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Archive for November, 2012

NFMGMA November Educational Session

Wednesday, November 28th, 2012

November 28, 2012, Alpharetta. For more information, visit North Fulton Medical Group Management Association

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Georgia Chapter of the American College of Cardiology Annual Scientific Meeting

Friday, November 16th, 2012

November 16-18, 2012, Reynolds Plantation, Greensboro. For more information, visit ACC Georgia Chapter Annual Scientific Meeting

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Georgia Medicaid Fair

Wednesday, November 14th, 2012

November 14, 2012, Gwinnett Convention Center. For more information, visit Georgia Medicaid Fair

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In Terms of Vascular Age, 50 May Really Be the New 60 for Women

Wednesday, November 14th, 2012

By Kimberly P. Champney, M.D., MSCR

From ATLANTA Medicine, 2012, Women’s Health, Vol. 83, No. 1

National public awareness campaigns for heart disease in women from the American Heart Association and other organizations have seen initial success. Between 1997 and 2006, the number of women recognizing that the leading cause of death among women is heart disease increased from 30 percent to 55 percent (1). Along with this increased knowledge, women have seen a decline in deaths secondary to cardiovascular disease. However, areas of concern still remain. For example, women know that cholesterol is an important risk factor for cardiovascular disease, but few women know their own personal cholesterol levels and other risk factors (1).

“Fifty is the new forty” is a common phrase heard today, especially as many famous women such as Oprah Winfrey, Christie Brinkley, Madonna and Sharon Stone approach or have turned 50. However, in terms of vascular age, 50 may really be the new 60 for women. For example, a 51-year-old teacher with a family history of heart disease reports good health. She feels well, is currently enrolled in Weight Watchers at work that meets twice a week. Her blood pressure is 140/82, total cholesterol 220mg/dL, HDL 34 mg/dL, LDL 145 mg/dL, and triglycerides are 198 mg/dL. She would like to know if she needs to take a statin, as prescribed by her primary care physician. She is 5’1”, weighs 147 lbs, body mass index (BMI) 27 and has a waist circumference of 37 inches. This 51-year-old lady is clearly not the “new forty” and in fact has a coronary artery calcium score of 25 estimated vascular age of 63. Vascular age can be calculated using data from the Multi-Ethnic Study of Atherosclerosis(MESA) knowing age, gender, cholesterol values, blood pressure and use of tobacco (3).

While this particular patient is not the “new forty,” epidemiologic data suggest that she is a more representative 50-year-old female today. Two out of every three women in the U.S. are overweight or obese, one out of three women will have high blood pressure, almost one in two will have elevated cholesterol, and less than one third of women report regular physical activity. By the age of 50, 40 percent of women will have one cardiovascular risk factor and 17 percent of women will have two or more traditional risk factors (2).

Heart Disease in Young Women

Despite the overall improvement in heart disease awareness and mortality among women, there is a slight increase in heart disease death rates seen in young women, ages 35-54 years. This trend “may represent the leading edge of a brewing storm (3).” We also know that it is younger, not older women, who have higher risk of death after myocardial infarction relative to men (4). This increase in cardiovascular mortality among young women is likely linked to obesity and the cardiovascular risk factors associated with obesity. Particular attention to cardiovascular risk should be given to women in this younger age group.

Cardiovascular Disease Among Minority Women

Racial disparities in healthcare are evident among many diseases, and this is of particular importance in Atlanta given the diverse population. Black women, particularly in southern states, have the highest incidence of uncontrolled hypertension, obesity, sedentary lifestyle and dyslipidemia. This combination of uncontrolled risk factors leads to increased mortality among minority women, particularly black women. Among young women, ages 45-64, with a first myocardial infarction, 18 percent of non-Hispanic white women will die within five years. More alarming is that among that same younger age group, 28 percent of black women will die within five years after a first myocardial infarction. This racial disparity among women is not as great among older women. This is a cause for concern because it is the younger age minority women at greatest mortality risk (2).

Identifying Cardiovascular Risk in Women

All women should have their cardiovascular risk classified by their provider as high risk, at risk, or ideal cardiovascular health. Along with appropriate risk stratification, providers must make it a priority to educate each woman regarding their personal cardiovascular risk factors and overall risk for future cardiovascular disease.

Pregnancy: A Unique Opportunity to Estimate a Woman’s Future Risk

The short-term risk to both mother and baby of preeclampsia and gestational diabetes is well understood. However, we are now learning that these pregnancy complications have long-term risk as well. Pregnancy is an early metabolic and cardiovascular “stress test” for many women. Women with a history of preeclampsia have a twofold increased risk of ischemic heart disease, stroke or thromboembolic event in the five to 15 years following pregnancy (6). Pregnancy can unmask endothelial and metabolic dysfunction early in life, and obstetricians should not miss this opportunity to intervene early on these at-risk women. Postpartum, women with preeclampsia and gestational diabetes should be referred to a primary care provider or cardiologist for risk factor modification (5).

Early Intervention on Future Cardiovascular Risk

While cardiovascular disease typically does not manifest until the fifth or sixth decade in life, it is well known that atherosclerotic process begins in the second and third decades. Despite this knowledge of the atherosclerotic process, risk factor modification is typically not emphasized early enough. Clinical trials have shown a 30 percent reduction in cardiovascular events when statins are started in patients age 50 to 60. Initiating statin therapy at age 30 may prevent 60 percent of cardiovascular events when initiated early in the disease process and outcomes measured over a lifetime rather than the standard five years in most clinical trials. Primordial prevention (prevention of risk factors) and early risk factor modification need to be a primary focus for medical providers.

In summary, significant improvements in the awareness and treatment or heart disease in women have been made. However, heart disease remains the leading cause of death for women. The increasing rates of obesity and heart disease in young women raise concern about the future of women’s health. Health care providers need to identify and intervene on women with cardiovascular risk factors early, making special note of high-risk subgroups like black women. Pregnancy complications such as preeclampsia and gestational diabetes should be viewed as a “failed metabolic stress test” and serve as an early warning sign of potential risk both to patients and their obstetric provider.

References
1. Mosca L, Mochari H, Christian A, et. al. National Study of Women’s Awareness, Preventive Action, and Barriers to Cardiovascular Health. Circulation 2006; 113:525-34.
2. American Heart Association. Heart Disease and Stroke Statistics – 2012 Update. Circulation. 2012:125:e2-220.
3. McClelland RL, Chung H, Detrano R, et. al., Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2006;113:30-7.
4. Ford ES, Capewell S. Coronary heart disease mortality among young adults in the US from 1980 through 2002. J Am Coll Cardiol. 2007;50:2128-32.
5. Vaccarino V, Parsons L, Every NR, Barron HV, Krumholtz HM. Sex-Based Differences in Early Mortality after Myocardial Infarction. N Engl J Med. 1999;341:217-225.
6. Mosca L, Benjamin EJ, Berra K, et. al., Executive Writing Committee. Effectiveness-based guidelines for the prevention of cardiovascular disease in women-2011 update. J Am Coll Cardiol. 2011;57:1404-23.
7. Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2001;335:974.
8. Steinberg D. Earlier Intervention in the Management of Hypercholesterolemia: What Are We Waiting For? J Am Coll Cardiol. 2010;56:627-29.

Kimberly P. Champney, M.D., MSCR  is a cardiologist at Northside Hospital. She received her medical degree from the Medical College of Georgia and her Masters of Science in Clinical Research from Emory University. She has been at Northside Hospital since August 2007. Her interests are in preventive cardiology, women and heart disease, pulmonary hypertension, and cardiac imaging. Dr. Champney is a member of the American Heart Association and a Fellow of the American College of Cardiology.

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Piedmont and WellStar Partner to Form Georgia Health Collaborative

Wednesday, November 14th, 2012

Piedmont Healthcare and WellStar Health System have announced a partnership to create the Georgia Health Collaborative, a first of its kind in the state. The new Collaborative will establish services and initiatives focusing on the development of innovative healthcare delivery models, economically aligned physician relationships and the creation of service line cost savings.

The formation of the Collaborative allows Piedmont and WellStar to share intellectual knowledge concerning clinical care and seek cost reductions through economies of scale.

The two not-for-profit health systems will remain independent but, through the Collaborative, serve a primary service area population of more than three million across north Georgia. With a combined 2,393 hospital beds, 10 hospitals, seven urgent care centers and more than 700 physicians in the Piedmont Physicians Group, Piedmont Heart Institute, and the WellStar Medical Group, the Collaborative will redefine the delivery of healthcare services in metro-Atlanta.

Piedmont and WellStar are well positioned in the Atlanta healthcare market to work together to achieve improved clinical results and reduction in costs as dictated in the 2010 federal Patient Protection and Affordable Care Act. Health systems that have a broader geographic reach and larger population base will be best suited to react to and sustain operations regardless of future federal and state legislative outcomes.

The Collaborative may add affiliate hospitals or health systems in the future. A Board of Directors for the Collaborative will be established and will include the system chairman of the Board, the CEO or COO of both health systems and two additional members from each system.

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Targeting Inflammation to Treat Depression

Wednesday, November 14th, 2012

Researchers at Emory University have found that a medication that inhibits inflammation may offer new hope for people with difficult-to-treat depression. The study was published Sept. 3 in Online First Archives of General Psychiatry.

“Inflammation is the body’s natural response to infection or wounding, says Andrew H. Miller, senior author for the study and professor of Psychiatry and Behavioral Sciences at Emory University School of Medicine. “However, when prolonged or excessive, inflammation can damage many parts of the body, including the brain.”

Prior studies have suggested that depressed people with evidence of high inflammation are less likely to respond to traditional treatments for the disorder, including anti-depressant medications and psychotherapy. This study was designed to see whether blocking inflammation would be a useful treatment for either a wide range of people with difficult-to-treat depression or only those with high levels of inflammation.

The study employed infliximab, one of the new biologic drugs used to treat autoimmune and inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease. A biologic drug copies the effects of substances naturally made by the body’s immune system. In this case, the drug was an antibody that blocks tumor necrosis factor (TNF), a key molecule in inflammation that has been shown to be elevated in some depressed individuals.

Study participants all had major depression and were moderately resistant to conventional antidepressant treatment. Each participant was assigned either to infliximab or to a non-active placebo treatment.
When investigators looked at the results for the group as a whole, no significant differences were found in the improvement of depression symptoms between the drug and placebo groups. However, when the subjects with high inflammation were examined separately, they exhibited a much better response to infliximab than to placebo.

Inflammation in this study was measured using a simple blood test that is readily available in most clinics and hospitals and measures C-reactive protein or CRP. The higher the CRP, the higher the inflammation, and the higher the likelihood of responding to the drug.

“The prediction of an antidepressant response using a simple blood test is one of the holy grails in psychiatry,” says Miller. “This is especially important because the blood test not only measured what we think is at the root cause of depression in these patients, but also is the target of the drug.”

“This is the first successful application of a biologic therapy to depression,” adds Charles L. Raison, first author of the study. “The study opens the door to a host of new approaches that target the immune system to treat psychiatric diseases.” Raison, formerly at Emory, is now associate professor in the Department of Psychiatry at the University of Arizona College of Medicine – Tucson.

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New Technology Allows Northside Physicians to Pinpoint Disease Earlier

Tuesday, November 13th, 2012

Physicians at Northside Hospital are the first to use Siemens Healthcare’s new SOMATOM Perspective computed tomography (CT) system, a 128-slice scanner designed to deliver high image quality and low-dose radiation. This is the first U.S. installation of the system, which is available at Northside’s Tower Imaging.

The non-invasive diagnostic imaging procedure, which uses a combination of X-rays and computer technology to produce detailed pictures, or “slices,” of the body, allows physicians to pinpoint disease earlier – from bone fractures and concussions to infections and blood clots – with greater precision and without surgery.  The technology may be used to study blood vessels; guide a surgeon to the right area during a biopsy; and identify masses and tumors, including cancer.

The SOMATOM Perspective 128-slice CT system provides high quality CT scans at the lowest radiation dose possible for the patient. Included as a standard option on the SOMATOM Perspective is SAFIRE (Sinogram Affirmed Iterative Reconstruction), the latest radiation-dose-saving technology.  To the patient, the lowest possible radiation dose is as critical as high image quality. SAFIRE helps reduce patient radiation dose by up to 60 percent, compared to previous techniques.

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Emory’s Kaslow Elected President of the APA

Tuesday, November 13th, 2012

Nadine J. Kaslow, professor and vice-chair in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, has been elected 2014 president of the American Psychological Association (APA).  She will serve as APA’s president-elect in 2013 and president in 2014.

Kaslow holds a joint appointment in Emory’s departments of psychology, pediatrics, emergency medicine and Rollins School of Public Health. She serves as director of the Postdoctoral Fellowship Program in Professional Psychology and she is the chief psychologist for the Grady Health System. She also serves as the psychologist for the Atlanta Ballet Company.

Kaslow’s vast experience in the delivery of healthcare services is expected to frame her APA presidency.

“Ensuring that psychology is an integral part of health care, and that mental health treatment and prevention services are accessible for all people, is one of the most critical challenges facing our society today,” Kaslow says. “As scientists, educators, advocates and health care professionals, psychologists are essential to the kind of interdisciplinary teams that will be necessary to optimize health care.”

Improving psychology’s educational opportunities and positioning psychology as a STEM (Science, Technology, Engineering & Math) discipline are other goals Kaslow listed among her priorities.

A long-time member of the APA Board of Directors and an APA fellow, Kaslow is past president of the American Board of Professional Psychology and the Association of Psychology Postdoctoral and Internship Centers, as well as three APA Divisions — the Society of Clinical Psychology, Psychotherapy and the Society for Family Psychology.
She is editor of APA’s Journal of Family Psychology and has authored more than 270 publications on the assessment and treatment of family violence, depression and suicide in youth and adults, post-traumatic stress disorder, couples and family therapy, women’s mental health, pediatric psychology, and a competency-based approach to psychology education and supervision.

Among her APA awards, Kaslow has received the Krasner Award for Distinguished Early Career Contribution to Psychotherapy; the Award for Distinguished Contributions to Family Psychology; the Heiser Award for her efforts in legislative advocacy and public policy; the Distinguished Contributions to Education and Training Award; and a Presidential Citation for her efforts to assist interns and postdoctoral residents affected by Hurricane Katrina. Most recently, Kaslow received the 2012 Elizabeth Hurlock Beckman Award for her extraordinary influence on the future of her students.

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Chappuis Opens Spinal and Rehabilitation Center

Friday, November 9th, 2012

James Chappuis, MD, FACS, has opened a state-of-the-art spinal surgery and rehabiliation center, SpineCenter Atlanta and Affiliates (SCA), on Howell Mill Rd. in Buckhead.

The board-certified physicians and professionals at SCA provide comprehensive spine care. In addition to spine surgery and non-surgical interventional spine treatments, services include physical therapy, personal training, aquatic rehabilitation, medical massage,  acupuncture and chiropractic.

Dr. Chappuis is double-board certified in orthopaedic surgery and spine surgery and has over 30 years experience in practicing medicine. In addition, he holds eight patents, with one of his inventions being used in spinal surgeries worldwide.

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WellStar Welcomes Leslie Choy-Hee and Rafik Raphael

Friday, November 9th, 2012

Two new physicians have joined WellStar Medical Group and will be seeing patients in Cobb County.

WellStar Medical Group, OB/GYN Hospitalist at Cobb welcomes Leslie Choy-Hee, M.D. Dr. Choy-Hee received her bachelor’s degrees in biology and psychology from Emory University and earned her medical degree from Emory University School of Medicine, where she also completed her residency in obstetrics and gynecology. Dr. Choy-Hee is board certified in obstetrics and gynecology and is a member of the American College of Obstetrics and Gynecology and Emory-Grady Society of Gynecologists and Obstetricians.

Rafik Raphael, M.D., has joined WellStar Medical Group, Internal Medicine. Dr. Raphael earned his medical degree from Cairo University School of Medicine in Cairo, Egypt. He completed his internship at Verdun General Hospital in Montreal and his residency in anatomical and clinical pathology at McGill University-affiliated hospitals in Montreal. He is board certified in special hematology, clinical and anatomical pathology. Dr. Raphael is a fellow of the American Academy of Family Physicians and the College of American Pathologists and is a member of the Georgia Academy of Family Physicians.

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