MedicineRitu Suri, MD, Family Practice

5 YearsJames Cahill, MD, OrthopedicsJohn Ditzenberger, MD, RadiologyJohn Doolan, DPM, PodiatryIsaiah Florence, MD, AnesthesiaJoshua Gross, MD, RadiologyNinette Kanarek, MD, PediatricsRobert Lee, MD, Internal MedicineGary Louizides, RNFA, General SurgeryJ. Christopher Mendler, MD, Family Practice/ Sports MedicineMatthew Nalbandian, MD, General SurgeryArgiro Papandrikos, DDS, General DentistryZev Schulhof, DMD, Oral & Maxillofacial SurgeryJeffrey Strain, MD, General SurgeryTracy Verrico, DO, Obstetrics & GynecologySarah Zeb, MD, Radiology

M e d i c a l S ta f fGrandRoundsMAy 8TBA

MAy 15“The MILD Procedure” Samyadev Datta, MD, Division Chief of Pain Medicine, HNMC

MAy 15TBA

MAy 22“Annual Diabetes Management, 2012” Mark Wiesen, MD & Maria Soper, RN, Department of Endocrinology, HNMC

JuNE 5“Hypercoagulable State & Emergent Oral Anticoagulants”Raimonda Goldman, DO, Department of Oncology, HNMC

JuNE 12TBA

JuNE 19“PCN Allergies & Hypersensitivity Testing” Patrick Perin, MD, Department of Allergy, HNMC

JuNE 26“HIV Symposium” TBA

Location: Marian HallTime: 9 - 10 a.m.

ApplauseNicholas J. Bevilacqua, DPM, FACFAS, hasauthoredachapterinthetextbook,International Advances in Foot and Ankle Surgery.Thiscomprehensivereferenceconsistsofchapterswrittenbyinternationallyrenownedpodiatric,orthopedicandtraumasurgeons,andisthefirsttrulyinternational,multidisciplinarymanualoffootandanklesurgeryfromthefield’sleadingsurgeons.ThetextispublishedbySpringerandwasreleasedinDecember2011. Dr.Bevilacquaauthoredthechapter,“PedalAmputationsinDiabetes,”whichprovidescurrent,up-to-datetechniquesusingascientificapproach,includingevidence-basedguidelines,andastep-by-stepapproachforselectedfootamputations. Dr. Bevilacqua is on staff at Holy Name Medical Center and is a member of the North Jersey Orthopaedic Specialists, PA, at 730 Palisade Ave., Teaneck, NJ. He can be reached at 201-353-9000.

James A. Charles, MD, FAAN, isaneurologistonstaffatHolyNameMedicalCenterasaheadachespecialistandClinicalAssociateProfessorofNeurologyatNewJerseyMedicalSchool.Heistheleadauthorofalandmarkarticlewiththenation’stopheadacheexpertsentitled“Favorableoutcomeofearlytreatmentofnewonsetchildandadolescentmigraine—Implicationsfordiseasemodification.”Journal of Headache and Pain,vol.10(4),2009 “MigraineisontheWHO’stop20listofdisablingdiseases,andisveryprevalentinthiscountry,”saysDr.Charles,whohaslecturedtoHNMC’sphysicians,andadultandpediatricnurses.HeisworkingwithHolyName’sadministrationandmedicalspecialiststoestablishaheadacheinfusionprogramforchildrenandadultsinthe

Nicholas J. Bevilacqua, DPM, FACFAS

future.TheMedicalCenter’EmergencyDepartmenthasalreadytreatednumerouspatientswithtargetedinfusionprotocolswithgreatsuccess,accordingtoDr.Charles. “Thereareapproximately28millionmigrainesuffererswitha3:1,female:maleratio,”notesDr.Charles.“Migraineprevalenceinchildrenisupto11%,andinteens,upto25%.Unfortunately,thisisabiologically-driven,potentiallydisablingdiseasethatismisunderstoodandmisdiagnosed.Theprognosisimproveswithearlytargetedtreatmentandrecognition.” Dr. Charles’ private office is located at 8841 Kennedy Boulevard, North Bergen, NJ 07047. He can be reached at 201-854-6614.

AneditorialbyRobert S. Rigolosi, MD,nephrologistandDirectoroftheRegionalDialysisCenteratHolyNameMedicalCenter,waspublishedintheMarch2012editionofRenal & Urology News.Inhisarticle,“Whatthe‘HDMarathonMan’TeachesUs,”Dr.Rigolosidescribeshowadherencetodiet,medicine,schedulingandfollow-uphelpedhispatient,EdStrudwick,survive39yearsandninemonthsonhemodialysis. “Patientsdobestwhentheyembracetheirnewdisease-drivenlifestyleandacceptwhattheyhavetodo,”explainsDr.Rigolosiinthearticle.Hepointsoutthatdiligentattentiontopatienteducationandencouragementfromthehealthcarestaffisessential,andherecommendsthatnephrologistsencouragehomehemodialysis—particularly,homeperitonealdialysis—becauseitallowsforgreaterflexibility.Dr.Rigolosialsoexplorestherapportbetweendoctorsandpatientsandtheirfamilies,andtheroleofinstillinghopeinlongevity. Mr.Strudwickunderwentabout5,800hemodialysistreatmentsduringhisexperienceatHolyNameandwasoneofthelongesthemodialysissurvivorsintheworld. Dr. Rigolosi is a member of the Renal&UrologyNewsEditorial Advisory Board. He can be reached at 201-833-3223.

James A. Charles, MD, FAAN

Robert S. Rigolosi, MD

6

OnJanuary18,2012,Dr.PaulLWeygandt,MD,JD,MPH,MBA,CPE,VicePresidentofPhysicianServicesatJAThomas,visitedHolyNameMedicalCenter.Thiswasascheduledphysicianeducationday,aspartoftheMedicalCenter’scontractwithJAThomas,thehealthcarecomplianceanddocumentationimprovementcompany. Dr.WeygandtreceivedanoverviewofHolyName’sClinicalDocumentation

Dr. Theophanis Pavlou, Pulmonary Medicine

Rebecca Rigolosi, ANP-BC, is an Adult Nurse Practitioner and CDMP Team Leader at Holy Name Medical Center.

ManagementProgram,metwiththeclinicaldocumentationspecialistteam,gaveinsightfulITsuggestionstoupdateourprogram,andpresentedcasescenariosforimprovingdocumentationtofoursessionsofphysiciangroups.Thesessionswereproductiveandinformative,eachgeneratinggooddiscussionandQ&Aopportunitiesaboutdocumentationtrends,preparationforICD10,andothersignificantissuesfacingphysicianstoday.

Dr. Mohammad Tehranirad, Internal Medicine/Hospitalist Dr. Jan Mrani, Internal Medicine Dr. Ohan Karatoprak, Family Practice

Dr. Paul Weygandt, Speaker

PhysicianICD10preparationisforthcoming,sopleasewatchforourannouncements.CDMPthanksyouforyourcontinuedsupport!

JANuARy FEBRuARy MARCH APRIL

CDMP Spotlight

Welcome New Appointments

Azer Alizade, MDObstetrics/Gynecology

Medical School: Moscow University Medical SchoolResidency: Lincoln Medical Center, Ob/GynPractice: 225 W. Spring Valley Ave., Suite 102, Maywood, NJ 07607Phone: 201-289-5906

Hazel Brana-Leon, MDObstetrics/Gynecology

Medical School: Universidad Autonoma de GuadalajaraInternship: New York Medical College, Fifth Pathway ProgramResidency: UMDNJ, Ob/GynPractice: 222 Cedar Lane, Suite 204, Teaneck, NJ 07666Phone: 201-836-4025

Basil Bruno, MDPediatrics

Medical School: UMDNJResidency: UMDNJ, PediatricsPractice: 55 Summit Ave., Hackensack, NJ 07601Phone: 201-343-3858

Daniel Chechik, MDSurgery/Ophthalmology

Medical School: Albert Einstein College of MedicineInternship: Beth Israel Medical Center, Internal MedicineResidency: Montefiore Medical Center, OphthalmologyFellowship: Montefiore Medical Center, Retina/VitreousPractice: 403 Clifton Ave., Clifton, NJ 07011Phone: 973-546-5700

Keith Christiansen, MDSurgery/urology

Medical School: Georgetown University School of MedicineInternship: Presbyterian Hospital, SurgeryResidency: George Washington University Hospital, SurgeryResidency: George Washington University Hospital, UrologyPractice: 12-01 Broadway, Route 4, Fair Lawn, NJ 07410Phone: 201-791-4544

David Chun, MDRadiology

Medical School: SUNY – Stony Brook, School of MedicineInternship: Westchester County Medical Center, Internal MedicineResidency: New York Medical College, RadiologyResidency: Columbia Presbyterian Medical Center, RadiologyFellowship: Columbia Presbyterian Medical Center, Breast Imaging/UltrasoundPractice: HNMC Breast Center, 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-833-7100

Jacob Chung, MDSurgery/Ophthalmology

Medical School: New York University School of MedicineInternship: Lenox Hill Hospital, MedicineResidency: University Hospital, OphthalmologyPractice: 111 Dean Drive, Suite 2S, Tenafly, NJ 07670Phone: 201-567-5995

Seema Dhorajia, DOSurgery/General Surgery

Medical School: New York College of Osteopathic MedicineInternship: UMDNJ, SurgeryResidency: UMDNJ, SurgeryFellowship: Hackensack University Medical Center, Minimally Invasive Laparoscopic SurgeryPractice: 35 Plaza Professional Center, 81 Route 4 West, Suite 401, Paramus, NJ 07652Phone: 201-646-1121

Jeffrey Farkas, MDSurgery/Neurosurgery - Neuroradiology

Medical School: SUNY Health Science Center at BrooklynInternship: Staten Island University Hospital, MedicineResidency: Montefiore Medical Center, RadiologyFellowship: Massachusetts General Hospital, NeuroradiologyPractice: 680 Kinderkamack Rd., Suite 300, Oradell, NJ 07649Phone: 201-342-2550

Richard Garden, MDSurgery/urology

Medical School: Mount Sinai School of MedicineInternship: Mount Sinai Medical Center, SurgeryResidency: Mount Sinai Medical Center, UrologyPractice: 555 Kinderkamack Rd., Oradell, NJ 07649Phone: 201-834-1890

Payal Ghayal, MDPediatrics

Medical School: Sri Ramachandra Medical CollegeResidency: Goryeb Children’s Hospital, PediatricsPractice: 714 10th Street, Secaucus, NJ 07094Phone: 201-863-3346

Ilona Hertz, MDRadiology

Medical School: SUNY DownstateInternship: Beth Israel Medical Center, PediatricsResidency: Mount Sinai Medical Center, Diagnostic RadiologyPractice: HNMC Breast Center, 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-833-7100

Steven Horowitz, MDMedicine/Physical Medicine & Rehabilitation

Medical School: SUNY Health Science Center at BrooklynInternship: Hospital University of Pennsylvania, Physical Medicine & RehabilitationResidency: Hospital University of Pennsylvania, Physical Medicine & RehabilitationFellowship: Beth Israel Medical Center, Pain Medicine/AnesthesiaPractice: 177 North Dean Street, Englewood, NJ 07631; 1414 New Kirk Ave., Brooklyn, NY 11226Phone: 201-510-3777 (Englewood); 718-759-6100 (Brooklyn)

Elaine Keller, CNMObstetrics/Gynecology

School: Quinnipiac UniversityPractice: 721 Clifton Ave., Suite 1A, Clifton, NJ 07013Phone: 973-471-0707

Boris Khaimov, PASurgery/Orthopedics

School: St. Vincent’s Catholic Medical CenterPractice: 401 Hackensack Ave., 10th fl., Hackensack, NJ 07601Phone: 201-343-3999

Farhana Khan, MDObstetrics/Gynecology

Medical Center: St. George’s UniversityInternship: University of West Virginia, Ob/GynResidency: Robert Wood Johnson University Hospital, Ob/GynResidency: Long Island College Hospital, Ob/GynPractice: 1070 Clifton Ave., 1st Fl., Clifton, NJ 07013Phone: 973-272-3136

George Kruse, MDMedicine/Psychiatry

Medical School: UMDNJResidency: Montefiore Medical Center, PsychiatryPractice: 610 Valley Health Plaza, Paramus, NJ 07652Phone: 201-265-8200

Sung-Won Lee, MDMedicine/Physical Medicine &

RehabilitationMedical School: Catholic University of KoreaInternship: Lenox Hill Hospital, Internal MedicineResidency: Lenox Hill Hospital, Internal MedicinePractice: 101 Broad Ave., Palisades Park, NJ 07650Phone: 201-941-2486

Indu Mirchandani, MDMedicine/Psychiatry

Medical School: Lokmanya Tflak Mun Medical CollegeResidency: Bronx-Lebanon Hospital, PsychiatryFellowship: New York Hospital – Cornell Medical Center, PsychiatryPractice: 610 Valley Health Plaza, Paramus, NJ 07652Phone: 201-265-8200

Erinn Noeth, MDRadiology - Teleradiology

Medical School: University of Iowa College of MedicineInternship: St. John’s Mercy Medical Center, TransitionalResidency: George Washington University Hospital, RadiologyPractice: 695 Dutchess Turnpike, Suite 105, Poughkeepsie, NY 12603Phone: 888-647-5979

Lisa O’Donnell, MDPediatrics

Medical School: St. George’s UniversityInternship: Long Island College Hospital, PediatricsResidency: Long Island College Hospital, PediatricsPractice: 55 Summit Ave., Hackensack, NJ 07601Phone: 201-343-3858

Kathleen Prendergast, NPMedicine/Psychiatry

School: Rutgers College of NursingPractice: 210 Valley Health Plaza, Paramus, NJ 07652Phone: 201-265-8200

Alicia Rodriguez-Barrera, PASurgery/General Surgery

School: Weill CornellPractice: 222 Cedar Lane, Teaneck, NJ 07666Phone: 201-530-1900

Bo Shin, DPMSurgery/Podiatry

Medical School: Ohio College of Podiatric MedicineResidency: St. John’s Episcopal Hospital – South Shore, PodiatryFellowship: St. John’s Episcopal Hospital – South Shore, Wound Care & Tissue HealingPractice: 2361 Lemoine Ave., Fort Lee, NJ 07024Phone: 201-944-4479

Gunjan Shukla, MDMedicine/Cardiology

Medical School: B.J. Medical CollegeInternship: St. Elizabeth Medical Center, Internal MedicineResidency: St. Elizabeth Medical Center, Internal MedicineResidency: St. Elizabeth Medical Center, CardiologyFellowship: Beth Israel Deaconess Medical Center, Cardiac ElectrophysiologyPractice: 20 Prospect Ave., Suite 701, Hackensack, NJ 07601Phone: 201-996-2997

Monica Srivastava, MDMedicine/Dermatology

Medical School: Johns Hopkins UniversityInternship: Georgetown University Hospital, MedicineResidency: New York University Medical Center, DermatologyFellowship: Beth Israel Deaconess Medical Center, Dermatology/Mohs SurgeryPractice: 222 Cedar Lane, Suite 303, Teaneck, NJ 07666Phone: 201-836-9696

Donna Tabas, CNMObstetrics/Gynecology

School: Columbia University School of NursingPractice: 71 Union Ave., Suite 101, Rutherford, NJ 07070Phone: 201-868-6868

George Tarng, MDMedicine/Internal Medicine (Hospitalist)

Medical School: St. George’s University School of MedicineInternship: St. Michael’s Medical Center, Internal MedicineResidency: St. Michael’s Medical Center, Internal MedicinePractice: 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-530-7931

Celia Thomas, DOPediatrics

Medical School: New York College of Osteopathic MedicineResidency: Morristown Memorial Hospital, PediatricsPractice: 714 10th St., Secaucus, NJ 07094Phone: 201-863-3346

Mary Thomas, MDPediatrics

Medical School: Chicago Medical SchoolInternship: St. Vincent’s Hospital, PediatricsResidency: St. Vincent’s Hospital, PediatricsPractice: 55 Summit Ave., Upper Montclair, NJ 07043Phone: 201-343-3858

Dina Vaynberg, MDMedicine/Psychiatry

Medical School: First Moscow Medical Institute, MDResidency: Middletown Psychiatric Center, PsychiatryResidency: Creedmoor Psychiatric Center, PsychiatryPractice: 610 Valley Health Plaza, Paramus, NJ 07652Phone: 201-265-8200

Renee Weslow, MDMedicine/Cardiology

Medical School: St. George’s UniversityInternship: Metropolitan Hospital, MedicineResidency: Mountainside Hospital, MedicineFellowship: University of Missouri Hospital, CardiologyFellowship: Columbia Presbyterian Medical Center, CardiologyPractice: 425 Livingston St., Suite 1, Norwood, NJ 07648Phone: 201-784-0071

Phil Whang, MDMedicine/Psychiatry

Medical School: UMDNJ-Robert Wood Johnson Medical SchoolInternship: Overlook Hospital, TransitionalResidency: New York Presbyterian Hospital – Columbia Campus, Physical Medicine & RehabilitationResidency: UMDNJ, PsychiatryFellowship: Yale New Haven Hospital, Geriatric PsychiatryPractice: 20 Washington Place, 3rd floor, VA Clinic, Newark, NJ 07102Phone: 973-676-1000

Dana Wisehart, NPSurgery/General Surgery

Practice: HNMC Clinic, 718 Teaneck Rd., Teaneck, NJ 07666Phone: 201-833-7183

Cynthia Zimm, MDPediatrics

Medical School: Albert Einstein College of MedicineResidency: Jacobi Hospital, PediatricsPractice: 95 North Washington Ave., Bergenfield, NJ 07621Phone: 201-384-0300

Appointments to the Medical Staff for December 2011, and January, February and March 2012.

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Dabigatran: Hemorrhagic Complications and Potential Death From TraumaDabigatran (Pradaxa) is a direct thombin inhibitor that was approved by the FDA in October 2010 to reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fi brillation. Two trauma surgeons point out a serious potential adverse effect related to the drug. While it may be diffi cult to treat a trauma patient on warfarin, its anticoagulant effect can be reversed in a number of ways, including use of vitamin K, plasma factor VIIa, and factor concentrates. In contrast, they point out there is no readily available means for assessing the degree of anticoagulation with dabigatran, there is no readily available reversal strategy, and life-threatening bleeding complications can occur after trauma. One option is emergency dialysis, but “the ability to perform rapid dialysis in patients with bleeding, whose condition is unstable or in those with large intracranial hemorrhages will present an incredible challenge, even at level one trauma centers.” Among patients taking dabigatran seen by Cotton et al, all appeared to have normal coagulation on conventional tests, but were grossly abnormal using rapid thromboelasto-graphy. They believe that physicians should discuss with their patients the potential for hemorrhagic complications resulting from trauma, and urge the FDA to consider hemorrhagic complications and death resulting from trauma be included as part of the routine surveillance of all newly approved oral anticoagulants. On December 7th, the FDA announced that it is now investigating postmarketing reports of serious bleeding events in patients taking dabigatran. Physicians should report adverse events or side effects related to dabigatran to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program.

CONCLuSION: Dabigatran may be associated with a high potential for hemorrhagic complications and death following trauma.

Hazard Alert: Do Not Use an Insulin Pen for Multiple Patients!Adapted from ISMP Medication Safety Alert, January 12, 2012, Volume 17 Issue 1

A single pen device is never suitable for use with multiple patients due to the risk of cross contamination and transmission of blood-borne diseases. In 2008, ISMP published at least two studies demonstrating that biological contamination of insulin occurred in up to half of all reused insulin pens. Air bubbles and pathogenic

Vitamin D3 is Up to 87% More Potent Than Vitamin D2

The dose of vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol) is designated in units. One unit of vitamin D3 is not equivalent in effi cacy to one unit of vitamin D2, according to Heaney et al. In a single blind, randomized trial, these investigators assessed the change in serum 25-hydroxyvitamin D [25(OH)D] levels in 33 adults who received 50,000 units weekly of either vitamin D3 or vitamin D2 for 12 weeks. Mean steady state 25(OH)D levels from vitamin D3 were nearly twice that from vitamin D2 (45 vs. 24ng/ml, p<.001). In addition, subcutaneous fat was signifi cantly higher with vitamin D3 compared with vitamin D2 (104 vs. 50 mcg/kg) as well as total calciferol in fat (104 mcg/kg vs. only 33ng/kg). Five weeks after the study period, 25(OH)D levels in 4 of 16 subjects fell below 32 ng/ml in the D2 group, with 3 falling to below starting levels, while none in the D3 group fell below 32ng/ml. Using the various measures tested, vitamin D3 was up to 87% more potent in raising serum 25(OH)D compared to vitamin D2.

CONCLuSION: Vitamin D3 is signifi cantly more potent than vitamin D2.

Importance of Adequate Vitamin D Levels for Patients with Heart Disease Numerous studies have demonstrated an association between vitamin D defi ciency and hypertension, peripheral vascular disease, diabetes, metabolic

syndrome, coronary artery disease, and heart failure, according to Vasek et al. In a retrospective observational study among outpatients, these investigators compared blood level data from more than 10,000 cardiovascular patients and they assessed the association of vitamin D defi ciency with cardiovascular morbidity and mortality, including the effect of vitamin D supplementation on survival. A total of 3,234 patients (29.7%) were in the normal range for vitamin D (≥30ng/ml) while 7,665 (70.3%) were defi cient (<30ng/ml). On multivariate analysis, vitamin D defi ciency was a strong independent predictor of all-cause mortality, amounting to more than a 2-fold greater risk over the study period, compared with vitamin D suffi ciency [odds ratio (OR) 2.64, 95% CI 1.901 to 3.662, p<0.0001]. Compared with patients who received vitamin D supplementation, there was a 3-fold risk for death in defi cient subjects (OR 3.07, 95% CI 2.222 to 4.228, p<0.0001) during the study period. Further analysis revealed that signifi cant differences in survival among patients were only seen in those who were vitamin D defi cient and received supplementation. No survival advantage was observed in those who were already vitamin D suffi cient and received supplementation. Those with greater body weight had signifi cantly lower vitamin D levels, suggesting that higher dose may be needed for these patients. The authors noted that previous studies using low vitamin D doses (400 to 800 IU daily) have not consistently shown a benefi t and that daily doses of 1,000 to 2,000 IU appear to be more appropriate.

CONCLuSION: Adequate dosing of vitamin D appears to improve survival in vitamin D defi cient cardiovascular patients.

Second-Generation Antidepressants Have Similar Therapeutic Effi cacy A meta-analysis by Gartlehner et al assessed the effi cacy of second-generation anti-depressants in the treatment of major depressive disorder. The drugs reviewed were bupropion (Wellbutrin), citalopram (Celexa), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fl uoxetine (Prozac), fl uvoxamine (Luvox), mirtazapine (Remeron), nefazodone, paroxetine (Paxil), sertraline (Zoloft), trazodone (Desyrel), and venlafaxine (Effexor). When head-to-head studies were not available, indirect assessments were done when two drugs were separately compared with placebo. All of the drugs were found to be about equally effective. Thus, a difference in side effects, dosing convenience, onset of action, cost, and indications for use other

than depression may guide the choice for a particular drug.

CONCLuSION: Current evidence does not warrant choosing a particular second-generation antidepressant on the basis of effi cacy alone.

Most Adverse Drug Emergencies in Elderly are Caused by Four Medications

Investigators used data from emergency department visits for outpatient adverse drug events among 58 hospitals. Nearly 100,000 emergency hospitalizations occurred annually due to medication injury in older patients (age >65), excluding cases of intentional self-harm, drug abuse, therapeutic failures, or drug withdrawal. About 48% of ADR-associated hospitalizations among the elderly were in patients over 80. Most emergency hospitalizations in the elderly resulted from a few medications that are not usually considered high-risk drugs or inappropriate by current national quality measures, according to the investigators. Four medications accounted for more than two-thirds of the adverse drug event-related emergency hospitalizations: warfarin (Coumadin) (33%), insulins (14%), oral antiplatelet agents [i.e. clopidogrel, (Plavix), Dabigatran, (Pradaxa)] (13%), and oral hypoglycemic agents [metformin, (Glucophage), glyburide, (Diabeta)(11%)]. Most hospital stays attributed to hematologic agents were for acute hemorrhages (71.3%). Nearly all hospitalizations attributed to endocrine agents were for hypoglycemia (94.6%). Nearly all hospitalizations involving warfarin, insulins, or oral hypoglycemic agents resulted from unintentional overdoses.

CONCLuSION: Improved management of antithrombotic and anti-diabetic drugs in the outpatient setting is needed to prevent thousands of the elderly from being hospitalized due to adverse drug events.

Pharmacy & � erapeutics newsletter now appears in MD360

9

CONTINUEDcontaminants can enter the cartridge after injection while the needle is still attached to the pen, even for short periods of time. In 2009, ISMP cooperated with the US Food and Drug Administration (FDA) on a Patient Safety News video (www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/transcript.cfm?show=86#9) that discusses how contamination can happen. The video was prompted by a 2009 incident at two US Army hospitals in which 2,114 insulin-dependent diabetic patients were placed at risk because insulin pens were used for multiple patients. Just last year, an incident in Wisconsin required notifi cation of more than 2,000 potentially exposed patients due to inappropriate sharing of insulin demonstration pens used during patient training.

Repeated event reports suggest that an alarming and widespread misunderstanding that sterility can be maintained between patients by affi xing a fresh needle on a pen device continues even today, despite fervent warnings from ISMP, the Centers for Disease Control and Prevention (CDC), FDA, and pen device manufacturers. Do not use an insulin pen for multiple patients! Last month, ISMP received two reports in which nurses knowingly used the same insulin pen for multiple patients. Both nurses thought the practice was acceptable because they changed the needle between patients. In one case, it was later determined that the original patient had human immunodefi ciency virus (HIV)! Follow-up exposure treatment and testing are being conducted on the affected patient. The nurse involved in the event reported that sharing insulin pens after changing the needle was routine practice at another hospital where she had worked. In the other case, two pens were used to administer insulin to three patients, even though each pen had a patient-specifi c label. One of the pens was borrowed from another

patient while the nurse was waiting for pharmacy to dispense an insulin pen for her new patient. Insulin pen cartons state that the pens are intended for “Single patient use only”; however, labels on the pens do not include this warning, and the cartons are rarely dispensed to patient care units. According to the CDC, evidence continues to mount that this dangerous practice is still affecting thousands of patients (www.cdc.gov/injectionsafety/blood-glucose-monitoring.html). This concern led the CDC to again issue a clinical reminder (www.cdc.gov/injectionsafety/clinical-reminders/insulin-pens.html), stating that the agency has increasingly become aware of reports of improper use of insulin pens, which places individuals at risk of infection. Insulin pens are convenient and offer the possibility of improving safety when viewed from the perspective of reducing dosing errors, particularly errors that occur when drawing the correct volume into a syringe and the addition of several extra steps in administration. The dose preparation step is simpler and involves just turning a dial to the prescribed dose and affi xing a special needle to the device before injection. However, keep in mind that insulin pens were originally designed for home use by diabetic patients, and less so for inpatient use.

Safe Practice Recommendations: To reduce the risk of cross contamination, insulin pens used in inpatient settings should be assigned to individual patients and labeled accordingly. Unfortunately, space is lacking on the pen for application of a patient label, so pharmacists must affi x a “fl ag” label, taking care to attach the label to the body of the pen, not the cap, without covering the drug name. If the label is on the cap, once the cap is removed, the

Drew Olsen, MD, is Medical Director of the Department of Pathology and Laboratory Medicine at Holy Name Medical Center. He can be reached at 201-833-3020.

Urinalysis Update FROM THE DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE

The Laboratory is now performing urinalysis on the Siemens AUWi: Automated Urinalysis Workstation. This instrument consists of a Clinitek Atlas that does traditional urine chemistry (dipstick) analysis and a Sysmex UF1000i, which performs automated microscopy. The system uses a fl uorescent dye in conjunction with fl ow-cytometry, a technology very similar to the hematology automated differential. The same technologies that were brought to bear on blood cell analysis have been adapted to provide fully automated urinalysis. Flow cytometry allows for more precise counting of particles in the urine than does traditional sediment analysis and does not require centrifugation of the specimen. Urinary formed elements are stained with a fl uorescent dye for nucleic acids and membranes. A laser is applied to measure size and detectors assess the complexity based on fl uorescence staining and light scatter characteristics. It combines

this information with impedance measurements in order to detect white cells, red cells, casts, epithelial cells, bacteria, yeast and sperm, in addition to precise quantitation of most formed elements. An automated microscopic examination will be performed, based on the character of the specimen and any positive urine dipstick chemistry analysis for bilirubin, blood, protein, nitrite, and leukocyte esterase. The automated microscopic report will have numeric results for WBC, RBC, squamous epithelial cells, and hyaline casts. Based on our lab’s sensitivity studies of the automated microscopic examination, criteria were set to fl ag specimens that need manual microscopic review by the technologist. The manual microscopic exam is triggered by the possible presence of yeast, transitional cells, renal cells, pathologic casts, crystals and sperm. Since the instrument is more sensitive and provides a specifi c

pen is no longer labeled. Please also heed the advice we provided in our February 12, 2009, HazardAlert! in which we noted that safety could only be assured through timely education and ongoing monitoring. Unfortunately, hospitals may fi nd education and monitoring diffi cult to accomplish due to staff turnover and time constraints. If ongoing education and continuous monitoring cannot be accomplished, hazardous conditions may persist, and hospitals may need to take a long, hard look to determine if patients would be safer is they were dispensed vials of insulin or prefi lled syringes. Another option is allowing patients to bring their own pens to the hospital for use, but only if the hospital has effective procedures in place to verify, label, and securely store the pens.

Holy Name Medical Center does not purchase, stock or dispense insulin pens. The Pharmacy Department takes great pride in our decision to continue utilizing insulin vials. Vials are now bar coded and scanned prior to administration, which is another step in our crusade to minimize medication errors and ensure patient safety!

Multi-Step Orders/Hold Orders Spark Confusion at HNMCMulti-step orders which are processed based on conditional prescribing, lead to confusion, delays of therapy, missed doses and put our patients in harm’s way. Unfortunately, these multistep orders require Nursing and or Pharmacy to interpret lab tests, read radiological results and give a certain dose of medication

based upon a result. The completion of these orders may take hours to days while crossing multiple work shifts, leading to increased confusion. For example, an order is written for albuterol 4 puffs qid & q2h prn if extubated. The patient remains on a ventilator x 72 hours and the albuterol order expires. A phone call is generated by the Respiratory Therapist to Pharmacy, as she is unsure what to do because the order has expired. The Pharmacist is unsure what to do because if he discontinues the order, the prescribing physician would be under the impression there are active orders for albuterol. The order is discussed with the Director of Pharmacy and it is decided to reprofi le the order and place it on hold with a clinical note advising the Therapist and Nurses of the new profi led order which has been placed on hold. A different outcome may have taken place had the Pharmacist not discussed it with the Director. The ambiguity of the order could have lead to a medication error. Through our patient safety reports, we have seen time and time again numerous reports of patients receiving the wrong dose, the wrong medication or not receiving any medication at all.

The Pharmacy strongly encourages all physicians to refrain from writing multi-step orders. We encourage you to write orders instructing the Nurse and/or Pharmacy to call the prescribing physician when a result is fi nalized to obtain subsequent orders. We ask for your cooperation with this practice as we continue to move forward with our campaign to reduce medication errors and promote patient safety!

References available upon request

quantitation of analytes, the new reference ranges are:

WBcs 0-7/ High Power field (HPf) RBcs 0-4/HPf Squamous epithethial cells 0-110/ low Power field (lPf)Hyaline casts 0-12/lPf In anticipation of the upgrade to the new urinalysis instrumentation and to ensure compliance with best practice in urine specimen collection, handling and transport, the Laboratory implemented use of the BD Vacutainer Urine Collection System both in-house and with our outreach clients. Specimen collection from catheterized patients was also standardized to include use of a BD Vacutainer Luer Lok Access Device (LLAD), which enables the collection of fresh specimens directly from the catheter, rather than from the indwelling catheter bag. In addition to the instrument upgrade, we wanted to prevent leakage, especially through the

pneumatic tube, avoid contaminated culture specimens and to standardize our pre-analytical process. Use of the Vacutainer Urine Collection System has led to improved specimen integrity and less rejection and re-collection for our patients. Each specimen tube has a barcode label read by the instrument barcode reader for patient safety and rapid identifi cation. We are confi dent that this standardization and reduction of analytical variables is a clinical benefi t for our patients. If you have any questions, please call me or Denise Gordon, our Hematology Supervisor, at ext. 3039.

J O I N U S

F O R A N E V E N I N G

O F F I N E W I N E A N D F O O D

I N S P I R E D B Y A R G E N T I N A

10

What is NJ-HITEC?New Jersey Health Information Technology Extension Center (NJ-HITEC) is the federally-designated Regional Extension Center funded by the Offi ce of the National Coordinator of the Department of Health and Human Services. The purpose of the Regional Extension Center (REC) is to assist physicians in achieving “Meaningful Use” – that is, improving healthcare quality, safety and effi ciency—through promotion of health information technology, including electronic medical records (EMRs).

How is achieving “Meaningful Use” of the EMR advantageous to doctors?Under HITECH (Health Information Technology for Economic and Clinical

Health), eligible healthcare professionals can qualify for Medicare and Medicaid incentive payments when they adopt certifi ed EHR technology and use it to achieve specifi ed objectives, known as “Meaningful Use.” One fi nancial benefi t is based upon Medicare claims. If the practice sees Medicare patients, it is eligible for an incentive equal to 75% of its allowable charges, up to $18,000 in 2012. Another fi nancial benefi t is the reduction in malpractice insurance rates, generally a 6% savings. Aside from the fi nancial benefi ts, there are considerable effi ciencies to be enjoyed by an electronic offi ce, including better access to information.

How is Holy Name working with NJ-HITEC and EMR companies?Holy Name Medical Center and NJ-HITEC are collaborating with Aprima, Jersey Health Connect and Priority One to bring the physicians a complete technology experience at HNMC’s Physician IT Fair on May 16 at the Medical Center. The IT Fair will demonstrate how the power of technology can deliver an end-to-end solution for local medical practices: an electronic health record connected to the health information organization, and built on a secure network proving meaningful use.

“EHR Answers from NJ-HITEC”

Physician IT Fair Marian Hall

May 16 7 a.m. – 3 p.m.

Breakfast & lunch included

Primary Care Providers Internal Medicine

OB/GYN & Peds

Free with sign up

It’s a new world.Technology in medicine is changing the way health care is delivered. Primary care physicians are connected to surgeons and specialists. Medical records are shared securely. Medications are reconciled by physicians. Practices are now proactively reaching out to patients to monitor chronic illness. Get on board!

Questions?If you are currently using Electronic Health Record technology and have questions about fi nancial incentives, the technology, and what it will mean to your practice, please call our offi ce for assistance. NJ-HITEC is your trusted advisor for meaningful use and health information technology.

NJ-HITEC is the State’s trusted advisor for Meaningful Use and Healthcare Information Technology. ONC Award Number 90RC0037/01

Ron Manke is the North Jersey Regional Director at NJ-HITEC. He can be reached at his offi ce, 973-642-4055; cell number, 201-632-5990; and manke@njhitec.org. Visit www.njhitec.org.

SAVE THE DATE

What programs does NJ-HITEC offer?

Medicaid Specialist 30% or more Medicaid encounters

within 90 days

Free with sign up

Specialist All physicians who do NOT meet

other offers

$500 membership

NJ-HITEC is proud to offer Holy Name Medical Center physicians

the following three programs:

Attend the physician IT Fair

May 167:00 a.m. until 3:00 p.m.

Marian Hall • Breakfast & lunch provided

Visit with theRepresentatives of these Organizations: • Aprima • Jersey Health Connect• Priority One• Priority One

Consult with the Experts to Help You Build a Workable and Reliable EMR System for Your Practice

FREEiPad

Drawing

See Real-Time Demos of Holy Name Medical Center’s: • Notes Management • Messaging • CPOE

Mark Your Calender for Three Events:

Mary Higgins ClarkHonorary Chair

Save the Date

RIDGEWOOD COUNTRY CLUB

PARAMUS, NJ 07652

INVITATION TO FOLLOW

FUNDS RAISED WILL SUPPORT

THE COMPASSIONATE CARE

PROVIDED AT

VILLA MARIE CLAIRE HOSPICE

IN SADDLE RIVER, NJ

SaturdaySeptember 22, 2012

7:00 p.m.

Annual Founders BallSaturday, October 27, 2012

The Waldorf = Astoria,New York, NY

For information on this event:Contact: 201-833-7143

Email: mcgarry@holyname.org

Now at Holy Name: MAGNETOM Aera 1.5T MRI

Leading-Edge, Precision

MR Imaging Diagnosis Staging

Surveillance

BETTER INFO = BETTER TREATMENT DECISIONS

High resolution for superb image quality

Open bore for claustrophobic patients

Access for obese patients to 550 lbs.

Faster scanning

Improved prostate care: No endo-rectal coil Target tissue for biopsy Phenomenal clarity

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First Quarter 2012 Adam Jarrett, MD, MS, ExecutiveVicePresident/ChiefMedicalOfficer Thomas Birch, MD, PresidentoftheMedicalStaffJane F. Ellis,VicePresidentofMarketing,PublicRelationsandCommunityHealtheditor:Barbara Franzese Cron,Director,MarketingCommunications

Please e-mail all comments and contributions to: editor MD360@holyname.org or call Jane Ellis, 201-833-3129 or Barbara Cron, 201-530-7904.

MD360º ispublishedbyHolyNameMedicalCenter’sDepartmentofMarketing/PublicRelationsandisintendedforusebythemedicalstaffofHolyNameMedicalCenter.

Magnet Recognition From the American Nurses Credentialing Center. Places

us among the top 5% of hospitals nationwide for

excellence in patient care.

Beacon AwardFrom the American

Association of Critical Care Nurses for exceptional acute

and critical care nursing.

Joint Commission Top Performer in Key Quality

MeasuresFor Excellence in Heart Attack, Pneumonia and Surgical Care

J.D. Power and AssociatesDistinguished 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.

Printed on Neenah Environment—a

100% post- consumer waste recycled paper.

Doctor’s DayHolyNameMedicalCentercelebratedDoctor’sDayonMarch30withfreehealthscreeningsforstaffphysicians,aswellasbuffetbreakfastandlunch.Over130doctorsparticipatedintheevent,whichranfrom7:30a.m.throughmid-afternoon. OccupationalHealth’sKarenNotarangeloandAllisonSinclairplannedandexecutedtheday’sactivities,whichfeaturedEKGs,chestX-rays,bloodtests,TBscreeningandphysicals. “Weappreciatetheenthusiasticresponseofourdoctors,”saidJasonKavountzis,MPT,OCS,DirectorofRehabilitationServices.“Butmoreimportant,wethankourmedicalstafffortheexpertcareandservicetheyprovidetoourpatientsandourMedicalCentereveryday.” ThefollowingHolyNamestaffmembershelpedmakeDoctor’sDaysuccessful:OHSinternistLalitaWagle,MD,andOHSnursesKathyThompsonandTeresaKaminsky;LouiseFronjian,Laboratory;MatthewKostelnik,EmergencyDepartment;RosalynYoung,Radiology;TanyaKiryako,FoodandNutritionServices;SultanSarwarandEvelynHernandez,EnvironmentalServices;andPaulOstrow,CommunityOutreach.