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Archive for February, 2010

Greenbaum Elected to the Council of the American Society of Pediatric Nephrology

Friday, February 26th, 2010

Larry Greenbaum, M.D., Ph.D., Chief of Nephrology at Children’s Healthcare of Atlanta at Egleston and Chief of Pediatric Nephrology at Emory University School of Medicine, was recently elected to the Council of the American Society of Pediatric Nephrology (ASPN).  Dr. Greenbaum is the first physician from Georgia to serve on the 10-person ASPN council and will serve until June 2013.

“As medical director of nephrology at Children’s, Dr. Greenbaum has proven himself as a respected leader among patient families, staff and colleagues,” said Amy Hauser, Service Line Administrator for Transplant Services at Children’s. “We are excited this opportunity will allow him to expand the scope of his leadership and represent Georgia on a prestigious national scale.”

During his three-year term, Dr. Greenbaum will lead the ASPN workforce committee as it seeks to evaluate current workforce needs in pediatric nephrology and increase the number of physicians who choose to become pediatric nephrologists. In response to a significant national shortage of pediatric nephrologists, Dr. Greenbaum will lead council efforts to establish methodology for assessing short-term and long-term workforce needs and develop recruitment programs.

The American Society of Pediatric Nephrology (ASPN) was founded in 1969 to promote optimal care for children with renal disease and to disseminate advances in the clinical practice and basic science of pediatric nephrology. For the past 39 years, the ASPN, which counts more than 600 members, has been and continues to be, the primary representative of the pediatric nephrology community in both the United States and Canada.

The Nephrology Program at Children’s provides comprehensive care to infants, children and adolescents with acute and chronic kidney disorders, high blood pressure, and fluid and electrolyte imbalances.  The program is home to Georgia’s only pediatric dialysis unit and manages about 45 dialysis patients a month, one of the largest volumes in the county. The Children’s Kidney Transplant Program is one of only a few pediatric transplant centers to have completed 400 kidney transplants.

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Sixty Percent of Atlanta’s HIV Cases in One Geographic Area Downtown

Friday, February 26th, 2010

The HIV epidemic in metropolitan Atlanta is concentrated primarily in one geographic area or cluster consisting of 157 census tracts centralized in the downtown area. This area concentrates 60 percent of the city’s HIV cases, according to research conducted by investigators in the Emory Center for AIDS Research (CFAR).

The prevalence rate of HIV within the cluster is 1.34 percent and is compatible with what the World Health Organization would describe as a “generalized epidemic,” a term used for places with an HIV prevalence of over 1 percent. In comparison, outside the cluster the HIV prevalence is 0.32 percent.

The research will be presented Thursday, Feb. 18 at the 17th Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco.

“Atlanta includes more than 60 percent of HIV cases in Georgia, but the distribution of the epidemic has not previously been explored,” says author and presenter Paula Frew, PhD, MPH, assistant professor of medicine at Emory University School of Medicine and an investigator in the Emory Center for AIDS Research (CFAR).

The investigators assessed prevalent HIV cases in four metro area counties – Clayton, DeKalb, Fulton and Gwinnett – to determine case distribution and the presence of service providers offering voluntary HIV testing and counseling services. They obtained HIV prevalence data, as of October 2007, from the Georgia Division of Public Health and matched it to census tracts. They also used data from the 2000 census to examine population characteristics such as poverty, race/ethnicity, and drug use.

The large Atlanta HIV cluster is characterized by a high prevalence of poverty, a greater percentage of African-American residents, and high prevalence of behaviors that increase the risk of HIV exposure such as injection drug use and men having sex with men.

The investigators also found that 42 percent of HIV service providers in Atlanta are located in the cluster, which should facilitate prevention and treatment.

With more than 50,000 new HIV infections reported yearly in the United States, according to the Centers for Disease Control and Prevention, the HIV/AIDS epidemic continues to be a public health problem. The number of HIV/AIDS cases is increasing faster in the South compared to other areas of the country. According to Kaiser State Health Facts, Georgia ranks 9th in the nation in the number of HIV/AIDS cases with more than 3,000 new HIV infections diagnosed in 2007.

“Prevention efforts targeted to the populations living in this identified area, as well as efforts to address their specific needs, may be most beneficial in curtailing the epidemic within this cluster,” Frew says.

Other authors of the study include Emory CFAR members Brooke Hixson, MPH; Saad B. Omer, MBBS, MPH, PhD; and Carlos del Rio, MD.

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HPV Vaccine Shows Promising Results in Genital Diseases in Young Women

Friday, February 26th, 2010

A five-year, multi-site international study has shown that human papillomavirus (HPV) vaccinations given to adolescents and young women decrease the number of abnormal Pap smears, biopsies and cases of genital warts.

Since some of these genital abnormalities are identified as precursors to cancer, it is anticipated that these findings will eventually translate into lower rates of cervical, vulvar and vaginal cancers.

HPV is one of the most common sexually transmitted infections. Although most infections will clear up without intervention, some infections with low-risk HPV (types 6 and 11) can cause genital warts and abnormal cervical cells, while high-risk types of HPV (types 16 and 18) can progress to cancers of the cervix, vulva or vagina.

“Cervical cancer is the second leading cause of cancer death in women worldwide, right behind breast cancer in women,” says Kevin Ault, MD, associate professor in the Department of Gynecology and Obstetrics, Emory University School of Medicine, and a co-investigator on this study. “This vaccine has been shown to reduce the number of biopsies and painful treatments in women, while also reducing cancer risks in a woman’s life.”

The researchers studied 17, 622 women aged 15 to 26 years who were enrolled in one of two randomized, placebo-controlled, efficacy trials for the vaccine targeting HPV types 6, 11, 16 and 18 (known as a quadrivalent vaccine). Women in one group were uninfected with HPV (negative to 14 HPV types), while another group had a mixed population of HPV-exposed and -unexposed women (intention to treat group). All women underwent cervicovaginal sampling and Pap testing.

In the group that was uninfected with HPV, vaccination was up to 100 percent effective in reducing the risk of HPV 16/18-related high-grade cervical, vulvar and vaginal lesions and of HPV 6/11-related genital warts. In the mixed group, vaccination was statistically significant in reducing the risk of any high-grade cervical, vulvar and vaginal lesions, genital warts, Pap abnormalities and cervical therapy, irrespective of HPV type.

“The HPV vaccine is specifically designed to prevent cancer in its earliest stages,” says Ault. “Researchers were aware of the tight link between HPV and cancer, which helped in the development of this vaccine.”

Ault continues, “Many of the treatments for HPV today can cause problems later in life for pregnant women, which can lead to premature delivery of their babies. We hope getting this vaccine during a woman’s younger years will prevent those complications, as well.”

The U.S. Food and Drug Administration approved the preventative vaccine, known as Gardasil, in 2006 for use in females nine to 26 years of age. To date, there is no vaccine specifically designed to treat HPV, once infected.

With this data now complete, the researchers are looking at the possibility of second-generation vaccinations for more types of HPV not covered by the quadrivalent vaccine.

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Northside Hospital-Forsyth now offers Percutaneous Coronary Interventions – PCI

Thursday, February 25th, 2010

Northside Hospital-Forsyth now offers Percutaneous Coronary Interventions – PCI (previously called cardiac angioplasty).

Currently, there is no provider located in Forsyth or Dawson counties offering this service. Northside Hospital-Forsyth is expected to primarily serve the residents of these two counties since approximately 70% of the hospital’s inpatients, outpatients and emergency department patients originate from this area. In 2007, more than 300 residents from Forsyth and Dawson needed PCIs and all of these patients had to leave their home counties in order to receive the necessary medical care.

In 2008, the Northside Hospital-Forsyth saw/treated more than 230 heart attack patients. Having an adult PCI program in place will allow the Hospital to provide the potentially “muscle saving” heart services without the patient having to be transported to Atlanta.

PCI is recognized as a critical interventional procedure for individuals suffering a heart attack due to blockage in the arteries. Historically, Georgia law only permitted PCI services to be provided in hospitals with on-site open heart surgery programs. However, in 2008, the Georgia General Assembly amended the CON (Certificate of Need) laws to permit any hospital offering diagnostic cardiac catheterization services to apply to offer PCI services without an on-site open heart surgery program, provided the hospital could demonstrate that it complies with strict criteria established by Georgia’s Department of Community Health to offer high-quality angioplasty services. One of the crucial requirements is for the hospital to have very specific protocol in place regarding expedited transfer of patients in the event it is determined the patient needs open heart surgery capabilities or back-up. Northside Hospital-Forsyth has partnered with St. Joseph’s Hospital of Atlanta if patient transfer is deemed necessary. The Hospital also has an agreement with Central Emergency Services and Air Methods (EMS services) to ensure timely transports, by ground or air, with advanced cardiac life support capabilities onboard.

“The high-quality service along with the experienced physicians and staff at Northside Hospital-Forsyth are of a very high caliber, and have performed hundreds of angioplasties at other hospitals,” said Aman Kakkar, M.D., Northside Hospital-Forsyth’s Cardiac Cath Lab Medical Director. The “team’s” combined experience includes more than 60 years of cath lab expertise, so cardiac patients can rest assured they will be in good hands at Northside Hospital-Forsyth.”

Additionally, the Hospital has been approved to open a second cardiac cath lab. This lab will further enhance the cardiac services available at Northside Hospital-Forsyth. The second lab will be operational in May. The existing cath lab saw more than 850 patients in its first 12 months of operation.

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Southeastern Critical Care Summit

Monday, February 8th, 2010

February 8-9, 2010 at the Emory Conference Center. For more information, contact Paula Massey at 404-616-0148 or pmassey@emory.edu

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AMGMA Meeting

Thursday, February 4th, 2010

February 4, 2010 at The Retreat at Dunwoody. For more information, visit www.atlantamgma.com

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Cobb Medical Society General Membership Meeting

Wednesday, February 3rd, 2010

February 3, 2010 at the Georgian Club. For more information, visit the Cobb Medical Society web site.

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Alcohol-Based Cleanser Found Superior to Iodine Formula in Battling Surgical Infections

Tuesday, February 2nd, 2010

Cleansing a patient’s skin prior to surgery with chlorhexidine alcohol – instead of the more commonly used povidone iodine – has proven to be a more effective and powerful barrier to reducing or preventing infections after surgery.

Research comparing the two strategies was reported in the Jan. 7, 2010, issue of the New England Journal of Medicine. The study was co-authored by Alexandra Webb, MD, assistant professor of surgery, Emory School of Medicine, and chief of general surgery at the Atlanta Veterans Affairs Medical Center. The findings by Webb and her team are important, as hospitals and health care providers are continuously striving to reduce and eliminate surgical site infections in patients.

The study was a randomized clinical trial between April 2004 and May 2008 at six university-affiliated hospitals across the United States, including the Atlanta Veterans Affairs Medical Center, which is affiliated with Emory School of Medicine. A total of 897 patients were randomly assigned to a study group: 431 to the chlorhexidine–alcohol group and 466 to the povidone–iodine group. Of the 849 patients who qualified for the intention-to-treat analysis, 409 received chlorhexidine alcohol and 440 received povidone iodine.

Webb and the team found that using chlorhexidine as the preoperative skin cleanser reduced infections by 41 percent compared with povidone iodine.

“This is a very important study on skin preparation to prevent surgical site infection on many levels and should be evaluated for consideration of change of practice in surgical protocol,” says Christian Larsen, MD, chair of the Department of Surgery, Emory School of Medicine. “This is an example of research that directly impacts the quality of patient care. A reduction of the surgical site infections of this magnitude would greatly reduce morbidity and have a major economic impact for hospitals, patients and employers around the country.”

More than 27 million surgical procedures are performed each year in the United States. According to the Centers for Disease Control and Prevention, there are approximately 1.7 million health care-associated infections each year in U.S. hospitals. Of these infections, 22 percent – or about 400,000 – are surgical site infections, which result in longer hospital stays, readmission or sometimes death.

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Dr. Rutledge Forney

Tuesday, February 2nd, 2010

A Second Chance — A “Late Start” in Medicine is Rewarding

By Helen K. Kelley

Dr. Rutledge Forney has always been a problem solver. First, she used that ability as a successful management consultant. Today, she’s a problem solver in her second career as a medical practitioner.

Growing up in Birmingham, AL in the 1960s, young girls were generally steered toward becoming homemakers and mothers and, just to be safe — in the event they didn’t marry — were encouraged to select a “gentler” career path than their male counterparts, such as teaching or bookkeeping. So, even though Forney had an aptitude for science and math and a quiet dream of becoming a doctor, she ended up choosing an alternate road — and using an alternate aptitude — in business.

However, in the late 1980s, Forney found herself at a career crossroads… and reexamining her childhood dream. It was a case of now or never. She applied and was admitted to Emory University’s School of Medicine and graduated with a medical degree in 1996.

“I was a late starter,” says Forney, who completed her residency in San Francisco before returning to Atlanta to practice dermatology in 2000. A lot of people don’t have the opportunity to start a new career in mid-life. I was fortunate.”

The business of medicine

Forney acknowledges that her former career in business has been very helpful in her present occupation as a physician, especially when it comes to making a practice run efficiently.

“The biggest challenge for a doctor is running a business,” she says. “We must ask questions like, ‘How can I deal with government restrictions and the amounts that insurance companies will allow us to earn, while still delivering excellent care to our patients?’ I spend a lot of time thinking about how to do things well in my practice. And it helps to view them through business glasses.”

Quality of patient care and patient satisfaction are crucial to the success of a practice, as is addressing the needs and desires of the current patient base, Forney notes. Right now, that patient base includes a growing number of baby boomers.

“Care and support of mid-life patients is a large part of the dermatology practice these days. Luckily, I’m a baby boomer fighting aging, myself,” she says. “These patients are coming to dermatologists for medical and surgical solutions for health problems such as psoriasis or skin cancer. But they’re also very interested in cosmetic treatments such as Botox, “fillers,” hair removal and skin care products.”

Forney and her colleagues at Dermatology Affiliates make it a point to stay abreast of the latest medical advances in dermatology, both surgical and nonsurgical.

“For example, in the world of skin cancer, there is a desire to find ways to treat skin cancers non-surgically. In the past eight years or so, several alternatives to surgery such as creams and light treatments have become available,” Forney notes. “I think we’ll see many more nonsurgical treatments in the near future.”

There is also a growing demand for laser procedures, not just for hair removal but also for treating sun-damaged skin. Dermatology Affiliates has a Fraxel Dual Wave Laser, which employs a new wavelength to resurface skin.

“The Fraxel Dual Wave is a notable advance,” says Forney. “But we hope that the need for it will, one day, become extinct, simply because people are more knowledgeable about their skin and the sun, and are taking better care of themselves.”

The MAA and the “10-90” Rule

Like most everyone else these days, physicians find themselves squeezed financially and they have to make tough decisions about where their dollars are getting the most return. Sometimes, this means cutting back on memberships in specialty associations.

Forney, who currently serves as President of the Medical Association of Atlanta (MAA), says that it’s important for associations to offer services that are of real value to members.

“There are so many organizations in which doctors already have to participate, so the MAA is constantly looking at ways to increase services and resources that will benefit members and make membership attractive,” she says.

Forney also points out that strides made by the MAA are beneficial not only to its members, but to all Atlanta area physicians.  She calls it the “10-90” Rule.

“Let’s say that about 10 percent of the Atlanta physician population are members of the MAA. Those 10 percent are carrying the other 90 percent,” she explains. “The members who are active participants are achieving results that benefit all doctors — yet all doctors don’t have to belong. Can you imagine the huge difference it would make if the other 90 percent would join the association and add their support?”

Forney is passionate about the MAA and encourages all area physicians to join — even if they can’t participate actively — because there is strength in numbers.

“Just because you’re not participating doesn’t mean you shouldn’t join,” she explains. “One of the main benefits to membership is being part of your local physician community. Being a part of it — even if all you do is read the association newsletter — makes you aware of what your community is doing and what’s going on in your profession, including political activity.”

The association has provided significant opinion and guidance in times of crisis and uncertainty for the health of the region’s citizens. A prime example of this is the struggling Grady Health System. Grady is the only level I trauma center within 100 miles of metro Atlanta, and also provides important emergency services for burn, asthma, sickle cell and stroke patients, among others.

“If Grady went under, it would affect all of us. Grady absorbs the lion’s share of treatment for trauma victims in Georgia. Patients with nowhere else to turn go to Grady. A huge number of physicians have trained at Grady. The MAA has been very vocal about the importance of Grady to the entire community,” Forney states. “Even if we can’t entirely change the situation, we can at least talk about it. It’s our responsibility to create awareness and gain support for issues like this.”

The MAA gives a unified voice to the Atlanta physician’s voice, especially when it comes to legislation. Considering the fact that Georgia’s Governor and other elected officials often turn to the MAA for expert advice and opinions, having a strong and active membership is critical, says Forney.

“What happens to physicians affects our patients. If doctors don’t have a role in setting healthcare policy at all levels, government will control it all. People would be shocked at the impact our government has on doctors’ lives,” she states. “As physicians, we should be able to shape the system for the better in terms of the health of America. We need to be at the table with an organized voice. We can’t be there as individuals; we have to be there as a group.”

For Rutledge Forney, it’s obvious that a second career in medicine was a natural progression from her earlier calling to the business world. She has been able to channel the best of both skill sets, plus a passion for making the healthcare world a better place, into one perfect occupation. Sometimes, a dream deferred evolves into a dream realized.

Rutledge Forney, M.D., is board certified in medical, surgical and cosmetic dermatology. Her practice, Dermatology Affiliates, has two locations — one in Buckhead and the other in East Cobb. For more information, log on to dermatologyaffiliates.com.

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Cardiovascular Consultants of Georgia joins Piedmont Heart Institute

Tuesday, February 2nd, 2010

Cardiovascular Consultants of Georgia (CCG) has joined Piedmont Heart Institute (PHI). “We are proud to have this distinguished group of cardiac specialists on our team serving area residents in Fayette and Coweta Counties,” said Michele M. Molden, president and CEO of the Piedmont Heart Institute.

Previously, CCG physicians were part of Cardiac Disease Specialists (which joined PHI in June 2008), and are members of the medical staffs of Piedmont Fayette Hospital and Piedmont Newnan Hospital. The nine-member practice has four office locations including Fayetteville (two locations), Newnan and Sharpsburg.

CCG will continue to serve its patients and our communities and also work with Piedmont Fayette and Piedmont Newnan hospitals to further develop their expertise and capabilities in cardiovascular medicine. Both hospitals already offer cardiology services including general cardiology, adult diagnostic cardiac cath, EKG, EEG, echocardiography, stress testing, cardiac imaging and cardiac rehabilitation. Soon, Piedmont Fayette Hospital will add interventional cardiology to its collection of cardiac services.

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