CLINICALUpdate St. Francis Hospital
News for Physicians from St. Francis Hospital, The Heart Center®
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Roslyn, NY • A Member of Catholic Health Services of Long Island
St. Francis Hospital a Part of Nationwide Study on Transcatheter Aortic Valve Replacement
Cancer Institute Surpasses Expectations in Its First Year
Research Team: (clockwise from top) Andrew Berke, M.D., Newell Robinson, M.D., Roberto Colangelo, M.D., and George Petrossian, M.D., are looking forward to the possibilities the new CoreValve device (inset) will bring to St. Francis Hospital and its patients.
Bhoomi Mehrotra, M.D.
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irector of Oncology, Bhoomi Mehrotra, M.D., had fairly lofty expectations of St. Francis Hospital’s Cancer Institute when it launched its first phase of development in December 2012. What has transpired in the Cancer Institute’s inaugural year has more than exceeded his highest hopes. “I knew what we needed to accomplish, but I wasn’t sure we would be able to do so,” Dr. Mehrotra said. “Everybody has really stepped up with the attitude, what do we need to do to take care of our patients? How can we make it better? This is pervasive at every level in which you interact with a colleague across the institution.” In little more than a year, the Cancer Institute has outgrown its accommodations and is now planning to move to a new facility where radiation oncology and surgical oncology offices can be brought together under one roof. But perhaps more importantly is the degree to which the Institute has broadened its professional base and ramped up the number and types of services it provides, while maintaining exceptional quality. In a sign of growing recognition, in 2013-14, U.S. News & World Report ranked St. Francis high performing regionally for Cancer for the second year in a row. “Cancer programs today require patient navigation, social service support, nutritional support, genetic counseling, psychiatry, and other aspects of care,” Dr. Mehrotra said. “It’s incredible that in such a short period of time we have been able to recruit really good talent to join us.”
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St. Francis Launches Bariatric Program U.S. News Ranks SFH in 8 Specialties Hospital Receives Another “A” for safety
The staff now includes two nutritionists who meet with most patients; a social worker who conducts programs and support groups and helps patients manage transportation and insurance issues; a genetic counselor who has helped doctors identify patients who may be at higher risk for hereditary cancers, and assess future care with those risks in mind; and a new oncology nurse who is helping the Institute ally with the National Cancer Institute and the Biomedical Research Alliance of New York, with a goal toward participation in clinical trials. At this point, about half of the Institute’s nurses are either oncology nursing certified or are undergoing exams to become certified. “By the end of the year, we plan that all of our nurses will be oncology certified,” Dr. Mehrotra said. The Cancer Institute has been busy forming alliances across Catholic Health Services (CHS) through the oncology service line; for the first time in January, physicians participated simultaneously in combined tumor boards via an audiovisual link with Good Samaritan Hospital in West Islip. “Our colleagues from medical oncology, radiation oncology, and the tumor registry were all able to contribute to the discussion ongoing at St. Francis,” Dr. Mehrotra said. “This year we are hoping to enhance that collaboration even more, so that the entire family of caregivers committed to cancer care across CHS will be able to access all of the collective talent that is there. I think this enhanced dialogue will truly benefit our patients.”
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Endoscopic Imaging Boosted with EUS Procedure
Neurosurgery Gains Ground at St. Francis
Tailored Treatments in SFH Orthopedics Department
SFH Earns Gold in Stroke Care Again
The OR team that performed the first bariatric surgery at St. Francis Hospital included (top row, left to right) Amanda Kallas, R.N.; Laura Jean Bonventere, R.N.; Shawn Garber, M.D.; Donna Franco, P.A.; Melanie Howard, P.A.; Lisa Phillips, M.D.; (bottom row, left to right) Mary Brady-Costello, R.N.; and Agneta Creutzman, CST.
St. Francis Hospital Launches Bariatric Surgery Program
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iven the association between heart disease and obesity, it seems only fitting that a world-class cardiac care center would launch a bariatric surgery program, which St. Francis did just this past fall.
“A lot of the patients who receive care at St. Francis suffer from obesity,” said bariatric program director Shawn M. Garber, M.D. “It’s an epidemic in the U.S. and on Long Island. We work in many other Catholic Health Services (CHS) hospitals and saw the need for a bariatric program at St. Francis as well – we thought it would be a good fit with the cardiac program here.” Dr. Garber brings a wealth of experience to the Bariatric Surgery Program; as director of the New York Bariatric Group, which has performed more than 10,000 procedures, he is among the
preeminent bariatric surgeons in the New York metro area. The group of bariatric surgeons at St. Francis also includes Spencer A. Holover, M.D.; John D. Angstadt, M.D.; and Eric A. Sommer, M.D. St. Francis offers the same procedures that are the cornerstones of any bariatric surgery program: laparoscopic gastric bypass, adjustable gastric band, and sleeve gastrectomy. What makes the program unique, however, is that while traditional laparoscopic surgeries require five small incisions, Dr. Garber and colleagues
U.S. News & World Report Ranks St. Francis among the Top Hospitals in the Nation in Eight Specialties
For the seventh year in a row, St. Francis Hospital, The Heart Center® has been recognized by U.S. News & World Report as one of the best hospitals in the nation. St. Francis ranked among the top 10 hospitals in the country for cardiology & heart surgery, ranking #8 nationwide – one of only two hospitals in the NY Metro area to make the top 10 in that specialty. It also rated among the best in the U.S. in seven other specialties: ear, nose & throat, gastroenterology & GI surgery, geriatrics, neurology & neurosurgery, and for the first time orthopedics, pulmonology, and urology. Once again, St. Francis was the top-ranked hospital on Long Island and the only LI hospital to be nationally ranked by U.S. News in any of the 12 data-driven adult specialties. The Hospital ranked fourth in New York State and fifth in the NY Metro area. “Congratulations to the physicians, nurses, and staff at St. Francis Hospital for this outstanding achievement,” says Alan D. Guerci, M.D., President & CEO of Catholic Health Services of Long Island (CHS). “To be ranked among the top 10 hospitals in the country for cardiology and heart surgery and to be nationally ranked in seven other specialties is a reaffirmation of our mission of providing excellence in patient care.” St. Francis was also recognized by U.S. News as high performing regionally in three specialties: cancer, diabetes & endocrinology, and nephrology. According to U.S. News, “only about 15 percent of hospitals are recognized for their high performance as among their region’s best. Just 3 percent of all hospitals earn a national ranking in any specialty.”
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offer both gastric banding and sleeve gastrectomy as single incision procedures. “We do the procedures through one incision in the umbilicus, so the patients have no visible scar after the surgery,” Dr. Garber said. “That sets us apart from other bariatric programs in the area.” The results of bariatric surgery are usually quite good, with patients losing 55 percent to 80 percent of their excess weight within one to three years after their surgery. Along with the excess weight, patients often experience a dramatic improvement in obesity-related medical conditions such as diabetes, sleep apnea, high blood pressure, cardiovascular disease, and degenerative joint disease. Surgery, however, is only one component of successful outcomes; patients need the support of a comprehensive team to help them achieve the best results. “It’s very important to have a multi-disciplinary team with a bariatric program,” Dr. Garber said. Along with appropriate infrastructure – a dedicated unit designed to meet the needs of bariatric patients – St. Francis Hospital’s bariatric program includes a dedicated team of professionals. “Our team includes a full-time nutritionist and psychologist, and we have support groups that meet every month,” said Dr. Garber. “We have a very comprehensive, multi-disciplinary team for these patients, which is essential for them to get the most out of their surgery.”
St. Francis Hospital Gets Another ‘A’ in Nationwide Safety Test For the fourth time, St. Francis Hospital has received an ‘A’ on a national safety score that rates hospitals on the quality of their care. The letterbased rating system was devised by The Leapfrog Group, a nonprofit organization that ranks hospitals nationwide. St. Francis was one of only four hospitals on Long Island to “ace” the test and was joined by one other CHS hospital, St. Catherine of Siena, which also received a grade ‘A’ score. “Patient safety is always a number one priority for us here at St. Francis and we believe consumers should have easy access to quality information so they can make educated choices about picking the best hospital for their care,” says Jack Soterakis, M.D., SVP of Medical Affairs & Medical Director. The rankings, which come out every six months, rely on data from Leapfrog’s own ratings as well as outside sources including the Centers for Medicare and Medicaid Services and the Joint Commission. Grades range from “A” to “F” based on 28 safety indicators. More than 2,600 hospitals were surveyed on how well they prevented errors, infections, injuries, and drug mix-ups and once again St. Francis was among the best.
Endoscopic Imaging Gets Big Boost with EUS Procedure
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or the last few years, gastroenterologists with St. Francis Hospital have had the capacity to perform endoscopic ultrasound (EUS). This minimally invasive procedure uses ultrasonic sound waves to capture images of the inside and outside of various internal organs, allowing for better visualization of the esophagus, stomach, rectum, bile duct and pancreas. “EUS identifies pathology in a large niche of patients with complex gastrointestinal (GI) disease that other imaging modalities such as radiographic imaging studies, endoscopic studies or ERCP may have missed,” said Anthony Celifarco, M.D., Director of Gastroenterology, noting that EUS also serves as an adjunct to radiographic or endoscopic imaging studies as well. For many situations, EUS has now replaced endoscopic retrograde cholangiopancreatography (ERCP). Though ERCP has long been considered the gold standard for imaging of the bile duct and pancreas and for diagnosing causes of obstructive jaundice, it carries a risk of pancreatitis,
The EUS Experts: Neeraj Kaushik, M.D. (left); Rajiv Bansal, M.D. (right); and Ian Storch, D.O. (not pictured), all perform endoscopic ultrasound at St. Francis Hospital.
which usually resolves but can be severe. “EUS is a great accomplishment in the evolution of endoscopic imaging for patients with various GI illnesses,” Dr. Celifarco said. “We now have a procedure that not only gives us better imaging, but carries a lower risk than other invasive pancreatic imaging studies.” EUS is often used for further evaluation of small pancreatic lesions identified on CT scan or MRI in patients with abdominal pain. “EUS not only allows imaging, it gives us a better sense of the size of the lesions, the characteristics of the lesions, and the relationship of the lesions to adjacent blood vessels and organs around the pancreas,” Dr. Celifarco said. “It also allows for drainage and sampling of those lesions, which is critical.” EUS is also helpful in diagnosing gastrointestinal stromal tumors (GISTs), which appear as small bumps under the lining of the stom-
ach. By providing an image below the surface of the stomach’s lining, EUS allows gastroenterologists to identify GISTs and sample them. “EUS, but it is also extremely important in staging various tumors of the esophagus, stomach, duodenum, pancreas and common bile duct,” Dr. Celifarco said. “It has enormous capability and is clearly becoming an important modality for imaging neoplastic problems of the upper GI tract. “I think it’s critical for every major institution to be able to offer EUS. Not only does it help gastroenterologists make a diagnosis, it helps us treat these patients more effectively,” he added. “Especially now, given the expansion of our outstanding medical oncology and surgical oncology programs at St. Francis Hospital, EUS is key to identifying patients with occult malignancy who can now be directed promptly to the appropriate service.”
Tailored Treatments, Skilled Professionals Distinguish Orthopedics Department New York is home to some of the best orthopedic centers in the country, and St. Francis Hospital is among them, thanks to the tailored treatments and skilled specialists that prompted U.S. News and World Report to rank the department 23rd in the country. For instance, until fairly recently Frank DiMaio, M.D. Craig Radnay, M.D. only a limited number of unisex implants were available options for knee replacement patients. But the differences between men and women go beyond height and weight, and data that emerged in the mid2000s shed light on the shortcomings of unisex models. “When you look at recent data generated with modern computer technology, there is no question that the original data and the design rationale for unisex knee replacements missed accommodating certain trait characteristics of a woman’s knee,” said Frank DiMaio, M.D., an orthopedic surgeon at St. Francis who helped redesign knee implants for one of the world’s leading joint replacement manufacturers. “Now, instead of having only a unisex version, we have a male version and female version.” The ability to offer a female-specific implant at this point in time is no small matter. “Women are more active now than ever, both in the workforce and in competitive sports, and at an earlier age,” said Dr. DiMaio, who performs about 500 joint replacements a year.
“In my practice I think I’ve done more knee replacements in women than in men over the past 20 years.” St. Francis also has surgeons such as Craig Radnay, M.D., who are highly-skilled in total ankle replacement, a particularly challenging procedure that should only be undertaken by experienced orthopedic surgeons well-trained in foot and ankle surgery. Historically, people have needlessly suffered from ankle arthritis because they were unaware of treatments that could help their pain. The surgery is a very involved procedure, but Dr. Radnay notes that his ankle replacement patients are among his happiest. “Some of my patients literally want to go shovel snow or play tennis within days of surgery because their discomfort is so dramatically improved.” The largest population of ankle replacement patients is people in their 60s and 70s, but Dr. Radnay and colleagues have been seeing patients as young as their 40s. “As people are more active from a younger age, and lifespan is increasing, the number of patients presenting with painful ankle arthritis is rising exponentially. In the right patients, total ankle replacement can improve ankle motion, function, pain relief, and quality of life,” said Dr. Radnay. According to Dr. DiMaio, the Orthopedics Department at St. Francis has experienced a significant increase in volume in recent years, due in part to national recognition of the Hospital and the department’s excellence.“For a community-based hospital world renowned in cardiology and heart surgery to extend its protocols to other service lines, such as cancer care and orthopedics, is a tremendous thing. We have excellent surgeons and nursing care, and both patients and physicians are extremely happy.”
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St. Francis Hospital CLINICAL UPDATE Winter/Spring 2014
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CLINICALUpdate is published by St. Francis Hospital, The Heart Center®. Questions or comments can be directed to St. Francis Hospital, Office of Development and Public Affairs, 100 Port Washington Blvd., Roslyn, New York 11576. (516) 705-6655. Copyright© 2014. All Rights Reserved. St. Francis Hospital is a member of Catholic Health Services of Long Island, the healthcare ministry of the Diocese of Rockville Centre. Jack Soterakis, M.D., Senior Vice President Medical Affairs/Medical Director Writers: Monica Smith, Rosemary Gomez, Contributing Photographer: William Baker Designer: Roger Gorman, Reiner Design
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Neurosurgery at St. Francis Gains Ground in Minimally Invasive Procedures With surgery of any type, minimally invasive techniques result in less trauma, which generally leads to better outcomes for patients: less blood loss Rick Madhok, M.D. during the procedure, reduced pain, fewer days in the hospital, and a quicker return to work and regular activities. Since Rick Madhok, M.D., joined the department of surgery at St. Francis last summer, he has worked to introduce new ways of performing minimally invasive brain and spinal surgeries, sometimes without any incisions at all. “We’re going through the proper committees and channels to get some procedures onboard, but there are others we’ve started to do at St. Francis already that have never been done here before,” Dr. Madhok said. Dr. Madhok’s interest in minimally invasive
surgery goes back to his residency and fellowship, where he focused on endoscopic procedures and skull-based procedures. Today, he and his team are able to operate on pituitary tumors trans-nasally through an endoscope, and he expects to be doing this type of surgery soon at St. Francis. In addition, some skull and spine procedures are done through incisions at a fraction the size of a standard open procedure. “We’re able to do smaller incisions, whether in the brain or in the spine, because instead of opening up those structures we’re essentially working through tubes,” he said. “We’re not cutting anything and creating trauma; we’re dilating tissue instead. For spinal procedures, this approach means a reduction in trauma to muscle. Surgery performed through tubes minimizes exposure and trauma to the brain. “There is less brain trauma associated with the procedures we do,” Dr. Madhok said. He reports that patients have shown a substantial interest in the minimally invasive procedures,
and that the hospital’s nurses and surgical department have been tremendously cooperative. “Everybody is on board at every level and it’s really wonderful,” Dr. Madhok said. He is also impressed by the growing collaboration between the hospital’s burgeoning departments – for instance, between the oncology program and the surgical department. “We’re working with them to do more neuro-oncology, which is where some of these minimally invasive surgeries for tumors come into play,” Dr. Madhok said. “We’re also working with orthopedics to increase the breadth of procedures done on the spine.” Recently, when Dr. Madhok was operating on a patient with a spinal tumor, the patient’s radiologist was able to witness the surgery in person. “He physically came to the OR and saw what the tumor looked life in real life – not just on an MRI,” Dr. Madhok said. “This is the kind of collaboration that I think is going to continue to distinguish St. Francis across Long Island, New York, and nationwide.”
St. Francis Earns Gold in Stroke Care Again St. Francis Hospital has once again earned the American Heart Association/American Stroke Association’s Get With The Guidelines® Stroke Gold Plus Quality Achievement Award. The award recognizes the Hospital’s commitment and success in providing a higher standard of care by ensuring that stroke paSt. Francis Hospital CLINICAL UPDATE Winter/Spring 2014
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tients receive treatment according to nationally accepted guidelines. It marks the third year that St. Francis has been recognized with this prestigious, quality achievement award. To receive the award, St. Francis staff developed and implemented preventive procedures to improve patient care and outcomes. These measures include aggressive use of medications, cholesterol reducing drugs, and smoking cessation, all aimed at reducing
death and disability and improving the lives of stroke patients. According to the American Heart Association/ American Stroke Association, stroke is one of the leading causes of death and serious, long-term disability in the United States. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.