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Archive for June, 2014

Medical Association of Atlanta Annual Meeting

Thursday, June 26th, 2014

June 26, 2014

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MAA Annual Meeting

Thursday, June 26th, 2014

June 26, 2014, Capitol City Club, Atlanta. For more information, visit Medical Association of Atlanta

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Northeast Georgia Physicians Group Surgeon, Casey Graybeal, MD., Now Offers a New FDA-Approved Procedure to Treat Reflux Disease

Wednesday, June 25th, 2014

Patients suffering from heartburn, acid reflux or gastroesophageal reflux disease (GERD) now have a new, safe and effective treatment alternative to taking daily medication.  Casey Graybeal, MD, a surgeon with Northeast Georgia Physicians Group (NGPG) Surgical Associates, recently performed the first surgical procedure in northeast Georgia using the FDA-approved LINX Reflux Management System.  LINX is a minimally invasive treatment that addresses the main cause of GERD, eliminates heartburn, and, unlike traditional surgical treatment, still allows patients to vomit and belch.

Dr. Casey Graybeal“Many of the patients I see have spent years taking medications to reduce their GERD symptoms, never knowing that other options are available to essentially cure the disease,” says Dr. Graybeal.  “With the new LINX device, I am able to address the cause of reflux disease and eliminate painful symptoms while maintaining esophageal function.”

GERD is a chronic, often progressive disease resulting from a weak muscle in the esophagus. The weakened muscle allows harmful stomach acid and bile to splash up from the stomach into the esophagus, often causing heartburn, chest pain, regurgitation, difficulty swallowing, shortness of breath, sore throat and cough.  If left untreated, GERD can lead to serious complications like Barrett’s esophagus and esophageal cancer.

Because GERD is caused by a mechanical defect in the lower esophagus, it requires a mechanical solution.  The LINX System is a small, flexible, interlinked band of medical grade, rare earth magnets enclosed in titanium beads.  The LINX System is implanted around the bottom of the esophagus, just above the stomach.  The magnetic attraction between the beads helps the esophagus close to prevent reflux. When a patient swallows, however, the band of beads separates temporarily to allow food and liquid to pass into the stomach.

Results from a clinical study showed that after treatment with the LINX System:

  • 100 percent of patients no longer experienced severe regurgitation
  • 99 percent of patients no longer experienced daily sleep disruption due to heartburn
  • 94 percent of patients were satisfied with their overall condition
  • 91 percent of patients no longer had to take daily GERD medication

Dr. Graybeal’s practice, NGPG Surgical Associates, offers comprehensive care from consultation to testing to diagnosis to treatment.  Their surgeons perform all types of general surgeries, but Dr. Graybeal personally performs more than 100 procedures for GERD each year.  He and his physician assistant, Jessica Keller, PA-C, recently began performing the LINX procedure at Northeast Georgia Medical Center.

 

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Clinical Trial Tests Possible Benefits of Brain Stimulation on Hand and Arm Movement Following Stroke

Tuesday, June 24th, 2014

Researchers at Shepherd Center in Atlanta are studying whether stimulating the brain before rehabilitation could yield greater gains in motor function for people recovering from stroke.

Shepherd Center is one of 12 U.S. centers participating in a clinical trial that is evaluating whether coupling navigated transcranial magnetic stimulation (TMS) of the brain with standard occupational therapy can measurably improve hand and arm function following a stroke. Experts say this approach could unlock a totally new, non-invasive treatment to promote recovery and function.

Shepherd Center Clinical Trial“It’s really a seminal study in neurorehabilitation that, if successful, will change common practices for how we take care of certain stroke patients,” said Ford Vox, M.D., a physical medicine and rehabilitation physician at Shepherd Center and primary investigator for this study. “We have this golden opportunity right after someone has a stroke when we know people are most likely to improve or recover function, and this therapy may offer patients the best potential.”

Shepherd Center is testing a navigated brain stimulation system developed by a Finnish medical technology company called Nexstim. It uses TMS therapy to apply a mild electromagnetic current to excite the brain, a technique that can be used to both investigate the brain’s functions and change them. The technique is growing in popularity as a way to map the brain before surgery and as a treatment for depression. Nexstim’s device provides visual guidance to the operator, who uploads and correlates MRI pictures of the patient’s brain with the device’s infrared guidance system. Then, the device creates a 3-D model of the patient’s brain, pinpointing the target site for stimulation in real time (called stereotactic guidance).

In this new trial, clinicians believe TMS works by slowing activity in the healthy area of the brain, which can become overly active following a stroke, causing detriment to the injured side.

The technology is akin to a more advanced version of constraint-induced therapy in which clinicians physically tie down a patient’s good arm, which forces the patient to use the injured side. With Nexstim’s non-invasive device, researchers are using electromagnetism to slow activity in portions of the healthy brain hemisphere that control the uninjured arm, similarly forcing the brain to use its injured half.

Eligible clinical trial participants receive either the navigated brain stimulation or a sham (simulated) treatment in conjunction with six weeks of hand and arm therapy provided by an occupational therapist. Researchers and study participants do not know whether they are in the treatment or simulation group. Visits start with 20 minutes of standardized, task-oriented activity followed by the treatment or simulated therapy and then an hour of upper-limb rehabilitation therapy.

The goal is to improve a patient’s range of motion, coordination, flexibility, strength, and use of the weak arm and hand. Specifically, researchers are interested to see whether – at the end of the study – patients are better able to perform daily activities, such as dressing, grooming, cooking, doing laundry, writing, typing and leisure activities.

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Exploring The Efficacy of PSA Testing

Tuesday, June 24th, 2014

By Rajesh Laungani, M.D. FACS

From ATLANTA Medicine, 2014, Vol. 85, No. 2

Dr. Rajesh Laungani

Rajesh Laungani, MD

To screen or not to screen, to treat or not to treat. The gold standard for prostate cancer screening is for men to undergo both a digital rectal exam (DRE) and a Prostate Specific Antigen (PSA) blood test (Figure 1).

The debate on prostate cancer continues to revolve around the efficacy and usefulness of PSA as a valid screening tool as well as the decision-making ability of clinicians to appropriately decide which patients should undergo treatment and which should not. In all honesty, it is a reasonable debate given the information and the current tools that we have at our disposal.

There is no doubt that the future of medicine and cancer lies within the “double helix.” The ability to unlock the DNA code will one day give us some insight in regards to predicting who will die of cancer and who may succumb to more natural causes. This insight is lacking in our PSA/prostate cancer decision tree and has led many patients to be overtreated, but it has also led many patients to be poorly screened, leading to delayed and late presentation of disease.

Let’s try and break down the debate with a few examples of patients you see every day in your practice.

 

 

Prostate Cancer Screening

Figure 1: Prostate Cancer Screening: DRE & PSA

Prostate Cancer Screening

Figure 1b: Prostate Cancer Screening: PSA

Patient 1

A 75-year-old healthy male walks into your office for a routine physical exam. You will obtain a lipid profile, check his blood sugar, check his urine and stool for blood, check his LFT’s and do a thorough physical exam. But, should you check his PSA this year?

Every year prior, his PSAs have been within normal limits. What are the chances at age 75, having not been diagnosed with prostate cancer thus far, that he will die from this disease? If we think his overall chance of death from prostate cancer is very low, why screen for it? In other words, why search for something that may likely be present (given the fact that as you get older your risk of prostate cancer rises) but may likely be clinically insignificant and may not require treatment. This would be a prime example of a patient that, if screened and diagnosed, could be overtreated (treated for a disease he will likely not die from).

Patient 2

A 55-year-old male presents to your clinic for his yearly physical. He recently completed a colonoscopy, exercises 3 times per week, does not smoke or drink and takes only a medication to help lower his cholesterol. Do you obtain a PSA as part of his routine laboratory evaluation? Based on new government guidelines, PSA is a poor screening test and does not impact the overall death rate from prostate cancer. But he is healthy, has at least a 25- to 30-year life expectancy and detecting prostate cancer (if in fact he is harboring it) at an early stage can potentially be curable. If you choose to adopt the government guidelines, you risk ignoring and missing the most common cancer seen in men and the leading cause of cancer-related death in men. This is a prime example of a man who could be under-screened and potentially die from a disease given his long life expectancy.

Recommendations

It has been established that those patients with risk factors for development and diagnosis of prostate cancer need to be aggressively screened and potentially treated. These men include those with a family history of prostate cancer (first-degree relative such as a father or brother) as well as those men who are African American. The American Urological Association (AUA) Guidelines (Figure 2) recommend that for men with risk factors, there should be an establishment of a baseline PSA value in their 40s, with annual screening beginning in their 50s. It advocates screening for all men to start in their 50s, regardless of risk factors.

The AUA has not accepted the recent statement put out by the United States Preventative Services Task Force (USPSTF) in regards to prostate cancer screening but has commented on the fact that interpretation of the PSA test and evaluation by the correct individuals may contribute to identifying those patients who would benefit most from annual PSA testing and screening.

The debate comes down to a simple fact: the error with PSA does not lie within the test itself, but instead in how we choose to use the test and how the test is interpreted. There is no doubt that PSA as a screening tool is far from perfect. We know that PSA may be elevated naturally with BPH, infection, inflammation, recent catheterization or urinary retention. At very high levels, PSA may correlate with aggressive prostate cancer, but on its own it is not diagnostic.

PSA can be interpreted based on absolute value as well as trend and change. PSA velocity as well as PSA doubling time have been shown to play a role in predicting diagnosis of prostate cancer as well as even death from prostate cancer. Other PSA tests, including Free PSA, PSA Density and Pro PSA, may help to differentiate benign elevations in PSA as well as differentiate slow-growing from more aggressive, rapidly growing tumors. Molecular marker testing provided by certain companies, recently highlighted in The New York Times, has brought some insight into predicting who may be harboring more aggressive diseases, therefore allowing physicians to avoid overtreatment.

Figure 2: PSA Screening Recommendations*

HIGH RISK PATIENT**                                                  LOW RISK PATIENT***

BASELINE PSA AT AGE 40 AND 45                          NO BASELINE PSA NECESSARY

PSA ANNUALLY AFTER AGE 50                               PSA ANNUALLY STARTING AGE 50

**High Risk Patients: Family history (first-degree relative diagnosed with prostate cancer) or African American

***Low Risk Patients: No family history or Caucasian, Asian, Middle Eastern

*Risk of prostate cancer in regards to age, absolute value of PSA as well as rate of change of PSA should be made by your urologist. Determination of need for a prostate biopsy for diagnosis of prostate cancer should be made by your urologist.

Summary

We as physicians have all come to realize that medicine in all of its perfection continues, in many regards, to still be an imperfect science. Decisions that we make on how to manage and treat our patients are based on the current tools that we have at our disposal, in this case PSA, but appropriate use of those tools is what defines us as physicians. A better screening and diagnostic test for management of prostate cancer is inevitable, as are the case for so many things in medicine, as technology advances us to see things on a molecular level. However, abandoning a test altogether continues to put a population of men at risk of dying from disease that is potentially very curable. Once again, it is not the test that is flawed as much as it is the interpretation and use of it.

Rajesh Laungani, M.D. is a urologist and serves as the Director of Minimally Invasive and Robotic Urology at Piedmont Hospital in Atlanta. He received his medical degree from the State University of New York Downstate College of Medicine and completed his surgical internship and urology residency at Henry Ford Hospital in Detroit, Mich., where he earned a fellowship in Minimally Invasive and Robotic Surgery from the Vattikuti Urology Institute. He earned his undergraduate degree from Brooklyn College. He maintains a strong interest in prostate cancer research and education and has ongoing collaborations with Georgia Tech, Clark Atlanta University and Emory University. 

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Gynecology and Obstetrics

Tuesday, June 24th, 2014

By Helen K. Kelley

From ATLANTA Medicine, 2014, Vol. 85, No.2

Through research and minimally invasive testing and surgical techniques, Atlanta physicians are making a difference for patients with high-risk pregnancies, gynecological cancers and more.

Non-Invasive Prenatal Testing Moves Toward Becoming Standard of Care

Non-Invasive Prenatal Testing (NIPT) is used to analyze cell-free fetal DNA circulating in maternal blood. It allows for earlier and more accurate detection of chromosomally abnormal pregnancies. Over the past two years, NIPT has become an increasingly popular option for women who desire aneuploidy screening during pregnancy in North America and Europe.

Cell-free DNA (cfDNA) fragments are present in the bloodstream. In pregnant women, cfDNA from both the mother and the pregnancy circulates in the maternal blood. NIPT is able to isolate and analyze the fetal fraction of the cfDNA and detect fetal trisomies such as Down syndrome (trisomy 21) with >99.9% accuracy with less than 0.1% (1/1000) false-positive rate.

According to Genevieve Fairbrother, M.D., M.P.H., with Obstetrics & Gynecology of Atlanta, the high accuracy of NIPT, along with the additional benefit of a decreased false-positive rate, has made this new approach a “game changer.”

“Prior to NIPT, the most accurate non-invasive, low-risk option had a 1/20 false-positive rate. These older tests could detect affected pregnancies 90 percent of the time, but out of a thousand women, there would be 50 false-positives and maybe only three true-positives,” she explains. “With a false-positive rate this high, it is difficult to counsel a woman when her ‘positive screen’ is correct less than 5% of the time.”

A non-invasive prenatal screen, NIPT requires only two vials of the patient’s blood and can be performed as early as the 10th week of pregnancy. From this blood sample, the test distinguishes between the mother’s cell-free DNA and that of her fetus. It determines normal levels of chromosomes using reference chromosomes, and then, with specialized probes, evaluates chromosomes of interest, such as chromosome 21, to determine if the pregnancy is affected.

“We’re so happy to have the ability to detect chromosomal abnormalities with this kind of accuracy and at the same time limit our patients’ exposure to unnecessary invasive tests such as CVS or amniocentesis. The advances that this technology has made in dramatically decreasing the false-positive rate are creating a paradigm shift in our approach to aneuploidy screening in pregnancy,” states Fairbrother. “The majority of insurance companies have agreed to cover this test for women who are age 35 and older at delivery. We have high expectations that an upcoming validation study of general risk patients involving more than 18,000 patients will prompt insurance companies to expand coverage for the general risk population. I offer it to all of my patients. I foresee NIPT becoming the new standard of care here in the United States.”

Can Diet and Exercise Modulate Ovarian, Fallopian Tube and Primary Peritoneal Cancer Progression-free Survival?

A clinical trial, overseen by John McBroom, M.D. at Piedmont Atlanta Hospital, is exploring whether or not a change in diet and exercise in women with ovarian, fallopian tube or primary peritoneal cancer has an effect on the length of time the patient is cancer-free following their initial treatment. Some studies suggest diet and exercise may improve survival for cancer patients, but no studies have been done to show if changes in diet and exercise can have an effect on cancer returning in women treated for ovarian, fallopian tube, or primary peritoneal cancer.

Other goals include finding out if the changes in diet and exercise will improve overall quality of life and the ability to be physically active. In addition, the first 200 patients to enter the study will have their blood and measure carotenoid levels tested, which will tell them about the kind of foods the patient is eating.

Patients are being sought for the trial. Among the criteria are:

• Histological diagnosis of epithelial ovarian cancer, fallopian tube or primary peritoneal carcinoma, clinical stage II, III or IV at diagnosis

• Completion of all primary chemotherapy and consolidation therapy at least 6 weeks ago, and no more than 6 months and 2 weeks, prior to enrollment and must be in complete remission

• Documented complete response to treatment based on normal CA-125 and CT scan or MRI with contrast

• GOG Performance Grade of 0, 1, or 2

• Not currently enrolled in an ongoing medically prescribed diet or physical activity regimen

• No other chronic disease that would preclude randomization into a lifestyle intervention trial

For more information, contact Franca Cenciarelli, 404-425-7927, franca.cenciarelli@piedmont.org

Breakthrough New Fibroid Surgery

Physicians at WellStar Kennestone Hospital are the first in Georgia to treat women with symptomatic fibroids using the Acessa™ Procedure.  Kevin Windom, M.D., recently performed the first of these procedures.

The minimally invasive procedure is highly effective and less invasive than most surgical alternatives, with faster recovery time and symptom relief. Additionally, the need for further fibroid treatment is reduced, as demonstrated by clinical studies in which 90% of patients three years after the procedure did not require further medical or surgical treatment.

Fibroids are benign, non-cancerous tumors in a woman’s uterus that, when symptomatic, can be very painful and cause heavy bleeding, pressure on the bladder or rectum, and abdominal discomfort and distention. The laparoscopic Acessa™ Procedure allows the surgeon, using a small scope and ultrasound guidance, to locate the patient’s fibroids and treat them individually with radiofrequency energy to destroy them. The surrounding healthy tissue is left intact and unharmed.

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Atlanta Doctor and Wife Publish Fictional Medical Novel: Scar Tissue

Monday, June 23rd, 2014

An Atlanta cardiologist, Dr. Don Jansen, and his wife, Debra Jansen, recently published a fictional medical novel, Scar Tissue, about a troubled heart surgeon.

Don practices non-interventional cardiology at the Emory St. Joseph’s Hospital of Atlanta. His primary interests include nuclear cardiology, heart failure and heart transplantation. He served as medical director of the heart transplant program for nearly twenty years and is one of the Southeast’s leading authorities in the field of heart failure. Don has dreamed of writing a medically-based fiction novel for years, and Scar Tissue has made that dream a reality.

Co-author Debra Jansen worked in retail management with Federated and Sak’s Fifth Avenue as a buyer and store general manager. After finishing her undergraduate degree at the Art Institute of Atlanta, graduating magna cum laude in the field of photographic imaging, Debra went on to win several international awards for her photography. She specializes in medical documentation and location portraiture and has published several cover and feature article photographs in ATLANTA Medicine, the journal of the Medical Association of Atlanta.

Interested in writing a book for years, Debra welcomed the collaborative opportunity to do so with her husband, thus utilizing both of their skills. Debra’s and Donald’s individual areas of expertise blend perfectly in the genre of medically-oriented novels. As a cardiovascular physician, Donald provides technical advice while Debra uses her creative writing and visual imagery skills to craft the narrative.

For more information, you can visit the book’s website here: http://www.debramacdonald.com/

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WellStar Working to Prevent Maternal Deaths During Pregnancy and Birth

Monday, June 23rd, 2014

WellStar is joining a multi-year, three-pronged initiative launched by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) to improve the treatment of pregnancy related complications.  The first initiative focuses on improving the treatment of obstetric hemorrhage—one of the leading causes of death during labor and delivery.

AWHONN’s Postpartum Hemorrhage (PPH) Project has gathered 54 birthing hospitals in Georgia and New Jersey to assess and improve clinical practices.  Additional hospitals in the District of Columbia are expected to join the PPH Project later this year.  Of participating hospitals, they had more than 125,000 births in 2012.  A full list of the participating hospitals is available on www.pphproject.org.

Women in the U.S. experience greater risk of death from pregnancy-related complications than women in 46 other countries.  While two to three women die every day in the U.S. from pregnancy-related complications, more than half of these deaths are preventable.  Incidents of obstetric hemorrhage (or bleeding too much during childbirth) have increased in recent years along with an overuse of inductions of labor.

Research suggests that women who have inductions of labor have a greater risk of experiencing postpartum hemorrhage.  Between 1999 and 2009, the number of women who received blood transfusions during and immediately after childbirth increased by 183%.  African American women are disproportionately affected by birthing complications with three to four times more deaths than women of all other racial and ethnic groups.

Supported by a grant from Merck for Mothers, AWHONN’s Postpartum Hemorrhage (PPH) Project is designed to:

  • increase clinician recognition of women at greatest risk of obstetric hemorrhage;
  • increase early recognition of women who are bleeding too much;
  • increase the readiness of clinical team preparedness to successfully respond to obstetric hemorrhage; and
  • improve clinician response to obstetric hemorrhage

Additional practice improvements will include identifying barriers to treating obstetric hemorrhage, sharing clinical best practices, and identifying how to more effectively implement similar improvements in all hospitals in the United States.

 

 

 

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Shepherd Center and Craig Hospital, Two Hospitals for Spinal Cord and Brain Injury Rehabilitation, Partner to Improve Patient Care and Access

Sunday, June 22nd, 2014

Shepherd Center and Craig Hospital, two specialized rehabilitation hospitals for people with brain and spinal cord injuries, recently announced they have agreed to establish an alliance to create a “center of excellence” for catastrophic injury rehabilitation, long-term acute care and medical care.

Shepherd Center Campus

Shepherd Center Campus

This alliance opens new opportunities to advance patient care, improve patient access to rehabilitation services and share practices with a wide array of healthcare partners.

The alliance was spurred in part by the Affordable Care Act (ACA), which has prompted realignment of networks and the post-acute continuum of care to focus on preventing hospital readmissions.

A central part of the joint effort will build on strategies to engage and educate patients and families throughout the entire rehabilitation process so they are better equipped with the skills and knowledge to identify and handle problems at home after discharge.

The alliance will utilize existing resources – for example, Craig Hospital’s Nurse Advice Line call center and Shepherd Center’s Transition Support Program – and create new portable resources (via mobile apps and web-based access) to keep patients and families connected. Craig Hospital and Shepherd Center plan to create new affiliations with other providers to strengthen the continuum of care, reduce complications, and help patients find primary and specialty outpatient care in their own communities, as needed.

Craig Hospital

Craig Hospital

Moreover, the alliance will provide research opportunities and launch an integrated education program to train providers within trauma centers, other rehabilitation facilities, long-term acute care hospitals, home health agencies, health plans and workers’ compensation programs on best practices for spinal cord and brain injury recovery.

While Craig Hospital and Shepherd Center remain independent, freestanding institutions, the new alliance will allow these hospitals to provide standardized care and remain competitive within a changing healthcare environment.

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2014 MS Leadership Class Raises Over $220,000 for Global MS Research

Wednesday, June 18th, 2014

The National MS Society, Georgia Chapter’s 2014 MS Leadership Class raised over $220,000 for global MS research. Fifty-two business men and women graduated from the class with honors in fundraising, having exceeded their class goal of $170,000 by over $50,000. This is the most funds raised in the history of the MS Leadership Class, dating back to 2009.  Money raised through the program is allocated to the Society’s research initiative to stop disease progression, restore function and end MS forever.

In addition to fundraising, class members volunteered in service projects throughout metro Atlanta. During MS Service Day 2014, the class in conjunction with The Home Depot Foundation, assisted with home modifications of 11 military veteran households of people living with the disease. They also joined over 6,000 people at Walk MS: Georgia 2014, to spread awareness and rally behind the strategy to develop, deliver and leverage resources to enhance care for people with MS and quality of life for those affected by the disease.

Class members also had the opportunity to sharpen their leadership skills by attending seminars such as the Executive Presence presented by Dale Carnegie, Surviving Change presented by PricewaterhouseCoopers LLP and the Emergency Preparedness Institute for Business Leaders presented by Atlanta Fire Rescue. Participants networked with some of Atlanta’s key business leaders who discussed their leadership philosophy and style, overcoming obstacles, and making key decisions during the Executive Roundtable sessions.

Click here to go to the MS Leadership Class website.

 

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