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The Jennings Clinic Patients Respond to Pioneering Orthopedic Care and Compassion
Also in This Issue Feminine Heart’s Mystique Sight-Saving Surgery
DoeS emotion have a PLace in BanKinG? You care deeply about the success of your practice. Sometimes, you smile to yourself while reviewing your statements. other times, you feel fed up. Passion. that’s what got you here. and that’s what sets us both apart from our competition.
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Atrium at Duke Cancer Center
Cancer Care As It Should Be.
Editor’s Note
Pioneering Spirit The Triad Physician cover story this month features Jennings Clinic, founded in 1973 by Jerome Jennings, an orthopedic surgeon whose stellar career is marked by a tenacious pursuit of promising treatments before acceptance in the United States. Dr. Jennings was the first orthopedic surgeon in the Triad to complete a fellowship in adult reconstruction surgery. He introduced advanced techniques for joint replacements and surgical implants to repair fractures. Later, he would be among the first to adopt arthroscopy. Decades later, the patients of Jennings Clinic and beyond continue to benefit from this physician’s pioneering spirit. Today, he is joined by Dr. Bryan Jennings (no relation). A closely knit medical team that includes on-site physical therapists assures responsive, personal care from Day 1 through to recovery. The focus of this issue also is on cardiology, and we welcome two contributing cardiologists Jonathan Berry and David Bohle. They present insight on women and heart disease. This issue of The Triad Physician offers a diverse range of contributors. Ophthalmologist Kathryn Hecker reviews the methods of cataract removal and intraocular lens placement. Phlebotomist Raymond Workman gives an overview of advances in the treatment of venous disease. Dermatologist Kevin Stein reminds all of the rising incidence of melanoma and importance of early detection. Gastroenterologist John Long discusses colorectal screening and proper polyp management. Immunologist Elizabeth Scannell heralds the arrival of hay fever season!
Editor Heidi Ketler, APR Contributing Editors Jonathan J. Berry M.D., F.A.C.P., F.A.C.C., F.A.H.A., F.C.S.A.I. David J. Bohle, M.D., M.S., F.A.C.C. Kathryn J. Hecker, M.D., F.A.A.O. John D. Long, M.D. Tracey Murphy, C.P.A. Elizabeth R. Scannell, M.D. Kevin Stein, M.D. Raymond Workman, M.D., R.V.T., F.A.C.S. Photography Anna Paschal Photography Creative Director Joseph Dally Contact Information for Marketing, Media & News: Angie Griffin angie@triadphysician.com 336-509-2209 News and Columns Please send to info@triadphysician.com Subscription Rates: $48.00 per year/$6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401
Also in this issue, certified public accountant Tracey Murphy explains the importance of “trust, but verify,” sage advice popularized by Ronald Reagan. The pioneering spirit is a live and well throughout the Triad, and The Triad Physician is a great vehicle for showcasing it. We welcome columns, news and announcements of interest to the medical community. We also invite you to consider the advertising value of a magazine dedicated to the Triad medical community. With deep appreciation and respect,
Heidi Ketler Editor
2
The Triad Physician
Every precaution is taken to insure the accuracy of the articles published. The Triad Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinion expressed or facts supplied by its authors are not the responsibility of The Tirad Physician. However, The Triad Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triad Physician.
Category
Contents
COVER STORY
6
Patients Respond to Pioneering Orthopedic Care and Compassion at
The Jennings Clinic
march 2012
FEATURES
8
DEPARTMENTS 10 Cardiology
Cardiology
17 News
Employing Better Risk Stratification for
• Heat-based Nanotube Treatments
Heart Disease in Women
Can Kill Breast Cancer Stem Cells
Recognize Unique Gender Differences in Women with Heart Disease Dr. Jonathan Berry discusses examples of gender-related differences in the diagnosis and treatment of heart disease.
9
Vol. 1, Issue 2
11 Phlebotomy
ing Hospital
Advances in Treatment of Venous
18 News
Disease Deliver Great Relief
• Novant Embraces Bedside Reporting
12 Practice Management
Dr. Kathryn Hecker reviews improvements
• High Point Regional Partners with Duke to Expand Heart and Cancer Care
Melanoma: Fighting Rising Incidence
Advances and Careful Patient Selection Increase Chances of Desired Results
Trust, but Verify
13 Dermatology Ophthalmology
• Alamance Is Named a Top Perform-
19 News
with Prevention and Early Detection
• Pediatrician Opens Green Building
14 Gastroenterology Vital Colorectal Screening and Proper
• Roy at Moorhead NeuroSpine
20 News
Polyp Management Are Often Over-
• Moses Cone Wages High-tech
looked
Germ War
16 Immunology
• Welcome to the Area
• Upcoming Event: Wells Fargo
in intraocular lenses that may reduce
Suffer Less with Improved Allergy
Tar Heel 10 Miler and Fleet Feet
dependency on glasses or contact lenses.
Awareness and Management
4+ Mile Run
March 2012
3
Category On the Cover
Patients Respond to Pioneering Orthopedic Care and Compassion at
The Jennings Clinic
By Vicki L. Friedman
Comprehensive, compassionate, experi-
His partner, W. Bryan Jennings, D.O., (no
Since the inception of what is now a 5,400
enced orthopedic care is why the Jennings
relation) concurs. He admits the personal
square-foot facility, the Jennings Clinic
Clinic has been a fixture in the Triad region
nature of the Jennings Clinic, which affords
has excelled in arthroscopic surgery,
for more than 30 years.
him the opportunity to get to know his
reconstructive surgery, sports medicine
patients and understand their needs, is
and physical therapy. In addition to the
Patients are not viewed as numbers with
what convinced him to join the practice in
physicians, two full-time physical therapists
problems when at the Jennings Clinic,
2004.
are on staff, as well as a registered nurse and two certified nursing assistants. They
located in Winston Salem, N.C. They are individuals with specialized needs, coming
“We like to think of our patients as our
serve a demographically varied clientele
to see two of the most respected surgeons
extended family,” says Bryan Jennings,
with problems ranging from carpal tunnel
in the field of orthopedics
orthopedic section chief at Medical Park
syndrome to rotator cuff tears and those
Hospital. “We get to know our patients, and
requiring total shoulder, hip and knee
“What we try to do is treat each individual
we work together with the patient to design
replacements.
with their problem and not just treat the
an individualized treatment plan. When you
problem,” says Jerome E. Jennings, M.D.,
come into this office, you see me or you
“I like being able to provide comprehensive
who founded the Jennings Clinic, located
see Jerome every time you come in. There
care to our patients,’’ says Bryan Jennings.
in the Forsyth Medical Park adjacent to
are bigger groups out there, but we like to
“I think our patients appreciate someone
Medical Park Hospital. “We try to treat the
say we offer excellent, comprehensive care
they can rely on to not only take care of
individual. We want our patients to know
in a comfortable environment.”
their mother’s total hip, but they can call
when they come to a specialist, they’re
after they fracture their ankle or their
being seen by a specialist.”
brother tears his rotator cuff.”
Jerome Jennings, MD & Sharon Butler, RN with patient discussing treatment options
Each member of the Piedmont Outpatient Surgery Center team has extensive ENT training and expertise, and a customer-service focus.
4
The Triad Physician
A Pioneer in the Field
was a time when they barely existed in
Seasoned in Sports Medicine
A graduate of the Medical College of
the United States. Jerome Jennings was
Bryan Jennings graduated from Des
Georgia in Augusta, Jerome Jennings
among the first to train local doctors in the
Moines University’s College of Osteopathic
finished his residency in orthopedic
new techniques, and he followed that path
Medicine and completed his residency in
surgery at North Carolina Baptist Hospital.
again with arthroscopic surgery.
orthopedic surgery at Grandview Hospital
During that residency, he completed a
and Medical Center at Ohio University.
fellowship in adult reconstructive surgery
He was awarded a sports medicine and
at the prestigious Princess Margaret Rose
arthroscopy fellowship at Orthopaedic
Orthopaedic
Edinburgh,
Research of Virginia in Richmond,Va.
Scotland, where he began to learn
During his fellowship, he was a member of
techniques not yet available in the United
the medical staff caring for the Washington
States. The year was 1972.
Redskins and many high schools and
Hospital
in
colleges. Currently he is team physician “I was the first one in this area to have a
for North Forsyth High School, joking it
fellowship in adult reconstruction surgery,”
is more rewarding to take care of patients
says Jerome Jennings. “Joint replacements
“who don’t have agents.”
were not being done in this country at that time. The cement you needed to use had
“What that basically taught me is when you
not been released by the (United States
take care of athletes – whether they are
Food and Drug Administration), so I went
professionals or weekend warriors – the
to England to learn.”
level of care and the type of procedures performed,
Following that, Jerome Jennings went
both
conservatively
and
surgically, are exactly the same.”
to Switzerland to learn primary internal fixation – the surgical implants to repair
Given the evolving world of youth athletics,
a fractured bone, rather than long-term
Bryan Jennings has become accustomed
use of casts and traction. Like full joint replacement, primary internal fixation was
Discussing Physician Therapy Treatment Plan with Adam Najmulski, PT, MPT
rarely used in America at the time.
to treating adults at a younger age for degenerative and post-traumatic arthritis, a malady he suspects stems from overuse
Jerome Jennings, past president of the Ar-
of joints in the adolescent and teen years.
“When I returned in 1972, there was
throscopic Association of North America,
Additionally, playing one sport year-round
almost no one performing primary internal
studied under Richard L. O’Connor, M.D.,
also predisposes youth to injury. On the
fixation,” Jerome Jennings says. “Only
whose work and research paved the way
other spectrum, the effects of obesity and
when nonsurgical treatments failed did
for arthroscopic surgery. Today patients
inactivity are growing problems.
you do open surgery for fractures” in this
benefit from Dr. Jennings’ decades of ex-
country.
perience and his pioneer efforts in the
Whatever the need, Bryan Jennings
field. He derives special satisfaction from
is comfortable finding a solution. His
Jerome Jennings offers an example
reconstructive surgery, which he believes
specialties include arthroscopic shoulder
involving a young female student traveling
has relieved more pain and suffering than
and knee reconstruction. He is well
home for Christmas from Appalachian
any other aspect of orthopedic surgery.
versed in general orthopedics and total
State University. Slipping on the icy road,
joint replacements, including reverse total “Being able to take a destroyed joint and
shoulder replacement when necessary
restore it to good function is a remarkable
and total hip reconstruction, including the
“She came into the hospital on a Friday
thing to do,” Jerome Jennings says. “By
anterior approach. Like Jerome Jennings,
night, and I operated on her and she went
replacing a hip, knee or shoulder and
he is skilled in all general orthopedic
home on Monday,” he says. “That opened
even ankles and other joints, we can
procedures excluding the spine.
some eyes and caused some controversy.”
relieve tremendous suffering and improved
she suffered five fractures in her body.
someone’s quality of life.
Frequently, orthopedic surgeons specialize
Adult reconstructive surgery and primary
in a single specialty they trained in during
internal fixation have become so routine
“That’s what we are about at the Jennings
their fellowship, says Bryan Jennings.
these days that many don’t realize there
Clinic.”
The result is an overwhelmingly large
March 2012
5
practice of multiple specialists focusing on individual areas required to provide comprehensive patient care. At the Jennings Clinic, you can get comprehensive care for hip, knee and shoulder problems by one physician that some other practices may or may not provide, says Dr. Jennings. “Our approach is
to
offer
consistent,
cutting-edge,
quality care in an intimate, friendly and comfortable environment.”
On-site Physical Therapy Physical therapy is an important aspect to treating many musculoskeletal disorders,
Jennings Clinic Physical Theraphy Treatment Area
and at the Jennings Clinic, therapists rely on the latest techniques to return patients
with the providers involved is really what
be greeted by fresh-brewing coffee and
to healthy and active lifestyles.
sets us apart. We’re able to control and
personnel who are attentive to their needs
certainly monitor our patients’ outcomes a
and wait times.
Jerome Jennings’ European training taught
little bit more closely.” “We might not be the first orthopedic office
him the importance of a team approach to patient care. During his early days in
Adam Najmulski, director of physical
that comes to the tip of your tongue when
group practice in this country, he noticed
therapy at the Jennings Clinic, says having
considering orthopedic care, just because
the minimal contact between physical
both physicians close by eliminates
we don’t have 50 physicians, 500 employ-
therapist and physician. Consultations
problems with miscommunication.
ees and five office locations,” Bryan Jennings says. “Patients always welcome the
about patients’ progress were generally “In other settings, I found getting in touch
small-practice environment, where they re-
with the referring physician was a matter
ceive the personal attention, excellent care
At the Jennings Clinic, Jerome and Bryan
of making a call and leaving a message,
in a friendly atmosphere not often found in
Jennings take an active role in their
hoping the doctor returned your call
many larger practices.
patients’ rehabilitation.
within a day or two,” he says. “Here at the
done over the phone.
Jennings Clinic, I can find the doctor in the
“What I find personally rewarding is that
“It’s a team approach to rehabilitating the
hall or in his office any time I need to. Both
the product we offer is not duplicated in
patient back to health,” Jerome Jennings
doctors visit the therapy area daily, as well,
this market. We want people to know we’ve
says. “It’s not just that we have a physical
and that visibility makes the patients feel
been providing care in the region for over
therapist in the building. We’re right there.
comfortable.”
30 years, and plan to continue to provide orthopedic care for the Triad community
There’s not a time when we’re not in contact or not able to be in contact. That
Make Yourself at Home
gives the patient a feeling of confidence
Technology wasn’t the only thing that made
that everyone is on the same page.”
an impression on Jerome Jennings when
The Jennings Clinic is located at 1900 S.
he studied in Europe. Doctors’ offices were
Hawthorne Road, Suite 410 in Winston-
Bryan Jennings shares his partner’s
often in townhouses where patients would
Salem. Dr. Jerome Jennings and Dr. W.
philosophy about the importance of on-site
sit by the fireplace, read a magazine and
Bryan Jennings are accepting new patients.
physical therapy.
drink a cup of tea while they waited for
For information, call (336) 765-1571 or
their appointments.
logon to www.jenningsclinic.com.
the ability to see how you’re progressing
“We don’t want to be a clinic that feels like a
Vicki L. Friedman is a free-lance writer in
firsthand, or more importantly, if you’re not
sterile factory,” Jerome Jennings says. “We
Chesapeake, Va. She and husband, Mike,
progressing,” he says. “I think that small
strive to give a comfy, homey atmosphere
are parents to sons Harry and Benjamin
environment where you can communicate
to our patients.” So patients can expect to
and two Japanese chins.
and surrounding region for years to come.”
“If you come to my clinic for therapy, I have
6
The Triad Physician
March 2012
7
Cardiology
Recognize Unique and Subtle Differences in
Women with Heart Disease By Jonathan J. Berry M.D., F.A.C.P., F.A.C.C., F.A.H.A., F.C.S.A.I.
The subject of women and heart disease
Studies have shown that symptoms upon
is becoming increasingly popular, thanks
presentation for a myocardial infarction
to such national movements as Go Red for
or acute coronary syndrome (ACS) differ
Women, which aims to increase awareness
between men and women, and women are
of heart disease in women.
less likely to be admitted to the coronary care unit or undergo coronary angiography.
Recognizing misconceptions regarding heart disease in women, as well as gender-
It is well established that women have a
related differences in the diagnosis and
higher degree of falsely positive exercise
treatment can save hearts and lives.
stress tests, however the degree of sensitivity and specificity of imaging-
Even though we are getting better
related
across the board at primary prevention,
between genders.
functional
studies
is
similar
cardiovascular disease (CVD) is the most common cause of death and disability in
And finally, even when you compare the
women. In 2007, CVD caused about one
degree of coronary artery disease (CAD)
death per minute in the United States,
in men and women with presentation
which was more then the sum of deaths
of chest pain at catheterization, women
caused by cancer, respiratory illnesses,
have a lesser degree of significant CAD.
Alzheimer’s and accidents combined.
Women are also more likely to have angiographically normal coronaries, as
For reasons that are not entirely clear,
well as diseases such as syndrome X,
women’s symptoms differ from men’s as
Takasubo syndrome and spontaneous
far as typical angina. They are more likely
coronary dissections.
Dr. Jonathan Berry is chief of the cardiovascular section for Cone Health System and president of the South Eastern Heart and Vascular Center. He earned his bachelor of arts in biochemistry/biophysics from Dartmouth College, Hanover, N.H., and his doctor of medicine from the University of Pennsylvania School of Medicine, Philadelphia, Pa. He did his internship, residency and general cardiology fellowship at Duke University Medical Center , and Interventional Fellowship at the University of Michigan. He is a fellow of the American Heart Association, American College of Physicians, Society of Coronary Angiographers and Interventionalists, Society for Vascular Medicine. He is a clinical associate professor of medicine at the University of North Carolina at Chapel Hill.
diligently and appreciate the differences in CVD presentation among women versus
to describe their pain differently and have more atypical symptoms, such as fatigue,
With all of this having been said regarding
men, and order the appropriate diagnostic
shortness of breath, pain in the back and
the prevalence of cardiovascular disease in
tests.
shoulders etc.
women and the gender-related differences, the most important aspect is recognition
The emphasis of heart health in February
On average, age of onset is older in women,
among the general population as well
helps to heighten awareness of gender-
and despite symptoms they are less likely
as the care providers. It is important for
related differences. It is up to health care
to undergo a diagnostic workup or referral
women to understand their symptoms and
professionals to continue the conversation
for a more invasive procedure in the event
when to seek medical advise. It is equally as
throughout the year in the mission to save
a noninvasive workup is abnormal.
important for health care providers to listen
hearts and lives.
8
The Triad Physician
Opthalmalogy
Advances and Careful Patient Selection Increase Chances of Desired Results By Kathryn J. Hecker, M.D., F.A.A.O.
Cataract surgery with intraocular lens
Multifocal or accommodating IOLs are also
placement has a high rate of success and
available, and these implants are designed
safety. Cataract surgery is indicated when
to provide a wider range of uncorrected
the level of visual impairment causes
vision. These types of lens implants are
disability with activities of daily living.
often referred to as “specialty” or “new technology” lens implants. Not every
In the United States, the most common
patient is a candidate for these types of lens
method of cataract removal is with
implants, and they involve extra cost to the
technology
patient.
called
phacoemulsification.
With this procedure, a 2-3 millimeter incision is made through either sclera or cornea.
Toric IOLs
Through this incision, an opening is made in
A patient with significant corneal astigmatism
the clear capsule surrounding the cataract.
may be a candidate for a toric IOL. A
The phacoemulsification process utilizes
topographer is an instrument that captures an
high frequency ultrasound of up to 45,000
image of the patient’s cornea. This produces
cycles per second to emulsify and aspirate
a topographical map of the cornea, showing
the dense central nucleus of the lens.
areas that are steep, flat or irregular. This map, along with several other measurements
Dr. Kathryn Hecker is certified by the American Board of Ophthalmology. She practices general ophthalmology at Hecker Ophthalmology, P.A., 1507 Westover Terrace, in Greensboro. Dr. Hecker completed her ophthalmology residency at Vanderbilt University in 1995. She completed her medical degree from the University of Texas Southwestern Medical School in Dallas, Texas, in 1991, then spent a year training in internal medicine at Stamford University in Stamford, Conn. Prior to her medical training, Dr. Hecker earned her undergraduate degree in education at Central Michigan University. She then worked as an elementary school teacher in Houston, Texas.
After the cataractous lens is emulsified
of the patient’s eye and cornea, are then
and removed, the clear capsule remains.
analyzed and used to determine if the patient
with either refractive or diffractive zones on
The capsule is supported by the zonules,
is a candidate for the toric IOL.
the IOL that allow for varying focal points. Accommodating IOLs are manufactured
similar to the support system of a suspension bridge, in a 360-degree fashion. The
Corneal astigmatism can be irregular or
with hinges or other technologies to
intraocular lens (IOL) is inserted into, and
regular. Patients who have regular astigma-
simulate the natural accommodation of the
supported by, the capsule. The incision gen-
tism are better candidates for a toric IOL.
ciliary muscles of the eye. Results with these
erally self seals, however, a suture may be
The toric IOL is available in several different
types of IOLs can be excellent, however
placed.
powers of astigmatic correction. An IOL in
proper patient selection is important.
a toric power appropriate for that patient’s The primary goal of cataract surgery is to re-
amount of astigmatism is implanted. Upon
The primary goal of cataract removal
store visual function. An additional benefit
implantation, the toric IOL is rotated and
and IOL implantation is restoration of
that is sometimes achieved is a reduction of
aligned with the corresponding axis of astig-
visual function with the lowest possible
dependency on glasses or contact lens wear
matism on the cornea. Excellent results re-
risk for complications. However, along
for distance, mid-range and/or near-visual
garding astigmatic correction with cataract
with this, many patients are interested in
activities. While this is not a realistic or de-
surgery have been obtained with the toric
hearing about their options for reduced
sired goal for all patients, it can be achieved
IOL.
dependence on spectacles or contact lenses for varying ranges. With advanced
for many patients. Recent technological advancements with IOLs have improved the ability to achieve this added benefit.
IOL technologies, we are now able to
Multifocal and Accommodating IOLs
achieve this for some patients.
Multifocal and accommodating IOLs are Toric IOLs, which are designed to neutralize
designed to correct vision at a wide range
For more information, visit the website
corneal astigmatism, are now available.
of focal points. Multifocal IOLs are made
www.heckereye.com.
March 2012
9
Cardiology
Employing Better
Risk Stratification
for Heart Disease in Women By David J. Bohle, M.D., M.S., F.A.C.C.
Each day, physicians use various tools
components, blood pressure levels, BMI,
to assess our patients’ risk for various
waist circumference, blood glucose and
diseases and conditions. Risk stratification
hemoglobin
A1C
allows us to prescribe interventional or
physicians
of
preventive care prior to onset of more
understand that if the basic numbers
serious conditions and is particularly useful
indicate a potential problem, that a consult
for one of the most preventable diseases
with a trained cardiovascular expert can
we face – heart disease. Traditionally
offer more detailed diagnosis.
levels.
Increasingly,
different
specialties
considered a man’s disease, heart disease is the No. 1 killer of women in America,
A valuable community resource now
even more common in African-American
available to patients is an inexpensive
and Latino women.
screening of risk factors for heart disease at Forsyth Medical Center Women’s Heart Center. The assessment costs $25 and includes several simple screenings: • Blood pressure check •C holesterol blood test (total lipids,
Dr. David Bohle is board certified in cardiology, interventional cardiology and internal medicine. He graduated from the University of Texas Medical School at San Antonio and completed his residency in internal medicine at the University of Arkansas for Medical Sciences, followed by a fellowship in cardiology at Wake Forest School of Medicine in WinstonSalem. Dr. Bohle practices at WinstonSalem Cardiology Associates and is director of the Women’s Heart Center at Forsyth Medical Center. Dr. Bohle is also a staff interventional cardiologist at Forsyth. He can be reached at (336) 277-2100 or www.winstonsalemcardiology.com.
HDL, LDL and triglycerides) • Glucose blood test • Weight/body mass index screening
duce the risk of an acute myocardial in-
•N on-invasive peripheral arterial
farction during a procedure by including a
disease test (ankle brachial index)
cardiac consult as part of the preoperative evaluation.
Last year nearly 250 women were screened, and we want to double that this
Recently, I encouraged my colleagues
year. Our goal is for every woman between
to download the Reynolds Risk Score
Women are a little more difficult for
the ages of 18 to 80 in this county and the
application to their smart phones and
clinicians
the
11 surrounding counties to be screened for
computers as a simple way to calculate
somewhat
risk factors. When we, as trusted medical
heart and stroke risk. If your patient’s score
different. An anginal equivalent, not
partners, recommend heart screenings,
is above a 10 percent risk in 10 years, a
menopause, may in fact be the cause of
our patients will be more likely to follow
cardiac evaluation may be recommended.
a woman in her 40s having new fatigue,
through.
to
symptomatology
diagnose can
because be
In addition to atypical symptoms, many
more anxiety and insomnia. Physicians of all specialties should con-
times physicians may not ask about the
Many organizations, such as the American
sider a cardiac referral as a routine part of
typical ones. Retrospective studies have
College of Cardiology and the American
risk stratification when appropriate indica-
revealed that the three most common
Heart Association, through its Red Dress
tors are present. Gynecologists may have
symptoms women had at least a week or
Campaign, encourage women to know
younger patients exhibiting symptoms who
two before a heart attack were:
their numbers – cholesterol levels of
could benefit from a cardiologist’s consult.
HDL, LDL, triglycerides and total lipid
Any specialist performing surgery can re-
10
The Triad Physician
•A dramatic and significant decrease in energy levels or exercise
• A significant change in sleep pattern, more anxiety, more worry
energy should be an immediate indication
the engine, the only way I can detect heart
for a cardiac consult.
disease is through a stress test or a heart catheterization. There is no other test, no
• Discomfort in the chest chest
matter what you hear about CT scans or
Heart attacks are almost never painful.
X-ray or lab work have never ruled out
carotid intima-media thickness tests, that
Chest
tightness,
ischemic heart disease. Just as your car’s
are as effective to diagnose plaque or build
indigestion symptoms or decrease of
diagnostic check includes accelerating
up in the arteries.
A pressure,
heaviness,
normal
electrocardiogram,
Phlebotomy
Advances in Treatment of Venous Disease Deliver Great Relief By C. Raymond Workman, M.D., R.V.T., F.A.C.S.
Venous disease has been around ever
Current treatment of venous disease still
since man began walking erect. The earth’s
focuses on obliterating the incompetent
gravitational pull combined with valvular
saphenous vein (great and/or small).
insufficiency in the veins of the pelvis and
However, now this is done with a procedure
legs leads to a standing column of blood
called endovenous thermal ablation.
that can be 4-6 feet tall. This can exert up to 2 psi at the bottom of the column (the
In this procedure a small catheter is inserted
calf/ankle). Leg swelling, spider veins,
in the distal portion of the vein. Using
varicose veins, chronic skin changes and
ultrasound guidance, a device is threaded
venous ulcers can all result from venous
through the catheter up the vein and
insufficiency.
positioned in the most proximal portion of the incompetent segment. The device then
Dr. Ray Workman is a board-certified vascular surgeon. He treats all types of vascular disease but has a special interest in venous disorders. He is the medical director of Salem Skin and Vein Specialists, where he works with his four vascular surgery partners. The office is located at 2827 Lyndhurst Ave., Suite 206, Winston-Salem, NC 27103. More information can be found at www.salemveins.com. Dr. Workman can be reached via e-mail at info@salemveins.com.
The exact cause of venous valve failure is not
delivers heat, and the endothelial lining is
well understood. There are certainly some
destroyed. This causes contraction of the
hereditary predispositions to this disease,
collagen in the wall of the vein leading to
any minor discomfort in the leg. Most return
but many patients present with no family
fibrotic and thrombotic occlusion. The
to work immediately with no down time.
history at all. Deep vein thrombosis can
device is slowly withdrawn to treat the entire
lead to deep venous valvular insufficiency
length of the offending vein.
Subsequent procedures may be required to remove any leftover veins if they are
and the post-phlebitic syndrome. Some occupations are found to be more common
There are two devices available for
symptomatic. Usually this can be done
among varicose vein patients, including hair
delivering the heat to the vein. One uses
by ambulatory phlebectomy, again under
stylists/barbers, teachers, manufacturing
radiofrequency energy and treats the vein
tumescent anesthesia. Cosmetic treatment
workers and some health care workers. All
in 7 centimeter segments. The other uses
of residual spider veins can be done with
of these jobs require long hours standing in
a laser fiber to deliver energy at the tip of
injection sclerotherapy using one of several
one place.
the device, and it is continually pulled back
commercially available agents.
to treat the entire vein. Both devices have Historical treatment of varicose vein disease
advantages and disadvantages but both are
While varicose vein disease will never be
centered on stripping or surgically removing
very effective at closing off the vein.
eliminated, modern treatment techniques have allowed it to be treated in a much more
the incompetent vein. Usually this was the great saphenous or small saphenous
This procedure is performed in the office
satisfying manner. Patients really appreciate
vein in the leg. This required spinal or
using tumescent anesthesia. Patients walk
the minimally invasive techniques, the
general anesthesia and was associated with
out of the office wearing a compression
shorter down time and the convenience of
significant post-operative pain and bruising.
stocking and rarely require more than non-
having these procedures done in the office.
steroidal anti-inflammatory medication for
March 2012
11
Practice Management
Trust, But Verify By Tracey Murphy, C.P.A.
A phrase made famous by the 40th
credit checks; verify employment history
president of the United States, Ronald
and education. Take steps to prevent the
Reagan, used as the title of books and
hiring of the potential problem employee
often quoted by politicians and media
before he or she can become your
alike, also applies to your medical
problem.
practice - Trust, but verify. 2) Segregate duties – As much as We inherently want to trust those who
possible, segregate duties to prevent an
work for us. Unfortunately, the undisputed
employee’s access to all steps in the cash
truth is that anywhere from 60-75 percent
receipts or cash disbursement process.
of physicians (depending on which survey
Have mail opened by someone with no
you read) will suffer financial loss from
responsibility for billing, collections or
employee dishonesty during their career.
bill paying. Have bank reconciliations prepared by someone without check
Trust Is Important but Not an
writing or signing authority. Never use
Internal Control
a signature stamp for check signing.
It is difficult in health care today to remain
Require purchase orders and verification
independent and profitable. Congress
of goods received before paying vendors.
has recently deferred the ever-looming
Require competitive vendor bidding with
sustainable growth rate adjustment for
vendor selection approved by a physician
another year, but the 27.4 percent Medicare
or someone outside the accounts payable
physician payment cut is still on the horizon.
department. Use an outside payroll provider to minimize risk associated with
You see difficult economic times ahead as
payroll checks and payroll tax deposits.
reimbursement declines, costs increase and administrative complexity grows.
3) Use technology – Limit access to
Your employees face difficult economic
software modules, inventory supplies,
times, too. Many have spouses who
cash drawers, etc., by use of personalized
have lost jobs. Many are supporting their
passwords or key codes. Turn on the
parents or adult children.
audit feature in your accounting software to track changes made by employees.
Statistics show that 10 percent of your
Have an inventory control system in place
employees will never steal under any
for pharmaceuticals, medical supplies
circumstances, 10 percent will always
and products for sale.
steal and 80 percent might steal, given the “right” circumstances.
4) Monthly reporting and monitoring – Review accounting software reports for
Those right circumstances are more
voided checks, checks made payable to
prevalent today than ever. Even long-term,
cash and vendors with the same address.
trustworthy employees may be a risk.
Review practice management reports
Take steps now to protect your practice.
for adjustments to patient accounts. Reconcile cash receipts recorded in
Six Simple, Cost-effective
the accounting software with receipts
Steps to Consider
recorded in the practice management
1) Before hiring – Perform background and
software monthly. Have an approval
12
The Triad Physician
Tracey Murphy, a certified public accountant and partner at Bernard Robinson & Co. L.L.P., works with physician practices and health care-related entities to develop financial best practices, compensation formulas, ancillary revenue sources, transition plans and other accounting and management strategies to help them achieve increased profitability. Bernard Robinson, the Triad’s largest locally based accounting firm with a staff of nearly 80, has been in business for 65 years, providing comprehensive and creative professional services to help its clients realize their objectives. Her website is www.brccpa.com
process for overtime and monitor it each pay period. 5) Watch for warning signs – Be mindful of employees who refuse vacations or promotions, work late or on weekends with no apparent need, appear to live beyond their means, are experiencing divorce/ family problems, have health/addiction issues, have unusual relationships with vendors. Are there increased patient complaints about inaccurate billings? Are bank deposits held or petty cash receipts missing? 6) Practice code of conduct – While it may seem trivial, have a written code of conduct, signed by employees when hired and annually thereafter that clearly states expectations and consequences related to dishonesty or embezzlement. Adopt a zerotolerance policy and provide a means for employees to report suspected problems anonymously. Finally, lead by example. Physicians, practice administrators and managers who exhibit high morals and ethics inspire employees to do the same.
Dermatology
Melanoma
Fighting Rising Incidence with Prevention and Early Detection By Kevin Stein, M.D.
Melanoma is the most dangerous form
rays. Products SPF 2-14 will claim to help
of skin cancer and leads to nearly 9,000
prevent sunburn and products SPF 15 and
fatalities annually in the United States.
higher will be able to state the claim of skin
The American Cancer Society estimates
cancer and skin-aging prevention. Claims
that 120,000 melanomas are diagnosed
of “waterproof” will no longer be allowed,
every year. Despite increasing knowledge
though claims of “water resistant” for 40
regarding
ultraviolet
or 80 minutes can be made. To ensure
radiation from the sun and indoor tanning
adequate protection, sunscreen must be
and more emphasis on full-body skin
re-applied every two hours.
the
dangers
of
examinations, the incidence of melanoma Most melanomas can be cured if detected
is rising.
and excised early. Dependent upon the
Dr. Kevin Stein is a board-certified dermatologist who specializes in general dermatology, skin cancer surveillance and treatment and minimallyinvasive cosmetic procedures. He graduated from the West Virginia University School of Medicine, completed an internship in internal medicine at the University of Virginia and a dermatology residency at New York Medical College in New York, N.Y. He is a physician with The Skin Surgery Center located at 1450 Professional Park Drive in Winston-Salem, N.C., and can be reached at (336) 724-2434. The practice website is www.skinsurgerycenter.net.
It is well established that ultraviolet
depth of invasion, sentinel lymph node
radiation from sun exposure and tanning
mapping and biopsy may be indicated,
bed use can lead to DNA damage and
and this adds important prognostic
subsequent malignant change and that
information and possibly a survival benefit.
intense periods of sun exposure causing
Until very recently, dacarbazine (DTIC)
sunburn are linked to an increased risk of
was the only FDA-approved medication for
melanoma. However, genetic factors also
metastatic melanoma. Recently approved
the World Health Organization, classified
play a role. One in 10 melanoma patients
for metastatic melanoma were ipilimumab
ultraviolet tanning devices in its Group
has a first-degree family member with a
and vemurafenib, the latter indicated for
1 list, one that also contains arsenic,
history of melanoma and a person with
patients with a BRAF V600E mutation,
asbestos, cigarettes and plutonium. Health
a first-degree family member affected has
which has been found in more than 60
care providers in several states, including
a 50 percent increased risk of melanoma
percent of melanomas investigated.
North Carolina, have introduced legislation limiting access of minors to tanning parlors.
compared to the general population. Other risk factors include fair skin, atypical
Many studies have detailed an increased
moles, a history of other skin cancers,
risk of melanoma in people who tan in-
Regular
immunosuppression and a history of organ
doors. Frequent tanners may receive 12
can lead to early detection and timely
transplantation.
times the ultraviolet A radiation compared
treatment,
to that received from the sun. Ultraviolet
melanoma treatment. Annual examinations
prevention
tanners are 74 percent more likely than
are recommended for those patients with
include avoiding midday sun, wearing
those who do not tan to develop mela-
risk factors for skin cancer development.
a wide-brimmed hat, sunglasses and
noma and also have a higher risk of non-
Primary care providers and dermatologists
protective clothing and regular application
melanoma skin cancers. Likely related in
must be instrumental in educating patients
of sunscreen. The United States Food
part to tanning bed use, melanoma is now
about these risks and also discussing the
and Drug Administration (FDA) has
the most common type of cancer in young
ABCDE (asymmetry, border irregularity,
created new labeling rules for sunscreen
adults age 25-29 and the second most com-
color variegation, diameter and evolution)
manufacturers that must be in place by
mon in young people age 15 to 29.
clinical criteria regarding melanoma. With
Measures
for
melanoma
complete which
skin is
examinations
paramount
for
our efforts, hopefully we can curb the
June 2012. In order for a sunscreen to be labeled as “broad spectrum,” it must
Finally, in 2009, the International Agency
protect against both ultraviolet A and B
for Research on Cancer, an affiliate of
rising incidence of melanoma.
March 2012
13
Gastroenterology
Vital Colorectal Screening & Proper Polyp Management Are Often Overlooked By John D. Long, M.D.
March is Colorectal Cancer Awareness
Radiologic tests, such as computed
month. In the United States, colorectal
tomography colonography, are also safe
cancer (CRC) is the third most common
but involve radiation exposure, and if a
cancer diagnosed in men and women and
cancer or polyp is detected, a colonoscopy
the second-leading cause of death from
is required to sample or remove the lesion.
cancer. Finally, Every
year
approximately
140,000
endoscopic
colonoscopy,
are
tests,
such
preferred
as
because
people are diagnosed with CRC, while
they can detect polyps and cancers but
approximately 50,000 people die from it.
also prevent cancer by removing polyps.
Patients diagnosed with early stages of CRC
The National Polyp Study showed that
have a survival rate nearing 90 percent.
polypectomy
reduced
the
incidence
of subsequent CRC by 75-90 percent. Given these facts, screening for CRC is
Although colonoscopy is the preferred
accepted as an essential part of preventive
modality, it is time intensive, invasive and
medicine. In recent years CRC incidence
associated with rare but important risks,
and
such as perforation and bleeding.
mortality
rates
have
declined,
attributed in part to increased screening
Dr. John Long is a board-certified gastroenterologist with Salem Gastroenterology Associates, 1830 S. Hawthorne Rd. , Winston-Salem , NC 27103 . He practices general gastroenterology with a special interest in esophageal disorders. A graduate from Eastern Virginia Medical School , Dr. Long completed his medicine residency at Winthrop-University Hospital in Mineola , NY and fellowship training at Tulane University Medical Center in Louisiana . For further information contact Dr. Long at (336) 765-0463 or go to www.salemgi.com
between hyperplastic and adenomatous
rates and the ability of colonoscopy to
Types of Colorectal Polyps
polyps and may carry a modest risk for
prevent cancer by identifying and removing
The majority of CRCs develop from
CRC depending on the subtype.
colorectal polyps.
preexisting
adenomatous
polyps.
Despite these encouraging trends, only
important polyps to identify and remove
Quality Indicators for Colonoscopy Performance
65 percent of eligible adults in the U.S.
during screening colonoscopy.
Ever since the use of colonoscopy as the
Therefore,
adenomas
are
the
most
undergo screening for CRC, and the reason
preferred screening test for CRC became
most often cited by patients is their health
A baseline adenoma indicates that the
more widespread about 10 years ago, it has
care professional failed to discuss testing
patient is at higher risk of developing
become apparent that despite a negative
with them.
future
Certain
exam, a small percentage of patients are
characteristics signal a higher risk, such as
found to have polyps or even interval
Screening Options
multiple (three or more adenomas) or an
cancers that were missed, the latter defined
All people age 50 or older should be of-
advanced adenoma (i.e. size greater than
as a cancer diagnosed within five years after
fered one of the several tests available for
10 millimeter, villous histology or high-
a negative colonoscopy. As a result, there
CRC screening.
grade dysplasia).
are now guidelines outlining the essentials
Stool tests (e.g. guaiac or immunochemi-
Two other types of polyps found during
cal), which detect the presence of blood,
colonoscopy are hyperplastic and serrated
The adenoma detection rate (ADR) for
are inexpensive, easy to perform and safe,
polyps. Hyperplastic polyps are usually
a colonoscopist is probably the most
but have to be repeated yearly in order to
small, found in the distal colon, and do not
important measure predictive of rates of
be effective, and cannot detect the majority
carry any increased risk for CRC. Serrated
missed polyps or interval cancers. Large
of polyps.
polyps, the newest type, represent a hybrid
studies of screening colonoscopy have
adenomas
and
CRC.
of a quality colonoscopy exam.
14
The Triad Physician
found that an ADR of 20 percent is an acceptable benchmark. Several
factors
are
associated
with
higher ADRs, including excellent bowel preparation and slower withdrawal times. Bowel preparation is inadequate in up to 20 percent of colonoscopies. Superior bowel cleansing is associated with higher ADRs, and split-dosing the prep is preferable. Finally, during colonoscopy mucosal inspection for lesions occurs during withdrawal, and the withdrawal time (WT) is the time taken from reaching the cecum to completion of the exam. A WT of six minutes or longer is associated with higher ADRs.
Surveillance Guidelines regarding the surveillance of patients found to have polyps on colonoscopy have been available since 2000 and were updated in 2008. Appropriate intervals for patients found to have polyps are: • Ten years for only one or more hyperplastic polyps; • Five years for only one or two nonadvanced adenomas (tubular histology, less than 10 millimeter in size); • Three years for multiple (three to nine) adenomas or one or more advanced adenomas; and • One year or less for more than 10 adenomas or a large sessile adenoma requiring piecemeal resection. Despite these clear guidelines, physicians frequently
do
not
follow
them:
61
percent of primary care physicians, 54 percent of surgeons and 24 percent of gastroenterologists would survey a hyperplastic polyp in five years or less. Ongoing efforts to increase rates of CRC screening, improve colonoscopy quality and promote adherence to guidelines for polyp surveillance, provide hope that the incidence and mortality rates for CRC in the U.S. will continue to decline.
March 2012
15
Immunology
Suffer Less with Improved Allergy Awareness and Management By Elizabeth R. Scannell, M.D.
It is the beginning of spring and I just heard the buzzing of a bee. Those already having allergy symptoms shouldn’t be too surprised. In North Carolina, pollen season begins in February. Approximately 35 million Americans have pollen allergies causing symptoms of nasal congestion, runny nose, itchy eyes, roof of mouth and throat and sneezing. Allergen exposure in asthmatic patients can trigger cough, wheeze and/or shortness of breath. Importantly, up to 70 percent of asthmatics have underlying allergies. People with allergies are also more prone to ear and sinus infections, as well as atopic dermatitis, also known as eczema. Hay fever, also known as allergic rhinitis, is caused by exposure to substances, such as pollen, dust mites, pet dander or mold that the immune system typically ignores. However, in people with allergic rhinitis, the immune system mistakenly identifies these allergens as “intruders” and generates a reaction against them. Most people with pollen allergies are allergic to the pollen of trees, grasses and/or weeds. Those who experience allergy symptoms all year long may have additional allergies to something in the home or work environment, such as dust mites, pet dander or mold. The cornerstone of allergy treatment is to avoid the allergens that trigger symptoms. It’s important to be aware of the local pollen count. Good sources are Allergy Partners online or The Weather Channel. When pollen peaks, measures can be taken to prevent symptoms. They include shutting windows, using air conditioning and staying indoors. Forty five percent of homes have enough dust mites to trigger allergies and asthma. Washing bedding in hot water at 130 degrees and encasing bedding may reduce dust mites in the bedroom. Humidifier use should be avoided since increased humidity promotes mite and mold growth. A variety of medications are useful in treating symptoms of allergies, asthma and eczema. Antihistamines are effective in alleviating itching and sneezing, while decongestants alleviate congestion. Nasal sprays (both steroid and antihistamine) effectively treat many nasal symptoms, while a variety of antihistamine eye drops are available for eye symptoms.
16
The Triad Physician
Dr. Elizabeth Scannell is an allergist/immunologist, practicing with Allergy Partners of the Piedmont. Appointments can be made by calling (336) 659-4814. For more information, visit www. allergypartners.com.
A board-certified allergist can identify specific allergies, as well as provide a treatment plan appropriate for each individual and their symptoms. Immunotherapy is a very effective treatment for allergic rhinitis, allergic conjunctivitis and asthma, as well as atopic dermatitis/eczema. Unlike medications that treat symptoms only, immunotherapy truly modifies the immune system and prevents symptoms from developing in the first place. Immunotherapy is effective in approximately 85 percent of adults and children, reducing symptoms and the need for medications. Immunotherapy also has been shown to prevent asthma in young children.
Legal Expertise, Health Care Knowledge Principal Karen McKeithen Schaede, a registered nurse for 10 years, brings in-depth understanding of health care to the practice of law. Our staff can assist you with: • Medical Practice Formation • Physician Employment • Medical Practice Sale, Acquisition or Consolidation • Medical Joint Ventures • Medical Staff Disputes • HIPAA Issues • Corporate Compliance • Contract Disputes • Employment and Labor Law 1175 Revolution Mill Drive Studio 7A Greensboro, NC 27405 Fax: (888) 392-2707 karen@shadylaw.net www.shadylaw.net
336-288-4055
Research News
Heat-Based Nanotube Treatments Can Kill Breast Cancer Stem Cells Wake Forest Baptist Medical Center
represent a promising approach for the
researchers
clinical management of cancers, including
have
proven
again
that
injecting multiwalled carbon nanotubes
“To truly cure a cancer, you have to get
breast cancer.”
rid of the entire tumor, including the small
into tumors and heating them with a quick, 30-second laser treatment can kill them. The results of the first effort involving
drive tumor growth and recurrence.
The Wake Forest Baptist research findings
population of cancer stem cells that could
are reported online ahead of the April print
give rise to metastasis,” Dr. Torti said.
publication in the journal Biomaterials.
“There’s more research to be done. We’re looking at five to 10 years of more study
kidney tumors was published in 2009, but now they’ve directed the science at breast
Using a mouse model, the researchers
and development. But what this study
cancer tumors, specifically the tumor-
injected tumors containing breast cancer
shows is that all that effort may be worth
initiating cancer stem cells.
stem cells with nanotubes, which are
it – it gives us a direction to go for a cure.”
very small tubes made of carbon. By of
themselves, said Dr. Torti, nanotubes
This research was a collaborative effort
biochemistry Suzy V. Torti, Ph.D., of Wake
don’t have any anti-tumor properties, but
between Wake Forest School of Medicine,
Forest Baptist, said breast cancer stem
if they are exposed to laser-generated,
the Wake Forest University Center for
cells tend to be resistant to drugs and
near-infrared radiation they start to vibrate
Nanotechnology and Molecular Materials
radiotherapy, so targeting these particular
and produce heat. This combination can
and Rice University. It was supported in
cells is of great interest in the scientific
produce a local region in the tumor that is
part by grants from the National Institutes
community.
very hot, she said.
of Health and the Department of Defense
“They are tough. These are cells that don’t
Using this method, the group was able to
divide very often. They just sort of sit there,
stop the growth of tumors that were largely
Co-authors include: Frank M. Torti, M.D.,
but when they receive some sort of trigger
composed of breast cancer stem cells.
Andrew R. Burke, Ph.D., Ravi N. Singh,
– and that’s not really well understood – it’s
This suggests that nanotube-mediated
Ph.D., David L. Carroll, Ph.D., James C.S.
believed they can migrate to other sites
thermal treatment can eliminate both the
Wood and Ralph B. D’Agostino Jr., Ph.D.,
and start a metastasis somewhere else,”
differentiated cells that constitute the bulk
all of Wake Forest Baptist; and Pulickel M.
she said. “Heat-based cancer treatments
of the tumor and the cancer stem cells that
Ajayan, Ph.D., of Rice University.
Lead
investigator
and
professor
Breast Cancer Research Program.
Hospital News
Quest Names Top Performing Hospital Alamance Regional Medical Center is one
mortalities, and safely reduced the cost
improve patient safety while reducing the
of four hospitals in North Carolina to be
of care for each patient’s hospitalization,
cost of care and readmissions.”
named a 2011 Top Performing Hospital in
according to a QUEST press release. In the last 30 months, hospitals participat-
a national health care collaborative. The Premier health care alliance’s national
“By collaborating with other hospitals to
ing in the QUEST collaborative reportedly
QUEST collaborative has identified 123
share our patient outcomes and best care
have reduced health care spending by
hospitals nationwide, including Alamance
practices, we are able to enhance the care
$2.85 billion through the delivery of high-
Regional, that achieved care outcomes that
we provide to patients while also taking
quality, evidence-based care. Collaborative
earned a Top Performance award.
a leadership role in driving better results
members also have a five percent lower
within the health care industry,” said John
mortality rate than hospitals who are not
The QUEST Top Performing hospitals
Currin, president and chief executive
participating in the collaborative.
increased delivery of evidence-based care,
officer, Alamance Regional. “Participating
saved lives by reducing avoidable hospital
in the QUEST program is also helping us
March 2012
17
News
Novant Embraces Bedside Reporting Patients and family members at Novant Health’s 13 hospitals are now a part of daily-report conversations once reserved for nurses and other health care staff members. Today, this type of information sharing is being retired, said Sallye Liner, R.N., Novant’s chief clinical officer. The Novant Health hospitals have begun to emulate what a handful of other hospitals around the country have adopted: inviting the patient and family members to participate in a new communication model called nurse bedside reporting. Nurse bedside reporting provides a safer method to hand off care when a patient is transferred to another unit or during a staff change. The incoming nurse and departing nurse, and sometimes other members of the health care team, conduct the report in the presence of the patient, and they invite the individual to join them in the conversation.
Topics during nurse bedside reporting may include a review of clinical information, such as patient allergies or medications, concern about a patient’s unstable blood sugar or high temperature and discussion of upcoming tests or procedures, as well as answering questions and addressing concerns. “Our nurses know that bedside reporting is their opportunity to talk about any issues that impact the care and safety of their patients. It’s also a chance for staff to get to know their patients better,” said Ms. Liner. Nurse bedside reporting provides many benefits to both patients and staff: 1) improved communication and patient understanding of their care, tests and procedures; 2) the ability for nurses to address patient care needs more quickly; 3) higher overall quality of care; 4) a more satisfactory patient experience; and 5) safer care with fewer incidences of medical errors.
“Most patients don’t have any medical training, but they do know their own body and can tell us about their medical history,” said Ms. Liner. “Patients today also want to have information about their care and treatment. When you put that personal knowledge together with a desire for information, the time is right to change health care communication for the better.” “If our goal is to improve patients’ health, then we should provide more opportunities for patients to become involved in their care,” said Sean Keyser, Novant’s vice president for operational improvement. “We’re embracing nurse bedside reporting and a host of other strategies that, when paired together, are powerful tools that are helping us improve health care for our patients,” said Ms. Keyser. As another example, Novant staff in both its hospitals and 360 physician practice locations use a national program called Ask Me 3 to help improve health care literacy and overall communication with patients.
High Point Regional Partners with Duke to Expand Heart & Cancer Care Point Regional Hospital was ranked No. 1 in the Triad for the third consecutive year in 2011.
High Point Regional Health System and Duke Medicine have entered into an agreement to expand program development and operational support for oncology and cardiovascular patient care programs.
expanded, offering area patients new and innovative treatment protocols through clinical trial opportunities. Duke also will provide support for quality and patient safety systems.
“After exploring several opportunities for a clinical affiliation with medical centers around the state and region, we found Duke Medicine to be the right fit,” said Jeffrey S. Miller, president of High Point Regional Health System. “This means our patients benefit from the very best of both treatment facilities, close to home.”
High Point’s Carolina Regional Heart Center offers the full spectrum of heart care services for diagnosis, treatment and education. The center houses the cardiac catheterization lab, a medically directed fitness center and the cardiac rehab program.
“The relationship of the best community oncology program in the Triad with the best oncology program in the state is an incredible match. Patients will be the real beneficiaries of the positive energy this relationship creates,” said Bernard Chinnasami, M.D., medical director, Hayworth Cancer Center.
Hayworth Cancer Center was the first in North Carolina to offer all oncology services under one roof (radiation, outpatient chemotherapy, inpatient care, CT/PET scans, clinical research and supportive care). According to U.S. News & World Report, Hayworth Cancer Center at High
Duke Medicine serves patients throughout the United States and beyond, with more than 61,000 inpatient stays and 1.8 million outpatient visits annually across the Duke University Health System. U.S. News & World Report consistently ranks Duke University Medical Center in the top 10 on
The agreement will provide High Point Regional Health System with access to the clinical, operational and clinical research expertise of Duke Medicine. Hospital-based research programs will be developed and
18
The Triad Physician
News its honor roll of “America’s Best Hospitals,” with a complete range of nationally ranked specialty services.
By entering into this relationship, High Point Regional Health System joins a network of Duke-affiliated hospitals and health systems
in communities throughout North and South Carolina, Virginia, West Virginia, and Florida.
Practice News
Pediatrician Opens Green Building When Ford, Simpson, Lively and Rice Pediatrics’ Bonnie Barth, L.P.N., found her young patient trying to “swim” on the blue stream-shaped floor tiles leading into the exam room of the new pediatric office, she knew the whimsical ambience was having the desired effect. The new 10,171-square-foot building at 2933 Maplewood Ave. was built in compliance with Leadership in Energy and Environmental Design (LEED) standards. Though many of the environmentally conscious building details are not visible to the practice’s young patients, the interior design leads them to believe something is special here. “We wanted to create the healthiest environment possible and to provide a feeling of warmth and cheerfulness, while subtly communicating the special green aspects of the new building,” said Dr. Robert Ford. One of 10 partners, Dr. Ford spearheaded the nine-month LEED project when the practice outgrew its 4,800-squarefoot office next door to the new location.
“While the extra 3 percent to 5 percent cost was a consideration, the positive impact on the environment and long-term reductions in energy costs convinced us that it was the right way to proceed for the health of our patients, staff and the community,” said Dr. Ford. The interior décor complements the use of healthier construction material and techniques with a nature theme – trees, flowers, fluffy blue clouds and the signature stream inlaid into the flooring. It also features flower-shaped lighting and large kite-like leaf hangings.
“We hope that by showcasing the steps we took for compliance to LEED standards – using upholstery materials that are green, biodegradable or have recycled content, purchasing mostly from local manufacturers, using low-emitting carpet and low-VOC (volatile organic compounds) paint, and specifying the most energy-efficient systems – we may inspire other Triad businesses to consider the many benefits of building green,” said Dr. Ford.
“The feedback from our patients and their parents has been overwhelming,” said Susan Kerby, manager of the busy WinstonSalem pediatric practice. “They tell us it feels more like an amazing outside play area than their doctor’s office – and when they find out it is environmentally-friendly, they are even more excited.”
Ford, Simpson, Lively and Rice Pediatrics is a Cornerstone Health Care practice. “Cornerstone is committed to investing in the future of health care delivery to the benefit of all our patients, employees, physicians and the communities we serve. …We saw this (project) as a tangible way to promote the health of each of these groups, now and in the future,” said Grace E. Terrell, M.D., president and chief executive officer of Cornerstone.
Dr. Ford and his partners plan to host an open house, with tours of the building, for local business and civic leaders in March.
For more information, visit www.cornerstonehealth.com or call (336) 794-3380.
Physician News
Roy at Morehead NeuroSpine Mark Roy, M.D., is now practicing on a full-time basis at the new Morehead NeuroSpine in Eden. Dr. Roy completed his medical training at the University of Kentucky College of Medicine in Lexington. He interned and completed his residency in neurosurgery at the University of Michigan Hospital in Ann Arbor. He is certified by the
American Board of Neurological Surgery. Prior to joining Morehead NeuroSpine, he was in practice with Vanguard Brain and Spine Specialists in Greensboro and saw patients in Eden on part-time basis. Dr. Roy specializes in the diagnosis and treatment of degenerative and acute cervical, thoracic and lumbar spine disorders using minimally-invasive and traditional approaches. He also treats compressive
pathology of peripheral nerves, including carpal tunnel, ulnar and radial neuropathy and non-traumatic brachial plexopathy. Morehead NeuroSpine, located at 518 S. Van Buren Road, Suite 6, is open Monday through Friday, from 8 a.m. to 5 p.m. For referral and appointment information, call (336) 635-6806.
March 2012
19
News
Moses Cone Wages High-Tech Germ War Moses Cone Health System is the first in
Xenex PX-UV device in, presses two buttons
Cone with a safer patient environment by
North Carolina to use the Xenex PX-UV
and leaves the room. Eight minutes later, the
reducing the number of microorganisms
against nasty bugs, such as Norovirus,
room has been disinfected without the use
which cause health care associated infec-
MRSA, Clostridium difficile and others, that
of chemicals. Studies have found that the
tions – and that’s a big step towards patient
can contaminate hospital rooms and remain
Xenex PX-UV device is 20 times more effec-
safety.”
there even after thorough room cleanings
tive than chemical cleaning in killing germs. Moses Cone Health System is using the sys-
by trained hospital staff. The Xenex PX-UV device uses a powerful
tem at The Moses H. Cone Memorial Hospi-
The high-tech germ fighter uses ultraviolet
xenon light bulb, whose pulses of UV light
tal, Wesley Long Community Hospital and
light and can disinfect a patient room in less
damage the DNA of bacteria and viruses,
Annie Penn Hospital in Reidsville. Initially, it
than eight minutes.
preventing them from being able to repro-
is being used to clean rooms where MRSA
duce or mutate. The light kills germs on TV
patients have stayed.
“The new Xenex technology enables our
remotes, telephones, ceilings, curtains and
team to provide a more thorough cleaning
other hard-to-disinfect surfaces.
Details about the Xenex system and its effectiveness against specific organisms are avail-
to every surface in a room, eliminating hardto-kill organisms, such as MRSA, in a fraction
“Innovative health care systems, like Moses
able at www.xenex.com. Information about
of the time,” says Mary Jo Cagle, M.D., chief
Cone Health System, are investing in Xenex
the results of the recently completed Xenex
quality officer, Moses Cone Health System.
disinfection technology to make their pa-
trial at The University of Texas MD Anderson
tients safer,” said Brian Cruver, chief execu-
Cancer Center is available by calling (800)
After thoroughly cleaning the patient room,
tive officer of Xenex Healthcare. “The Xenex
553-0069.
the environmental services worker plugs the
system will help provide patients at Moses
Welcome to the Area
Physicians Gerardo Enrique Arnaez Zapata, MD Yadkin Valley Adult Medicine, Elkin
Ashley Snell Chaplin, MD Internal Medicine Wake Forest Baptist Health Winston-Salem
Matthew Ramsey Eskridge, MD Alliance Urology Specialists Greensboro
Scott Farrell Gallagher, MD Winston-Salem
Andrew Michael King, MD Wake Forest University Winston-Salem
Paul Persad,MD Dept of Veterans Affairs Winston-Salem
Elizabeth Ann Rees, MD Emergency Medicine Wake Forest University Baptist Medical Center Winston-Salem
20
The Triad Physician
Upcoming Event Maureen Alice Tumolo,MD Greensboro
Chapel Hill’s Big Running Event in April to Benefit UNC Lineberger
Physician Assistants
For a second year, the Wells Fargo Tar Heel 10 miler and Fleet Feet 4+ mile run will benefit UNC Lineberger Comprehensive Cancer Center April 21.
Thomas Alan Furlong, PA
Runners can register online at http://tarheel10miler.com and enter the code “beatcancer5” to donate $5 per entry to cancer research and treatment in our community.
Radiation Oncology Pilot Mountain
Thomas Christopher Gaines, PA Emergency Medicine Alamance Regional Medical Center Burlington
Tiffany Gail Greene, PA Wake Forest U. School of Med-ER Greensboro
Karen Prueter, PA Neurological Surgery Greensboro
Dana Ann Shumate, PA Family Medicine North Wilkesboro
A $30 donation to the cancer center will be made for each volunteer who affiliates with UNC Lineberger. “Thank you to Endurance Magazine for once again choosing UNC Lineberger as a charity partner,” said Shelley Earp, M.D., UNC Lineberger’s director. “Our missions are aligned; we are all working to make Chapel Hill and North Carolina healthier.” The races attracted more than 3,500 runners to Chapel Hill last April. Among those in the crowd were UNC researchers, doctors, nurses and other staff – all running a hilly course to benefit cancer research and treatment at UNC Lineberger Comprehensive Cancer Center. Overall, more than $10,000 was raised for the cancer center’s programs. Runners wishing to raise more for UNC Lineberger should watch the cancer center’s Facebook page for information on how to set up their own individual or team fund-raising website.
Each year communities come together to create a world with less cancer and more birthdays. At Relay For Life they celebrate the lives of those who have had cancer, remember those lost, and fight back against this disease. Š 2009 American Cancer Society, Inc.
Join your local Relay event. Visit RelayForLife.org or call 1-800-227-2345. Together we’ll stay well, get well, find cures and fight back.
Greensboro
High Point
Winston Salem
June 2, 2012
June 2, 2012
June 2, 2012
CLEVELAND CLINIC
FORSYTH MEDICAL CENTER
Forsyth Medical Center is now affiliated with #1 ranked Cleveland Clinic. Forsyth Medical Center has been selected as the Triad region’s only affiliate heart hospital for the Cleveland Clinic — ranked #1 in the nation by U.S. News & World Report, 17 years in a row. This transforms our healthcare landscape forever. With Forsyth Medical Center and Cleveland Clinic working together, you have the best of the best on your side, with access to the most advanced research, programs, technologies and techniques in the world of cardiovascular medicine and surgery. Now there’s no need for you or your loved ones to travel for most cardiac care. Or to compromise. The #1 choice in cardiovascular care is right here for you.
www.forsythmedicalcenter.org/heart www.clevelandclinic.org/heart