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Archive for September, 2014

Marcus Foundation Gift Will Enhance Grady Health System’s Emergency Department and Stroke Center

Tuesday, September 30th, 2014

The Marcus Foundation has awarded Grady Health System $30 million to help fund the expansion of the Grady Emergency Department and The Marcus Stroke and Neuroscience Center. $20 million will go towards the construction of Grady’s new $76 million Emergency Center. $10 million will be used to renovate existing hospital space to establish a multi-disciplinary outpatient center, expanding the scope of the Marcus Stroke and Neuroscience Center.

“This incredibly generous gift brings the Marcus Foundation’s total investment in Grady to $50 million since 2009. The state-of-the-art Marcus Stroke and Neuroscience Center and the Marcus Trauma Center have saved thousands of lives. This new funding will allow Grady to enhance its role as the state’s leading provider of emergency care and make our outpatient neurology services among the best in the nation,” said Grady President and CEO John Haupert.

“Our continued support is a testament to our firm belief that Grady is essential to the health and well-being of not just Atlanta and the metro area, but the entire state of Georgia. By helping to create and expand its nationally and internationally renowned emergency and stroke services, The Marcus Foundation is making an investment that we believe will make Grady the national standard of emergency care,” said Bernie Marcus, Marcus Foundation Chairman.

Work on the Emergency Department expansion and redesign began in March 2014 and is expected to be completed in 2016. The Marcus Foundation gift will be combined with $50 million in other philanthropic donations to fund the project. A start date has not been set for the Marcus Stroke and Neuroscience Center expansion.

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Gary E. Myerson, M.D.

Monday, September 29th, 2014
Gary E. Myerson, M.D.

Gary E. Myerson, M.D.

Dr. Myerson is a Founding Fellow of the American College of Rheumatology and is an active participant of the Arthritis Foundation. He also serves on the Medical Staff as Team Rheumatologist for the Atlanta Falcons Football Club. Dr. Meyerson practices with the Arthritis and Rheumatology of GA.

Dr. Myerson wrote Understanding the Immune Response From ATLANTA Medicine, 2012, Rheumatology, Vol. 83, No. 3

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Athan Tiliakos, D.O.

Monday, September 29th, 2014

Athan Tiliakos, MDDr. Athan Tiliakos graduated from the Kirksville College of Osteopathic Medicine and did his postgraduate training in Internal Medicine at Drexel University College of Medicine, where he also served as a Chief Medical Resident.  He underwent fellowship training at Emory University. Dr. Tiliakos is currently involved in clinical trials and epidemiologic research projects relating to Rheumatoid Arthritis and Systemic Lupus Eryhtematosus, with a particular interest in health disparities and their effects on disease outcomes. He teaches at the Emory School of Medicine and is particularly involved in clinical education at Grady Memorial.

Dr. Tiliakos wrote Giant Cell Arteritis: A Brief Review From ATLANTA Medicine, 2014, Immunology, Vol. 85, No. 3

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New Breast Cancer Treatment Options Boost Survival, Offer New Hope

Wednesday, September 24th, 2014

By Anita Johnson, M.D.

As a surgical oncologist focused on treating breast cancer, I see daily how devastating a breast cancer diagnosis can be. But I also see daily how new and often cutting-edge treatments give women the hope and courage they need to help manage or overcome the physical, mental and emotional challenges of breast cancer, and in many cases, beat the disease altogether.

One in eight women will develop breast cancer in her lifetime. While the leading risk factors are well known – older age, family history, mutations in certain genes – the most important risk factor for breast cancer is simply being a woman.

The fact that any woman can develop breast cancer is one reason annual mammograms and clinical breast exams are so important; regular screening helps detect cancer early. As with every type of cancer, when breast cancer is discovered early there are more treatment options available, survival rates are longer and the cure rate is higher.

In the U.S., trends in breast cancer are encouraging. Data from the National Cancer Institute (NCI) show consistent declines in both new cases and deaths from breast cancer since 1990. Further, the U.S. Centers for Disease Control and Prevention (CDC) reports that from 2001 to 2010 the incidence of breast cancer among U.S. women did not increase, while mortality decreased 2 percent annually.

What’s most notable about these data is that breast cancer mortality is decreasing faster than incidence – meaning that women with breast cancer are living longer. That trend also is borne out by NCI data: although only 75 percent of women with breast cancer survived more than five years in 1975, in 2011 more than 90 percent did.

There may be several reasons behind the decline in breast cancer deaths. However, new technologies and improvements in existing treatments are very likely contributing to higher survival rates and improved quality of life for women with breast cancer.

For example, a new technology called the MarginProbe System helps surgeons determine if cancer cells are present in the margins of tissue that has been removed. The technology helps reduce the rate of second surgeries following lumpectomy. In addition to continued refinements in breast-conserving and reconstructive oncoplastic surgery techniques, there is an array of advanced treatment technologies available today.

Genomic testing is an innovative new diagnostic tool that allows tumors to be examined on a genetic level. By identifying mutations that occur in a cancer cell’s genome, doctors can better understand what caused the tumor and tailor treatment based on these findings. Genomic testing might suggest a drug normally used for another type of cancer could be an appropriate treatment for breast cancer based on the genetic properties of the tumor.

Another example is intraoperative radiation therapy (IORT), one of many new technologies that deliver radiation more precisely, helping minimize damage to healthy tissue and treatment times. With IORT, radiation is delivered directly to the tumor site after a surgeon has removed the tumor. A 30-minute dose of IORT can often replace weeks of traditional radiation.

In addition to radiation, there have been numerous advances in chemotherapy treatments for breast cancer. Targeted therapy blocks specific molecules involved in tumor growth by directing drugs or other specially-created compounds (e.g., man-made immune system proteins) to attack cancer cells. A targeted therapy called chemoembolization delivers medication through a catheter directly into a tumor using image guidance. The chemotherapy drugs are mixed with particles, called microspheres, which block blood flow to the tumor.

With so many options available to treat breast cancer today, treatments can almost be tailored to the individual based on factors such as her genetic profile, location of the tumor, the type of tumor and whether the cancer has spread, among others. However, which treatment a woman ultimately chooses is a very personal decision best made in collaboration with her family, personal physician and oncologist.

The specter of breast cancer can be frightening, but it is important to remember that most women will not develop the disease. Women who are at an increased risk should talk to their doctors about how often they should receive mammograms and what other screenings, such as genetic testing, might be beneficial. Although breast cancer continues to claim too many lives – more than 40,000 this year – advanced treatment options are having a significant impact on survivability and quality of life.

Anita Johnson, MD, FACS, is medical director of breast surgical oncology at Cancer Treatment Centers of America at Southeastern Regional Medical Center in Newnan, Ga. 

 

 

 

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Giant Cell Arteritis: A Brief Review

Wednesday, September 24th, 2014

By Athan Tiliakos, D.O.

From ATLANTA Medicine, 2014, Vol. 85, No. 3 

Cerebral Giant Cell VasculitisGiant Cell Arteritis (GCA), or Temporal Arteritis, is the most common primary vasculitis. The disease is characterized by inflammation of the large and medium-sized vessels, predominately favoring the branches of the proximal aorta.

Epidemiology

GCA is a disease that typically occurs in people older than 50 years old, with a peak incidence in the seventh decade of life. GCA appears to be more common in Caucasians of Northern European descent (1, 2 and 3).

A study looking at the incidence of GCA in Shelby County, Tenn., revealed a decreased incidence in African Americans compared to Caucasians (4). The reported incidence in areas of southern Europe, Asia and North Africa was lower. Women appear to be affected more than men at a ratio of 3:1 (1, 2 and 3).

Pathogenesis

Experimental evidence supports a major role of a T-cell mediated process in the pathogenesis of GCA. Dendritic cells (DCs), located in the adventitia of medium and large-sized vessels, are activated via Toll-Like Receptor binding by specific ligands (including those resulting from infective agents).

These activated DCs, via release of chemokines, lead to recruitment and stimulation of CD4 T-cells and macrophages through the vasa vasorum into the vessel wall. These activated CD4 T-cells and macrophages then secrete pro-inflammatory cytokines. In particular, interactions between activated T-cells and the macrophages in the adventitia produce IL-1, IL-6 and Transforming Growth Factor beta, whereas in the media, they produce metalloproteinases and participate in oxidative damage. These factors then lead to fragmentation of the internal elastic lamina, intimal proliferation, thrombosis and possible vessel occlusion (5, 6, 7 and 8).

Clinical Features

The clinical features of GCA could be broadly classified in two ways: those that are caused by systemic inflammation, and those that are a result of ischemia. Fevers, fatigue, weight loss, night sweats, Polymyalgia Rheumatica-like symptoms (pain and stiffness in the neck, shoulder/pelvic girdle area) and elevated acute phase reactants are common signs and symptoms that could be attributed to systemic inflammation. Peripheral synovitis can also occur, but usually less frequently (9, 10, 11, 12 and 13).

When looking at the features that result from vascular injury, headaches have been shown to be the most common, being present in 90 percent of patients. The headaches are usually located in the temporal or occipital areas and may be associated with scalp tenderness. Jaw claudication is also common (9, 10, 11, 12 and 13).

Ocular symptoms are feared complications of GCA. The most common ocular manifestation of GCA that leads to vision loss is Anterior Ischemic Optic Neuropathy (AION). AION results from occlusion of the posterior cilliary arteries. The vision loss is usually painless and acute. Amaurosis fugax and diplopia may precede the acute vision loss. Posterior Ischemic Optic Neuropathy and Central Retinal Artery Occlusion can also be seen. Fever, weight loss, jaw claudication, diplopia, transient visual loss and older age are predictors of worse visual prognosis (9, 10, 11, 12 and 13).

Limb claudication, and the alteration of peripheral pulses stemming from large-vessel involvement, occurs in less than 20 percent of patients. Cough and hoarseness can be seen in less than 10 percent of patients. Other infrequent manifestations (<5 percent of patients) may include: peripheral neuropathy, tongue claudication, ischemia of the central nervous system, tissue necrosis, and deafness (9, 10, 11, 12 and 13).

Diagnosis

The temporal artery biopsy (TAB) is the most useful tool for diagnosing GCA. A biopsy is usually attempted on the symptomatic side. A contralateral biopsy, however, may be warranted in patients with a high suspicion for GCA and a negative, initial TAB. Given the potential focal positioning of the inflammatory infiltrate, it is important to obtain a sufficient sample of the temporal artery. Studies have shown that biopsy lengths of 0.5cm to 3cm are adequate for histologic analysis (12).

The stereotypic histologic morphology of GCA is a “panarteritis” or transmural inflammation of the vascular wall. The elastic lamina may be fragmented. In more chronic disease, intimal hyperplasia may cause arterial lumen occlusion (12).

Laboratory data are also very useful in the diagnosis of GCA. The erythrocyte sedimentation rate (ESR) and C-reactive protein are usually elevated. Weyand et al. noted that 25 percent of patients with positive temporal artery biopsies had normal ESRs prior to the initiation of glucocorticoids. Anemia and thrombocytosis can also be seen (13).

Imaging modalities, such as, ultrasound (US), magnetic resonance angiography (MRA), and computed tomography angiography (CTA) have been studied. Early inflammatory changes in the superficial branches of the aortic arch can be visualized with ultrasonography, while MRA and CTA are more useful in evaluating the thoracic and abdominal aorta.

Treatment

Glucocorticoids have been the mainstay of treatment for GCA. Typically, in patients without end-organ damage, prednisone is initiated at 1mg/kg/day. The dose is then usually titrated down, only when a patient’s symptoms and inflammatory markers have normalized. Mazlumzadeh et al. were able to show that patients who received “pulse dose” intravenous steroids (15mg/kg of ideal body weight per day) tended to experience increased frequencies of sustained remission after treatment compared to patients who received a standard dose of 40mg/day of prednisone. In addition, over time, the patients who received the pulse-dose steroids were able to more rapidly taper their oral prednisone dose (15).

In an attempt to mitigate the various short-term and long-term complications of glucocorticoids, several trials utilizing various disease-modifying drugs have been performed. Unfortunately, trials using methotrexate, infliximab, adalimumab and etanercept were unable to show any glucocorticoid sparing effect (16).

Recently, interest has been shown in the humanized monoclonal antibody to IL-6 receptor, tocilizumab. Several case reports, as well as a case series reported by Unizony, et al., revealed promising clinical results. Long-term, randomized-control trials are currently in planning (17).

Retrospective reviews have shown the benefits of low-dose aspirin therapy in GCA, including the potential decrease in risk of ischemic events and vision loss. Appropriate bone protective measures should be taken with glucocorticoid treatment (16).

Prognosis

Despite treatment, 60 percent of patients will experience disease relapse (7). Vigilant monitoring of clinical signs and symptoms is needed to prevent long-term complications.

 

BIBLIOGRAPHY

1) Gonzalez-Gay M, Vasquez-Rodriguez T, Lopez-Diaz M, Miranda-Filloy J, Gonzalez-Juanatey C, Martin J, and Llorca J. Epidemiology of Giant Cell Arteritis and Polymyalgia Rheumatica. Arthritis and Rheumatism 2009; 61: 1454-1461.

2) Richards B, March L, and Gabriel S. Epidemiology of large-vessel vasculitidies. Best Practice and Research Clinical Rheumatology 2010; 24: 871-883.

3) Kermani T et al. Increase in age at onset of Giant Cell Arteritis: A population study. Annals of Rheumatic Diseases 2010; 69: 780-781.

4) Smith C, Fidler W, and Pinals R. The epidemiology of Giant Cell Arteritis: Report of a ten-year study in Shelby County, TN. Arthritis and Rheumatism 1983; 26: 1214-1219.

5) Ly K, Régent A, Tamby M, and Mouthon L. Pathogenesis of Giant Cell Arteritis: More than just an inflammatory condition? Autoimmunity Reviews 2010; 9: 635-645.

6) Weyand C, Younge B, and Goronzy J. IFN-γ and IL-17: the two faces of T cell pathology in Giant Cell Arteritis. Current Opinions Rheumatology 2011; 23: 43-49.

7) Weyand C and Goronzy J. Immune mechanisms in medium and large-vessel vasculitis. Nature Reviews Rheumatology 2013.

8) Weyand C, Liao J, Goronzy J. The immunopathology of Giant Cell Arteritis: Diagnostic and therapeutic implications. Journal Neuro-Ophthalmology 2012; 32: 259-265.

9) Salvarani C, Pipitone N, Versari A, and Hunder G. Clinical features of Polymyalgia Rheumatica and Giant Cell Arteritis. Nature reviews Rheumatology 2012; 8: 509-521.

10) Weyand C and Goronzy J. Giant Cell Arteritis and Polymyalgia Rheumatica. Annals of Internal Medicine 2003; 139: 505-515.

11) Salvarani C, Cantini F, and Hunder G. Polymyalgia Rheumatica and Giant Cell Arteritis. Lancet 2008; 372: 234-245

12) Borchers A and Gershwin E. Giant cell arteritis: A review of classification, pathophysiology, geoepidemiology and treatment. Autoimmunity Reviews 2012; 11: A544-A554.

13) Kermani T et al. Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of Giant Cell Arteritis. Seminars in Arthritis and Rheumatism 2012; 41: 866-871.

14) Pineles S and Arnold C. Giant Cell Arteritis. International Ophthalmology Clinics 2007; 47: 105-119.

15) Mazlumzadeh M et al. Treatment of Giant Cell Arteritis using induction therapy with high-dose glucocorticoids. Arthritis and Rheumatism 2006; 54: 3310-3318.

16) Yates M, Loke YK, and MacGregor AJ. Prednisolone combined with adjunctive immunosuppression is not superior to prednisolone alone in terms of efficacy and safety in Giant-Cell Arteritis: meta-analysis. Clinical Rheumatology 2014; 33: 227-236

17) Unizony S et al. Tocilizumab for the treatment of large-vessel vasculitis. Arthritis Care and Research 2012; 64: 1720-1729.

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DeKalb Medical Announces Dr. Raoul Mayer, Vice President of Medical Affairs

Wednesday, September 24th, 2014

Dr. Raoul Mayer, M.D., joined the DeKalb Medical executive team as the Vice President of Medical Affairs, effective immediately. In his new role, Dr. Mayer will be involved in the Medical Staff Executive Committee, Professional Practice Evaluation Committee, Health and Conduct and Credentials.   

In addition to the aforementioned responsibilities, Dr. Mayer will also have administrative responsibilities for the podiatry residency program. He takes over for Dr. Reg Gilbreath, M.D., who resigned in late June.

Dr. Mayer has been on staff at DeKalb Medical Center for over 17 years and is a graduate of Columbia College and Mount Sinai School of Medicine in New York. He completed his General Surgery training at Mount Sinai Hospital and Colon and Rectal fellowship at the University of Minnesota.  In 1977, he joined Atlanta Colon and Rectal Surgery, one of the largest single sub-specialty colon and rectal groups in the Southeast.

Additionally, Dr. Mayer has served as Chief of Surgery, Chief of Staff and Chairman of the Physician Advisory Committee and has been involved with many hospital leadership committees.

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The American Medical Association’s Fact Sheet Will Assist Physicians in Complying With New Federal Regulations

Tuesday, September 23rd, 2014

The American Medical Association (AMA) released a new fact sheet today to assist physicians in complying with new federal regulations on prescribing hydrocodone and help avoid disruptions in patient care. The rule, effective October 6, 2014, reschedules hydrocodone combination products (HCPs) into Controlled Substance Schedule II. Millions of patients will be impacted by this new rule from the Drug Enforcement Administration (DEA), and the new resource will help physicians understand the rule and avoid interruptions in access to medically necessary HCPs for their patients.

“The AMA is strongly committed to combating prescription drug abuse and diversion while at the same time preserving patient access to medically necessary treatments for pain,” said Dr. Robert M. Wah, President of the AMA. “This new fact sheet explains how new regulatory changes impact both physicians and pharmacists, which will help ensure patients continue having access to the care they need under the new federal rule.”

Prescriptions for HCPs issued before October 6 that have authorized refills can be dispensed in accordance with current DEA rules for refilling, partial filling, transferring, and central filling of Schedule III-V controlled substances until April 8, 2015. However, due to state laws and limitations on some pharmacy and insurance processes – some health insurers and pharmacies may deny requests for refills on or after October 6. To help ensure continuity of care for patients and reduce confusion, the AMA is encouraging prescribers to act now to provide new hard copy or electronic prescriptions for patients, rather than depending on existing refills. 

In addition to providing helpful resources like these to physicians, AMA intends to continue its advocacy efforts for a multi-pronged approach to address prescription drug abuse and diversion. That approach includes patient and physician education, increased access to treatment programs and life-saving overdose prevention medications like naloxone, adequate funding for prescription drug monitoring programs and prescription drug take-back programs.

The new fact sheet is available here

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WellStar East Cobb Health Park is a “One Stop Shop” for Outpatient Medical Services

Wednesday, September 17th, 2014

WellStar East Cobb Health Park opened its doors September 15, serving as a comprehensive, one-stop shop for outpatient medical needs.  Patients will now be able to see their doctor, have necessary tests performed and get prescriptions filled in one convenient location.

The three-story 162,000 square-foot East Cobb Health Park is WellStar’s second health park.  A similar facility opened in Acworth two years ago.  The health park concept brings primary and specialty physician offices together with comprehensive diagnostics, laboratory services, rehabilitation therapy, urgent care, a retail pharmacy, among other services.  At the East Cobb facility, an outpatient surgery center is expected to open mid-2015.

The East Cobb Community was very involved in the construction of the facility, providing input and suggestions throughout the process.

Outpatient medical services are a major growth area in the healthcare industry with growth expected to top 23 percent nationally over the next decade.

“A health park is all about bringing outpatient and physician services directly to the communities we serve,” said Joe Brywczynski, senior vice president health parks development. “Residents no longer will have to endure long drive times, frustrating traffic congestion and multiple trips to access their health services at various locations. By combining and coordinating services under one roof, we will improve patient and family convenience and access to their outpatient care needs. The health park is truly a one-stop-shop opportunity.”

The new health park is located at 3747 Roswell Road NE, Marietta, Ga.  It includes a wide array of services:

  • Primary Care Providers and Medical Specialists
  • Comprehensive Diagnostic Center (Imaging, Women’s Imaging, Lab & Pre-admission Testing)
  • Outpatient Surgery Center (opening targeted at July 1, 2015)
  • Urgent Care Center
  • Breast Center (planned)
  • Spine Center (planned)
  • Cardiac Diagnostics
  • Sleep Center
  • Physical Therapy and Sports Medicine (OrthoSport WellStar)
  • Cardiac & Pulmonary Rehabilitation
  • Retail Pharmacy
  • Lactation Consulting
  • Community Education & Wellness Center
  • Parkside Bistro

These services will be integrated with a multi-specialty mix of physicians to include a strong foundation of primary care physicians: family physicians, internal medicine, pediatrics and OB/GYN services. Specialists will include cardiologists, pulmonologists, ENT, neurosurgery, pain management, chiropractic care, vascular surgery, general surgery, allergy/asthma, endocrinology, urology and orthopedics.

Two additional health parks are planned in Vinings and Cherokee County.

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Risks and Benefits of Lung Cancer Screening

Monday, September 15th, 2014

September 15, 2014, Gwinnett Medical Center Cancer Institute, Lawrenceville, Ga. For more information, visit  Georgia CORE

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AMGMA September Meeting

Thursday, September 11th, 2014

September 11, 2014, Atlanta. For more information, visit Atlanta Medical Group Management Association

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