Consult - Diabetes - Summer 2011 by Mary Jones Smith

Inside this folder:

Consult Summer 2011 | Diabetes

Contents 3 Diabetes Program 9 Diabetes Practice Tool 13 The latest diabetes-related ophthalmology services 17 Updates on our wound care services 21 Innovative pancreatic islet cell transplantation 23 Treatments and services for diabetes-related complications 29 Updates on new services and facilities available for your patients at Ohio Stateâ&#x20AC;&#x2122;s Medical Center

Ohio Stateâ&#x20AC;&#x2122;s

Consult Summer 2011

The Ohio State University Medical Center

Diabetes Program w Comprehensive services for diabetic and prediabetic patients w New services and programs to better serve your patients w Updates on our nationally recognized endocrine research programs

Diabetes Management Medical Director: Kwame Osei, MD

DC3 provides evidence-based clinical practice guidelines for team members to follow, assists patients with goal setting and achievement, and follow-up phone calls to more effectively transition patients to outpatient care.

Patient Care — Diabetes Program

Close attention to hospitalized diabetes patients and their glucose control is paramount. Research indicates that hospitalized patients who have diabetes or elevations in glucose levels due to illness have longer lengths of stay, higher rates of postsurgical complications and readmission, and higher mortality rates. Our diabetes team works closely with patients from admission through hospitalization and outpatient follow-up to provide a continuum of care.

Diabetes is challenging to manage without an excellent team with breadth of expertise in the intricacies of the disease. This expertise is attained through education and training, access to and involvement in the latest research, global alliances and patient care — day in and day out. This expertise is represented in the Diabetes Program at The Ohio State University Medical Center. Part of the Division of Endocrinology, Diabetes and Metabolism, the Diabetes Program offers comprehensive services for patients diagnosed with diabetes or prediabetes conditions from a superbly experienced team. Services include:

• Comprehensive diabetes education (details follow). • Evaluation for and training in the complete spectrum of technology and devices, including pumps and monitors (details in Practice Tool).

• Outpatient care — The outpatient clinic at CarePoint East offers convenient access to diabetes care. Continuity of care is important. In between visits, patients or their providers can send us weekly glucose records to determine if medication adjustments are warranted. The glucose information can be entered into a secure system and automatically transferred to the patient’s electronic medical record. “The more we know about how much insulin the patient requires, the more likely we will be able to get the patient to target glucose levels without causing hypoglycemia,” says Kathleen Dungan, MD, assistant professor of medicine in the Division of Endocrinology, Diabetes and Metabolism.

• Transplantation (details in Pancreatic Islet Transplant Tab). Additionally and importantly, team members in our Diabetes Program work closely with and facilitate patients’ access to other specialists at Ohio State’s Medical Center in areas that affect diabetes care, including cardiovascular disease, obstetrics and ophthalmology. “Physicians refer patients to us because they are difficult cases to manage and the doctors have done everything they can. We can offer new hope to these patients,” says Kwame Osei, MD, director of Ohio State’s Division of Endocrinology, Diabetes and Metabolism. “We are privileged to provide seamless care across all appropriate specialty areas to ensure diabetes patients receive the best possible care and return to the physicians who referred them with the tools to better manage their disease.

• Inpatient care — Ohio State’s Medical Center has had an inpatient Diabetes Program at both University Hospital and University Hospital East. Team members include university physicians, advanced practice nurses, certified diabetes educators and dietitians. Patients also benefit from care provided by diabetes unit resource nurses — specially trained nursing champions who serve as leaders and liaisons between the inpatient Diabetes Program and specialty areas.

We do this for patients at every phase of diabetes — from the newly diagnosed to those who have life-threatening complications or end-stage disease. Diabetes and diabetes alone is our focus.”

The inpatient team recently developed the DC3 program — Diabetes Control, Compliance and Continuity to assist patients with very poorly controlled diabetes improve outcomes, such as HbA1c and need for readmission.

4 Diabetes Program

Patient education

• Islet cell transplantation — This research is the epitome of advancing care for patients who have severe beta cell pancreatic diseases. The Diabetes Research Center works closely with Ohio State’s Comprehensive Transplantation Center, and has a laboratory solely focused on basic research of islet cell biology (see enclosed tab on Pancreatic Islet Cell Transplant).

Patients who have diabetes must be well educated and well trained to succeed in managing their disease and preventing complications. For this reason, diabetes education is a top priority at Ohio State’s Medical Center. Patients are assessed to determine the type of education program most appropriate for their needs, and classes are tailored to meet the needs of a group of participants. Components of our diabetes education program include:

• Glucose control — Research initiatives include retrospective and prospective studies of the optimal methods of implementing insulin therapy in the inpatient setting and the use of continuous subcutaneous glucose monitoring technology.

• General diabetes education — For patients diagnosed with prediabetes or newly diagnosed with diabetes, and for those who need a refresher course for self-management. Focuses on blood glucose monitoring, carbohydrate counting, meal planning, exercise, medications, day-to-day living with diabetes, complication avoidance and treatment of short-term complications.

Some preliminary studies at Ohio State’s Medical Center have indicated that extreme fluctuations in glucose are associated with cellular dysfunction, heart rhythm abnormalities and death. As a result, additional research is under way to determine optimal and individualized measures to stabilize glucose fluctuations, enhance the benefits of glycemic control and reduce the risks for hypoglycemia.

• Intensive diabetes education — For patients who manage their diabetes by monitoring blood glucose and taking rapid-acting insulin prior to each meal. Focuses on monitoring and recording blood glucose levels, carbohydrate counting and dosing insulin, carbohydrate ratio and sensitivity factor, evaluating blood glucose trends, medication adjustments, healthy eating, complication avoidance, and treatment of acute complications.

Dungan recommends that every newly diagnosed type 1 diabetes patient be evaluated for clinical trial applicability. “Some trials are appropriate only for patients in the first months after diagnosis. We hope that such clinical trials will be able to determine whether various therapies help preserve the remaining functional pancreas. Access to a trial such as this is more easily facilitated at academic medical centers with subspecialty care programs,” says Dungan.

• Insulin pump — This course began 20 years ago and has served 1,000 pump therapy patients to date. The course focuses on the management of insulin delivery.

Osei emphasizes that the work of Ohio State’s Medical Center in the Diabetes Research Center is important because it determines the direction for patient care. “Patients come to us for pancreatic islet cell transplantation and pancreas transplantation. We have expertise in these areas because of our research,” says Osei. “Our patients can be involved in clinical trials as we explore novel therapies for diabetes and pursue new avenues of research in the treatment of obesity.”

• Continuous retrospective or real-time glucose sensor. • 1:1 Nutrition — For patients who are current on diabetes management but need help managing their nutrition. • Individual sessions for patients who have disabilities, including hearing problems and language barriers. • Diabetes support group for patients and family members — introduced in 2011.

Research — Creating a World Without Diabetes The vision of the Diabetes Research Center at The Ohio State University Medical Center is “To create a world without diabetes.” Fulfillment of this vision involves dedication to advancing diabetes research, education and patient care through innovative study and trial. Our research team has been at the forefront of developing modes of insulin delivery and islet cell implantation devices, and measures to prevent and improve the management of diabetes.

Patient Referrals... Please contact us at 614-292-3800 to make a referral or with questions. We appreciate your referrals and the opportunity to partner with you on the care of your patients.

Researchers are involved in studies that provide patients with access to state-of-the-art clinical trials for new drugs and technologies. Areas of research include the following: 5 Diabetes Program

When to refer a patient The Diabetes Program at The Ohio State University Medical Center provides care for patients from new diagnoses to end-stage disease. Often, primary care providers want more concrete direction about what should trigger a referral for more specialized care from a comprehensive medical center. We offer these general recommendations for when to refer for specialty care: Type 1 diabetes • The patient has frequent hospitalizations for hypoglycemic episodes. • The patient has impaired kidney function and a creatinine level of more than 3. This patient may be a candidate for kidney transplantation.

For patient referrals call

614-292-3800

• The patient is transitioning from childhood to adulthood care. • The patient has a complication such as gastroparesis or hypoglycemia. • The patient would like to consider using a technology (pump, monitor). • The patient needs to lose weight or has significant, difficult-to-manage post-prandial excursions and could benefit from the extra injection therapy of a noninsulin injectable medication, such Symlin. This is the only medication currently approved for the treatment of type 1 diabetes that is known to cause significant weight loss. • The patient needs to have a major surgical procedure. In particular, diabetes patients who have a continuous subcutaneous insulin pump usually need the attention and expertise of an endocrinologist during their hospitalization.

Type 2 diabetes • The patient is using 200 or more units of insulin per day or has A1C of more than 9 percent despite all efforts to manage the condition. We evaluate the patient for causes of insulin resistance, determine if specialized therapy with concentrated insulin is indicated, and consider other therapeutic options. • The patient is failing one or more oral agents and may be a candidate for a noninsulin injectable medication, such as Victoza, Byetta or Symlin. These are the only medications approved for the treatment of type 2 diabetes that are known to cause significant weight loss.

• The patient is obese and has a body mass index of more than 35. This patient may be a candidate for bariatric surgery, which is the most effective way to induce long-term remission in patients with type 2 diabetes. • The patient needs to initiate insulin therapy or intensify an insulin regimen.

Ohio State’s Experience in Diabetes • The Division of Endocrinology, Diabetes and Metabolism at The Ohio State University Medical Center was established as one of the oldest true divisions in the field of endocrinology 30 years ago. • The Division of Endocrinology, Diabetes and Metabolism at Ohio State has been recognized as among the best by the U.S.News & World Report survey of America’s Best Hospitals for six consecutive years. In the 2011 ranking, Ohio State was ranked 20th. • Faculty in the Division of Endocrinology, Diabetes and Metabolism are nationally and internationally recognized in endocrine research. Research is conducted through the Diabetes Research Center, a multidisciplinary center dedicated to diabetes patient care, education and research, with the ultimate goal of curing type 1 and type 2 diabetes. • Ohio State’s Medical Center received the Anthem Hospital Quality Program Meritorious Award for best practices in diabetes management for quality performance in glycemic control initiatives in its inpatient diabetes care. 6

Diabetes Program

The Ohio State University Medical Center’s CEO Shares His Diabetes Journey

teven Gabbe, MD, Senior Vice President for Health Sciences and CEO of The Ohio State University Medical Center, was diagnosed with diabetes mellitus more than 40 years ago. Since then, Gabbe hasn’t lived a day without diabetes, but he hasn’t let it limit him either, and he wants to share his experience with others living with diabetes.

Steven Gabbe, MD

Gabbe says that simple message of diabetes as a condition and not a disease has stayed with him for more than 30 years. “I share that message with my patients and, in turn, I learn from them,” he says. “Pregnant women with diabetes are incredibly motivated to do whatever they can to have healthy babies. I have been inspired by their commitment, and that has helped me on my journey with diabetes.”

Gabbe has an insulin pump and says it has given him greater flexibility in living with diabetes, including managing hypoglycemia and exercise. Gabbe has successfully completed two marathons and multiple half-marathons, and rides a tandem bicycle with his wife Pat in Pelotonia, the annual event that benefits cancer research at Ohio State’s James Cancer Hospital and Solove Research Institute.

“I’ve learned important lessons,” says Gabbe. “I haven’t let my blood glucose control me. Rather, I chose to control it and my future. As a medical student newly diagnosed with diabetes, I was advised to consider pathology or radiology, specialties with a predictable lifestyle that would be more compatible for someone with diabetes. But I chose my own path. My passion was in obstetrics and gynecology, specifically high-risk obstetrics and maternal-fetal medicine. A career in academic medicine, with research and teaching, ensured I would have long and irregular hours that could make managing my diabetes difficult, but I followed my heart and have never regretted that decision.”

“When I began my journey with diabetes, there were few insulin options available. We used glass syringes and needles that had to be sharpened,” says Gabbe. “So much has changed, and I’m more optimistic than ever about advances in research and patient care. New insulin analogues and oral medications, portable blood glucose meters, glycosylated hemoglobin measurements, insulin pumps and continuous glucose sensors are available to help patients adjust to even the most hectic and erratic work schedules and lifestyles. We have also completed our first islet cell transplant at the Medical Center. I am confident that, in the future, we will see sensors talk to pumps, creating an artificial pancreas, and research in stem cell biology and immunology that will lead to interventions that can prevent and cure diabetes.”

Gabbe credits his success in managing his diabetes, in part, to his health care providers – physicians, nutritionists, diabetes nurse educators, social workers and pharmacists. One of Gabbe’s physicians, Jorge Mesman, MD, at the University of Southern California Los Angeles County Women’s Hospital, provided important advice: “Don’t think of diabetes as a disease. Think of it as a condition that you live with. I bet that if you follow your diet, get regular medical care, exercise and don’t smoke, you will be far healthier than most of your friends.”

Look for info on our Global Diabetes Summit in the Consult Newsletter 7 Diabetes Program

Physicians Dara Schuster, MD

Kwame Osei, MD

Associate Medical Director, Evidence-Based Practice, Associate Professor

Division Director, Endocrinology and Metabolism Clinical Interests: diabetes and nutrition, type 2 diabetes mellitus

Clinical Interests: diabetes and glucose metabolism

Samuel Cataland, MD

Manuel Tzagournis, MD

Ralph W Kurtz Chair in Endocinology; Section Chief, Diabetes

Professor Emeritus Clinical Interests: endocrine diseases, internal medicine

Clinical Interests: diabetes mellitus, endocrine tumors of the pancreas

Elizabeth Essig, MD

Jie Wang, PhD

Assistant Professor Clinical Interests: diabetes, general endocrinology

photo not available

Assistant Professor Clinical Interests: islet cell research

Kathleen Dungan, MD

Trudy Gaillard, RN, PhD, CDE

Assistant Professor

Assistant Professor of Medicine

Clinical Interests: diabetes, general endocrinology, type 2 diabetes

Research Interests: Lifestyle interventions, non-traditional risk factors, diabetes mortality and morbidity in African-Americans

The Ohio State University Medical Center Diabetes Management www.medicalcenter.osu.edu/go/diabetes

ÂŠ 2011 The Ohio State University Medical Center â&#x20AC;&#x201C; 7 CORP20110208-06

Ohio State’s

Consult Practice Tool

Roadmap to Diabetes Care

This exercise is especially appropriate for patients who have poor glycemic control, glycemic variability, hypoglycemia, discordant HbA1c/self-monitored blood glucose results or variable daily patterns. This also is a useful trial for patients who are considering real-time continuous glucose monitoring.

Diabetes is a lifelong condition that requires careful monitoring, regular checkpoints and changes in regimen to maximize patients’ overall health and well-being. Diabetes specialists at The Ohio State University Medical Center follow a general roadmap when caring for patients with diabetes. We share this roadmap with you, as a practice tool. When your patients with diabetes develop unmanageable complications or plateau in their ability to control their blood sugar levels, blood pressure and other important measures, we are pleased to evaluate their condition and recommend steps to help you and them regain control of their health.

– Consider continuous subcutaneous insulin therapy (insulin pumps). The convenience and adherence this therapy offers is invaluable for many patients, particularly those who require very low insulin or variable basal insulin patterns; or who have severe hypoglycemia, glycemic lability or unpredictable life patterns (e.g., work swing shifts, travel frequently or run long distances).

Type 1 Diabetes

– Consider real-time continuous glucose monitoring. Interstitial fluid glucose measurements are displayed on a sensor every five minutes for a more comprehensive picture of glucose patterns. Patients can adjust therapy based on trends and notice impending hypoglycemia or hyperglycemia. Proper training about limitations and optimal use is crucial for long-term adherence and success with this technology.

For patients with a new diagnosis: w Provide general diabetes survival skills education. w Determine if patients qualify for available clinical trials. Interventions via clinical trials are intended to help to protect any residual pancreatic function.

– Consider pramlintide. This non-insulin injectable medication can be used with insulin therapy to help curb post-meal excursions and promote weight loss.

For all patients with type 1 diabetes: w Provide general diabetes education, plus the following for motivated patients:

For all patients three to five years after diagnosis:

– Implement intensive insulin therapy, including carbohydrate counting and physiologic insulin dosing. – Create retrospective one-week continuous glucose monitoring reports with detailed food/insulin/activity logs. Provide expert interpretation and suggestions for intervention, and recommend changes to improve health and well-being. Many insurance carriers will cover repeated analyses over time to determine the efficacy of recommended changes.

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Diabetes Practice Tool

For patients who have severe hypoglycemia: w Evaluate for an insulin pump and/or continuous glucose monitoring, or transplant â&#x20AC;&#x201D; pancreatic islet cell or solid organ. For patients with end-stage complications: w Provide a forum for treatment, referral and evaluation for transplant candidacy.

Type 2 Diabetes For patients with a new diagnosis: w Provide general diabetes education and care. For patients who are failing one or two oral agents: w Provide general diabetes education, care and intensification of therapy. w Consider education about and implementation of non-insulin injectable agents (including exenatide or liraglutide) that can be used to help curb post-meal excursions and promote weight loss. For patients who are failing basal, prandial or pre-mix insulin:

For patients who are severely insulin resistant (requiring more than 250 units/day): w Consider U500 concentrated insulin with or without insulin pump. w Evaluate for secondary causes, such as Cushingâ&#x20AC;&#x2122;s syndrome. w Consider for bariatric surgery program (not limited to those who are severely obese).

w Provide general diabetes education and care. For all patients at the time of diagnosis:

w Intensify insulin regimen to multiple injections (basal bolus therapy). w Create retrospective one-week continuous glucose monitoring reports with detailed food/insulin/activity logs. Provide expert interpretation and suggestions for intervention and recommend changes to improve health and well-being. Many insurance carriers will cover repeated analyses over time to determine the efficacy of recommended changes.

w Ensure comprehensive screening for microvascular complications and risk-factor management for macrovascular complications. w Provide comprehensive multi-factorial therapy with the aim of preventing, slowing or halting the progression of complications. w Provide a forum for treatment of complications, referral and evaluation for transplant candidacy. w Offer opportunities for involvement in clinical research studies.

For patients who are failing fixed meal dosing: w Intensify diabetes education, including carbohydrate counting and physiologic insulin dosing.

For patients who have advanced disease with beta-cell depletion:

w Consider education about and implementation of pramlintide. This non-insulin injectable medication can be used with insulin therapy to help curb post-meal excursions and promote weight loss.

w Consider insulin pump.

w Create retrospective one-week continuous glucose monitoring reports with detailed food/insulin/activity logs.

w Consider real-time continuous glucose monitoring. w Create retrospective one-week continuous glucose monitoring reports with detailed food/insulin/activity logs. w Evaluate patients with complications for transplant suitability.

10 Diabetes Practice Tool

Insulin Pump Therapy

Continuous Glucose Monitoring

Insulin pump therapy involves short-acting insulin delivered in two ways:

Continuous glucose monitoring is the measuring or sensing of blood glucose every one to five minutes. It is a useful tool for guiding treatment decisions and understanding patients’ blood sugar trends. It is not a replacement for finger-stick monitoring of blood sugar.

• Basal rate — Continuous infusion of small amounts of short-acting insulin that keeps blood glucose in the desired range between meals and overnight. Variable programmable rates cover changes in basal insulin requirements throughout the day, including increasing requirements in the early morning period (dawn phenomenon). Basal insulin is easily interrupted, increased or decreased to accommodate temporary changes in basal insulin requirements (acute illness, exercise). Alternate patterns may be programmed for patients with variable daily patterns (such as those who work swing shifts).

Through a tiny glucose-sensing device (sensor) inserted under the skin, changes in glucose in the interstitial fluid are measured. Information is transmitted wirelessly from the sensor to an attached blinded recorder (retrospective use) or monitor approximately the size of a cell phone, which is worn on the belt or carried in a pocket or bag (real-time use). The Ohio State University Medical Center offers a full range of continuous glucose monitoring systems, including one that communicates with an insulin pump. Our Continuous Glucose Monitoring Program allows patients to learn more about monitoring systems, see examples, meet with manufacturers’ representatives, talk with diabetes educators, learn about the responsibilities of using a monitor and check insurance coverage. Patients who opt to incorporate a monitoring system into their diabetes regimen participate in our intensive education and monitoring system program to help ensure their success.

• Bolus — short-acting insulin to cover carbohydrate intake and/or to bring down high blood sugar. The amount needed is determined with a customized bolus calculator that takes into account the grams of carbohydrates consumed and the blood sugar. Customized settings prevent insulin over-dosing. An insulin pump is a small device, similar in size to a cell phone. The pump delivers insulin continuously through a small, plastic tube that is changed approximately every three days. Advantages of an insulin pump include: • No multiple daily injections • Decreased blood sugar swings • Decreased HbA1c and hypoglycemia • Increased flexibility

To Make a Patient Referral

• Stabilized, decreased or reversed complications of diabetes

Please call 614-292-3800

• Improved quality of life The Ohio State University Medical Center offers training for a full array of insulin pumps and a free Insulin Pump Program Information Session. The session allows patients to learn more about pumps, see examples, meet with manufacturers’ representatives, talk with diabetes educators, learn about the responsibilities of using an insulin pump and check insurance coverage. Patients who opt to incorporate a pump into their diabetes regimen participate in our intensive education and pump management program to help ensure their success

11 Diabetes Practice Tool

The Ohio State University Medical Center Practice Tool | Roadmap to Diabetes Care medicalcenter.osu.edu

Ohio Stateâ&#x20AC;&#x2122;s

Consult Summer 2011

The Ohio State University Medical Center

Ophthalmology w Eight fellowship-trained retina specialists w Expert care and management of diabetic retinopathy

w Comprehensive department can manage all diabetes-related ocular issues

Diabetes-Related

Ophthalmology Care Department Chair: Thomas Mauger, MD The Havener Eye Institute, Department of Ophthalmology, at The Ohio State University Medical Center provides routine and specialty diagnostic, treatment and surgical services in the following areas: • • • • • • • •

Retina and vitreoretinal disease Corneal and external disease Glaucoma Neuro-ophthalmology Ophthalmic pathology Ophthalmic plastic and reconstructive surgery Pediatric ophthalmology Refractive/LASIK surgery

Ohio State has been involved with all major trials of VEGF inhibitors for macular degeneration and, more recently, diabetic retinopathy and its complications. “We provide state-of-the-art care for diabetic retinopathy, including access to clinical trials, imaging, diagnostic capabilities, surgical techniques and management of complications,” says Thomas Mauger, MD, chair, Havener Eye Institute, Department of Ophthalmology and associate professor of ophthalmology. “Our comprehensive department can manage every ocular issue that arises as a result of diabetes, including retinopathy, cataracts, glaucoma and cornea problems. This level of care and access to the latest treatments is not available elsewhere in this area.”

Our eight fellowship-trained retina specialists treat a wide range of retinal conditions including diabetic retinopathy, which is the most common cause of legal blindness for people ages 20 to 65. Closely managing patients’ diabetes and co-morbidities to prevent and minimize the effects of retinopathy is our priority. “Uncontrolled blood sugar and blood pressure are risk factors, and anemia and renal problems can aggravate retinopathy and contribute to developing macular edema,” says Alan Letson, MD, chief of the Retina Division and professor of ophthalmology at Ohio State’s Medical Center. “Tight blood sugar control can help to prevent retinopathy.

Ohio State’s Experience in Ophthalmology • The Havener Eye Institute, Department of Ophthalmology, sees 50,000 patients per year—almost one-fourth of the entire outpatient visits of The Ohio State University Hospitals Clinic.

“It is difficult to undo the damage caused by retinopathy. Therefore, recognition of patients’ visual problems and early diagnosis through annual ophthalmic exams are critical. Most primary care physicians assume their patients with diabetes are seeing ophthalmologists, but this isn’t always the case. Either a comprehensive ophthalmologist or retina specialist can provide the most accurate screening and access to the latest treatments, helping to prevent irreversible damage to the eye.”

• Two years ago, the Havener Eye Institute, Department of Ophthalmology, moved from The Ohio State University Medical Center campus to a new location on Olentangy River Road, easily accessible from State Route 315. The facility includes a state-of-the-art surgery center. It features ample, free on-site parking for patients. • Retinal specialists at The Ohio State University Medical Center use the latest imaging tools, including high-resolution digital color fundus photography, fluorescein angiography, indocyanine green (ICG) angiography, fundus autoflorenscence, time domain and spectral domain optical coherence tomography (OCT) and multiple-frequency ocular ulstrasound imaging.

Faculty in this department serves as principal investigators for clinical trials of diseases including diabetic retinopathy. Ohio State’s Medical Center is a participating site in the Diabetic Retinopathy Clinical Research Network (DRCR.net), a collaborative network dedicated to facilitating multicenter clinical research of diabetic retinopathy, diabetic macular edema and associated conditions. The National Eye Institute, part of the National Institutes of Health, funds the DCRC.net. Vascular Endothelial Growth Factor (VEGF) inhibition has been the new treatment focus for diabetic retinopathy.

• Faculty in the department, including Alan Letson, MD, serve on the Ohio Diabetes Alliance, a statewide advisory group comprised of more than 40 organizations interested in decreasing the burden of diabetes in Ohio. 14

opHthalmology

department Chair Thomas F. Mauger, MD

Frederick Davidorf, MD

Chairman of the Department of Ophthalmology Associate Professor of Ophthalmology

Emeritus Professor, Ophthalmlogy Clinical Interests: Vitreoretinal surgery, diabetic retinopathy, retinal detachments, ocular melanoma, retinitis pigmentosa, vein occlusion

Specialty/Research Interests: Corneal transplantation, anterior segment - surgery and disease, cataract surgery

Retina Specialists

Paul Kurz, MD Assistant Professor-Clinical, Ophthalmology

Susie Chang, MD

Clinical Interests: Diseases of the retina, uveitis

Assistant Professor, Ophthalmology Clinical Interests: Retina, diabetic retinopathy, retinal detachment, macular and retinal degeneration, macular diseases, retinal vascular diseases

L. Carol Laxson, MD, PhD Assistant Professor-Clinical, Ophthalmology Clinical Interests: Diabetic retinopathy, vitreoretinal disease, macular degeneration

Colleen Cebulla, MD, PhD Assistant Professor, Ophthalmology Clinical Interests: Ocular oncology, uveal melanoma, vitreoretinal diseases, retinal detachment, diabetic retinopathy, macular degeneration, retinal surgery

Alan Letson, MD William H. Havener Chair in Ophthalmology Chief, Retina Division Professor-Clinical, Ophthalmology

John Christoforidis, MD Assistant Professor, Ophthalmology

Clinical Interests: Retinal vascular diseases, endothelial disease and function, retinal clinical trials

Clinical Interests: Retinal detachment, macular degeneration, diabetic eye disease, vascular occlusions

Michael Wells, MD Assistant Professor-Clinical, Ophthalmology Clinical Interests: Diseases of the vitreous and retina including diabetic retinopathy, hypertensive retinopathy, sickle cell retinopathy, macular degeneration, retinal detachment, ocular trauma

• Faculty in the department are involved in multicenter clinical trials funded by the National Eye Institute. Through research, our faculty members contribute to medicine’s base of knowledge of ocular diseases through efforts aimed at new treatments for the prevention and treatment of blinding disorders.

Patient Referrals...

• The Ohio State University Medical Center has received endowment funds for research in angiogenesis and diabetic retinopathy.

We appreciate your referrals and the opportunity to partner with you on the specialized ophthalmologic treatment of your patients.

• Faculty in the department have produced several major textbooks for advancing ophthalmic medical education in recent years.

Havener Eye Institute, Department of Ophthalmology eye.osu.edu 614-293-8116

• The Department of Ophthalmology at The Ohio State University was officially formed in 1929. 15

opHthalmology

The Ohio State University Medical Center Ophthalmology www.eye.osu.edu

Ohio Stateâ&#x20AC;&#x2122;s

Consult Summer 2011

The Ohio State University Medical Center

Comprehensive Wound Center w A national leader in wound care research w Wound outcomes exceed national benchmarks w Treating one of the largest volumes of patients in the U.S.

Comprehensive Wound Center Executive Director: Chandan K. Sen, PhD

The Comprehensive Wound Center provides diagnosis, state-of-the-art dressings, patient education and treatment, including the following:

Clinical Director: Richard Schlanger, MD, PhD

• Hyperbaric oxygen—Approximately 12 percent of our patients benefit from this therapy. For the convenience of our patients, Ohio State’s Medical Center has six individual hyperbaric oxygen chambers in three locations. Hyperbaric oxygen increases growth of new blood vessels and stimulates the immune system. It is an effective treatment for many diabetic foot ulcers.

Research Directors: Gayle M. Gordillo, MD and Sashwati Roy, PhD Medical Director, Hyperbaric Medicine: Sorabh Khandelwal, MD Patients who have diabetes are at great risk for developing skin ulcers that do not heal. Chronic wounds affect 10 to 15 percent of the 20 million individuals with diabetes, and cause significant quality-of-life and public health problems. When these ulcers occur, usually accompanied by uncontrolled blood glucose and other problems, it is essential to have appropriate specialty care. A comprehensive wound center, with experience in diabetology, vascular medicine, peripheral vascular disease, surgery and plastic surgery, can keep the amputation rate of diabetes patients below one percent and prolong patients’ lives and productivity.

• Skin substitutes • Negative pressure therapy • Topical oxygen • Growth factor therapy • Opportunities to enroll in clinical studies and trials testing the latest technologies “We encourage primary care providers to tell their patients to speak up as soon as they notice a break in the skin that doesn’t look right,” says Schlanger. “Skin, especially on the bottom of the foot or lower extremity, should be intact. If it is not, patients who have diabetes are at higher risk for infection. They should not ignore this condition and think it will improve on its own.”

The Comprehensive Wound Center at The Ohio State University Medical Center is a national leader in wound research and provides advanced, research-based care for chronic, non-healing wounds.

Patients in the Comprehensive Wound Center are instructed how to protect themselves from developing this unnecessary complication. Education includes weight control, diet and exercise, footwear choices, glucose control and foot care.

“The Ohio State University Comprehensive Wound Center is dedicated to providing the best possible patient care through an interdisciplinary team of clinical experts, cutting-edge research and educational programs” says Chandan K. Sen, PhD, executive director of the Comprehensive Wound Center and an internationally renowned wound scientist.

“Wound care is a specialty area that not every medical center can provide appropriately. As a multispecialty academic medical center, we have vast resources and the latest research to provide true bench to bedside wound care.”

“At Ohio State’s Medical Center, we are focused on how to prevent wounds and, when they do occur, make them a minor inconvenience instead of a major life change,” says Richard Schlanger, MD, PhD, clinical director of the Comprehensive Wound Center.

Ohio State’s Experience in Wound Care

The team of professionals in the Comprehensive Wound Center, dedicated to wound care, includes physicians, nurses, social workers and diabetes educators who work closely with patients to provide state-of-the-art wound care and instruction for better living.

• The Comprehensive Wound Center at The Ohio State University Medical Center was founded in 2005 under the leadership of world-class wound scientist Chandan K. Sen, PhD. Sen, who chairs the National Institutes of Health study section on Surgery, Anesthesia and Trauma. Sen is also the editor-in-chief of the National Wound Healing Society’s publication “Advances in Wound Care.”

As a result, the Comprehensive Wound Center has a 92-percent wound heal rate and a less than 0.92 percent amputation rate— both are better than the national benchmarks.

• Our physicians and staff have a combined 150 years of wound care and hyperbaric therapy experience. Members 18

Comprehensive Wound Center

Wound Center directors Chandan K. Sen, PhD

Gayle Gordillo, MD

Executive Director, Comprehensive Wound Center Professor, Department of Surgery

Associate Professor, Plastic Surgery Clinical Interests: Research, clinical trials

Clinical Interests: Ischemic wounds, diabetic ulcers, clinical research

Wound Center team

Sashwati Roy, PhD Associate Professor, General Surgery

Said Atway, DPM

Clinical Interests: Diabetic ulcers and inflammation, clinical research

Assistant Professor, Clinical, Department of Orthopaedics, Division of Podiatry

Richard Schlanger, MD, PhD

Clinical Interests: Foot and ankle reconstruction, diabetic wound care, nail abnormalities, bunions, heel pain, ankle sprains

Chief, Surgical Services University Hospital East Clinical Director, Comprehensive Wound Center Associate Professor, Clinical Surgery

Colin Kaide, MD Assistant Professor, Clinical, Department of Emergency Medicine

Clinical Interests: General surgery, thoracic and endocrine surgery, breast and cancer surgery

Clinical Interests: Emergency medicine, hyperbaric medicine, emergency airway management, sedation/analgesia

Sorabh Khandelwal, MD Medical Director, Hyperbaric Medicine; Director, Medical Student Education Associate Professor, Clinical, Department of Emergency Medicine

Sherman Katz, MD Clinical Assistant Professor, Department of Surgery, Division of Vascular Diseases and Surgery Clinical Interests: General and peripheral vascular surgery, cerebrovascular diseases, trauma and critical care

of our wound care team are international and national experts in wound care, hyperbaric medicine, soft tissue infection and oxygen research.

Donald Norris, MD Clinical Assistant Professor of Emergency Medicine

• Ohio State’s Comprehensive Wound Center is one of few wound centers in the United States whose research activities are supported by grants from the National Institutes of Health, as well as by the Department of Defense.

Brian Porshinsky, MD

• The Comprehensive Wound Center is a leading educational center for training physicians about wound healing. Ohio State offers a 60-hour CME course in wound care every month for physicians, nurses and other providers.

Associate Director, Burn Center Assistant Professor, Surgery Clinical Interests: Acute burn care, fluid resuscitation after burns, burn reconstruction

• The Comprehensive Wound Center is one of the leading university-based wound care centers in the United States and has one of the largest volumes of wound care patients in the United States. • Wound care specialists at Ohio State’s Medical Center, including Richard Schlanger, MD, PhD, are regularly consulted by the United States Congress about wound care prevention.

Robert VanCourt, DPM Clinical Assistant Professor of Orthopaedics, Division of Podiatry Clinical Interests: foot and ankle surgery, wound care, reconstruction of foot deformity 19

Comprehensive Wound Center

Patient Referrals... We appreciate your referrals and the opportunity to partner with you on the care of your patients. Comprehensive Wound Center www.medicalcenter.osu.edu/go/wound 614-293-4811, 888-340-3163 Ohio State provides wound care services in four central Ohio locations: CarePoint Gahanna, CarePoint Lewis Center, Ohio State’s Martha Morehouse Medical Plaza and Ohio State’s University Hospital East.

The Ohio State University Medical Center Comprehensive Wound Center www.medicalcenter.osu.edu/go/wound

Ohio State’s

Consult Pancreatic Islet Cell Transplant Director: Amer Rajab, MD, PhD

“Patients who have diabetes that negatively affects their quality of life but are not in kidney failure may opt to try islet cell transplantation to avoid a major surgery,” says Rajab, who has a PhD in pancreatic islet cell transplantation. “Patients who have islet cell transplantation can have a pancreas transplant down the road if it becomes necessary.”

Some patients with type 1 diabetes may be candidates for pancreatic islet cell transplantation. Researchers hope that this novel therapy, which is transforming how the disease is treated, may ultimately cure type 1 diabetes.

Window of Opportunity

The Ohio State University Medical Center is one of just a few centers in North America approved to perform pancreatic islet cell transplantation in the research phase. In early 2011, Amer Rajab, MD, transplant surgeon and associate professor, Surgery, led a team that performed Ohio State’s first islet cell transplantation.

For every patient for whom pancreatic islet cell transplant is a possibility, there is a window of opportunity when transplant is a realistic option. This critical window must not be closed. To ensure it remains open, transplant specialists should see patients as early as possible in the disease process. Even if a patient is not ready for transplant, specialists can help determine when it might be a possibility, the likely timeline and the steps necessary to ensure the patient’s health for transplant.

Pancreatic islet cell transplantation takes clusters of cells (islets) from a donor pancreas and transfers them into the liver of another person. Once implanted, beta cells in the islet begin to make and release insulin—mimicking the function of the pancreas. This procedure could mean patients with type 1 diabetes could avoid daily insulin injections.

Physicians Amer Rajab, MD, PhD Associate Professor, Surgery

“Islet cell transplantation provides a unique opportunity to lessen the need for insulin and eliminate the fear of hypoglycemia.”

Clinical Interests: laparoscopic living donor nephrectomy, pancreatic islet cell transplantation, organ preservation

Kwame Osei, MD, director of Ohio State’s Division of Endocrinology, Diabetes and Metabolism

Elizabeth Essig, MD

Osei was instrumental in developing the islet transplantation program. “Our ultimate goal is to perform islet transplantation for type 1 diabetes without the need of immunosuppressive drugs,” says Osei.

Assistant Professor Clinical Interests: diabetes, general endocrinology

Patient Selection Islet cell transplantation is much less invasive than organ transplant but currently requires the same follow-up, including immunosuppressant therapy to avoid rejection of the new cells. Only the cells that secrete insulin are transplanted from a donor pancreas to the patient via injection. Patients who may be appropriate for pancreatic islet cell transplantation have type 1 diabetes that generally cannot be controlled with good medical management, but do not have kidney dysfunction, or it has been treated with a kidney transplant.

Patient Referral We welcome your referrals. We maintain an ongoing commitment to our referring physicians to keep you informed about your patient while they are in our care, and to return your patient to you for ongoing care.

medicalcenter.osu/go/transplant 614-293-6724 / 800-293-8965

Pancreatic Islet Cell Transplant

The Ohio State University Medical Center Pancreatic Islet Cell Transplant medicalcenter.osu.edu/go/transplant

ÂŠ 2011 The Ohio State University Medical Center â&#x20AC;&#x201C; 07 CORP20110208-07

Ohio Stateâ&#x20AC;&#x2122;s

Consult Summer 2011

The Ohio State University Medical Center

Diabetes Related Complications w Clinical advances in neuropathy w Specialty podiatry care w Diabetes related orthopaedic specialties

Complications from Diabetes Neuropathy

“Effectively managing and treating diabetic neuropathy from its earliest stage is critical for improving patient outcomes and avoiding complications, including hospitalization and amputation. This process begins with a thorough workup from specialists in neuropathy. Let us help your patients benefit from our experience with evidence-based neuropathy treatment.”

Co-Director, Peripheral Neuropathy Clinic: Victoria Lawson, MD Neuropathy due to diabetes is very common, but every patient deserves a comprehensive work-up to ensure the accuracy of the diagnosis, determine if other types of neuropathies are present and identify exacerbating factors.

Ohio State’s Experience in Neuropathy • The Ohio State University Medical Center is one of 15 Neuropathy Centers of Excellence — and the only one in Ohio — as designated by the Neuropathy Association. Centers of Excellence are defined as hubs of neuropathy care and research led by pioneering neurologists in the field, to ensure patients have access to compassionate, coordinated care and the resources needed to battle neuropathy.

Four neurologists specializing in neuromuscular diseases staff The Ohio State University Medical Center’s Peripheral Neuropathy Clinic. These physicians focus on neuropathy patients in their practices and are actively involved in neuropathy-related research. The comprehensive neuropathy workup at Ohio State’s Medical Center includes electromyography, quantitative sudomotor axon reflex testing (QSART), nerve conduction studies, autonomic testing and skin biopsy. In addition, patient and family education in the Peripheral Neuropathy Clinic includes fall prevention, safety, pain control, and maximizing each patient’s health and quality of life. This includes instruction and assistance in normalizing blood pressure and weight, controlling blood glucose, ceasing tobacco use, eating healthy and limiting alcohol use. Every means is undertaken to work as a team to slow the progression of neuropathy, relieve pain, manage complications and restore function lost to the condition.

• Victoria Lawson, MD, is a member of the Neuropathy Work Group of the American Academy of Neurology. The 10-member work group, comprised of individuals from a handful of Centers of Excellence in neuropathy, is charged with establishing guidelines for the best neuropathy care.

Patient Referrals for Neuropathy

“We employ the latest diagnostic tools along with unparalleled experience for the best diagnosis available. Then, we determine how to improve the patient’s condition and how to prevent progression of the condition,” says Victoria Lawson, MD, co-director of the Peripheral Neuropathy Clinic and assistant professor of neurology. “We consult with referring physicians and recommend treatment strategies for their patients. Pain management is a very important aspect of treating diabetic neuropathy patients. We stay abreast of evidence-based pharmacological and non-pharmacological therapies, including electrical stimulation, acupuncture and other techniques to avoid opiate medications when possible.

When you need more specialized neuropathy care for your patients, we hope you will consider referring them to us. We promise to communicate with you about your patients, provide feedback and refer them back to you for ongoing care. Contact us for neuropathy consultation at: 614-293-4969, option 3. Medical records can be faxed to 614-293-6111 or mailed to: Neurology Medical Records 395 W. 12th Ave., 7th Floor Columbus, OH 43210

24 Diabetes Related complications

Podiatry

“Diabetes can result in neuropathy, immunocompromise and peripheral arterial disease. These risk factors predispose patients to ulceration and infection, and once an ulcer or infection develops it is much more difficult to heal secondary to these comorbidities we see in these patients.” says Monson. “For these reasons, even fairly routine foot problems unrelated to diabetes need special attention in diabetes patients. The feet of diabetes patients can be the site of a convergence of events that are very difficult to manage and require specialty care and state-of-the-art technology to remedy. Podiatrists at Ohio State, in collaboration with our other specialists, strive to help patients avoid the painful, life-changing complications of diabetes. In addition to treating patients, we provide comprehensive education to help them keep their feet and ankles healthy and in good working order.”

Chief, Division of Podiatry, Director, Podiatric Residency Program: Erik Monson, DPM People who have diabetes are at increased risk for foot problems that can have life-altering consequences. The importance of a podiatry specialist in the lives of these patients is to prevent minor irritations from becoming major complications. And, when serious conditions occur, a podiatrist at an academic medical center has relationships with and immediate access to the specialists who may be called into action, including vascular surgery, plastic surgery, wound care, infectious diseases and endocrinology. Foot and ankle problems at The Ohio State University Medical Center are the purview of the Division of Podiatry in the Department of Orthopaedics. Our podiatrists provide surgical and nonsurgical treatment of deformities, arthritis and painful soft tissue conditions of the foot and ankle, and the problems associated with diabetes. Specialty care for diabetes patients includes:

Patient Referrals for Podiatry The Ohio State University Medical Center Section of Podiatry, Department of Orthopaedics,

• Annual checkups

ortho.osu.edu 614-293-BONE (2663) or 888-861-8081

• Evaluation and referral for diabetic shoes, orthoses, bracing and prostheses • Debridement • Nail care • Care for conditions including: – Foot and ankle ulcers – Bunions, hammertoe and other structural deformities – Plantar fasciitis – Osteomyelitis – Infections that require hospitalization and potential surgical management – Neuropathy – Charcot arthropathy

The excess weight often associated with diabetes takes a heavy toll on patients’ joints, especially hips and knees. Many of these joints will require replacement.

Erik Monson, DPM, Chief, Division of Podiatry and assistant professor-clinical of orthopedics, recommends referring patients for a podiatry evaluation in the following situations:

The Department of Orthopaedics at Ohio State provides comprehensive, innovative services from a faculty that has grown by almost half in the last two years. Today, there is no area of orthopaedic surgical care we cannot provide:

• Patient has nonpalpable pedal pulses

• Adult reconstruction

• Patient has neuropathy as measured by SemmesWeinstein monofilament testing

• Hip preservation

Orthopaedics Medical Director: Andrew Glassman, MD

• Foot and ankle

• Patient has structural deformity, including bunion, hammertoe or prominent bone spur, that increases risk for ulceration

• Spine • Hand and upper extremity • Fragility fracture

• History of previous foot amputation 25

Diabetes Related complications

MAKOplasty Knee Resurfacing

The Adult Reconstruction/Total Joint Replacement Surgical Program at Ohio State excels in complicated cases. Many general orthopaedic surgeons can perform straightforward joint replacement. Our surgeons, on the other hand, regularly see patients who have co-morbidities or need revision surgery. This specialization requires a higher level of technical requirements.

The Ohio State University Medical Center now offers MAKOplasty partial knee resurfacing, an innovative treatment option for certain adults with osteoarthritis. MAKOplasty allows the surgeon to use a robotic arm to assist in the precise removal of damaged tissue and placement of the implant. The surgeon resurfaces the diseased portion of the knee, sparing the patient’s healthy bone and surrounding tissue. An implant is secured in the joint to allow the knee to move smoothly again.

Patients who are morbidly obese or have significant medical co-morbidities, including diabetes, are best served with short operations.

MAKOplasty has the added benefits of faster recovery times, less pain and less trauma for the patient when compared to traditional knee replacement surgeries.

This is where the advantage of having a fellowship-trained joint replacement surgeon whose practice is solely devoted to joint reconstruction is critical. Patients with diabetes who have joint replacement surgery are at a higher risk for complications, and their glucose levels must be controlled before, during and after surgery. A multidisciplinary medical center with expertise in diabetes management, orthopaedics, infection control, neurology, cardiovascular and other relevant specialties is the ideal setting for surgery for diabetes patients.

This treatment is appropriate for early- to mid-stage osteoarthritis in the medial, patellofemoral or lateral compartment. It also can be performed as a bicompartmental procedure on both the medial and patellofemoral portions of the knee. Currently, three members of Ohio State’s Orthopaedics team are accepting patients for MAKOplasty:

In some cases, patients are so overweight that joint replacement is not advisable until significant weight loss occurs. The Ohio State University Medical Center offers bariatric surgery services to assist patients in preparing for joint replacement.

• Andrew Glassman, MD • Matthew Beal, MD • Jeffrey Granger, MD Contact The Ohio State University Medical Center Orthopaedics, ortho.osu.edu 614-293-2663 (BONE) / 888-861-8081

Ohio State’s Experience in Orthopaedics • The Department of Orthopaedics at Ohio State has been ranked by U.S.News & World Report as among the nation’s best for five years. • Thomas Ellis, MD, has successfully performed more than 600 hip arthroscopies — more than any other surgeon in Ohio. • Andrew Glassman, MD, has performed several thousand hip replacement and several thousand knee replacements. He has participated in the design of more than a dozen total hip prostheses and two total knee replacements. • Christopher Kaeding, MD, co-director of Sports Medicine Institute at Ohio State, is co-investigator in the first National Institutes of Health grant-funded ($1.3 million) large multicenter prospective study of functional outcomes after ACL reconstruction. • Research funding for the department has increased by 483 percent in the last two years. 26

Diabetes Related complications

Bariatric Surgery

Weight-loss professionals at Ohio State work closely with surgical patients to assist them in the lifelong journey of eating sensibly and being physically active. For patients who are not candidates for bariatric surgery, Ohio State also offers a comprehensive nonsurgical weight-management program.

Medical Director: Bradley Needleman, MD Morbid obesity alone is a serious, life-threatening medical state. When combined with diabetes, the consequences can be grave. Aggressive treatment is in order.

Candidates for bariatric surgery must attend one of our free bariatric surgery information sessions, which are offered monthly at an off-campus location with free, convenient parking.

Patients who have type 2 diabetes and a body mass index (BMI) of 35 or higher may be candidates for bariatric surgery.

For a list of classes and times, contact us at 614-293-5123 or medicalcenter.osu.edu/go/bariatric.

The effects of bariatric surgery and the attendant weight loss for patients with type 2 diabetes are significant. Almost 90 percent of morbidly obese patients in a national study* returned to normal blood sugar levels within the first year after bariatric surgery. Approximately 60 percent remained diabetes-free five to 16 years later. In other words, for many patients, type 2 diabetes goes into remission after bariatric surgery.

Ohio State’s Experience in Bariatric Surgery • The Ohio State University Medical Center has had a weight-loss surgery program for more than 30 years. • Our surgeons perform 300–400 weight-loss surgeries each year. Studies show that, when surgeons with expertise in the procedure perform weight-loss surgery, the risk of complications is lower.

Ohio State researchers estimate that bariatric surgeries pay for themselves in two to four years when the costs of medications, treatment and loss of productivity are calculated. The payback in quality of life and life itself for patients who have diabetes is incalculable.

• The Ohio State University Medical Center was designated a Bariatric Surgery Center of Excellence by the American Society of Metabolic and Bariatric Surgery in 2005 and was redesignated in 2009.

Most bariatric surgeries at The Ohio State University Medical Center are performed with minimally invasive techniques, which result in reduced trauma to skin and muscle, shorter and less painful recovery and less scarring. Surgical options include:

• Our bariatric surgery program has complication rates that are superior to the national standards. • Surgeons at Ohio State performed the first minimally invasive gastric bypass surgery in central Oho and the first laparoscopic gastric banding surgery in the state.

• Roux-en-Y gastric bypass

• Dean Mikami, MD, bariatric surgeon, helped to develop the endoscopic device used in the new incisionless StomaphyX procedure, and he was the first surgeon in the United States to perform surgery with it. Dr. Mikami has helped train more than 500 surgeons in the United States on this procedure.

• Adjustable gastric band • Sleeve gastrectomy • StomaphyX (gastric bypass revision)

Contact The Ohio State University Medical Center Bariatric Surgery Program medicalcenter.osu.edu/go/bariatric 614-293-2888 email: obesitysurgery@osumc.edu *Duke University Medical Center Bariatric Outcomes Longitudinal Database study and Virginia Commonwealth University study, 1993-2003.

27 Diabetes Related complications

The Ohio State University Medical Center Diabetes Related Complications www.medicalcenter.osu.edu/go/diabetes

ÂŠ 2011 The Ohio State University Medical Center â&#x20AC;&#x201C; 7 CORP20110208-10

Ohio State’s

Consult | Summer 2011 |

Ohio State’s Medical Center Launches Telestroke Program

Michel Torbey, MD

Other benefits of our program include: • Dedicated stroke neurologists

Three regional hospitals are serving as launch sites for The Ohio State University Medical Center’s Telestroke collaborative. Ohio State’s Medical Center serves as the hub hospital for Southeastern Ohio Regional Medical Center (Cambridge), Barnesville Hospital and Coshocton County Memorial Hospital.

• Central Ohio’s only neuro-critical care physicians whos provide additional expertise for patients with neurological conditions in the ICU setting • Specialized surgical suite — one of only a few in the world — that integrates neurosurgical and radiological capabilities, resulting in less movement of the patient and expedited treatments. This suite is staffed 24/7 by anesthesiology, nursing and the necessary OR staff to respond at any time of the day

“Offering telestroke services in these communities means faster diagnosis and the chance for life-saving treatment of stroke patients,” says Michel Torbey, MD, medical director of Ohio State’s Neurovascular Stroke Center. When a suspected stroke patient arrives in the emergency department of one of the participating hospitals, a “stroke alert” is activated at both the receiving hospital and Ohio State, which mobilizes a team of stroke experts who, through the use of web camera, phone, real-time testing and patient interview, can help the rural hospital determine the best treatment option for the patient.

“By collaborating with other hospitals, we come together to offer the best system of care to stroke patients.” Eric Sauvageau, MD, surgical director of Ohio State’s Neurovascular Stroke Center

Why Choose Ohio State for Telestroke? In the past year, Ohio State’s Medical Center has greatly expanded its comprehensive stroke center, including the addition of the only two dual-trained endovascular neurosurgeons in central Ohio — Eric Sauvageau, MD, and Ciaran Powers, MD. “We are rapidly growing this program and are seeking to expand the network of stroke collaborations we can create across the state,” says Torbey Eric Sauvageau, MD

Ciaran Powers, MD

Get More Information If you would like to learn more about our Telestroke collaborative, or are interested in finding out details on how your hospital might take part, please contact Karen Jackson, director, Regional Outreach, at 614-366-2415 or Karen.Jackson2@osumc.edu. 29

2011

Referral Guide Now Available

State of the Art EP Labs Bring Ohio State’s Ross Heart Hospital a Step Above the Rest At a Glance:

This reference tool provides at-aglance referral contacts and listings for all services at Ohio State’s Medical Center and The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. If you would like to request copies, please contact:

Franklin County: Noreen Palmer 614-366-6680 East/Southeastern Ohio: Karen Mitchell 614-293-4352 North/West Ohio: Bill Cox 614-293-2824

• Recent expansion to six EP labs • Upgraded to state-of-the-art equipment • New Stereotaxis technology to treat complex ablation cases

When Ohio State’s Richard M. Ross Heart Hospital opened in 2004, there were three electrophysiology labs. Now, with the most recent expansion, there are six. Construction to open additional EP labs began in February 2010 with all renovation expected to be complete by the end of the summer. Equipment in five of the six labs has been upgraded to the most state-of-theart standards. The sixth EP lab has a magnetically guided catheter system built by Stereotaxis that is the only lab of its kind in central Ohio. This technology is extremely beneficial for complex ablation cases. The catheter is gently pulled by the magnetic field instead of pushed manually, improving safety of the procedure and precision in directing the catheter. Ohio State’s Ross Heart Hospital has been designated a Center of Excellence by Stereotaxis. “Improving our existing EP labs in addition to creating new labs, speaks to our mission of providing excellent patient care in a timely manner,” says Rich Davis. Currently, Ohio State’s Ross Heart Hospital is expanding EP lab space as well as the number of patient prep/recovery rooms. With a total of 23 rooms, more patients can be accommodated, including overnight observation of post-procedure outpatients. The increased capacity also allows patients to be evaluated and treated more quickly. Expedited treatment helps, in some cases, to prevent further cardiovascular events in high-risk patients. An integrated video system makes it possible for physicians to have four images displayed on a large high-definition flat screen at one time. The hospital is also set up so that the images on the screen can be sent to other physicians throughout the hospital or around the world for a quick and convenient second or third opinion on a patient or for training other physicians.

You can also view a mobile version of the referral guide from your smart phone by visiting medicalcenter.osu.edu.

“The Ohio State University Medical Center recognizes that the care of patients with heart rhythm abnormalities is a rapidly growing field that relies on advanced technologies and highly-skilled physicians. With this expansion, not only has Ohio State invested in a spectacular working environment, but we are also establishing ourselves as an international leader, utilizing a variety of technologies to provide care personalized to each patient,” says Emile Daoud, section director, electrophysiology at Ohio State’s Ross Heart Hospital.

to referr a patient: call 614-293-7677 or 888-293-7677. To learn more about Ohio State’s Ross Heart Hospital, visit medicalcenter.osu.edu/heart. 30

New Radiation Oncology Wing with the Most Advanced Radiation Therapy Available Now Open At a Glance: • The only site in Ohio, and one of only 65 in the world, with a Varian TrueBeam linear accelerator

CarePoint East Now Open

• New wing offers added convenience for breast cancer patients • OSUCCC-James radiation oncology experts specialize in the treatment of breast cancer

Experts at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC-James) are providing advanced radiation technology that provides faster, more precise treatment of breast tumors at the new JamesCare Comprehensive Breast Center.

CarePoint East opened this summer and includes:

arePoint East combines a wide variety of outpatient health services in a single setting for easy and convenient access for patients in eastern Columbus and the surrounding region. Constructed in the former veteran’s administration building, CarePoint East houses 136,000 square feet of health services, conveniently located directly off I-670.

• Cardiac/Pulmonary Rehabilitation

The new radiation oncology wing offers added convenience for patients by offering on-site radiation treatments in the same location where they can also receive digital mammography, diagnostic imaging and other breast health services.

• Cardiology • Endocrinology • Family Practice

We are the only location in Ohio, and one of only 65 institutions worldwide, using the Varian TrueBeam linear accelerator. This innovative system enables specially trained radiation oncologists to perform image-guided radiotherapy and radiosurgery treatments on breast cancer patients. Compared to older radiation technologies, this system significantly reduces the amount of healthy tissue – including the heart and lungs – affected by radiation treatments.

• General Internal Medicine • Infectious Diseases • Infusion Suite • Laboratory Services • Nephrology • Occupational Medicine

“This is a real game-changer that will enable us to treat all breast cancer patients – even the most challenging cases – with unprecedented speed and precision,” said Dr. Arnab Chakravarti, chair and professor of the department of radiation oncology at OSUCCC-James.

• Orthopaedics

The radiation oncology team specializes in the treatment of breast cancer and works closely with all breast cancer disciplines, including medical oncology, surgical oncology and reconstruction, to select the optimal treatment plan for each patient.

• Sleep Medicine

• Physical Therapy • Pulmonary Medicine • Radiology/Imaging

• Spine Center CarePoint East offers plenty of free, convenient parking. On-site security will also be available to help with lockouts and jump starts. If patients require testing or an overnight hospital stay, Ohio State’s University Hospital East is located less than two miles away.

Radiation Oncology Wing Open House Learn more about the TrueBeam linear accelerator and take tours of our new space.

To refer a patient, call 614-688-6400.

October 7 | 5 - 6:30 p.m. 1145 Olentangy River Road, Columbus, OH 43212 31

Save the Date! MATCH Conference 2011

Global Diabetes Summit 2012 November 14 – 17

At a Glance: • 3rd Annual Conference on Critically Ill Hospitalized Patients • Updated with the most current topics in critical care • Topics span research to practice

Plan to attend the Multidisciplinary Approach to the Treatment of the Critically ill Hospitalized patient conference, MATCH 2011. More than 270 people attended this popular annual conference last year.

In November 2012, The Ohio State University Medical Center’s Diabetes Research Center will host the second Global Diabetes Summit in Columbus, Ohio. Participants, including the world’s leaders in diabetes research and treatment, will focus on finding ways to stop the rapid spread of one of the world’s most debilitating, costly and preventable diseases. The theme of the summit is “New Horizons in Diabetes: Genetics to Personalized Health Care.”

Topics are selected based on emerging information and identified needs of critical care professionals. Each session is taught by multidisciplinary teams to provide a full perspective of the topic. Planned topics range from research to examination of processes (Early Response Teams) to practice (identification of sepsis and immediate response) to professional aspects (identification of PTSD in professionals). This conference is designed for all health professionals involved in critical care, including physicians, nurses, pharmacists, respiratory, speech, occupational and physical therapists, and emergency medical personnel.

The last day of the summit features a community event open to diabetes patients, their families and community members. This event includes panel discussions; workshops on topics including glucose sensors, diabetes and obesity in young people, healthy cooking and physical activity; self-care sessions; and a health exposition with screenings and vendors. The first Ohio State-hosted summit, in 2007, attracted more than 650 physicians and researchers representing 14 countries and five continents.

Keynote Speakers: Catherine L. Hough, MD, MSc, Assistant Professor Division of Pulmonary and Critical Care Medicine at The University of Washington

The summit is the brainchild of Kwame Osei, MD, director of Ohio State’s Division of Endocrinology, Diabetes and Metabolism. Osei held a similar event in 1995 in Africa. “Diabetes is a universal global disease. We gather professionals who are presidents of prestigious medical organizations and those who wrote the textbooks about diabetes so that we can share breaking news about what is working around the world and patients can benefit from this expertise,” says Osei. “We are aiming toward an interdisciplinary roadmap for the prevention, detection and treatment of diabetes.”

Jim O’Brien, MD, MSc, Associate Professor Division of Pulmonary, Allergy, Critical Care and Sleep and a member of the Center for Critical Care at The Ohio State University Medical Center

Mark Your Calendars: November 2, 2011 8 a.m. to 3 p.m. COSI, 333 West Broad Street, Columbus, 43215 Cost: $100 per person

The summit is recommended for specialists in family medicine , internal medicine endocrinology, obstetrics/ gynecology, cardiovascular medicine and other subspcialties, nurses, nurse practitioners, nutritionists and diabetes educators. Supporting organizations include the International Diabetes Federation, American Diabetes Association, Juvenile Diabetes Research Foundation and American Association of Diabetes Educators.

To learn more or register, visit ccme.osu.edu

Coronary Calcium Scoring Offered at Outpatient Centers

Mark Your Calendar: Upcoming Heart CME

At a Glance: • CT scan detects plaque build-up in arteries

Wednesday, September 14, Noon – 5 p.m. The Blackwell, The Ohio State University

• No appointments necessary — results back to you within 24 hours

Third Annual Women’s Cardiovascular Conference: The Beat of a Women’s Heart

• Patients self-pay for this elective test

Featuring guest speaker Nanette Wenger, MD, Emory School of Medicine

A Coronary Calcium Scoring test from The Ohio State University Medical Center provides a clear picture of plaque build-up on arteries in the heart, indicating a risk for Coronary Artery Disease. We can conduct this simple CT scan in just 30 minutes and provide the results back to you and your patient within 24 hours.

Friday, September 23, 7:30 a.m. – 5 p.m. Ohio Union, The Ohio State University Third Annual Acute Myocardial Infarction Update: Raising the Bar on Therapies and Outcomes in 2011 A statewide symposium to improve STEMI patient outcomes presented in partnership by Ohio State’s Heart and Vascular Center and Ohio

The cost of the scan is $249 (not covered by insurance). You need to provide a referral to any patients you feel might be at risk for coronary artery disease. Patients do not need an appointment — we will have patient scans completed within 30 minutes of the patient’s arrival.

Mission: Lifeline.

Friday, October 7 – Sunday, October 9 Marriott Orlando World Center, Orlando Florida

Make a referral: Scans Offered at Two Convenient Locations

Third Annual Contemporary Multidisciplinary Cardiovascular Medicine: A Disease Based Learning Experience

CarePoint Gahanna 920 N. Hamilton Road Gahanna, 43230 614-366-0829 • M-F 8 a.m. to 3:30 p.m.

Physicians can earn up to 20.25 AMA PRA Category 1 Credit(s) ™ for only $195.

To learn more about these and other courses offered by Ohio State’s Center for Continuing Medical Education, visit ccme.osu.edu.

JamesCare Comprehensive Breast Center 1145 Olentangy River Road Columbus, 43212 614-688-7210 • M-F 8 a.m. to 3:30 p.m.

Connect With Resources from Ohio State’s Medical Center

Our Regional Outreach team is here to assist you in accessing the resources, education and patient referral information you need most from Ohio State’s Medical Center. Call your Regional Outreach Coordinator at any time for information such as: • Help with the referral process • Requests for visits/calls with OSU physicians • Requests for patient materials • Access to CME and clinical research opportunities

Franklin County: Noreen Palmer | 614-366-6680 East/Southeast Ohio: Karen Mitchell | 614-293-4352 North/West Ohio: Bill Cox | 614-293-2824

Ohio State’s Ross Heart Hospital Recognized for Heart Attack Expertise

served by the Ross Heart Hospital, this means that processes are in place that meet strict criteria aimed at:

hio State’s Richard M. Ross Heart Hospital has received Chest Pain Center Accreditation from the Society of Chest Pain Centers (SCPC), an international organization dedicated to eliminating heart disease as the number one cause of death worldwide.

• Reducing the time from onset of symptoms to diagnosis and treatment.

Hospitals that have received SCPC accreditation have achieved a higher level of expertise in dealing with patients who arrive with symptoms of a heart attack. They emphasize the importance of standardized diagnostic and treatment programs that provide more efficient and effective evaluation as well as more appropriate and rapid treatment of patients with chest pain and other heart attack symptoms. They also serve as a point of entry into the healthcare system to evaluate and treat other medical problems, and they help to promote a healthier lifestyle in an attempt to reduce the risk factors for heart attack. To become an Accredited Chest Pain Center, Ohio State’s Ross Heart Hospital engaged in rigorous evaluation by SCPC for its ability to assess, diagnose and treat patients who may be experiencing a heart attack. To the community

• Treating patients more quickly during the critical window of time when the integrity of the heart muscle can be preserved. • Monitoring patients when it is not certain that they are having a heart attack to ensure that they are not sent home too quickly or needlessly admitted to the hospital. The Ross Heart Hospital provides the entire continuum of care for the heart patient and includes such focal points as dispatch, Emergency Medical System, emergency department, cath lab, quality assurance and community outreach program. By becoming an Accredited Chest Pain Center, the Ross Heart Hospital has enhanced the quality of care for the cardiac patient and has demonstrated its commitment to higher standards.

Ohio State Physicians

In The News

been elected to fellowship in the American Academy of Microbiology.

William Farrar, MD, the Dr. Arthur G. and Mildred C. James Professor in Surgical Oncology and chief, Division of Surgical Oncology, has been selected as director of the new JamesCare Comprehensive Breast Center. Farrar is one of the nation’s foremost experts in breast cancer detection and treatment, as well as a leader in the central Ohio cancer community. Having trained as a surgical resident under Dr. Arthur G. James, the founder and namesake of the cancer hospital, Farrar has played an invaluable role in Ohio State’s emergence as a national leader in cancer care.

Robert Higgins, MD, director of the Comprehensive Transplant Center and of the Division of Cardiac Surgery, has been appointed to the Residency Review Committee for Thoracic Surgery for the Accreditation Council for Graduate Medical Education (ACGME). The committee accredits thoracic surgery fellowship training programs in the United States. Larry Jones, MD, has been named director of the Burn Center at The Ohio State University Medical Center. Among his goals, Dr. Jones plans to expand collaboration among Ohio State’s trauma, surgical, rehabilitation and wound healing teams to advance burn research and care. He also plans to incorporate the use of telemedicine to improve burn injury care. He comes to Ohio State from Pittsburgh where he was burn director at West Penn Hospital, and previously served as director of the trauma and burn center at University of Pittsburgh Medical Center-Mercy Hospital. He is a graduate of Indiana University School of Medicine and completed his residency in surgery at Miami Valley Hospital in Dayton.

Chandan Sen, PhD, professor of surgery and vice chair of research, the Department of Surgery, and associate dean for Translational and Applied Research in The Ohio State University College of Medicine, has been selected as chair of the Surgery, Anesthesiology and Trauma Study Section, Center for Scientific Review of the National Institutes of Health (NIH). R. Lawrence Moss, MD, has joined the faculty of the Division of Pediatric Surgery as the E. Thomas Boles Professor of Pediatric Surgery. He is also surgeonin-chief at Nationwide Children’s Hospital (NCH). Moss earned his medical degree at the University of California – San Diego. He completed his surgical residency at Virginia Mason Medical Center in Seattle and fellowships at Northwestern University and Children’s Memorial Hospital in Chicago. Prior to joining OSU and NCH, Moss was surgeon-in-chief and chief pediatric surgeon at Yale University.

Ali Rezai, MD, Director, OSU Center for Neuromodulation and Neurosurgical Innovations has been elected president of the Congress of Neurological Surgeons (CNS), one of the largest neurological societies worldwide. In addition, Dr. Rezai also holds appointments as president of the American Society of Stereotactic and Functional Neurosurgery (ASSFN) and as president-elect of North American Neuromodulation Society (NANS).

Larry Schlesinger, MD, director of the Center for Microbial Interface Biology, of the Division of Infectious Diseases and of the Medical Scientist Program, has

Central Ohio’s

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One of America’s Best Hospitals, 19 Years in a Row

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• Cancer (20)

We are pleased to share that The Ohio State University Medical Center has been ranked in 11 specialties out of the 16 ranked by The U.S.News & World Report 2011 rankings of “America’s Best Hospitals”. Of these 11 specialties, seven ranked in the top 25 nationally. In addition, U.S. News rated Ohio State as the No. 1 hospital in central Ohio in the magazine’s newly created “metro rankings.”

• Cardiology/Heart Surgery (24) • Diabetes/Endocrinology (20) • Ear, Nose and Throat (17) • Gynecology (Women’s Health) (25) • Nephrology (39) • Neurology and Neurosurgery (45)

The U.S. News rankings are based on quality measures such as patient volume, mortality and safety, nursing excellence including Magnet designation, staffing levels, reputation and technology. The 11 specialties recognized and their newest rankings are:

• Orthopaedics (36) • Pulmonology (25) • Rehabilitation (11) • Urology (46)

Your Resources Referring Physicians medicalcenter.osu.edu/referringphysicians Referring physician information, links, downloads and forms, patient education materials, maps and directions

Physician Relations 800-293-4326 or mdrelations@osumc.edu Physician Relations supports the needs of community physicians and their staff as they interact with OSU Medical Center

The Ohio State University Comprehensive Cancer Center– Arthur G. James Cancer Hospital and Richard J. Solove Research Institute The James Line: 614-293-5066 cancer.osu.edu Patient referral center, clinical trials and research information, patient education materials

OSU Regional Outreach Program Franklin County, Noreen Palmer....................614-366-6680 East/Southeast Ohio, Karen Mitchell..........614-293-4352 North/West Ohio, Bill Cox..............................614-293-2824 Outreach provides access to OSU Medical Center services, specialty physicians, continuing medical education and other Medical Center programs Physician Directories To request a copy of our physician directory or to request updated sections for your existing directory, please call your Regional Outreach Coordinator (above).

Continuing Medical Education ccme.osu.edu Continuing Medical Education programs, including Category I CME offerings online through OSU MedNet21, traditional lecture series and Grand Rounds

Physician Referral Guide To request a copy of the Physician Referral Guide, call your Regional Outreach Coordinator or visit medicalcenter.osu. edu/referringphysicians to access an online version.

Physician-to-Physician Consultation Line 800-293-5123, option 1 Consult with an OSU Medical Center physician, discuss specific patient-related cases, appointment referral, transfer a patient

Physician Resources

Contact

OSU Medical Center medicalcenter.osu.edu

Referring physician information, patient education materials, maps and directions

The Arthur G. James Cancer Hospital and www.cancer.osu.edu Richard J. Solove Research Institute

Patient referral center, clinical trials and information, patient education materials

OSU Medical Center http://ccme.osu.edu Center for Continuing Medical Education

Web site featuring Continuing Medical Education programs including: Category I CME offerings online through OSU MedNet21, traditional lecture series and Grand Rounds

Physician-to-Physician 1-800-293-5123; option 1 Consultation Line

Consult with an OSU Medical Center physician, discuss specific patient-related cases, appointment referral, transfer a patient

Physician Relations 1-800-293-4326 mdrelations@osumc.edu

Physician Relations supports the needs of community physicians and their staff as they interact with OSU Medical Center

Franklin County: 614-366-6680 OSU Regional Outreach Program East/Southeast Ohio: 614-293-4352 North/West Ohio: 614-293-2824

Outreach provides referring physicians with access to OSU Medical Center services, specialty physicians, continuing medical education and other medical center programs