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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: editorMD360@holyname.org 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

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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.

Communicate with Your Colleagues:

Write an article for MD360. Share an exciting new

development in your speciality, give your opinion on a

health-related issue or tell about a recent achievement.

Email your submission to: editorMD360@holyname.org.

Contributions are accompanied by the author’s photograph,

Holy Name title and practice contact information.

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