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Contents Midwest Medical Edition
March 2011
Cover Feature
Regular Features 2
|
Publisher’s/Editor’s Page
17 |
Grape Expectations
Vintage of the Decade? By Heather Taylor Boysen
29 |
Then & Now
The Evolution of Pathology By Dr. Brad Randall
30 |
News & Notes News from around the region
32 |
Learning Opportunities Upcoming Symposiums, Conferences and CME Courses
In This Issue 4
|
AMA Offers Tips for Working with Seniors
5
|
Local Doctor Trained in New Hand Surgery
7
|
Some Cuts Never Heal SDAHO sends a message to the state legislature
14 | Managing CT Dose: Advancements to Reduce Exposure By Andy Beers
15 |
Stent Graft Offers Hope for Complex AAA
26 | Rules for Youth in Healthcare By Terry Dell
In Review The Immortal Life of Henrietta Lacks Reviewed by Amy Hallisey
page
23
Music & Medicine
A Balancing Act For health professionals who also have a passion for the arts, life is about striking a balance. As we launch our new Doctors in the Arts column, we asked three local musicians to share with us how they incorporate music and medicine into their lives. Whether they are performing on stage or jamming in the basement, playing Bach or playing rock, these providers have found that a healthy dose of creativity keeps them on their game. By Darrel Fickbohm
page
8
From Us to You
Staying in Touch with MED
Steffanie Liston-Holtrop
Alex Strauss
A
t MED, we recognize that, even for busy medical professionals, life is about more than medicine. Many of you are also parents, cooks, teachers, athletes, and, yes, artists. In fact, some of the world’s greatest scientific minds also produced great art and, for many, the preferred means of expression was music. When we invited doctors in our region to tell us about their own artistic pursuits, the vast majority of respondents were musicians. This month’s cover story features three of them, but it is also meant to inspire you to share your artistic experiences – musical or otherwise – with your colleagues through MED in future Medicine and the Arts columns. Tell us what you’re creating – and why – at Alex@MidwestMedicalEdition.com. The past two decades have seen an explosion of growth and innovation in medicine in South Dakota and many of you have had a front row seat for those changes. We invite you to share your observations and memories for our Then & Now column. Our thanks to Dr. Brad Randall for his views on the remarkable changes he’s seen in pathology during his career. We also welcome your book and movie recommendations (or warnings!) for In Review. When it’s one of those you just can’t keep to yourself, share it with your colleagues through MED. Like the practice of medicine, MED is constantly evolving our services to keep pace. At MidwestMedicalEdition.com you can read past issues of the magazine and reach us with your comments. As we work to expand the website, you will also soon find additional news, extended interviews, links and marketing opportunities. Finally, as we round out our first full year of publication, we want to thank you for your continued interest in MED. It is our goal to be your preferred source for timely, relevant information about our rapidly changing medicine community and your partner in marketing your practice and growing referrals. Let us know how we can serve your needs better. We always welcome news about your practice or ideas for articles or regular columns you would like to see. Steffanie is looking forward to seeing some of you at this year’s Spring MGMA conference in the Black Hills.Be sure to stop by her booth for a chance to win some free advertising. Enjoy the spring thaw! —Alex and Steffanie Steff@MidwestMedicineEdition.com Alex@MidwestMedicineEdition.com
Write to us! Don’t forget we want to hear from you.
Publisher Editor in Chief Cover Design Design/Art Direction Web Design
Steffanie Liston-Holtrop Alex Strauss Darrel Fickbohm Corbo Design 5j Design
Contributing Writers
Andy Beer Heather Boysen Terry Dell Darrel Fickbohm Amy Hallisey Charlotte Hofer Dave Hewett
Advisory Board
John Berdahl, MD Mary Berg, MD Michelle L. Daffer, MD James M. Keegan, MD Timothy Metz, MD Patty Peters, MD Juliann Reiland-Smith, MD Luis A. Rojas, MD Daniel W. Todd, MD
Published by
MED Magazine, LLC Sioux Falls, South Dakota
Contact Information Steffanie Liston-Holtrop, Publisher 605-366-1479 Steff@midwestmedicaledition.com Alex Strauss, Editor in Chief 336-295-3017 Alex@midwestmedicaledition.com Fax 605-271-5486 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website MidwestMedicalEdition.com
2011 AD / Editorial Deadlines April/May Issue March 5th
Sept/Oct Issue August 5th
December Issue November 5
June Issue May 5th
November Issue October 5th
Jan/Feb Issue December 5th
July/August Issue June 5th
March Issue February 5th
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©2010 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 3500 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@midwestmedicaledition.com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@midwestmedicaledition.com. MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.
2
Local Hospitals Name New Physician Leaders
Dr. Michael Elliot
Bell, Elliott Take on New Roles Gynecologic Oncologist Dr. Maria Bell with Sanford Clinic Women’s Health in Sioux Falls and Pediatrician Dr. Michael Elliott with Avera McGreevy Clinic in Sioux Falls have been chosen by their health systems to take on new leadership roles. Dr. Bell has accepted the position of Chief Medical Director for Sanford Development and Research. In her new role, Dr. Bell will facilitate clinical and translational research for both the Sioux Falls and Fargo campuses. Specifically, she will assist physicians, researchers and other providers in the development of their research ideas as well as facilitate the implementation of their research protocols to improve patient care. Additionally, she will assist in the facilitation of undergraduate, graduate and medical students into Sanford’s clinical and translational research. This is a part-time position for Dr. Bell who will continue to see patients three days per week. “I believe strongly that maintaining my clinical activity allows me to relate to and have credibility with the clinicianresearchers at Sanford,” says Dr. Bell. “I would miss seeing my patients if I took a full time administrative position. This opportunity allows me to have the best of both worlds I truly love.” Dr. Elliott, who served most recently as medical director of Avera Children’s Hospital & Clinics, will take on the additional role of Senior Vice President for Medical Affairs and Chief Medical Officer for the Avera McKennan regional network.
March 2011
Dr. Elliott has been on staff at Avera McKennan since 2002. He has been active in physician leadership at Avera McKennan, having served most recently as vice chief of staff on the Avera McKennan Medical Executive Committee, and previously as secretary-treasurer. As Chief Medical Officer, Dr. Elliott will represent physicians in senior management of the hospital, and is responsible for hospital quality and risk management programs, research functions, leadership of eICU and inpatient care provided by intensivists, surgicalists and hospitalists. “Medicine is always changing, and technology and practices are continually
MidwestMedicalEdition.com
Dr. Maria Bell
improving,” Dr. Elliott said. “It’s our goal as Avera McKennan physicians to be satisfied with nothing less than comparing ourselves with the best, so people can receive the highest quality care in or near their home communities.” ■
3
Survey Invites
Physicians
to Weigh In on Burdensome Regulations. WASHINGTON – The American Medical Association (AMA) has developed a new survey that invites physicians to provide their input on how federal rules and regulations impact their practices. The survey is in response to an executive order issued by President Obama on January 18, which called on all government agencies to complete an analysis of rules that may be ineffective, insufficient or excessively burdensome. The AMA believes this executive order is an opportunity to reduce physicians’ administrative burden. “Paperwork and administrative burdens already take up amount of a physician’s time–time that could be better spent with patients,” said AMA President Cecil B. Wilson, M.D. “The results of this survey will help the AMA identify which federal rules and regulations create the most burden for physicians without providing positive benefits for patients.” Physicians who participate in the survey can select which rules and regulations negatively impact administrative costs and add to the burden of paperwork for their practices, or interfere with patient care. The survey is available on the AMA Web site at www.ama-assn.org/go/ regrelief. ■
You’re always there for them.
We’re always here for you. We have defended and supported the individual needs of health professionals for more than 30 years. And nobody is more personally committed to protecting you from the risks you face every day. To learn more, call 888-397-3034 or visit MMICGroup.com
Exclusively promoted and recommended by the South Dakota State Medical Association.
4
New eBook
Highlights Practice Management and Ideal Office Design for Older Patients CHICAGO – As millions of baby boomers turn 65, the American Medical Association (AMA) has released a relevant new eBook, Geriatric Care by Design, A clinician’s handbook to meet the needs of older adults through environmental and practice redesign. The eBook helps physicians design their practices to address the unique needs of older patients. Topics include practice evaluation, structural design, health literacy and patient self-management. “This eBook provides practical solutions from geriatric care experts for how to design a practice that best serves the health care needs of older patients,” said AMA President Cecil B. Wilson, M.D. “The strategies presented in the book can help physicians, clinicians and office staff successfully manage challenges, such as accessibility issues and coordination of care.” Case studies and lessons learned from primary and specialty care are included that provide information and clear insight on how to design an environment that meets the needs of physicians and patients. The eBook format features easy-toimplement ideas and resources to help physicians make changes in their practices. It is designed to fit the lives of busy physicians with bullet points, checklists, tables and links to resources for additional information. For more information on Geriatric Care by Design or to purchase this eBook visit http:// www.ama-assn.org/go/geriatric-careby-design. ■ Midwest Medical Edition
Local Physician
Trains in Advanced Hand Deformity Procedure Robert Van Demark, Jr., MD
Orthopedic surgeon Robert Van Demark, Jr., MD recently recently completed a course for needle aponeurotonmy that is now a recognized procedure for Dupuytren’s contracture. Dr. Van Demark trained at The Hand Center in Jupiter, FL under the direction of Charles Eaton, MD, who was the first to perform the technique in the U.S. and developed the training course. Dupuytren’s contracture is a hand deformity that usually develops slowly over decades and affects the connective tissue under the skin of the palm. Once this occurs, the fingers affected can’t be straightened completely, which can complicate everyday activities such as placing hands in the pockets, putting on gloves or shaking hands.
“Needle Aponeurotomy is a minimally invasive treatment for Dupuytren’s contracture,” said Dr. Van Demark, who is with Sanford Orthopedics & Sports Medicine. “The alternative is a more complex surgical treatment, which requires several months of recovery. Needle Aponeurotomy allows for a more rapid recovery, and in most cases, it’s possible to return to near normal activities without bandages within a few days of treatment.” The technique was developed in Paris by Dr. Lermusiaux at the Hopital Laribosière. Dr. Eaton was instructed on this method by Dr. Lermusiaux in 2003 and was the first physician to offer this procedure in the United States. ■
Saturday, March 12, 2011 7:00 p.m. • Washington Pavilion, Sioux Falls Physicians donating their musical talents to benefit children with special needs. Dr. Wilson T. Asfora Dr. Christopher Carlisle Dr. Dennis Knutson Dr. Marian S. Petrasko Dr. Ronald Rossing
Crab Grass Crew Dr. Richard Barnett Dr. Lisa Ellis Dr. Tom Weisbecker Augustana Flute Choir
Reception with musicians follows, with fantastic silent auction! Tickets $18 Get yours now at the Pavilion: 367-6000 or washingtonpavilion.org A Benefit For:
March 2011
MidwestMedicalEdition.com
CHILDREN’S CARE HOSPITAL & SCHOOL 5
Sanford to Open New Training Facility Second POWER Center to Open Summer of 2011 Sanford has announced that it will open a new stateof-the-art athletic training facility in Fargo. The 20-thousand square foot Sanford POWER Center will be similar to one opened in Sioux Falls in 2008. It will be located in the Urban Plains Development, adjacent to the Sanford YMCA Family Wellness Center in southwest Fargo.The Center will offer 25 yards of artificial turf, four 40-yard running lanes, one of which will feature incline, a half basketball court, weightlifting, cardio
and other training areas, a hockey treadmill, artificial ice space, physical therapy with private treatment rooms and locker rooms. The price tag on the facility is a $2.5 million. Sanford POWER is offered through Sanford Orthopedics & Sports Medicine. It is designed to meet the training and physical conditioning needs of all levels of athletes. Training sessions are led by National Strength and Conditioning Association certified specialists. â–
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6
Midwest Medical Edition
Some Cuts
Never Heal By Dave Hewett, President/CEO, SDAHO
SDAHO sends a message to the state legislature
D
uring the first two weeks of March, the South Dakota State Legislature will likely decide at what level it will fund the State’s Medicaid program. Governor Daugaard has proposed cutting reimbursement levels by 10% — roughly the level providers were being paid five years earlier. Medicaid, of course, is the State/ Federal program that provides health care coverage to our poorest populations in the State – low income women and children, the disabled, and the elderly who have exhausted their resources. In response to Governor Daugaard’s proposed 10% cut, the South Dakota Association of Healthcare Organizations has embraced the theme that “Some Cuts Never Heal”. And, while not reflective of the care provided, the moniker certainly expresses the notion that such a policy decision has longlasting implications for health care delivery to Medicaid recipients. Health care providers already accept payment levels for Medicaid patients/ residents that are well below the cost of care being provided. Some choose to limit the number of Medicaid patients they see for just that reason. A 10% cut
March 2011
in reimbursement will only exacerbate that problem. But what may be more distressing about the debate in Pierre is the lack of attention being given to the longer-term implications of this budget decision. First, if Medicaid patients can’t get the care they need from the best level of care, they will seek care from other sources. Inevitably, this means more primary care being delivered in emergency rooms. Second, a 10% cut is not going to be made up in the following year. In fact it may take another four or five years to get back to reimbursement rates that are being paid in 2011. And the result? Well, see above. We all know that decisions have consequences. The current direction of the Legislative debate in Pierre is singularly focused on eliminating the State’s structural deficit in 2012 and then moving on. (To what is unclear.) But that singular focus has severe consequences for the way the State provides its array of services from health care to education to law enforcement. In these remaining days of the 86th Legislative Session, we must be prepared to tell our elected officials about those consequences and the fact that “some cuts never heal”. ■
7
Music&
There are two means of refuge from
Dr. Petrasko performing with Julie Melik-Stepanov in the annual CCHS fundraiser, Doctors in Concert.
By Darrel Fickbohm
When the idea first came to us that we should write a piece on medical professionals, we quickly found that there was an immense artistic current moving through the medical community, and that the passion for creating and performing matched these artists’ desire to excel in their separate disciplines. Although we heard from painters, poets, writers and singers, in the end, we chose three musicians to launch what will be ongoing coverage of physicians in the arts, and encouraged them to tell us their stories in their own words. Emergency Room Physician Chris Carlisle, MD, is a cellist with the South Dakota Symphony Orchestra. Psychologist Donald Baum, PhD, is a drummer in the Sioux Falls-based rock bank Wanderlust XI. And Cardiologist Marian Petrasko is a concert pianist and who has performed in the Doctors in Concert event in Sioux Falls. We hope their stories will inspire you to share your own artistic endeavors with MED for future issues.
&Medicine the miseries of life: music and cats. —Dr. Albert Schweitzer, physician and musician
Chris Carlisle, MD Emergency Physician
W
hen I was a kid growing up in Texas, a very dedicated teacher came into the area and proposed an orchestra program. He was laughed out of the council meetings time after time until he finally must have succeeded in convincing them that the program was needed. This guy actually came and pulled me out of the sign-up line for band, where I was waiting to be a drum player and said, “Uh… you don’t want to play drums. You want to play cello.” He probably knew better than me; in the end I think it served me well. I actually majored in music my first year . . . and wasn’t as good as I thought I was. So I switched to engineering. But I kept playing; we had an excellent orchestra in the community. Engineering was too lacking in the artistic, for me, and my roommate said one day that he didn’t think I was very happy. He asked if I had ever thought of med school. It turned out to be the most fulfilling thing I ever did. I put away my cello after that and got down to work. I didn’t play at all for a long time. It came back to me after I had kids and they started taking piano lessons. Through that I got connected to the guy who was in charge of the local community orchestra, and after that I was gradually inspired to try out for the South Dakota Symphony Orchestra. A couple things happened that got me seriously inspired: The Pavilion was built, and it was such a beautiful facility, and
10
&
Cellist
then Yo Yo Ma, the great cellist, was going to come play here. I couldn’t resist anymore. All of a sudden I had no excuses, and I had to at least try. I think I got up to my original playing level quickly, but then progress came in small increments. Getting back to the pattern of practicing was the hardest part. MED: We think of doctors as being so terribly busy. How do you juggle the schedule?
Dr. Carlisle: Well, in emergency medicine, I’m not really on call, which helps. But the strange shifts have to be accommodated. I was afraid that my partners would be at a disadvantage, but in fact, I found the very opposite. They’ve been very supportive. MED: What are your limits? Are things changing for you, and do you ever feel that one side of your life is lacking?
Dr. Carlisle: Well, yes. And it has to do with, as I get older, my time becomes more precious. In both cases, with my career and in music, it’s harder and harder to allocate the time for things that get more important as you get older. For instance, relationships—my wife Jeanie and I grow closer the older we get and so being away for things that don’t involve her directly becomes more difficult. The same with the job; it has its own demands—it’s getting busier and busier. MED: Do you believe that there is a correlation between your scientific and your artistic sides?
Dr. Carlisle: Oh boy . . . Well, I’m not sure there is one. They probably
reside in separate areas of the brain, but they probably contribute to one another—one side probably makes the other easier to do. Some of my most admired scientific minds were also musical as well, and I think there must be some crossover in the brain that causes the two to have many more similarities than I’m able to put together. Albert Einstein, a violinist, comes to mind. MED: How has your art turned around and affected your scientific side.
Dr. Carlisle: Well on a more material level I think it’s allowed me to tolerate being a physician a lot longer. (laughs) I dropped music because I got tired of it and didn’t want to do it for a while. Then, as I got to practicing medicine I gradually got back into music. Once again, it’s hard to separate the two.
Midwest Medical Edition
Donald Baum, PhD Psychologist
I
think, when I was younger I had big dreams of being in a rock band that “made it.” I grew up with bands like the Rolling Stones and the Beatles—bands that set the stage for all the acts that have come along since then. It was a different kind of world back then, and every kid wanted to be in a band. That was really how I got started. I’ve been in quite a few different bands all these years. It was never anything that I made a living at, but it was always kind of my first love—I always found a way to play. I think there’s definitely a correlation between the scientific and the artistic. Especially with drumming, there’s a correlation between patterns. It’s mathematics and rhythm. Just as musicianship and psychology work together: they both have sort of a creative perspective. Different, yes, but both give a lot of leeway for creative intelligence. I can’t read a note of music. I have just taken it all in by listening and working to develop my own style. So all of my playing has been by ear which I think has given me a less structured, maybe more flexible approach. I’ve always leaned in the direction of rock/fusion, which is a combination of contemporary jazz structures played with the basic sound of rock. I still play that way. The band I’m in now has another psychiatrist as the guitarist, Dr. Jay Weatherill. He’s a creative, high-intensity player. We just blend very nicely and we have a great time. We call our band Wanderlust XI. We thought of being called Shrink Attack and a bunch of other funny ones, but in
March 2011
&
the end, we thought we better not do that. One time a patient complained of “wanderlust in a spouse.” And I had to ask them, “What is that?” And they said, “Well, you know. It’s that thing that every German gets. They’re always looking over the next horizon to see what’s out there,” and I’m thinking, that’s me. I told the guys in the band and they were okay with that name.
Drummer
“The medical culture always seems to push the achievement/perfection thing to the limit. Nothing is ever good enough, and I think that carries on into the music, too.”
It’s a balancing act, between the medical and musical worlds. You don’t want to put all your eggs in one basket, which works the other way around, too. The therapy and Psychology makes drumming that much more fun—it’s such a release. They both benefit from each other, though. The drumming is creative, but it’s also very physical, so it’s also like a workout for me. That’s always the way I’ve played. When I’m with patients, it’s always a lot of concentration and I’m, sometimes, hearing a lot of really difficult things people are going through. Drumming is a completely different world that balances the two sides.
It doesn’t surprise me at all that many physicians tend to music. I think part of that is how the medical culture always seems to push the achievement/perfection thing to the limit. Nothing is ever good enough, and I think that carries on into the music, too. We pretty much have no time to rehearse during the week. We typically practice on Friday nights in the converted third stall of my garage, which has been renamed the “Baum shelter” of course. That’s where we hang out, where playing loud won’t upset the family.
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11
Marian Petrasko, MD, PhD Cardiologist
I
started in early childhood: the torture of piano, of course, and finally after two years of practicing, I started to enjoy it. You knock on the key and the tone is there—no need to create it like in the strings or the wind instruments where you are a part of it. In that way it’s a little bit different. I started being able to play certain pieces and really started to understand what music gives you. Actually, it took me about five years until I really started to like it. I remember that I played some sonata, probably Beethoven, and it was that exact moment. It was at the end of high school when I started thinking about choosing between a “real job” or music—I decided to keep it [music] as a hobby. But there are always chances to play. After I moved here, I found out that they have this wonderful Doctors in Recital program. So I made a call to the Children’s Care Hospital and School to see if I could audition and be a part of it. They let me play that very year—something from Chopin, I think. It was a great experience. It’s totally different to play something for someone else besides yourself or your family. It’s more difficult. You practice to perfection.
“As a physician you start to see the vulnerability as a race and how little the difference is between life and death, or ill and healthy. Perhaps you are looking for something to recharge you after looking at such issues.” I would say that Physicians tend to make good musicians because they tend to be perfectionists and tend to pay more attention to detail. To become a physician is quite difficult and requires that you learn how to study hard. You need to have a goal to make it, and picking up other things is quite natural after that. The search for perfection is the biggest factor. But as a physician you
&
Pianist
start to see the vulnerability as a race and how little the difference is between life and death, or ill and healthy. Perhaps you are looking for something to recharge you after looking at such issues. I play on my own, in the evenings when the smaller kids are sleeping and the bigger kids are off playing games or working on their homework. After a difficult day, it sort of just washes out the brain. It helps me get ready to help people the next day. It provides me some time to recharge and do more, perhaps, over a shorter period of time at work. I think it make me more ready. MED: Piano is the instrument of the heart. As a cardiologist, had you ever heard that quote?
Dr. Petrasko: Yes, I have, but I think it was Lord Byron who said, “Music is in everything,” which is better.
MED: Do you leave the world of science completely to enter the one of music?
Dr. Petrasko: No, I don’t! Historically, they say that medicine is strictly science and I would also disagree with that. It’s a science and it is social and it is also an art. Music to me is something between the rational and the emotional. Cardiologist Dr. Marian Petrasko
12
Midwest Medical Edition
Intensive Care for Newborns
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Managing CT Dose
Advancements to Reduce Exposure By Andy Beer
Recent studies suggest that the risk of developing cancer increases after undergoing numerous CT scans across a lifetime. Though CT is a proven diagnostic tool and the benefits of the exam typically outweigh the risks, new technological advancements and protocols are emerging to help make CT exams healthier.
C
T is an indispensable tool in medicine and has been used for routine exams of the entire body, and in diagnosing a variety of conditions and diseases since 1974. CT’s effectiveness is evidenced through the increased number of systems installed and scans performed, which results in exposing the overall population to higher levels of radiation. There are more than 10,000 CT scanners in use in the U.S. according to the Center for Disease Control and Prevention. CBS News reported that from 2000 to 2007, the annual number of CT scans almost doubled to 69 million. To minimize patients’ exposure, experts recommend decreasing the number of CT studies prescribed and finding a happy medium between the dose needed to obtain a quality scan yet stay within safety measures. The FDA launched a new initiative in April in an effort to promote justification for ordering each procedure and to optimize dose for each scan. 14
California recently enacted a new law that includes dosereporting requirements. More than 4,500 medical professionals have signed a pledge called “Image Gently” to reduce unnecessary radiation exposure to children. Decision support programs are being used more frequently as a tool to help physicians determine if an imaging procedure is necessary, and may help reduce the amount of long-term exposure a patient receives. In addition, The Advisory Board Company reports that new machines are being introduced that promise to lower radiation dose while maintaining a highquality image. The newest CT system from Siemens requires a fraction of the radiation dose that previous systems required to scan even the tiniest anatomical details. ■ Andy Beer is Vice President of Sales at Cassling, an Omaha based company offering professional, marketing and field services to healthcare organizations. ■ Midwest Medical Edition
New Stent Graft System Dr. Michael Bacharach,
Offers Hope for Complex AAA
Dr. Michael Bacharach, a physician with North Central Heart Institute, is the first in North and South Dakota to use a new minimally invasive treatment for Abdominal Aortic Aneurysm. The device was recently approved by the FDA. Developed by Medtronic, the Endurant AAA Stent Graft System repairs an abdominal aortic aneurysm (AAA) without open surgery. Left untreated, AAA’s can burst unexpectedly, often with fatal consequences. This “silent killer” is the third leading cause of sudden death in men over age 60. Avera Heart Hospital’s vascular intervention team recently conducted their first endovascular aortic repair (EVAR) with the new device. The procedure is performed by making a small incision near the groin and inserting a stent graft (a specially woven fabric tube sewn onto a flexible wire frame) compressed on a delivery catheter, then threaded up through the patient’s blood vessels. At the site of the AAA, the stent graft is expanded within the aorta, creating a new path for blood flow that reduces pressure on the bulge and the risk of rupture. In the past, patients with complex anatomy could not always be treated with EVAR technology. Medtronic’s newest device allows more complex patients to undergo this therapy. An alternative to EVAR with stent grafts is open surgical repair, where the weakened segment of aorta is removed and replaced with a synthetic tube. Open surgery is more invasive, requiring a
March 2011
minimum hospital stay of five days and several months for complete recovery. By contrast, the hospital stay and recovery time following EVAR is typically much shorter. ■ Reference: 1 Ohki T, Veith FJ. Endovascular Repair of Ruptured, AAAs In treating AAAs, endovascular repair may hold the key over open repair to lowering mortality. Endovascular Today. January 2004;47-51.
MidwestMedicalEdition.com
15
Black Hills Clinic to Join National Diabetes Research Project Regional Medical Clinic – Endocrinology is one of just over 50 sites selected to participate in a large national study of type 1 diabetes. A $26 million grant from the Leona M. and Harry B. Helmsley Charitable Trust is being used to develop a national T1D Exchange, a research initiative that includes a data repository, a biobank, and an interactive website with mobile capability. The T1D Exchange is designed to increase understanding of the disease, improve care, and accelerate new therapies for type 1diabetes through the promotion of collaborative research and data sharing. The first stage of building the Exchange has involved assembling a network of clinical centers caring for people of any age with type 1 diabetes. The centers, including Regional Medical Clinic – Endocrinology, are located throughout the United States and encompass both university-based sites, urban and rural areas, and a diverse range of racial and ethnic groups. The T1D Exchange Clinical Center Network will foster the
rapid development and dissemination of studies designed to improve the care and lives of people with type 1 diabetes. The patient population and datasets will be expanded through the web and mobile platforms. “I find this study very interesting. There is little information on a global level about people living with type 1 diabetes,” said Rachel Edelen, M.D., Pediatric Endocrinologist with Regional Medical Clinic – Endocrinology. “The Exchange adds a new dimension to the existing endocrine research studies and may increase awareness so that more patients from our area can participate in future research studies in a more informed way.” The central goal of the T1D Exchange will be to create a new model that combines the best aspects of traditional clinical research with the expanding fields of health information and social networking. ■
Discover a Healthy New You!
A comprehensive approach to specialty care.
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Midwest Medical Edition
Grape Expectations
Vintage of the Decade? By Heather Taylor Boysen
A
s I was opening cases of wine in my store the other day, I was like a kid in a candy store. An adult candy store anyway. I was opening cases of some truly stellar red wine from California –Napa Valley to be exact. My hands were actually tingling and like my children at any gifting occasion, I couldn’t wait to open the next package. Not only were many of the wines new to our store and the South Dakota market, which is exciting in itself, but they are also products of the 2007 vintage. Did you just hear angels sing? If you don’t read wine magazines or pay attention to what the wine experts write, let me tell you that the 2007 vintage is a real doozy. A perfect growing season combined with a beautiful harvest and a plethora of extremely talented winemakers and abracadabra, we have magic! Could 2007 be the magical vintage of the decade for Napa Valley and the surrounding area? Robert Parker has declared 2007 the greatest vintage since 2001 and 2002 and Wine Spectator is calling 2007 “The Vintage of the Decade”. Parker has even gone so far as to say that it is “the most
consistent vintage everywhere in the North Coast, as well as across varietals – everything from Zinfandel to Chardonnay, Pinot Noir to Merlot, Cabernet Sauvignon to Cabernet Franc.” I think one of the reasons the 2007 vintage is so exciting for me is it crosses many lines in our little wine world. It doesn’t just encompass Cabernet Sauvignon. This is a vintage year to take many varietals very seriously particularly if you are a collector. Don’t be afraid to pull a Zinfandel off the rack and Bordeaux-style red blends coming out of Northern California are also spectacular. (Bordeaux-style blends usually include anyone of the following grapes: Cabernet Sauvignon, Merlot, Cabernet Franc, Petit Verdot and Malbec.) The 2007 Jordan Chardonnay has incredible flavors and leaves you wanting more. The vintage also crosses economic lines. There are outstanding winemakers out there producing wonderful wine for under $20. These are the gems that go quickly when super vintages are declared, but they are still out there to be had. Wine choices in the $20 to $100 price range are actually almost overwhelming. While there may not be many bottles of one kind of wine, there are many wines available in this price range. Then there is what I call the Big Mac Daddies. These are the over $100 wines including Joseph Phelps Insignia,
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Robert Mondavi’s Opus One, Blackbird Illustrations, Shafer, Plumpjack and others who have received iconic status in the wine world. All are currently releasing the 2007 vintage. For all of you Green Bay Packers fans, Charles Woodson’s wine, TwentyFour, is also a 2007 Napa Valley Cabernet. The other reason I think this vintage is so thrilling is that it has people excited about wine again. Don’t get me wrong, a person with a liking for wine doesn’t exist on “vintage of the decade” wines alone. But we all need a little passion and romance every now and then. The spark that makes a wine buying experience really exciting has become a bonfire with the 2007 California vintage. ■
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Regional’s CT Scanner Helps Unlock
33 Million Year Old Mystery
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The CT Scan at Rapid City Regional Hospital produced raw data and images of the entire skull so that scientists can study the internal structure. A puncture mark can be seen on the top of this image.
Midwest Medical Edition
Kylie and Skylar Ferguson of Georgia discovered the fossil while on vacation in the Black Hills last summer.
RAPID CITY, S.D. — A 33 million year old saber tooth cat fossil recently met state-of-the-art 21st century technology at Rapid City Regional Hospital (RCRH). On January 27th, Badlands National Park, in partnership with RCRH, completed a CT scan of the well preserved skull, which was discovered by a 7-year-old Georgia girl on vacation in the park last summer. “Saber tooth cat skulls with intact canines are extremely rare,” said park paleontologist Rachel Benton. “In addition to that, bite marks on this skull make it scientifically significant. The CT scan will provide researchers with information that can be used to determine what type of animal attacked this cat and probably caused its death.” Several bite marks on the skull indicate the cat died a violent death, probably from attack by another saber tooth cat. The CT scan will allow paleontologists to assess internal damage
from the bite marks. Once the size and dimension of the bites are known, paleontologists will be able to determine what type of animal made the bites. The Regional Hospital CT scanner used to produce 3-D images of the skull was a dual source Siemens SOMATOM Definition Flash, 128-slice CT, which offers fast, high-quality images in less than five seconds. RCRH installed the new scanner in July of 2010. “We are excited to partner in this project,” said Cindy Hougland, RT, RCRH Supervisor of MRI and CT. “We purchased and installed this technology to benefit all patients in this region. It is a bonus that we can utilize it to help our scientific community in this manner.” Kylie Ferguson discovered the fossil last summer while vacationing in Badlands National Park with her family. The family was on hand to witness the CT scan of her discovery. “Our whole family is extremely excited,” noted Kylie’s father, Tom Ferguson. “We are so glad we attended the Junior Ranger program and reported this fossil. This discovery gives other children a chance to get excited about the science happening in our national parks.” In addition to the scientific research aspect, the CT scan will also provide raw data to make a 3-D model of the skull. A machine at South Dakota School of Mines and Technology will build the model. The resulting plastic cast will be more durable than the fragile fossil and can be displayed at the Ben Reifel Visitor Center – just a few hundred feet from where the animal died. Skull casts will eventually be available for sale through the non-profit Badlands Natural History Association (BNHA) bookstore and online. BNHA supports scientific research and educational programs in the park including this project. ■
Following the CT scan of the saber tooth cat fossil, the 3-D CT images were analyzed by, L-R, Darrin Pagnac, Assistant Professor Geology and Geological Engineering at the South Dakota School of Mines and Technology; Cindy Hougland, RT(R), (MR), (CT), Rapid City Regional Hospital Supervisor of MRI and CT; and Rachel Benton, Badlands National Park Paleontogist
March 2011
MidwestMedicalEdition.com
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Prevention. Diagnosis. Treatment.
Whether your patient is a child with spinal deformities or fractures, a competitive/recreational athlete with a sports injury or active adults exhibiting signs of chronic musculoskeletal disease, the physicians at Sanford Orthopedics & Sports Medicine take a multidisciplinary approach to surgery, research and clinical consultations. • Total Joint Replacement • Anterior Approach Total Hip Replacement Surgery • Sports Medicine • Upper Extremity • Lower Extremity • Pediatric Orthopedics • Foot care Get stronger. Play smarter. Return to performance.
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In Review What You’re Reading, Watching, Hearing
Written by Rebecca Skloot
The Immortal Life of Henrietta Lacks Reviewed by By Amy F. Hallisey RPh, FASCP
M
any of us learned about HeLa cells in school. HeLa cells were the first “immortal” human cells grown in culture. This cell line was established in 1951 and is still alive today, being used in medical research around the world. Before HeLa cells, scientists had been trying to culture human cells for years but had failed in their effort to find a cell line that would be “immortal”. An immortal cell line would dramatically improve the flexibility and scope of cellular research. But there was something special about HeLa cells, which were cervical cancer cells, that made them both prolific and durable. As predicted, these immortal HeLa cells have been invaluable in medical research. They were used to develop the first Polio vaccine. They went up on the first space mission. And they have played a vital role in research on cancer, AIDS, cloning, gene mapping, in vitro fertilization, etc…. We know about the HeLa cell line but have you ever wondered about the history of this line? Rebecca Skloot’s book The Immortal Life of Henrietta Lacks tells the story of the woman whose cells were used to create this line. Skloot creatively weaves together the story of the development of the famous HeLa cell line with the story of Henrietta Lacks herself, the poor African American woman from whom these cells were taken (and from whom comes the “HeLa” name). Lacks was from a family of Southern tobacco farmers. In 1951, four and a half months after the birth of her 5th child, she went to March 2011
Johns Hopkins in Baltimore with complaints of a painful “knot” in her abdomen. She was diagnosed with cervical cancer and a biopsy was taken of these cells. This biopsy, which was subsequently shared with some of the top researchers in cell culture, was the beginning of the HeLa cell line. Lacks herself died within a year of her diagnosis at the age of 31. But the book does more than tell a story. It also brings up interesting bioethics concerns. Although HeLa cells have enabled hundreds of millions of dollars of potentially life-saving research, neither Lacks nor her family ever gave permission for her cells to be taken or shared, nor did they know about it until decades later. Meanwhile, the Lacks family continued to live in poverty, oblivious to the impact their relative had on medical science. Skloot does a great job presenting the facts and perspectives without trying to influence the reader to a certain point of view. I enjoyed learning the technical history of this famous line of cells but I also enjoyed getting to know, in a personal way, the woman and her family from which this line was derived. The book is non-fiction but the family storyline reads like fiction. The Immortal Life of Henrietta Lacks could stand alone just on the rich personal history of Lacks herself. This book was educational and thought provoking. It was a New York Times Bestseller, has broad appeal, and was written for a general audience. However, if you are a health care professional, I believe you will appreciate its scientific detail and ethical dilemma even more. ■ MidwestMedicalEdition.com
The book does more than tell a story. It also brings up interesting bioethics concerns.
Write to us! Do you have a media review? A book, film, or article? How about an opinion on a current event? Write to us at: Alex@MidwestMedicalEdition.com
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Sanford Health Locally owned and operated since 2003
Recognized as One of the Most Highly Integrated Healthcare Networks SDI Releases 2011 TOP 100 IHNs Rating
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The furniture built to withstand time 229 S Phillips Ave Downtown Sioux Falls, 57104 PH. 605.373.0700 artisanhousegalleries.com
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Sanford Health has been honored for its integration. SDI recently announced the SDI 2011 Top 100 IHNs, the 14th edition of its annual assessment of the 100 most integrated healthcare networks (IHNs). SDI’s report, regarded as the nation’s premier rating system, evaluates IHNs on their performance and degree of integration. The ratings are based on SDI’s IHN Rating System, which evaluates each network’s ability to operate as a unified organization in eight categories: integration, integrated technology, contractual capabilities, outpatient utilization, financial stability, services and access, hospital utilization and physicians. “The connection between our physicians, clinics, hospitals, health plan and other services means our patients have a more seamless experience,” said Becky Nelson, Sr. Vice President and Chief Operating Officer, Sanford Health. “That connection also provides for high quality and safety which is why integrated systems frequently rank among the best for patient care.” IHNs that made both the top 100 continued to improve their integrated technology scores, particularly in the area of information services (IS) integration. Additionally, IHNs in the top 100 saw increases in scores for having real-time central medical records. These scores may further grow in the coming year in response to the Centers for Medicare & Medicaid Services’ initiatives to have providers adopt and achieve meaningful use of electronic health record technology. “In anticipation of Medicare payment reform, many hospitals, physician groups, and health systems are looking into the formation of accountable care organizations (ACOs),” said Pat Witman, Associate Product Director, Healthcare Profiling Solutions for SDI. “IHNs, with their network of providers already in place, are well-positioned to enter this arena.” To see the top 100 networks, visit the IHN information page at www.sdihealth.com. ■ Midwest Medical Edition
Doctors Moonlighting
as Chefs
to Fight Cancer By Charlotte Hofer American Cancer Society
P
hysicians from around the area are turning cooking into an art form to raise money to fight cancer. It’s the American Cancer Society’s 2011 “Lights Camera, Action for a Cure!” Gala, coming up March 26 at the Washington Pavilion. Several area doctors are outdoing themselves in an effort to create
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March 2011
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fabulous meals (to be prepared at a later date) which will be auctioned off during the Gala. “If you’ve never bid on ‘Dinner with Docs’ this is your chance,” said Jami Gates, American Cancer Society event organizer. “We hope docs will outdo each other not only on the cooking, but on the bidding too, because each dollar raised goes to save lives and create more birthdays for people with cancer.” While the American Cancer Society can’t reveal everything, here’s a little preview of just one of the delicious dinners to be auctioned off at this year’s Hollywood Gala: A Mexican Fiesta for Two by Dr. John Lee, Sanford, which even includes his secret family recipe gingerbread cake! Guest will enjoy cocktails, an auction, dinner, an awards show, a dessert bar and entertainment. The event starts at 6:00 pm. Tickets are $100 per person or $750 for a table for 8. Black tie is optional. Call 605-323-3553 to reserve tickets. ■ 25
Youth in Healthcare The SDSO is proud to have
Doctor Chris Carlisle as a member of our Orchestra
A Professional Off Stage and On! Still to enjoy this season
The Music of Romeo & Juliet with Lara St. John
Saturday, March 19 at 7:30 pm Sunday, March 20 at 2:30 pm
Handel’s Messiah Saturday, April 9 at 7:30 pm Sunday, April 10 at 2:30 pm
Mahler Celebration Saturday, April 30 at 7:30 pm Mahler: Das Lied von der Erde “The Song of the Earth” Wagner: Tannhauser Overture and Venusberg Music
Vi br a n t l Ma s t er f u Al iv e!
For tickets call the Washington Pavilion Box Office 605-367-6000 sdsymphony.org
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T
By Terry Dell, Risk Analyst
he healthcare industry has historically employed large numbers of minors (16-17 years old). For many youth this is their first taste of a real job. One of the main challenges of employing minors is keeping them safe. The US Department of Labor also understands this challenge and implemented Child Labor requirements under the Fair Labor Standards Act (FLSA) in 1938. Initially the FLSA prohibited minors from performing work in “oppressive child labor”. Over time, Hazard Orders have been developed to clarify which jobs are considered too hazardous for minors to perform. Mechanical hoists, cranes and other lifting equipment with capacity over 1,000 pounds were considered too dangerous for minors to operate. Prior to July 2010, lifts and hoists normally used for patient transfer could be operated by minors because their capacity is less than 1,000 pounds. However, in July 2010, a Hazard Order was changed and the 1,000 pound exception was removed. (See Wage and Hour Division Fact Sheet #43 for a full list including prohibitions that affect other jobs in healthcare such as Kitchen and Facility Management) The Hazard Order now reads: HO 7. Power-driven hoisting apparatus—bans operating, riding on, and assisting in the operation of most power-driven hoisting apparatus such as forklifts, nonautomatic elevators, Bobcat loaders, skid steer loaders, backhoes, manlifts, scissor lifts, cherry pickers, work-assist platforms, boom trucks, and cranes. Does not apply to chair-lifts at ski resorts or electric and pneumatic lifts used to raise cars in garages and gasoline service stations. Interpreting the above HO7, it essentially states that youth under age 18 may not operate or assist in the operation of power driven hoists including those designed to lift and move patients (Hazardous Order No. 7, Fair Labor Standards Act interpretation, July 2010). Employers need to be aware that current minor employees may not continue to use the lifting devices until they turn 18. New hire training classes must take into consideration if the new employee is a minor, as minors are not allowed to operate lifting devices during training programs. Employees under 18 can still work in healthcare but it is the responsibility of the employer to ensure that no employees under 18 operate or assist in the operation of mechanical lifts. ■ Terry Dell holds an M.A. in Human Factors Psychology and has performed and published research in a variety of areas. He is an OSHA authorized trainer and an ergonomic specialist with RAS Companies. References: US Department of Labor Wage and Hour Division Fact Sheet #52 “ The Employment of Youth in the Health Care Industry” http://www.dol.gov/whd/regs/compliance/whdfs52.pdf US Department of Labor Wage and Hour Division Fact Sheet #43 “Youth Employment Provisions of the Fair Labor Standards Act (FLSA) for Nonagricultural Occupations” http://www.dol.gov/whd/regs/compliance/whdfs43.htm Marnie Prochniak, Minnesota Department of Labor State of West Virginia Department of Health and Human Resources Memorandum “Nursing Assistant Policy: Minors under 18 in the clinical setting”. October 2010 Wisconsin Department of Health Services: “Employment of Youth in the Healthcare Industry”. October 2010
Midwest Medical Edition
Lung Avera McKennan Physicians Support Association Praises Charitable Projects South Dakota The past year was one of generous giving for Avera McKennan physicians, through efforts locally and also around the world.
The Avera McKennan Medical Staff collected funds from among its members, and donated a total of $50,000 to the Haitian Health Foundation in the wake of the January 12, 2010 earthquake that left a million people homeless. The donation is providing medical care, shelter and food to people devastated by the earthquake in the Jeremie region. Physicians also donated $1,500 to purchase medications to be sent with Dr.
March 2011
Patty Peters of Avera McGreevy Clinic when she traveled to Haiti on an Avera medical mission trip in May. The Haitian Health Foundation has been in southwestern Haiti for over 25 years, and Avera has had a relationship with the foundation through the Haiti Mission Project since its beginnings. The medical staff also donated $6,000 to help another Third World nation – St. Vincent, a Caribbean island in the Grenadines. Dr. Stephen Nanton, pediatric gastroenterologist with Avera Children’s Hospital & Clinics and a native of St. Vincent, secured used endoscopy equipment donation and recruited a medical team of physicians and staff to go with him in January to St. Vincent, in order to train local doctors on its use. “They have never had this type of equipment there,” Dr. Nanton said. “Recommendations are that adults over age 50 have a screening colonoscopy every 10 years to screen for colon cancer, and that’s just not happening in St. Vincent. If someone needs endoscopy, they have to leave the country and have it done elsewhere.” With these donations, endoscopy will be free for the 130,000 people of St. Vincent, which has socialized medicine. “Anyone who needs it can have it,” Dr. Nanton said. ■
MidwestMedicalEdition.com
Smoking Ban
The American Lung Association has recognized South Dakota for its efforts to reduce a major cause of illness – smoking and exposure to second-hand smoke. Last year, the state was given a rare “I” or incomplete grade for smoke free air from the ALA, as voters had not yet approved a statewide smoking ban. This year, South Dakota earned a “B” grade for smoke free air and a special “thumbs up” to voters who overwhelmingly voted in favor of the ban during the November 2010 election. The report also singled out South Dakota for exceeding the recommended “investment per smoker” in funding its Quit Line telephone service. But other grades were not as good. In the tobacco prevention and control spending category, the state’s grade slipped from a “D” last year to an “F.” Grades in the two remaining categories remained the same as last year: a “C” for the state’s cigarette tax; and an “F” grade for cessation, which revaluates services and products offered to state employees and Medicaid recipients to help them quit smoking. The American Lung Association in South Dakota will advocate for a return to the $5 million level of funding for tobacco prevention and control, as well as ensuring the new smoke free law remains strong and is enforced fairly statewide. SOURCE American Lung Association in South Dakota. ■
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Telemedicine projects receive federal funding Projects in South Dakota are among 106 projects nationwide selected to receive more than $34.7 million in federal grants to fund educational projects and expand access to health care services in rural areas through Rural Utilities Services’ Distance Learning and Telemedicine Program. The Distance Learning and Telemedicine (DLT) Grant Program provides access to education, training and health care resources in rural areas. In South Dakota: An award of $438,561 to Avera Health will be used to assist rural hospitals serving 10 counties in a three-state region to implement a telemedicine and distance learning consortium, with the primary purpose of enhancing their emergency service capabilities through telecommunication technology. Equipment and instruments such as mobile video systems, telephonic stethoscopes, examination cameras, digital mammography, e-pharmacy automated dispensing units, and other equipment will be installed and connected throughout the
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consortium. Medical training will be deployed to help build a larger cadre of health care professionals in these frontier areas. An award of $447,734 will be used to expand services to telehealth specialty consultations, teleradiology, eICU,
ePharmacy, and eEmergency care to 10 rural Avera clinics in three extremely rural areas of South Dakota, North Dakota and Iowa. Services as common in urbanized areas as a dermatologist appointment will be available to the rural communities in these service areas. The project will broaden the reach of the emergency departments and access to medical resources connected to the network. An award of $220,878 will fund eConsult telemedicine project which will expand an existing system to connect 51 end-users to 20 Avera specialty clinic sites. Among the specialists that will be available to the rural end-users are oncology, pediatrics, neonatology, endocrinology, and gynecology. The consultations will be conducted via the funded video-conferencing equipment. In particular, this program is aimed at Native Americans, the frail, elderly, and other rural residents typically without access to specialty care. These projects affect some of the most rural counties in South Dakota, North Dakota and Iowa. ■
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Midwest Medical Edition
What has changed in pathology? MED Magazine caught up with Dr. Brad Randall, one of the area’s best known forensic pathologists, to get his perspective.
Then & Now Our Changing Medical Landscape
The Evolution of Pathology Smaller samples, faster answers By Dr. Brad Randall, Forensic Pathologist
I
think that one of the biggest changes in the pathology side, was this: when I started out, biopsy specimens were the size of your thumb, and there was no colonoscopy, yet. We had a rigid sigmoidoscope that only went so far into the body and it took large biopsy samples. Now we have the snakelike tubes going in people with tiny little biopsy forceps. Now a big biopsy is the size of a pencil eraser and most of them are only the size of the diameter of graphite in a pencil. I think one of the biggest changes, from when I started to now, is just the sizes of the samples we work with. I noticed it most with frozen sections of breast biopsies—this was
March 2011
pre-mammography—so these were lumps that people could feel. So we transitioned from a frozen section off of a large sample—maybe as big as an egg, into a tiny sample from a tumor that you couldn’t detect, except with the x-ray. Before, we did our analysis while the patient was on the table and she might wake up with or without a breast. Now we make our diagnosis from a little needle biopsy. It changed the nature of our work because pathology is really pattern recognition: the smaller the mosaic the harder it is to see the pattern. The size of the biopsies was an important change that affected the way we worked every day. Another thing is the speed at which you can turn things around. It used to be a four-day process. With the advent of smaller tissue samples, now it’s submitted one day and we have it back by the next afternoon. The next big change was introduction of immunohistochemistry, what we refer to as the brown stains. When I started, you made a diagnosis from a pattern; the malignant cells had a different pattern than benign cells. But you didn’t know what they were doing. Now, with immunohistochemistry, when you look at the cells that bother you, you can tell whether they have estrogen receptors or not, for instance, or are making thyroid hormone or not. You can tell not only the pattern but also the functionality. It allows you to look at them and say, “Yes, it’s a bad
MidwestMedicalEdition.com
looking cell but it’s doing this, so it’s okay.” The technology that drove this innovation is basically the ability to develop antibodies against almost anything you want to look at and supply them with markers bound to hormones that will tip us off. The third change was in cytology. When I started, as I’ve said, you needed whole tissue to do anything. Then came the thin needle biopsies. We don’t usually get a piece of tissue; we draw conclusions from small groups of cells. If you have a lump in your thyroid it’s really easy to stick a thin needle into it and get a good initial diagnosis due to advances in cytology. On the forensic pathology side, I don’t think there have been any major changes. DNA is a tool for the crime lab, but it hasn’t changed the way we collect our stuff. We still do autopsies in the same way. We’re using the same knives and scalpels that they were using a hundred years ago. ■
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Do you have a memory or observation on the practice of medicine in our region? How have things changed? What’s improved? What do you miss?
Contact us at: Alex@MidwestMedicalEdition.com or call 605-366-1479
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News & Notes
Happenings around the region
Avera
Sanford
The Avera Transplant Institute’s bone marrow transplant program has been awarded renewed accreditation from the Foundation for the Accreditation of Cellular Therapy (FACT) for demonstrating compliance with the FACT-JACIE International Standards for the full scope of bone marrow transplant programming. This includes autologous and allogeneic adult transplantation, Avera McKennan’s donor collection facility, cellular therapy processing laboratory, and overall program administration. One of 183 FACT-accredited bone marrow transplant centers in the nation, this represents Avera’s third three-year accreditation for autologous (own cells) transplant, and second three-year accreditation for allogeneic (donor cells) transplantation.
The Leona M. and Harry B. Helmsley Charitable Trust has awarded Sanford Health $2,060,151 to upgrade mammography services for patients in Canby, Webster, Winner and Worthington. The grant will be used to purchase state-of-the-art digital mammography units, replace radiologist workstations and upgrade the mammography room and patient waiting area. The hospital will replace its analog mammography equipment with digital mammography equipment. In the last two years, the Rural Healthcare Program of The Helmsley Charitable Trust the Trust has awarded more than $84 million in grants to nonprofit organizations in the region.
Thomas P. Rasmusson, President and CEO, Avera Queen of Peace Health Services, will retire effective June 30. Rasmusson has been President and CEO since 2003. Rasmusson is a Fellow in the American College of Healthcare Executives; he is on the South Dakota Chapter ACHE Board of Directors and has served on the Council of Regents and the Regents Advisory Council. During his tenure, Avera Queen of Peace underwent a six million dollar building and remodeling project in 2006 and expanded cancer services including the addition of Brachytherapy in 2009. Rasmusson also serves on the South Dakota Association of Healthcare Organizations Board of Trustees. Avera McKennan Hospital & University Health Center has been selected as the National Institute of Mental Health (NIMH) Outreach Partner for 2011 through 2013 for the state of South Dakota. Avera McKennan joins a nationwide network of 55 mental health organizations that disseminate research from NIMH about the causes, diagnosis, treatment, and prevention of mental disorders, and promote public involvement in research studies. Avera McKennan’s involvement with the Outreach Partnership Program will be in concert with NAMI South Dakota (National Alliance on Mental Illness). Avera Behavioral Health Services provides both outpatient and inpatient care at the 110-bed Avera Behavioral Health Center, the largest private inpatient facility in the region.
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Sanford Medical Center Fargo has received the American Stroke Association’s Get With The Guidelines® (GWTG)--Stroke Gold Performance Achievement Award. To receive the Award, Sanford Medical Center demonstrated a high level of adherence to key performance measures for more than 12 consecutive months. These include the use of clot-busting medications whenever possible, appropriate blood thinning and clot prevention medications, cholesterol-reducing drugs, and smoking cessation, among others. Sanford Medical Center in Fargo is the first and only center in North Dakota to receive this nation award. Dr. Dennis Stevens, a neonatologist with Sanford Children’s Hospital, has received the national 2010 Outstanding Achievement Award from the Association of University Centers of Disabilities. Dr. Stevens is a Professor of Pediatrics with the Sanford School of Medicine and director of the South Dakota LEND (Leadership Education in Neurodevelopmental Disabilities) Program. He has over 30 years of experience in academic pediatrics and clinical care of critically ill newborns and their families in South Dakota and the Upper Midwest. Sanford Health has announced the arrival of the new lead transplant and hepato-biliary & pancreatic surgeon, Dr. Thav Thambi. Dr. Thambi joins Sanford from Miami Valley Hospital in Dayton, Ohio where he worked for four years as Associate Director of Transplant Surgery after completing his Transplant Surgical Fellowship at the University of Cincinnati. Dr. Thambi is certified in general and transplant surgery and has expertise in general, transplant hepato-biliary and pancreatic, advanced laparoscopic, and endocrine surgery. He is the only surgeon in the region that does laparoscopic liver resections.
Dr. Thomas Braithwaite, Medical Director of Sanford Clinic Hospitals, Sanford USD Medical Center was recently named one of the top ten Hospitalists in the country by ACP Hospitalist, a publication of the American College of Physicians. The editors look for hospitalists who “are making notable contributions to the field, whether through clinical skills, innovation, community involvement, improved work flow, patient safety, research, teamwork, leadership, mentorship or quality improvement.” Under Dr. Braithwaite’s leadership, Sanford’s hospitalist program has grown to more than a dozen. He created compensation and incentive programs, modified work schedules and established the hospitalist program as the primary teaching service for USD. Sanford Health is planning a new facility and major expansion in Moorhead, Minnesota. A new clinic will be located on 24.5 acres adjacent to the new I-94 and the 34th Street interchange on the south side of Horizon Shores. No time table for construction has been set, but the facility is expected to be completed in the next few years. Sanford opened its first clinic in Moorhead in 1985 and currently has three facilities there including a clinic, FastTrack and pharmacy. Sanford’s current clinic is 16,700 square feet, has 26,000 patient visits annually, nine providers and more than 40 employees.
The National Committee for Quality Assurance (NCQA) has honored Sanford Health Plan‘s HMO with the highest achievement: Excellent Accreditation. The NCQA review includes a two-day, onsite review by surveyors, including physicians. NCQA also reviews health insurance plan performance in five categories. Sanford Health Plan received four out of four stars for access and service, qualified providers and getting better categories. It received three stars for staying healthy and living with illness. Sanford Health Plan has been approved to sell individual health insurance plans under the elite1 name in North Dakota. Sanford already offers health plans for small and large employer groups as well as Medicare products (Select and Supplement). The non-profit entity currently covers more than 67,000 people in South Dakota, northwest Iowa, southwest Minnesota and North Dakota. Sanford is also working on licensing in northwestern Minnesota. Becker’s Hospital Review has listed Sanford Health in its list of 15 growing healthcare systems. Sanford is now the largest employer in North and South Dakota, with 30 hospitals and a network of clinics serving five states. The 2009 merger with MeritCare brought in 27 regional clinics and two hospitals. From June to August 2010, Sanford recruited 75 physicians, compared with its previous pace of hiring 60-70 in a whole year.
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Regional Rapid City Regional Hospital (RCRH) has received the Get With The Guidelines® Heart Failure Gold Plus Performance Achievement Award from the American Heart Association. The award recognizes RCRH health care providers for their excellence in the treatment of patients with heart failure. The award is given only to hospitals achieving 85 percent or higher adherence to all Get With The Guildelines Heart Failure Performance Achievement indicators for two or more consecutive 12-month intervals and achieving 75 percent or higher compliance with four of nine Get With The Guidelines Heart Failure Quality Measures to improve quality of patient care and outcomes. Helen Nichols, RD, LN, CDE, Diabetes Educator, at Lead-Deadwood Regional Hospital, was recently recertified in Diabetes Education by the National Certification Board for Diabetes Educators (NCBDE). Certification renewal is awarded to individuals who successfully complete the continuing education renewal option and have maintained a level of contemporary knowledge in diabetes education. Certification is awarded for a five-year period.
Patty Bambeck, Psychiatric Nurse Practitioner at Regional Rehabilitation Institute, recently received the South Dakota Nurses Association (SDNA) Pioneer in Nursing Award at the SDNA Annual Convention and Honors in Mitchell, S.D. This award recognizes a nurse who exemplifies the spirit that motivates other nurses to follow on a path less traveled. Bambeck was nominated for creating and implementing the first pain clinic in western South Dakota. Bambeck also designed and currently implements a program within the Regional Rehabilitation Institute’s Pain Management Clinic that addresses the mental health needs of patients with chronic pain.
The Black Hills Neurology physician group and The Sleep Health Center have joined Rapid City Regional Hospital. Clinic services will continue at the current Black Hills Neurology location but will be renamed Regional Medical Clinic – Neurology and Rehabilitation and Regional Sleep Health Center. Black Hills Neurology has been in operation for almost 30 years providing neuroscience services in Rapid City and at outreach locations in South Dakota, Nebraska, and Wyoming. To show their support in the fight against cancer, hundreds of Regional Health employees organized and danced in their version of the “Pink Glove Dance.” More than 50 departments from hospitals, clinics, corporate offices and senior facilities within Regional Health participated in the video. Local cancer survivors danced at Mt. Rushmore and are also featured in the video. The cancer awareness video is part of this year’s Tough Enough to Wear Pink fundraising campaign. It can be found at http://www.youtube.com/ watch?v=HbmidLnc9X4.
Massa Berry Regional Medical Clinic has announced the addition of Michael Hogue, M.D., a family medicine physician, to the clinic staff. Dr. Hogue is board-certified in family medicine and earned his medical degree from the University of North Dakota School of Medicine in Bismarck, N.D. He completed his residency at Sioux Falls Family Practice Center in Sioux Falls, S.D. Dr. Hogue also provides hospitalist services at Sturgis Regional Hospital and has additional certification in basic life support and advanced cardiac life support. Regional Health has finalized the sale of Dorsett Regional Senior Care and Belle Fourche Regional Senior Care, which includes Sunpointe Regional Senior Care. The purchasing party is the Fox Trust that will lease the property back to Mission HealthCare, LLC, of Jordan, Minnespta. Mission HealthCare is a provider of long-term care and assisted living facilities in Minnesota and South Dakota.Dorsett Regional Senior Care in Spearfish is a 120-bed skilled nursing facility specializing in rehabilitation. Belle Fourche Regional Senior Care, an 83-bed nursing home, and Sunpointe Regional Senior Care, a 16-unit assisted living center, provide social, rehabilitative, and professional services. The sale affects approximately 170 employees and 200 residents.
March 2011
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Learning Opportunities Happenings around the region
March, April 2011 March 4 – 5 Advanced Cardiac Life Support Provider Training Location: Avera Education Center, Classroom 2 Information: 605-322-8950 March 5 5:00 pm
14th Annual Hospital of the Northern Hills Benefit Ball Location: Spearfish Holiday Inn and Convention Center Tickets: 605-644-4242
March 7 8:30 am – noon or 12:30 – 4:00 pm
Neonatal Resuscitation Renewal Certification Location: Sanford Health Center for Learning and Innovation, Sioux Falls Information: Nikki.Terveer@sanfordhealth.org
March 10-12 SD Academy of Physician Assistants, Winter/Spring CME Conference Registration, 7:00 am Location: Best Western Ramkota Hotel, Rapid City Information & registration: nafmb@dakota2k.net Just for Fun…. March 12 Doctors in Concert 7:00 pm Location: The Washington Pavilion Ticket information: 605-367-6000 March 14 – 15 8:00 am – 4:30 pm
Pediatric Advanced Life Support Provider – Aberdeen Location: Avera St. Lukes Education Center Information: 605-622-5588
March 24-25 Registration, 7:30 am
Perinatal, Neonatal & Women’s Health Conference Location: Sanford USD Medical Center, Schroeder Auditorium Information: Nikki.Terveer@sanfordhealth.org
March 29 8:30 am - 11:30 am
Addictions and Genetics Location: Avera Education Center Auditorium, Sioux Falls CNE Credit Offered Registration online at: www.averamckennan.org/conferences
April 2 8:00 am – 3:00 pm
Avera Transplant Institute and Center for Liver Disease: State-of-the-Art Management of Liver, Kidney, and Pancreatic Diseases Location: Avera Education Center Auditorium Credits Offered: CME and CNE, Pharmacy, Social Work Registration online at: www.averamckennan.org/conferences
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April 12
Advanced AWHONN Fetal Heart Monitor
7:45 am – 5:45 pm
Location: Avera Education Center, Classroom 1 Information: 605-322-8950
April 13 12:30 – 3:30 pm
Living with Grief: Spirituality and End-of-Life Care Location: Avera Education Center Auditorium Continuing Education credits available through Hospital Foundation of America Registration online at: www.averamckennan.org/conferences
MED reaches more than 3500 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for the Learning Opportunities calendar to the editor at Alex@MidwestMedicalEdition.com.
Midwest Medical Edition
South Dakota Physicians— the time to act is NOW! Here are the FACTS:
ANY cut in Medicaid funding is a tax increase for the insured and those paying privately! ANY cut in Medicaid funding may result in decreased access to primary care for those patients! ANY cut in Medicaid will result in increased utilization of hospital emergency rooms! ANY cut in Medicaid will result in the loss of millions in Federal funding! A 10% cut = a $40 million loss!!
ANY cut in Medicaid will cause private payers in nursing homes to spend through their savings faster and be on Medicaid sooner! ANY cut in Medicaid could result in the loss of jobs, services and even possible closure of some health care facilities!
Time is running out! Contact your local legislator now at:
http://legis.state.sd.us/ sessions/2011/ MembersByDistrict.aspx
SDAHO represents 53 hospitals and 34 long term care facilities across SD providing a “unified voice” for its members with state and federal advocacy.
For more information on how to get involved, contact SDAHO President/ CEO Dave Hewett, at (605) 366-7335 or dave.hewett@sdaho.org. Additional information on how to get involved and the “big picture” of health care in South Dakota is available at: www.sdaho.org.
“It’s what I live for.” “ Using my hands to take a raw piece of wood and transform it into something useful is my passion. My stress relief. My hobby. For years I dreamed of building my own woodshop. Never did I dream I had heart disease.” The specialists at Sanford found Dave was on the verge of having a major heart attack. But they
caught it early. Saved his heart. Transformed his life. “ I put my heart in their hands so I could get back to my workshop. It’s what I live for.” That’s why we’re here. Sanford Heart. heart.sanfordhealth.org
100-11395-1380 2/11
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