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Archive for July, 2009

Georgia Society of Otolaryngology Annual Meeting

Friday, July 24th, 2009

July 24-26, 2009. Kiawah Island Club, South Carolina.  For more information, contact alice@theassociationcompany.com.

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The First Pediatric Berlin Heart Procedure in Georgia

Friday, July 17th, 2009

July/August 2009 By Julie Budnik It has been a big year for Yasir Yesuf and his family. Yasir, a native of Ethiopia, just celebrated his first birthday thanks in large part to the extremely dedicated and talented medical professionals at Children's Healthcare of Atlanta (CHOA). In December of 2008, Yasir became the first pediatric patient in the state of Georgia to receive the EXCOR Pediatric ventricular assist device, better known as the Berlin Heart. In the past, families of infants and children who were critically ill with debilitating cardiac problems and awaiting transplantation had very few treatment options. The best physicians could hope for was to keep their patients managed with medications or place them on extracorporeal membrane oxygenation (ECMO) and hope that a donor heart would become available sooner rather than later. Unfortunately, many children continued to deteriorate and by the time a heart became available, they were often too ill with multiple organ failure to have a successful outcome. Pediatric cardiologists and surgeons now have a lifeline to offer these children that is very promising in terms of keeping these kids healthy enough to have a fighting chance at a good transplantation outcome - the Berlin Heart. The EXCOR Pediatric ventricular assist device is manufactured by Berlin Heart. The European-based company provides a variety of ventricular assist devices (VDAs) for use in the adult population and the first-ever pediatric device for infants and children. The pediatric device is offered with three different kinds of cannulas, made of high-quality medical silicon, to address anatomical differences in patients. The EXCOR Pediatric blood pump has five volume choices ranging from 10 ml to 60 ml depending on a patient's weight and body surface. The entire device is powered by a laptop computer installed in the Ikus driving unit that powers the pump. The EXCOR Pediatric unit has triple redundancy to the system to ensure patient safety and device reliability.

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The inflow cannula is implanted into the left ventricle with the outflow being attached to the aorta. Essentially, the Berlin Heart is acting as the left ventricle. An additional device may be implanted in to the right ventricle if full support is necessary. Although VADs are commonly used in adult patient populations, there have not been any devices available for children under the age of 3 or infants. The Berlin Heart offers the first real hope for many pediatric patients. "The Berlin Heart allows us to support the circulation of critically ill children awaiting heart transplantation - especially infants - more safely than with previously used devices," said Dr. Kirk Kanter, Chief of Cardiothoracic Surgery at Children's Sibley Heart Center and professor of cardiothoracic surgery at Emory University School of Medicine. "With the Berlin Heart, we can get children waiting for a transplant off the ventilator, walking around and eating - making them better candidates for heart transplantation when a suitable donor does become available." 05702200908000-2.jpg The Berlin Heart has not yet been fully approved by the Food and Drug Administration (FDA); however, CHOA has been granted permission to use the device as a bridge to transplant on a case-by-case compassionate-use basis. Compassionate use is a term used to define the provision of experimental medications or treatments prior to final FDA approval. According to Dr. Brian Kogon, pediatric cardiothoracic surgeon at CHOA Sibley Heart Center and Chief of Adult Congenital Cardiothoracic Surgery and assistant professor at Emory University School of Medicine, patients are considered for the Berlin Heart only when all other options have been exhausted and it is determined that the heart will not recover of its own accord. At that point, the steps to implant a Berlin Heart device take place. "When we have patients who present with cardiomyopathy, we go through many steps to support the heart in hopes that they will recover using everything from medication to mechanical support," said Dr. Kogon. ECMO, a heart-lung bypass, has been the standard in supporting critically ill children awaiting heart transplantation. The patient must be sedated with a paralytic agent to be placed on the ECMO device. The rate of complications is significant with patients on ECMO. "This device is much more invasive, with less than half of the patients surviving until transplantation is available," said Dr. William Mahle, Medical Director of Clinical Research and pediatric cardiologist at CHOA Sibley Heart Center. Dr. Mahle is also associate professor of pediatrics at Emory University School of Medicine. "Of the patients that are on ECMO, there is an 80% increased chance that they will reject their donor heart when it is implanted as well as an 80% increased chance of death within the first five years," said Dr. Mahle. The Berlin Heart only supports the heart rather than the heart and lungs and therefore the patient can be awake and ambulatory unlike ECMO. Patients can also be on the device for an extended period of time if necessary. Heart failure causes children to lose weight or not to gain weight at all. "The Berlin Heart can prevent this from happening and therefore these children are much healthier going into the transplant," said Dr. Mahle. The EXCOR Pediatric VAD is similar to other devices in that a pneumatic device is used that squeezes with each heart beat. "The Berlin Heart is much smaller, which is why it is ideal for pediatric patients," said Dr. Mahle. "The challenge is that there is an increased risk of clotting within the pump, which is why heparin or warfarin is given to address these issues." While the internal device is not reused, the external pumping device that powers the Berlin Heart is rotated among hospitals. The demand for the device is ever increasing and there is a wait, although according to the staff at CHOA, the manufacturer has been extremely responsive in expediting delivery. "We enjoy having the Berlin Heart as an option because there are few choices in children who are small," said Dr. Kogon. In fact, at the time of this interview, Dr. Kogon was preparing to do a potential Berlin Heart procedure the following day on a 1-month-old female whose heart was not showing signs of improvement. To date, more than 200 Berlin Heart procedures have been performed in the United States. The pediatric cardiac surgeons led by Dr. Kanter rely heavily on the team approach to make the process of implanting the Berlin Heart a success. There are four heart transplant coordinators, critical care nursing staff and cardiac intensive care support staff. The research team deals with all of the FDA paperwork and is responsible for getting the device to the surgical team. Anesthesia, surgical attendings and residents, perfusionists, blood bank staff and post-op care are all involved, along with many others. "It is important to have all of these areas of expertise to make the chances of success high," said Dr. Kogon. "The Berlin Heart opens up the repertoire of what we can do and the services we can provide to our patients," said Dr. Mahle. Dr. Mahle reports that 18% of infants have died while waiting for a donor heart. He has high hopes that the Berlin Heart will greatly reduce this number in the future. Dr. Mahle offers the following advice to other physicians and centers who are considering pursuing the Berlin Heart procedure as an option. "You must have a team in place before you get the first patient because of the detailed process. Anticoagulants and management of blood products are essential and you must have a lot of experience with ventricular-assist devices to be successful." Dr. Mahle also recommends that the nursing staff be well trained in the post-op care of the patients receiving the Berlin Heart and in fact the manufacturer recommends that the same person be in charge of post-op wound care. Although the cost of this cutting-edge procedure can exceed $100,000, CHOA supports its use and Dr. Mahle reports that most major insurers are supportive of the device and therefore this should not be a barrier to treatment. 05702200908000-4.jpg The physicians and staff at CHOA are very proud of the fact that the Berlin Heart procedure is now an option for their most medically fragile pediatric patients. "This device has allowed a child who would not have survived for transplantation to have an option," said Dr. Kogon. "We have a center that has the personnel who can do this kind of complex procedure." The significance of CHOA offering this type of surgical option is crucial for the state of Georgia and the region. "Children's has always offered comprehensive cardiac care, which means a child should never have to leave the state for the care they need," said Dr. Mahle. "We are strongly committed to this." The Berlin Heart is just one real-life example of how technology is improving daily and offering new options to patients who once had no options. "This extraordinary possibility has allowed these kids to survive and live a normal life," said Dr. Kogon. Dr. Mahle agrees and went on to say, "The Berlin Heart has gone from being a novelty to an important tool for treating critically ill children." The devoted team at CHOA helped young Yasir have a new chance at life with the use of the Berlin Heart and a successful heart transplant. The hope at CHOA is that many more children will live to see many more birthdayswith use of this dynamic technology in the hands of a skilled and talented team.

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Georgia Pain Initiative’s Conference on Policies and Paths to Improvement

Friday, July 17th, 2009

July/August

National and state experts in the field of pain management discussed topics ranging from patient and prescriber perspectives on pain to the state of pain management in Georgia at the Georgia Pain Initiative’s recent conference, “Connecting Pain Management Policy and Practice to Serve Our Communities.”

The Georgia Pain Initiative was founded to improve the quality of life of Georgia’s children and adults affected by pain through education, advocacy, public policy and the promotion of excellence in clinical practice. It is a project of the American Cancer Society and is a member of the Alliance for State Pain Initiatives. The Georgia Pain Initiative is led by a steering committee that includes representatives from the Georgia Composite Board of Medical Examiners, Georgia Association of Health Plans, Georgia Cancer Coalition, Georgia Drugs and Narcotics Agency, and the American College of Physicians, along with physicians, pharmacists, nurses, social workers and caregivers

The GPI was instrumental in helping improve Georgia’s national pain policy grade, issued by the University of Wisconsin’s Pain and Policy Studies Group, from a D+ to a B in one year. The work of GPI has received commendation from Governor Sonny Perdue and recognition nationally from the Alliance of State Pain Initiatives.

Featured speakers at the day-long conference on May 18 included national speakers Scott M. Fishman, M.D., chief of the division of Pain Medicine and professor of anesthesiology at the University of California, Davis; Rebecca Kirch, associate director of policy, American Cancer Society Cancer Action Network; Aaron Gilson, MS, MSSW, Ph.D., director of U.S. Program, Pain and Policy Studies Group, University of Wisconsin; and June L. Dahl, Ph.D., Alliance of State Pain Initiatives, University of Wisconsin School of Medicine and Public Health. Expert presenters from Georgia included Kelly Erola, M.D., chief medical director, Hospice Savannah; Steven House, M.D., Assistant Professor of Family Medicine, Mercer University School of Medicine; and Sarah Leahy, RN, Clinical Operations Manager of the Center for Pain Relief Children’s Healthcare of Atlanta

Speakers said some key barriers to pain control are fear, misperceptions and confusion on the part of physicians and patients about addiction, dependence and pain medicines; lack of knowledge among patients and their families; and insufficient training for healthcare professionals.

They also said physicians are often reluctant to prescribe pain medications or renew prescriptions because they are unaware of what laws and policies allow and fear possible investigations and legal consequences.

“The stories that you read and hear about are the ones where a doctor has prescribed opioids or other medications for a patient and the results have been negative,” Gilson said.  “Those rare cases are the ones that make the news. Stories of patients suffering pain most often don’t make the news. We don’t hear about the cases where patients are in constant pain because their physicians are worried about the possible consequences of prescribing opioids and other medications.”

Ms. Kirch pointed to a pain research survey conducted among Georgia physicians to gauge their knowledge, attitudes and practices regarding pain management. All physicians licensed in Georgia received the written survey, and 12 percent responded.

The survey also pointed to a communications gap between physicians and their patients. According to the survey, 58 percent of patients say they are asked regularly by their doctors about their pain levels, while 93 percent of physicians say they regularly ask about and assess pain.

Addressing pain in cancer patients, Ms. Kirch said, “Patients should not accept pain as a normal part of cancer. Controlling pain is part of quality cancer treatment.”

The Georgia Pain Initiative is now offering “Pain Management: Providing Effective Treatment for Your Patients,” a one-hour training designed for medical residents, nursing students and pharmacy students. The course addresses myths and misconceptions about treating pain; proper assessment of pain; pharmacological treatments, including opioid use; treating chronic and disease-related pain; and pain in palliative care. For more information on this training; for resources and information about pain management; or to become involved in the work of the Georgia Pain Initiative, please visit the website at www.georgiapaininitiative.org or contact Brittany Freeman at (404) 949-6495.

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Morehouse Grad to Be Surgeon General

Friday, July 17th, 2009

President Barack Obama named Morehouse School of Medicine (MSM) Trustee Dr. Regina Benjamin as U.S. Surgeon General. Benjamin’s nomination marks the second MSM trustee to hold a high-profile position with the Obama administration. Eric Holder, then-vice chairman of MSM’s board of trustees, was confirmed as U.S. Attorney General in February.”Regina Benjamin has been a key member of our board leadership at Morehouse School of Medicine, and we are proud, though not surprised, to see her named Surgeon General,” said MSM President Dr. John E. Maupin Jr. “Her work on our board has demonstrated a real commitment to improving the health of our communities and reducing healthcare disparities, and I have no doubt her public service as Surgeon General will be a benefit to all Americans.”

Prior to her nomination, Benjamin founded Bayou La Batre Rural Health Clinic in Bayou La Batre, Alabama, and served as the clinic’s chief executive officer. She was named a John D. and Catherine T. MacArthur Foundation fellow in 2008, which awarded her a $500,000 fellowship grant to continue providing quality medical care to underserved communities.

She served as associate dean for rural health at the University of South Alabama’s College of Medicine, where she administered the Alabama-AHEC and USA Telemedicine Programs. She also served as president of the State of Alabama Medical Association.

Her commitment and self-sacrifice have been recognized by the American Medical Association board of trustees, where she became the first African-American woman and first person under 40 to be elected to its board. Her other accolades include being named by Time magazine as one of the “Nation’s 50 Future Leaders Age 40 and Under,” and “Woman of the Year,” by People magazine.

Benjamin earned a bachelor’s degree from Xavier University of Louisiana and was a member of the second graduating class of MSM, in 1982. She completed her doctor of medicine from the University of Alabama at Birmingham and her residency in family practice at the Medical Center of Central Georgia. Benjamin also holds an M.B. A. from Tulane University.

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Georgia Lung Associates Founder Lost to Cancer

Friday, July 17th, 2009

Dr. Edward I. Swartz, founder of Cobb-based Georgia Lung Associates, passed away Sunday, July 12, at the age of 59 after battling cancer. He is survived by his wife Eileen and four children.

Dr. Swartz founded Georgia Lung Associates in 1984 and led its growth into the largest pulmonary practice in the state. He prided himself on always putting his patients first, and the practice reflected that attitude.  In addition to focusing on his patient’s pulmonary care, he also gave special attention to their emotional needs as well.

“We have all suffered a tremendous loss,” said Georgia Lung Associates Partner Stuart Simon, MD. “Dr. Swartz was a talented physician, and a wonderful person. His patients were always his top concern.”

Dr. Swartz was not your typical physician. Being an avid Atlanta Braves fan, he wanted everyone to share in his enthusiasm. The Georgia Lung Center at Kennestone featured a mini-Braves museum with artifacts dating back to the early 1900’s. The Georgia Lung Center at Cobb is adorned with Braves paraphernalia throughout, including signed jerseys, bats, balls, gloves, and posters.

Dr. Swartz felt strongly about being part of the community and helping in any way possible. For years, Georgia Lung physicians have provided care to the uninsured through the Cobb Clinic. Georgia Lung also awards a scholarship, named the Edward I. Swartz Magnet Scholarship, every year to a deserving college-bound senior from South Cobb High School who wants to pursue a career in the health sciences. The award, begun in 2002, pays up to $8,000 to each student over four years.

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MAA to Support 13th Congressional District Health Fair

Friday, July 17th, 2009

The Medical Association of Atlanta has agreed to assist Congressman David Scott by providing medical screenings at his 5th annual health fair. Dr. Yolanda Whyte from the MAA will be coordinating physician volunteers to provide health screenings for skin cancer, diabetes, depression, asthma as a service to the community.

The health fair is being held in the 13th congressional district at Mundy’s Mill High School in Jonesboro, GA. The health fair is expected to serve 1500 constituents from Cobb, Clayton, Douglas, Fulton, Henry, and DeKalb Counties.

The Medical Association of Atlanta is committed to champion our community’s well-being and safety while advocating a healthy environment in which physicians practice and serve

Event: 13th Congressional District Health Fair
Date: Saturday 8/15/09, 10am-2pm
Location: Mundy’s Mill High School at 9652 Fayetteville Road (Hwy 54) Jonesboro, GA 30238

For more information contact David Waldrep 404-881-1020

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Cervical Cancer Study

Friday, July 17th, 2009

Emory Winship Cancer Institute is enrolling patients with cervical cancer in a study aimed at refining how radiation is delivered against tumors.

The study tests the use of radio-frequency beacons, sometimes described as “GPS for the body,” to gain information on how the cervix moves over the course of external radiation treatment.

“Our long-term goal is to deliver radiation more accurately, which may improve the effectiveness and reduce the side effects of treatment,” says principal investigator Peter Rossi, MD, assistant professor of radiation oncology at Emory University School of Medicine.

About 11,000 women were diagnosed with invasive cervical cancer in the United States in 2009. The disease is responsible for approximately 4,600 deaths per year, according to the American Cancer Society.

A cervical tumor may move day to day, and even second to second based on patient movement, breathing or filling of the adjacent bladder or rectum. This movement can complicate treatment for cervical cancer.

External radiation treatment, a key component of curative treatment for advanced cervical cancer, is given over minutes a day for several days or weeks. Because of the uncertainty of motion, larger fields of radiation may be necessary, which also may cause more radiation exposure to healthy organs such as the bowel or bladder, possibly causing side effects.

Two beacons, each roughly the size of a grain of rice, are attached to a plastic sleeve that lines the cervix and is applied without surgery. Researchers want eventually to use the beacons to shape the radiation beam and avoid healthy organs, but first need more information about how the cervix and the beacons move during treatment.

During radiation treatment, the beacons are activated and a detection system determines their exact location in the body, 20 times a second, which is similar to GPS.

“Using the beacons, we’ve reported that it’s possible to reduce the size of our radiation field and reduce side effects during prostate cancer treatment,” Rossi says. “This study is part of an effort to make women with cancer able to benefit from this technology as well.”

Patients with cervical cancer grades 1B to 4 are eligible for the current study.

The beacons are made by Calypso Medical and have been FDA-approved for prostate cancer but not for other types of cancer.

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Surgeons Perform Single-Site Incision Surgery on Pediatric Patients

Thursday, July 16th, 2009

Surgeons at Children’s Healthcare of Atlanta recently implemented the next step in minimally invasive surgery—single-site incision surgery. This technique is being used during routine surgeries at Children’s.

Traditional laparoscopic surgical incisions are made in different locations on the abdominal wall, resulting in several small scars. The single-site method, however, is considered scarless because only one incision is made in the belly button and is typically difficult to see. Patients who undergo single-site procedures enjoy all the benefits of laparoscopic surgery, such as rapid recovery and less pain than that associated with traditional open surgery.

Surgeons at Children’s are using this method for multiple procedures, including appendectomy, removal of the spleen, and stomach surgery.  “Single site surgery takes minimally invasive surgery (laparoscopic surgery) to the next level,” said Mark Wulkan, M.D., who performs surgery at Children’s and is an Associate Professor of Surgery and Pediatrics at Emory University School of Medicine. “Children leave the operating room with virtually no scars.”

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