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Archive for November, 2013

Dr. Paul Emerson Joins The Task Force for Global Health

Friday, November 29th, 2013

Dr. Paul Emerson will join The Task Force for Global Health as director of the International Trachoma Initiative (ITI). His appointment begins January 6, 2014. As director, Dr. Emerson will be responsible for the overall success of ITI’s trachoma elimination efforts with program partner Pfizer to achieve the global elimination of blinding trachoma by 2020.

About 21.4 million people, primarily women and children, have active trachoma. The disease slowly and painfully robs people of their sight, as repeated infection turns eyelashes inwards, scraping the cornea and eventually causes irreversible blindness. Women, traditionally the caretakers of children, are almost twice as likely as men to develop blinding trachoma.

Dr. Emerson joins ITI from The Carter Center, where he has been director of the Trachoma Control Program since 2004. Through ITI, Pfizer has distributed 340 million treatments of donated Zithromax® to treat and prevent blinding trachoma in 28 countries in Africa and Asia. The Carter Center recently distributed the 100 millionth dose of Zithromax® donated by Pfizer in Ethiopia.

At The Carter Center, Dr. Emerson provided oversight to program activities in Mali, Niger, Nigeria, Ghana, South Sudan, Sudan and Ethiopia.  He served as the Co-Director of the Malaria Control Program (2006) and has held the title of Adjunct Assistant Professor at the Rollins School of Public Health at Emory University since 2009.

Prior to joining The Carter Center, Dr. Emerson worked in a number of other positions including Research Fellow and Lecturer of Biological and Biomedical Sciences, at the University of Durham where he was the grant holder and Principal Investigator leading a small team on multi-country evaluations of trachoma control programs assisted by HKI and World Vision.  He has worked for the Medical Research Council Laboratories in The Gambia, the Ministry of Education in Botswana, and the Ministry of Education in Kenya.

Dr. Emerson has published more than 100 peer-reviewed papers, and authored several letters, editorials and manuals in the areas of Surgery, Antibiotics, Facial Cleanliness, Environmental improvement, innovation, integration, and surveys and surveillance in the fields of trachoma and malaria control.  Dr. Emerson holds a doctorate in Biological and Biomedical Sciences from the University of Durham and an MSc in Applied Parasitology and Medical Entomology from the Liverpool School of Tropical Medicine.


Hoven Urges Congress to Repeal SGR Before Jan. 1, 2014

Thursday, November 28th, 2013

Ardis Dee Hoven, M.D., President, American Medical Association, made the following statement regarding the Medicare Sustainable Growth Rate:

“Today’s release of the final Medicare payment rule serves as an urgent reminder to Congress that there are just 34 days before physicians who care for Medicare patients will face a steep payment cut of about 24 percent due to the short-sighted, fatally flawed Medicare payment formula – the SGR.

“There is real momentum in Congress for an SGR repeal this year. The U.S. House Ways and Means Committee and the U.S. Senate Finance Committee have issued the first bipartisan, bicameral congressional proposal acknowledging the broken Medicare payment formula has to go, while the U.S. House Energy and Commerce Committee has unanimously approved a bill to repeal the SGR.

“The timing is right: repealing the SGR formula this year and paving the way for a more stable and innovative Medicare program would cost half as much as last year’s projection. In fact, if we eliminate the fiscally foolish SGR once and for all it would cost less than all 15 of the previous patches that Congress has put in place over the last decade.

“Congress should act decisively this year to pass the SGR repeal, provide positive updates and improve the performance programs. Otherwise it risks spending additional billions of taxpayer dollars on another patch that preserves the broken Medicare payment formula for another year or two.

“The clock is ticking. At stake are innovations that would make Medicare more cost effective for current and future generations of seniors.  These innovations are not possible if physicians are worried about drastic cuts to Medicare rates that have remained almost flat since 2001, while the cost of caring for patients has gone up by 25 percent.

“Innovation requires stability and investment:  investment in health information technology to help share information at the point of care, investment in staff to help coordinate care, and investment in time for physicians to consult with each other about a patient’s care.

“Repealing the SGR this year will give Medicare a firm and stable foundation so physicians can pursue delivery innovations that help improve care and reduce costs.”


Spinal Cord Injury: State of the Art Interventions for Recovery

Tuesday, November 26th, 2013

By John L. Lin, M.D., FACP, FAAPMR

From ATLANTA Medicine Vol. 84, No. 4

As a subspecialty of rehabilitative medicine, spinal cord injury medicine has evolved extensively since its first historical description 5,000 years ago by the Egyptian physician Imhotep on a papyrus as “an ailment not to be treated.”

More than 2,000 years ago, Hippocrates treated spinal injuries with traction and recognized the correlation of spinal cord injury and paralysis. Galen deduced that respiratory dysfunction in animals corresponded with high spinal cord transection. The middle ages saw the evolution of spinal manipulations in reducing thoraco-lumbar dislocations. By Renaissance, surgical refinement brought forth treatments with laminectomy. The year 1860 saw descriptive details of incomplete hemiparetic spinal cord injury by Brown-Sequard and introduction of the term “quadriplegia” in 1881.

Despite the increasing medical knowledge by the turn of 20th century, mortality from spinal cord injury reached 95 percent, with four in five succumbing within two weeks of a cervical injury. It was not until the second half of the last century that progression of spinal cord medicine has taken a significant leap forward with the introduction of halo in managing high cervical injury, along with other spinal orthotics, improved bladder management in decreasing mortality due to reflux nephropathy, evolution of bladder surgical interventions, functional electrical stimulation for paralytic muscles and transcutaneous electrical stimulation for afferent dysesthesia as well as enhanced imaging with computed tomography and magnetic resonance imaging amongst other technological advances.

Nevertheless, the last decade has witnessed geometric growth in advances of spinal cord medicine, from researches in regeneration and neuroprotection to promotion of neuroplasticity. Other advances include functional electrical stimulation, advanced electronic/computer assisted mobility and assistive devices and novel implanted organ function augmentation devices, in addition to the myriad of pharmacological agents treating secondary co-morbidities as well as enhanced understanding of spinal cord medicine through multi-center collaborations.

Although stem cell transplantation has been a well-recognized research front for spinal cord injury, decades of hard work has yet to result in the panacea that was once sought. Initial studies involving amphibian models demonstrated ependymal regeneration. Mammalian models were less robust in inducible regeneration, although it was noted that lifelong proliferation and differentiation of spinal tissues occur in uninjured rodent models.

Around the world, multiple sources of stem cells have been studied. These include autologously derived bone marrow progenitor cells, fetal neural tissues and allelic human embryonic stem cells. The latest of these clinical trials in the U.S. was the oligodendrocyte progenitor cell implantation trial involving several spinal cord injury model system centers. Without any breakthrough regeneration and recovery, the trial has ceased to enroll further subjects since the second half of 2012, although follow through for post-injection evolution of complications continues.

Though not technically stem cell in nature, other cell therapies and surgical implantations are also noteworthy. The autologous incubated macrophage implantation attempted to minimize secondary spinal cord injury at the cellular level from forming intra-spinal scar tissues that are thought to be prohibitive of neurological regeneration. In addition, hope was to have macrophage derived growth factor stimulate neuronal regeneration. Lack of funding and subject recovery ceased further trial enrollment in 2006.

The discovery of potential regenerative ability of olfactory ensheathing cells lead to trials in Portugal, Australia, and Russia. Despite early encouraging anecdotes in non-controlled observations, no success has been duplicated under the rigor of scientific methodology. Other trials, too, including peripheral nerve derived Schwann cell transplantation and omental transplantation have not proven to be efficacious.

Still, other non-cell therapy based interventions have garnered enthusiasms since the methylprednisolone trials of 1980s, undaunted by the lack of success of GM-1 ganglioside and 4-aminopyridine. These treatments aim at halting the secondary spinal cord injury associated with the molecular level of chemical releases and physiological sequelae of primary assault causing spinal cord injury.

The most publicized of these is undoubtedly the hypothermia treatment received by a national football league player from Buffalo, N.Y., who sustained a tetraplegic injury during a kickoff tackle. Although touted as a significant advancement and re-awakening of a decades-old intervention due to the significant neurological recovery of the football player in subsequent months, the much vaunted hypothermia received much criticism in the medical/scientific community, both for the haphazard administration by the medical staff as well as for the lack of scientific evidence and medical safety of the intervention. However, other neuroprotective agents under trial today such as basic fibroblast growth factor infusion continue to engender interest and promise. Enrollment of the latter continues yet at Grady Hospital’s trauma center.

Non-pharmacological interventions for spinal cord injury have entered the fray over the last decade. These mostly come at the heels of suggestive feline and rodent models. The most widely studied are the body weight supported resistive treadmill ambulation with robotic assistance. Data showing improved gait, decreased supportive staff assistance and some improved spasticity for motor incomplete syndrome with potential for ambulation using assistive devices such as a walker reflects the growing popularity of this intervention. Data on gait or neurological improvement for motor-complete patients are unproven, although effects on secondary endpoints, e.g. cholesterol and glycemic markers, are being investigated.

An anecdotal case presentation over the last year has fueled the speculation on the effect of epidural spinal stimulation on signal conduction through the injured spinal cord and possible effect on neuronal recovery. This, along with functional magnetic stimulation, reflects the continued interests in advances in neurological recovery using non- pharmacological interventions.

Despite the lack of significant progress in neurological recovery, technical advances continue to improve the quality of life for persons living with spinal cord injury. Recovery in rehabilitation medicine may not always reflect physiological changes, but rather, functional adaptations, psychological normalization and social re-integration. To that extent, improved computer technology has brought environmental/ computer control to those with high-level tetraplegia using the eye gaze system. Those with ventilator dependence have seen non-invasive ventilation and diaphragm pacing systems replace permanent ventilation. Non-functional tetraplegics now have tongue control drive possibilities for power wheelchair control. Paretic limbs have seen improved and accelerated functional return with devices such as functional electrical stimulation coupled with computational resistance to maintain muscle bulk and minimize atrophy.

Implantable sacral nerve stimulators improve urinary function. External neuro-electrical stimulator of the peroneal nerve during active gait cycle improves ambulation and minimizes contact orthotics that may lead to skin pressure ulcers. Most intriguingly, wearable robotic devices such as exoskeletons are making the transition from military applications to aiding paraplegics in ambulation. While mostly still in pre-market stages, the next years will witness persons with paraplegic spinal cord injuries walk without the use of their spinal cord.

In summary, it is an exciting time to be involved in spinal cord medicine. Advances on multiple fronts, scientifically, technically, functionally and even accessibility-wise, such as through the evaluation and adaptation of the Americans with Disability Act by the European Union, ultimately lead to better lives for persons with spinal cord injury and a society with equality and independence for all.

John L. Lin, M.D., FACP, FAAPMR is a staff physiatrist in the Spinal Cord Injury Program at the Shepherd Center. Dr. Lin is board certified in physical medicine and rehabilitation, spinal cord injury medicine and internal medicine and is a graduate of Medical University of South Carolina and Emory University. He completed a dual residency in internal medicine and rehabilitation medicine at Temple University Hospital in Philadelphia, where he also served as the chief resident in his final year. Dr. Lin is an assistant professor at Emory University School of Medicine and has served as Associate Residency Program Director for the Department of Rehabilitation Medicine at Emory. He has also served as the director of Spinal Cord Injury Service and as a primary- care physician at the Atlanta Veterans Administration Medical Center.


Northeast Georgia Physicians Group Welcomes Sherry Dorsey

Monday, November 25th, 2013

Northeast Georgia Physicians Group (NGPG) is proud to welcome Sherry Dorsey, CMPE, as its new president and chief administrative officer.  In this role, Dorsey will guide NGPG – a network of more than 200 physicians, physician assistants and nurse practitioners representing more than 20 specialties at more than 50 locations throughout Northeast Georgia – which the Atlanta Business Chronicle ranks as Atlanta’s ninth-largest physician practice.

Dorsey comes to NGPG from Adventist Health System in Orlando, Fla., where she was responsible for 21 multi-specialty medical practices and more than 1,300 physicians in 10 states as chief operating officer of Physician Enterprise. Among her many duties, Dorsey actively worked with medical leadership to prepare for reform, clinical integration and related Patient Centered Medical Home initiatives. Prior to her time at Adventist, Dorsey worked for 17 years with HealthPoint Medical Group, an affiliate of BayCare Health System and St. Joseph’s Hospitals and one of the largest multi-specialty physician groups in the Tampa Bay, Fla., area.

Dorsey received her MBA from the University of Alabama and started her career in Atlanta, where she worked for The Emory Clinic until 1991. During her time in Tampa Bay, she served 11 years on the Hillsborough County Healthcare Advisory Board and was actively involved in several community organizations supporting homeless and abused women and children.


Navy Lt. Cmdr. Leah Brown Earns Bronze Star for Improving Care for Afghan Women

Monday, November 25th, 2013

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs

The Tarin Kowt district of Afghanistan is mired in poverty, wracked by warfare, and beset by a host of concerns such as lack of available medical care.

Lt. Cmdr. Leah Brown helped to alleviate some of that medical care shortage by providing direct patient-centered care to the local population during her time recently deployed with Combined Joint Special Operations Task Force – Afghanistan.

Brown, an orthopedic doctor at Naval Hospital Bremerton received the Army Bronze Star for her humanitarian efforts when she assigned to the Role 2 hospital in Tarin Kowt Forward Operating Base, located in southeast Uruzgan province from Oct. 2012 to May 2013.

“I was part of a medical team utilized by special operations and we took on a humanitarian assistance role to visit the local hospital which served the entire province. They had a very large catchment area. It is also one of the poorest regions as well as a very traditional area that really needed dedicated medical support,” said Brown, an Atlanta native who attended Benjamin E. Mays High School and the University of Georgia for her undergraduate work before going to Ohio State University and the Cleveland Clinic Foundation for medical school before her 10 years of Navy service.

Brown noted that as part of the Role 2 hospital’s medical team, she and others were invited by the local hospital equivalent of chief medical director to help them care and offer services to the surrounding population. Brown conducted orthopedic surgeries that the local doctors couldn’t handle as well as provided orthopedic care to many local children and men. She made such a positive impact, she even started treating women.

“Being able to treat Afghan women was a very big deal due to their rigid beliefs rooted in old ways. It was a huge turnaround and a big accomplishment,” Brown said, adding that as part of an all-female team, they really made a strong positive impression in providing health and wellness care.

As a result of their efforts, Brown attests that the all-female medical team really helped to win over hearts and minds and facilitate relationships.

“We started to see women on a regular basis at the Role 2. But at the start, we never saw any. Then we started to see young girls, then older women and then mid-adult age women. This symbolized that we had advanced in our relationship and were trusted. We visited the hospital and coordinated getting the patients to the base to the Role 2 facility which was one of the reasons it was such a big deal. It also helped to have an advanced female medical team made up of an orthopedic doctor, anesthesiologist, critical care nurse, hospital corpsman and translator. We pulled from every level of care we had to comprise our team,” said Brown.

The all-female team became high profile in the area, primarily all Navy with three Air Force personnel. They utilized all the resources at their disposal and devoted extra time and effort helping the local populace. Brown and her team shared what they could, donating underutilized supplies such as gauze and a few instruments. All this helped to show that they were willing to assist the locals. Still, they were in the midst of a very volatile region of the country. They were always very careful in going to the hospital to provide medical care. Hospital visits were always carefully coordinated with safety and security being of paramount importance.

The local hospital itself had seen better days. Three decades of war had depleted skilled medical workers, what supplies were to be had, and there was a limited infrastructure, not only in the hospital but throughout the region.

“The hospital staff was limited due to the constant danger and there were simply not a lot of resources. It was also frustrating to see so much poverty and what the prolonged war had done to the country. In conversation with our translators, they would share on how it used to be. It’s sad,” Brown said.

Due to local tradition, the Tarin Kowt hospital was segregated along gender line. There was an entire separate area in the hospital for women, which lacked many of the amenities found on the other side of the hospital.

“It was vastly different. We even provided a lot of health items for women. Their female medical director, really an equivalent to a midwife, was aggressive in pushing the agenda for women’s health care. We did mid-wife training for a group of 14-15 year old girls, who were essentially the only providers available for women there. The main concern for medical attention for women was it was just mainly required during the birthing process,” related Brown.

Along with being smack in a war zone and trying to deliver medical care to a populace in need, there were constant logistical, location and logical issues to handle and try to comprehend on a daily basis. Those dilemmas were part of the legacy of constant warfare, pain, and suffering for overlapping generations over the past 30 years.

“Dealing with the Afghan people in such a different environment to ours, and trying to understand the psychology of them living in nearly impossible situations was so difficult,” Brown shared, adding that the cultural divide would always lessened when a local hospital provider would contact them to see a specific patient.

“There were many cases I remember such as when we were asked to care for a local child with a femur fracture that had been that way for a week, and the provider added an ‘oh by the way can I send another I’m caring for.’ The other kid, around 10 to 12 years old, had wounds sustained from live ordnance – with a finger already amputated, an upper extremity open wound and a serious tibia fracture. We took care of him and essentially saved his leg,” said Brown.

Local children finding improvised explosive devices and unexploded ordnance were a constant theme. Another local child found ordnance and the resulting blast caused a huge skull defect.

“The child’s father had cared for him but we took him in and immediately provided emergency care. With treatment and therapy the young child went from being bed ridden to using a walker to zooming around our area,” remembered Brown, adding that they then got to send him to the Role 3 multinational medical unit at Kandahar Air Field and then on to Landstuhl Regional Medical Center in Germany for neurological help. “It was case by case consideration, but that’s an example of doing all we can.”

“It was a hard deployment but our entire base embraced what we did at the hospital. Everyone got involved, from helping with a blood transfusion to bearing a litter. There was a definite ‘what can we do to help?’ feeling at the FOB. From the gate to operating table to recovery, a local was never alone. The morale of our forces always got a boost from helping a local who received medical care. It gave us all an improved outlook,” Brown said.

The deployment also had traumatic moments. Special Warfare Operator 1st Class Kevin Ebbert, a hospital corpsman with 18-Delta combat medical training, was killed in action on November 24, 2012 while supporting stability operations in Uruzgan Province.

“I was able to work with a great team. We made due with the resources we had. There was no ‘Gucci medicine’ practiced here. We were all a little proud to do a lot without all the extras that are normal at our military treatment facilities. We got used to that. I wish people knew more on what we did,” stated Brown.

Brown’s efforts did get noticed internally with the Army Bronze Star. Her advice for those following?

“Practice medicine with the total altruistic reason that got you into the field in the first place. You get what you get and you provide what you can, even if it’s just a band-aid or pair of crutches with a smile,” shared Brown.

Note: Role 2 is a Battalion Aid Station providing emergency surgical care, stabilizing hemodynamic status in order to send the patient to the Role 3. It is also where the wounded are linked up with a nurse and physician in the chain of evacuation. A Role 1 refers to emergency medical care in the field, historically handled by independent duty corpsmen. The Role 3 multinational medical unit at Kandahar Air Field has the highest level of care available in theater, with additional capabilities such as specialist diagnostic resources, specialist surgical and medical capabilities, and preventive medicine. Landstuhl Regional Medical Center, Germany, is the largest American hospital outside the United States and an example of a Role 4 facility. Role 5 sites are stateside rehabilitation facilities.


Pulmonary and Critical Care of Atlanta Welcomes Dr. Venkatesh Lakshminarayanan

Sunday, November 24th, 2013

Pulmonary and Critical Care of Atlanta welcomes Venkatesh Lakshminarayanan, M.D., Ph.D. He joins a team of medical professionals who are trained in internal medicine, pulmonary and critical care.

Dr. Lakshminarayanan completed his fellowship at the University of Missouri. After receiving his Ph.D. and M.D. from Rush Medical College in Chicago, Ill., Dr. Lakshminarayanan went on to complete his residency at the University of Nevada. He then joined the faculty at Yale University School of Medicine at Griffin Hospital, where he served as chief resident.

Dr. Lakshminarayanan has extensive experience in both internal medicine and pulmonary/critical care, has published his research numerous times and has presented his work at symposiums across the country.


Male Infertility Issues Play Significant Role, According to Piedmont Urologist

Sunday, November 24th, 2013

Couples having trouble getting pregnant need to look beyond the age-old myth that infertility is just a women’s problem and consider testing for male infertility issues, says Cara Cimmino, M.D., urologist and male infertility expert with Piedmont Physicians Urology Specialists.

“For years, people believed infertility was a women’s problem but research continues to show us that male infertility is just as common,” said Dr. Cimmino, who earned her medical degree from the University of Michigan. “Half of all infertility cases are due, in part, to male infertility issues. Approximately 30 percent of infertility cases are caused by male factors alone, and another 20 percent of cases are a combination of male and female factors.”

Dr. Cimmino says medical issues, environmental factors and lifestyle choices all play a role in male infertility. For example, men who smoke and drink alcohol have a significantly lower sperm count than those who do not, which can lead to infertility, according to the National Institutes of Health. Male infertility also is caused by birth defects, cancer treatments like chemotherapy and radiation, obesity and more.

“With at least 15 percent of couples struggling to have a child, infertility is a prevalent and frustrating issue for many people who hope to become parents someday,” said Dr. Cimmino. “It is important that couples time intimacy correctly and have intercourse leading up to and during ovulation.”

Couples who have been trying to get pregnant for more than 12 months should seek advice from a specialist, says Dr. Cimmino. If testing confirms that male infertility is an issue, doctors can work with couples on a solution.

“Couples facing infertility should know that there is still hope,” said Dr. Cimmino, who also treats low testosterone, erectile dysfunction, Peyronie’s Disease and works to preserve fertility in male cancer patients. “Today, there are a number of therapies and surgeries to help them start the family they have been wanting.”




Northside Hospital Cancer Institute Earns National Accreditation with Commendation

Friday, November 22nd, 2013

The Commission on Cancer (CoC) of the American College of Surgeons has granted Three-Year Accreditation with Commendation to the Northside Hospital Cancer Institute, as a result of surveys performed during 2013.

Established in 1922 by the American College of Surgeons, the CoC is a consortium of professional organizations dedicated to improving patient outcomes and quality of life for cancer patients, through standard-setting, prevention, research, education and the monitoring of comprehensive, quality care. When patients receive care at a CoC facility, they benefit from a multidisciplinary approach to treating cancer, with a team that includes surgeons, medical and radiation oncologists, diagnostic radiologists, pathologists and other cancer specialists, resulting in improved patient care.  Patients also have access to information on clinical trials and new treatments, genetic counseling and patient-centered services including psycho-social support, a patient navigation process, and a survivorship care plan that documents the care each patient receives and seeks to improve cancer survivors’ quality of life.

Like all CoC-accredited facilities, Northside maintains a cancer registry and contributes data to the National Cancer Data Base (NCDB), a joint program of the CoC and American Cancer Society. This nationwide oncology outcomes database is the largest clinical disease registry in the world. Data on all types of cancer are tracked and analyzed through the NCDB and used to explore trends in cancer care. CoC-accredited cancer centers, in turn, have access to information derived from this type of data analysis, which is used to create national, regional, and state benchmark reports. These reports help CoC facilities with their quality improvement efforts.

To earn voluntary CoC accreditation, a cancer program must meet or exceed 34 CoC quality care standards, be evaluated every three years through a survey process, and maintain levels of excellence in the delivery of comprehensive patient-centered care. Three-Year Accreditation with Commendation is only awarded to a facility that exceeds standard requirements at the time of its triennial survey.

Many of Northside’s physicians are nationally recognized for their treatment of cancer.


NFMGMA Meeting

Wednesday, November 20th, 2013

November 20, 2013, Villa Christina, Atlanta. For more information, visit Georgia Medical Group Management Association


AMGMA Meeting: ICD-10 Updates

Thursday, November 14th, 2013

November 14, 2013. For more information, visit Atlanta Medical Group Management Association



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