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Archive for September, 2012

Coalition of Atlanta Medical Societies – Legislative Dinner

Monday, September 24th, 2012

September 24, 2012, Crowne Plaza Atlanta Perimeter at Ravinia.  For more information, visit Medical Association of Atlanta.

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NFMGMA September Educational Session

Wednesday, September 19th, 2012

September 19, 2012, Alpharetta. For more information, visit North Fulton Medical Group Management Association

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Atlanta Medical Group Management Association A/R Summit

Tuesday, September 4th, 2012

September 13, 2012. For more information, visit Atlanta MGMA

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How “High Tech Dummies” Are Revolutionizing Pediatric Healthcare Training

Tuesday, September 4th, 2012

Medical education has traditionally relied on the concept of ”see one, do one, teach one” to educate learners. However, with increasing numbers of trainees and reduced training hours, there are fewer real patient opportunities for learners to be exposed to less common medical conditions.

Following release of the Institute of Medicine’s report, To Err is Human: Building a Safer Health System, patient safety has become a major focus in healthcare, and educators are emphasizing the need for more hands-on learning before medical trainees have contact with real patients. Therefore, new approaches to medical education are required, and simulation using realistic mannequins and scenarios helps provide needed training opportunities.

What is Simulation?

Simulations “scenarios” are cases designed to closely approximate real-world situations for the purposes of training and evaluation. Modern-day simulation finds
its roots in commercial aviation, nuclear power and the military, where inherent risks of catastrophic error exist on a daily basis and where training in the real world would be too costly or dangerous.

The era of modern medical simulation began with the first “high-fidelity” simulator designed by Denson and Abrahamson(1). Fidelity is the extent to which the appearance and behavior of the simulator or simulation match the appearance and behavior of the simulated system. High-fidelity simulators facilitate student interaction by providing direct feedback in the form of physical findings such as heart sounds, breath sounds, palpable pulses, blinking eyes and even speech. Patient responses, generated by the mannequin’s operator through a computer-driven model, allow vital signs to change in response to administered medications or interventions.

Because of their extensive life-like capabilities, simulators can be quite expensive, approximately $40,000 to $50,000. Nonetheless, developing simulation programs that teach a variety of health care providers the cognitive, technical and behavioral aspects of managing a wide array of medical conditions is a wise investment.

Although simulation experiences are designed to be as real as possible in order to facilitate experiential learning, there are many challenges inherent in achieving this realism. This underscores the tremendous advantage of using high-fidelity simulation in which the simulator is able to mimic real physical findings and real physiological responses. However, the cost and limited availability of high-fidelity simulators means that they cannot be used in all areas of medical training – yet. To maximize their value and potential, medical educators aim to match the amount of realism to the desired educational objectives of the simulation session.

For simulations in which a high degree of realism is desired, the primary goal of the simulation-based educator should be to “suspend disbelief,” allowing students to immerse themselves in learning experiences that most closely match those encountered in real life. Realism can be created in a number ways, such as replicating the environment, documentation, patient monitors, addition of multidisciplinary team members, using actors, limiting instructor involvement during the scenario and requiring the utilization of normal resources (i.e. drawing code drugs and requiring them to be given through an IV to the mannequin).

Benefits of Simulation

With few opportunities for hands-on practice with real patients, certain skills are taught didactically. Limited opportunities to practice skills, especially in pediatrics, impair learner proficiency and performance, erodes provider confidence and increases the chances of medical errors or adverse outcomes.

Incorporating David Kolb’s Experiential Learning Model2, simulation can provide a learning experience that incorporates key elements to make the experience realistic (the simulation) with immediate “real-world” relevance. A major benefit of simulation education in pediatrics is that it increases exposure to acutely ill or injured children in an immersive environment. Simulation provides additional and ongoing opportunities for experience and practice in the assessment and management of children and also enhances the capability for reflection, generalization and application.

Using simulation for team training, with the incorporation of human factors that contribute to medical errors, may have even greater benefits. The quality of team behavior has been shown to improve following simulation training and may lead to a subsequent reduction in the number of medical errors.

Pediatric Simulationin Atlanta

Over the last several years, there has been a dramatic increase in simulation-based pediatric training and education in greater Atlanta. In July 2009, Emory and
Children’s Healthcare of Atlanta developed the Pediatric Education, Safety and Quality Development Through Simulation (PEDSIM) program to enhance education of residents and other trainees.

PEDSIM facilitates team building and communication in a safe and controlled environment and helps residents and fellows learn to function as team leaders, applying physiologic principles in real time – before actually taking care of children. The Emory Center for Experiential Learning (ExCEL) provides a state-of-the-art facility for residents and fellows to receive task- and scenario-based training.

Simulation experiences also take place in patient rooms at Children’s Healthcare of Atlanta hospitals, where medical teams are called upon to manage and care for a child without any forewarning (i.e. mock codes). This “in situ” simulation adds the highest degree of fidelity to any scenario. Additionally, the program helps interns become proficient at performing lumbar punctures by implementing “just in time training.” Interns practice on a mannequin with supervision “just” prior to performing the procedure on a “real” patient. (PEDSIM link: http://med.emory.edu/excel/pedsim/)

This year, the Children’s Training, Excellence and Mastery through Simulation (TEAMS) Center was created. With a dedicated group of simulation experts and specialists, the TEAMS center will aim to embed key elements of crisis resource management (CRM), such as role clarity, team building concepts and enhanced communication skills with healthcare providers. These CRM principles are of paramount importance to high-quality and safe healthcare delivery.

Using portable high-fidelity mannequins, we simulate a variety of clinical situations in an effort to standardize workflow and provide staff and physicians experience in managing infrequent but critical events. Thanks to the generous support of Neal and Joan Allen, a simulation room equipped with video-recording capabilities is being constructed at Scottish Rite that will provide a dedicated area within the children’s hospital for medical staff to train.

These are just the beginnings of a vision to have simulation play a key role in education, quality and safety for the children of Atlanta. In the future we will
be conducting continuing medical education (CME) programs, expanding to satellite outpatient care clinics and developing community outreach programs for local healthcare providers to increase exposure to pediatric- based procedures and patient management.

By incorporating simulation into routine medical training at Emory and Children’s Healthcare of Atlanta, we hope to use this novel educational vehicle to continually improve safety and quality of care to pediatric patients throughout our community. We are also working to become a model program nationally for use of simulation in graduate and continuing medical education.

References
1. Denson JS, Abrahamson S. A computer-controlled patient simulator. JAMA 1969; 208:504-8.
2. Kolb D. Experiential Learning: Experience as a Source of Learning and Development. Englewood Cliffs: Prentice Hall, 1984.

Kiran Hebbar, M.D., F.A.A.P. is Assistant Professor of Pediatrics, Emory University School of Medicine. He is Pediatric Critical Care Medicine, Medical Director Children’s TEAMS Center for Simulation, Medical Director Egleston, Technology-Dependent ICU Children’s Healthcare of Atlanta at Egleston.

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Blood Test for Alzheimer’s Gaining Ground

Tuesday, September 4th, 2012

The possibility of an inexpensive, convenient test for Alzheimer’s disease has been on the horizon for several years, but previous research leads have been hard to duplicate.

In a study published online and in the upcoming issue of the journal Neurology, scientists have taken a step toward developing a blood test for Alzheimer’s, finding a group of markers that hold up in statistical analyses in three independent groups of patients.

“Reliability and failure to replicate initial results have been the biggest challenge in this field,” says lead author William Hu, assistant professor of neurology at Emory University School of Medicine. “We demonstrate here that it is possible to show consistent findings.”

Hu and his collaborators at the University of Pennsylvania and Washington University, St. Louis, measured the levels of 190 proteins in the blood of 600 study participants at those institutions. Study participants included healthy volunteers and those who had been diagnosed with Alzheimer’s disease or mild cognitive impairment (MCI). MCI, often considered a harbinger for Alzheimer’s disease, causes a slight but measurable decline in cognitive abilities.

A subset of the 190 protein levels (17) were significantly different in people with MCI or Alzheimer’s. When those markers were checked against data from 566 people participating in the multicenter Alzheimer’s Disease Neuroimaging Initiative,  only four markers remained: apolipoprotein E, B-type natriuretic peptide, C-reactive protein and pancreatic polypeptide.

Changes in levels of these four proteins in blood also correlated with measurements from the same patients of the levels of proteins [beta-amyloid] in cerebrospinal fluid that previously have been connected with Alzheimer’s. The analysis grouped together people with MCI, who are at high risk of developing Alzheimer’s, and full Alzheimer’s.

“We were looking for a sensitive signal,” says Hu. “MCI has been hypothesized to be an early phase of AD, and sensitive markers that capture the physiological changes in both MCI and AD would be most helpful clinically.”

“The specificity of this panel still needs to be determined, since only a small number of patients with non-AD dementias were included,” says Hu. “In addition, the differing proportions of patients with MCI in each group make it more difficult to identify MCI- or AD-specific changes.”

Neurologists currently diagnose Alzheimer’s disease based mainly on clinical symptoms. Additional information can come from PET brain imaging, which tends to be expensive, or analysis of a spinal tap, which can be painful.

“Though a blood test to identify underlying Alzheimer’s disease is not quite ready for prime time given today’s technology, we now have identified ways to make sure that a test will be reliable,” says Hu. “In the meantime, the combination of a clinical exam and cerebrospinal fluid analysis remains the best tool for diagnosis in someone with mild memory or cognitive troubles.”

Hu’s research began while he was a fellow at the University of Pennsylvania. Collaborators included David Holtzman from Washington University at St. Louis, Leslie Shawand John Trojanowski from the University of Pennsylvania, and Holly Soares from Bristol Myers Squibb.

The Alzheimer’s Disease Neuroimaging Initiative is supported by the National Institutes of Health and several pharmaceutical companies. Hu’s research is supported by the Viretta Brady Discovery Fund.

Reference: W.T. Hu et al. Plasma multianalyte profiling in mild cognitive impairment and Alzheimer disease. Neurology 79, 897-905 (2012)

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New Northside Medical Campus Expands Healthcare Services to Community

Tuesday, September 4th, 2012

Northside Hospital-Cherokee has purchased a commercial/residential development in Woodstock, Ga. for the construction of a new four-story, 100,000 square-foot, Class A Medical Office Building (MOB). The building will be called the Northside-Cherokee/Towne Lake Medical Campus.

The medical campus will offer a variety of outpatient medical services and a wide array of physician practices, representing numerous medical specialties.

Woodstock’s total population is projected to increase by 14.7 percent from 2011 to 2016 and total households are expected to increase by 15.6 percent during the same time frame. Additionally, Woodstock’s total population represents approximately 44 percent of Cherokee County’s total population. This expected growth will require increased access to local health care services for this community.

The new medical campus is expected to be completed and open for business as early as August 2013. It is located close to Northside’s Holly Springs Medical Campus as well as the site of the future home of the Northside Hospital-Cherokee replacement campus.

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Emory University Hospital Midtown Selected to Participate in National Breastfeeding Effort

Tuesday, September 4th, 2012

Emory University Hospital Midtown (EUHM) has been selected as one of 90 hospitals across the U.S., and one of seven in Georgia, to participate in a new national effort to improve breastfeeding rates in states where rates are currently the lowest. Although breastfeeding is one of the most effective preventive health measures for infants and mothers, half of the babies born in the U.S. are given formula within the first week of life. By nine months of age, only 31 percent of babies are breastfeeding at all.

The new 22-month initiative, called Best Fed Beginnings, seeks to reverse these trends by dramatically increasing the number of U.S. hospitals implementing a proven model for maternity services that better supports a new mother’s choice to breastfeed.

“We recognize that for women who plan to breastfeed, the hospital experience strongly influences a mother’s ability to start and continue breastfeeding,” says Ruth Simmons, coordinator of EUHM’s Lactation Support Services. “This new program shows our commitment to support mothers’ wishes after delivery.” Simmons is leading the Best Fed Beginnings program at the midtown hospital.

The program is led by the National Initiative for Children’s Healthcare Quality and the Centers for Disease Control and Prevention, the program guides hospitals in pursuit of what’s referred to as “Baby-Friendly” designation. The designation verifies that a hospital has comprehensively implemented the American Academy of Pediatrics-endorsed Ten Steps to Successful Breastfeeding, as established in the WHO/UNICEF Baby-Friendly Hospital Initiative.

Breastfeeding rates are higher and disparities in these rates are virtually eliminated in hospitals that achieve Baby-Friendly status.

“Our goal is to make system-level changes to our maternity care practices, which will guide us to reaching Baby-Friendly designation,” says Evelyn Jirasakhiran, nursing director for Women’s Health Services at EUHM. “We are excited about the process, which will greatly benefit our mothers and their newborns in the short- and long-term.”

Breastfeeding has multiple health benefits for both infants and mothers. For infants, it decreases the severity of illnesses, optimally supports neurodevelopment and reduces the risk of becoming obese later in childhood. For mothers, breastfeeding decreases the risks of breast and ovarian cancers, diabetes and cardiovascular disease.

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WellStar Pulmonary Medicine Welcomes Binu George, M.D.

Tuesday, September 4th, 2012

Binu George, M.D., has joined WellStar Medical Group, WellStar Pulmonary Medicine.

Dr. George received his bachelor’s degree in biology from Emory University and his master’s degree in developmental biology from Georgia State University. He earned his medical degree from Morehouse School of Medicine. Dr. George completed his residency in internal medicine from Morehouse School Medicine – Grady Memorial Hospital and his fellowship in pulmonary critical care from George Washington University Hospital.

Dr. George is a member of the American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine and the Society of Hospital Medicine.

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Gift Allows Shepherd Center to Expand Research on Neurobiology of Spinal Cord Injury

Tuesday, September 4th, 2012

With a $1.2 million gift from friends and supporters of former Shepherd Center patient Billy Hulse of Atlanta, Shepherd Center is expanding its research aimed at learning more about the neurobiology of spinal cord injury in people who are undergoing rehabilitation. Led by Keith Tansey, M.D., Ph.D., director of spinal cord injury (SCI) research, neuroscientists in the Shepherd Center Spinal Cord Injury Lab hope to find new ways to increase function and quality of life for people with SCI.

The lab — now called the Betty and Billy Hulse Spinal Cord Injury Lab in honor of Billy Hulse and his wife — will be dedicated in a ceremony on Sept. 11 at Shepherd Center. Scheduled to speak at the event are the Hulses, Dr. Tansey and Atlanta philanthropist Tommy Holder, who helped spearhead the fundraising effort with his wife Beth and the Hulses. In just three months, they exceeded their fundraising goal of $1 million.

The funds will allow the Hulse Spinal Cord Injury Lab to hire additional researchers and buy new equipment that will help researchers secure additional grant funding. Dr. Tansey started the lab several years ago with a small grant that funded equipment needed to get research under way.

“This gift is going to allow us to expand the lab in a way that would not have been possible if we were just going grant by grant,” Dr. Tansey says. “We can hire people sooner, and we will collect pilot data faster, which in turn will help us secure additional grants and publish our work faster. This accelerates our scientific endeavor beyond where we would have been in a typical academic environment.”

 

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