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Archive for August, 2015

2015 GOGS Annual Meeting

Thursday, August 27th, 2015

August 27-30, 2015, The Ritz-Carlton, Amelia Island, FL. For more information, visit Georgia Obstetrical and Gynecological Society

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Physicians Partner with Children’s to Create The Children’s Care Network

Thursday, August 27th, 2015

Children's Care NetworkTo meet the new demands of a changing healthcare market, a group of community physicians partnered with Children’s to create The Children’s Care Network, a physician-led, taxable nonprofit subsidiary corporation of Children’s Healthcare of Atlanta. The Children’s Care Network, Georgia’s only clinically integrated pediatric network, will demonstrate performance and value by emphasizing data-driven approaches to quality improvements.

Pediatricians can benefit from a unified, collaborative system that offers group purchasing power, cost savings, technical resources, and an association with Children’s—the largest and most trusted pediatric healthcare system in the state.

Patients will receive care provided by pediatric-trained physicians.

Achieving better outcomes and improved coordination at a lower cost is the crux of The Children’s Care Network, which was formed to create a clinically integrated network. Unlike physician-hospital organizations or accountable care organizations, The Children’s Care Network is built on several tenets:

• Legal framework—The network must enforce the guidelines within the participation criteria, including treatment outcomes and additional practice improvements, such as participation in a population health management tool.
• Physician leadership—Physicians have the dominant voice in the development of protocols and establishing benchmarks for the network. This leadership structure helps maintain and strengthen the delicate balance between hospital and private practice needs.
• Participation criteria—The network maintains codified guidelines that are applicable to every practice member—large or small.
• Performance improvement—Outcome standards include improving operational efficiencies and reducing duplicative clinical actions. Bigger, Smarter, Faster.
• Information technology—Population health management tools and other technology that can work for a variety of practices to analyze the efficacy of the network’s quality and outcomes benchmarks.
• Contracting options—Once clinically integrated, the network will enable members to jointly negotiate payer incentives for improved outcomes and reduced cost.

Enrollment for Founding Members of The Children’s Care Network ends June 30, 2015. Enrolling as a Founding Member allows a practice to participate actively in the clinical integration process and receive a reduced membership rate of $200 per physician. Enrollment will not re-open again until a later date, when membership dues may increase.

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2015 GOGS Annual Meeting

Thursday, August 27th, 2015

August 27-30, 2015. For more information, visit Georgia Obstetrical and Gynecological Society

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LLCMGMA Meeting

Wednesday, August 26th, 2015

August 26, 2015, Lanier Park Campus, Gainesville, Ga. For more information, visit Georgia Medical Group Management Association 

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CRH Healthcare Continues to Grow in Greater Atlanta Metro

Wednesday, August 26th, 2015

CRH Combined with CRH Healthcare’s four Atlanta area urgent care centers under the Peachtree Immediate Care brand, CRH is now the leading operator serving America’s ninth largest MSA of 5.6 million people. While physicians in each center will continue to lead each medical practice, CRH will lead a team of operators that will manage the practices’ non-clinical operations.

With centers in Douglasville, Hiram, Acworth, East Cobb, Peachtree Corners, Buford, Johns Creek, Gwinnett, North Point, Decatur, and next year in Snellville, Physicians Immediate Med is geographically complementary to CRH’s current centers in Fayetteville, Mableton, Newnan and LaGrange. Physicians Immediate Med is open seven days a week providing walk-in care for injury, illness, and minor emergencies as well as family care. All the centers have lab capabilities and digital x-rays onsite, allowing patients to be seen for nearly all non-life threatening medical issues without the long wait or high costs of an emergency room. The centers provide a convenient alternative to emergency rooms and urgent care options in the area.

“We opened our first walk-in center thirty years ago in Atlanta and have really become part of the community over the years. We are proud of what we have built but the time was right to combine organizations with CRH to further enable our growth in serving Atlanta. The staff and I look forward to working with the team at CRH Healthcare,” said Dr. Mersberger, Founder of Physicians Immediate Med. Bill Miller, CEO of CRH Healthcare added, “This combination made tremendous sense. It brings together two successful companies to make one great team and Atlanta’s leader in walk-in care.” The acquisition, CRH’s fourth in three years, is part of CRH Healthcare’s growth strategy in the greater Atlanta metro region, which is part of a broader southeastern strategy that also includes three centers in Huntsville, AL operated under the Urgent Medcare brand.

In support of the acquisition and their future growth expectations, CRH also brought in a new, equity sponsor, MSouth Equity Partners, which is also based in Atlanta. Capstar and Cadence Bank provided additional financing for the transaction.

 

 

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Spotlight on Cosmetic Surgery

Tuesday, August 25th, 2015

By Helen K. 9k=Kelley

Cosmetic surgery has experienced growing popularity over the past 15 years. With less-invasive techniques, procedures that require little or no downtime for patients and greater affordability, cosmetic surgery has become a preferred alternative that addresses people’s desires for both improved appearance and health. Affordability and fast recovery time drive am increase in cosmetic rhinoplasty.

Whether it’s for a better appearance or to correct a functional problem, the number of people seeking rhinoplasty is on the rise, according to William E. Silver, M.D., a triple board certified facial plastic surgeon with Atlanta Institute for Facial Aesthetic Surgery.

“The cosmetic aspect of rhinoplasty has increased for several reasons. For example, we now have outpatient surgery centers that offer this type of surgery, which means that hospitalization is no longer required; therefore, the cost has dramatically decreased,” Dr. Silver says. “Additionally, patients can undergo relatively complicated procedures as outpatients at these centers, with improved anesthesia management and faster recovery time. There has also been an increase in the number of people of various ethnic origins who desire surgery to create a different or softer appearance.”

With respect to functional nasal surgery, Dr. Silver says that more and more patients are realizing that they can achieve two goals at one time.

“They can undergo functional and cosmetic procedures in just one surgery,” he says. “I believe this option has contributed to the increase in people seeking cosmetic rhinoplasty.”

Dr. Silver adds that advances in technology and non-surgical treatments and techniques have improved rhinoplasty procedures.

“We now have instrumentation that makes it relatively easy to do suturing inside the nose. There is no longer a need for all the nasal packing that we used to do in order to hold nasal structures in place,” he says. “Another advance is the use of computer imaging, which has helped tremendously as a communications tool. We can use the technology to define and compare the patient’s desires with the surgeon’s goals so that they are ultimately matched.”

For women who want to get their bodies back after having babies, “mommy makeover” surgery is ideal, says Bernadette Wang Ashraf, M.D., a board certified plastic surgeon with Artisan Plastic Surgery. The surgery, which actually involves two procedures — one to enhance/restore the breasts and the second to repair the abdomen — has grown steadily in popularity over the past 15 years, according to Dr. Ashraf.

“In my practice, I have seen a definite increase in patients seeking the mommy makeover. I think the main reason for its popularity is that so many women are healthy, with good diets and exeHelen K. Kelleyrcise routines, but are still frustrated with some of the changes their bodies go through after pregnancies,” she explains. “No amount of diet or exercise can perk up breasts or remove excess abdominal skin or repair abdominal muscle separation — but the mommy makeover surgery can. And it is done safely with great results.”

The most common surgery for enhancing and restoring the breasts in the mommy makeover is breast implants, with or without a breast lift. Since breasts commonly deflate after pregnancy, the implants help to restore their volume. However, some patients have enough breast tissue that can be used to lift and reshape the breasts, thereby eliminating the need for implants.

The most common procedure to repair the abdomen after pregnancy is a “tummy tuck,” or abdominoplasty, in which excess skin and fat is removed and rectus muscles are repaired.

Dr. Ashraf says there are several benefits to having both breasts and abdomen addressed during the same operation.

“First, the patient undergoes just one surgery, so there is only one anesthesia and one recovery period. There is also a slight cost advantage when combining procedures,” she says. “By addressing both the breasts and abdomen at the same time, the result is that the patient feels like the upper and lower part of her chest and torso match, with much better proportions.”

Dr. Ashraf says that the main recovery period for a mommy makeover is about two weeks, but adds that most patients feel it takes up to six weeks for full recovery and that it may take months for all swelling to subside. And she cautions that not every woman is a good candidate for the surgery.

“This surgery isn’t appropriate for anyone whose overall health is not good,” she says. “Furthermore, it’s not a substitute for proper diet and exercise, and it is not a surgery for weight loss. We strongly recommend that a woman be within 20 percent of her ideal weight in order to get the best results.”

Alexander S. Gross, M.D., medical director of Georgia Dermatology Center, is double board certified and experienced in treating all aspects of advanced medical dermatology. He says that the biggest upward trend in surgeries in his practice are tumescent liposuction and short incision facelifts, both of which have experienced improvements as well as lower costs in recent years.

“I’ve beWilliam Silveren doing liposuction for close to 20 years now, but I haven’t raised my prices in 20 years,” he notes. “I think you can attribute that lack of increase in price to advances in equipment and technology, such as smaller cannulas and power-assisted devices that reduce the trauma of the procedure and allow us to complete it more quickly.”

Dr. Gross adds that short incision facelifts, commonly referred to as “lifestyle lifts,” are increasingly popular because they offer the advantages of fast recovery time and affordability.

“The short incision facelift involves a few sutures that can usually be covered by the patient’s hair and allows him or her to return to work and active life within a couple of days. It’s less costly than a full facelift,” he says. “However, the longevity of the procedure is not equivalent to having a full facelift. So the patient has to weigh cost and recovery time against longevity.”

Another trend in dermatology, and not a good one, is the increase in incidence of skin cancer in the U.S., most notably in younger people, says Dr. Gross.

“I probably spend 50 percent or more of my day diagnosing skin cancer. It’s an epidemic,” he says. “The particularly scary thing is that incidence of melanoma has doubled in the last 20 years, and we’re seeing more and more cases in children and adolescents.”

Dr. Gross attributes this increase to the use of tanning beds as well as lack of use of sunscreens.

“People have a perception that tanned skin is pretty skin, so many think tanning beds are a safe way to get it,” he explains. “What they don’t realize is that people who use tanning beds have a 70 percent chance of getting melanoma in their lifetime.”

Dr. Gross says that physicians, especially primary care physicians and pediatricians, can help reduce the incidence and impact of skin cancer by incorporating a skin exam into their patients’ regular physicals and giving warnings about tanning beds and using sunscreens with UVA and UVB protection.

“It doesn’t take much time to examine the skin while you’re doing other things, like listening to the patient’s heart and lungs or examining their eyes, ears, nose and throat,” he says. “Familiarize yourself with what different types of skin cancers look like, and don’t be afraid to refer your patient to a dermatologist if you even have a grain of suspicion that something doesn’t look right. Going forward, skin cancer will continue to be a huge issue, and primary care physicians can be at the forefront of diagnosing it.”

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Ovarian Cancer In The Future Perfect Tense

Tuesday, August 25th, 2015

Benedict BenignoNOTES FROM AN INSIDER
By Benedict B. Benigno, M.D.

Ovarian cancer is an avaricious tumor, and its domain is nothing less than the entire abdominal cavity. It can extend from the deepest part of the pelvis up to the diaphragm and to the right and left of the colon and everything in between. It can appear after a few weeks of the mildest symptoms, and by then it has already declared open season on the body of a woman. It is fiendishly difficult to treat and unrelenting in its destructive ambition. It is a modern day scourge, casting a narrow and selective net, forever changing the lives of its victims.

The initial symptoms of ovarian cancer are vague and frequently present as gastrointestinal disorders. The ovary is the only organ in the body that has its functioning cells facing the interior of the abdomen, so long before a tumor actually forms, cells detach and implant on the undersurface of the diaphragm, the capsule of the liver, and most important, on the surface of the bowel.

Hundreds of nodules accumulate on the serosal surfaces of the large and small bowel, impeding the smooth flow of intestinal contents, and cause, along with the production of ascites, the cramping distention of the abdomen, which is the hallmark of ovarian cancer. The presentation is actually an intermittent, partial small bowel obstruction and represents a stage 3 cancer at the time of diagnosis. The finding of a stage 1 cancer is usually a serendipitous event – the surgeon is operating for some other reason, and a small nodule on an ovary is discovered.

Despite what you may have been told, there is no way to screen for ovarian cancer. CA-125 is a protein that has been around since 1981 and is merely a test for inflammation. It is by no means specific for this cancer. In fact, the CA-125 blood test is negative in 20 percent of patients with advanced cancer.

My lecture on ovarian cancer contains a slide with the heading, Is It Possible To Screen For Ovarian Cancer? The remainder of the slide contains the word no in 41 languages. Many laboratories are involved in the discovery of a diagnostic test for ovarian cancer that would approach 100 percent accuracy. Such a test would be one of modern oncology’s Holy Grails!

The Ovarian Cancer Institute was founded in 1999, and its work is centered in the McDonald Laboratory in the Department of Biology at The Georgia Institute of Technology. For the past 15 years, we have been investigating the genetic and molecular structure of ovarian cancer in the hope that a highly accurate diagnostic test might one day emerge.

Tissue and serum samples are immediately flash-frozen in my operating room at Northside Hospital and transported to the lab at Georgia Tech. They are stored in the minus 80 degree Celsius freezer, rendering them “eternal.” These specimens can be as accurately studied 100 years from now as they would be on the day they were collected. We now have one of the largest serum, tissue and data banks for ovarian cancer in the world.

This work is unfortunately expensive. Several years ago the Institute paid $250,000 for a laser capture dissection microscope. This device allows us to outline precisely the tissue we wish to analyze and then detach it from the specimen. The DNA from this tissue is extracted, thus allowing for precision analysis. The DNA is not contaminated by stroma or connective tissue but represents the epithelium of the ovarian cancer. The DNA is then transported to a microarray analyzer. This unit allows us to identify genes that are aberrantly expressed in ovarian cancer tissue.

Years ago, if researchers were interested in studying the genetic morphology of a cancer, they would have to proceed one gene at a time. Today, the microarray analyzer prints out the entire genetic composition of a cancer in quadruplicate on a microchip the size of a thumbnail.

The Ovarian Cancer Institute is very fortunate to be located at Georgia Tech, where there are so many departments working in areas related to ovarian cancer research, including bioengineering, bio-informatics and nanotechnology. There are many ways in which basic science research may eventually impact the way in which patients with cancer of the ovary are treated, but for now, the Ovarian Cancer Institute is focusing on three areas.
1) The Diagnostic Test

If only it were as simple as it is with cancer of the cervix. A pap smear is positive, a biopsy directed with the colposcope shows a CINIII lesion and a LEEP conization is done in the office under local anesthesia completing treatment and preserving the uterus.

The pap smear, unfortunately, is useless in the diagnosis of cancer of the ovary. A positive pap smear has led me to the diagnosis of this cancer only three times in my career. A diagnostic test for ovarian cancer must approach 100 percent accuracy, otherwise cancers will be missed or women will undergo unnecessary surgery.

Our initial attempts at the discovery of a diagnostic test at the Ovarian Cancer Institute involved the study of proteins. These are large and cumbersome structures that produced inaccurate results. We eventually started using mass spectrophotometric analysis of metabolites found in our serum samples. This instrument is amazingly accurate in separating out peaks in similar metabolites from the many samples studied.

We published our results several years ago and reported a nearly 100 percent accuracy. The only time that we found a positive result in a patient with a benign tumor was in someone whose mother and grandmother had died of ovarian cancer. The justifiable criticism of this paper concerned the fact that there were so few samples from stage 1 cancers. No one wants a diagnostic test that is positive only in advanced disease. We then purchased 90 serum samples from patients with stage 1 disease and found that our test picked up every one of them. The data analysis is complete, and we are about to publish our results. It should be noted that the test will be run on a single drop of serum and cost only a few dollars.
2) Targeted Gene Therapy

Very little has changed since Sidney Farber ushered in the modern age of chemotherapy in the mid-1940s. Newer drugs have been developed, dosage has changed as have routes of administration. One thing, however, has remained constant – the pineal gland gets as much of the drug as does the nucleus of the cancer cell.

This is most unfortunate since chemotherapy is a poison, and the dose and the interval between treatments is directly related to the body’s ability to withstand repetitive poisoning. It would be wonderful to be able to deliver the chemotherapy drug to the cancer cell and only to the cancer cell. This would allow the use of a dosage unthinkable today.

Modern genetic profiling identifies specific genes disrupted in a cancer. It is estimated that only 10 percent of mutated genes in a cancer are druggable at the protein level, which is the level at which drug therapy is currently focused.

Targeted gene function at the RNA level is preferred because all malfunctioning genes in a cancer can be targeted at the RNA level. The problem resides in the inability to deliver these RNA-inhibiting drugs directly to the cancer cell. It is important to remember that DNA is the same in every cell, but RNA codes for specific function. In collaboration with the nanotechnologists at Georgia Tech, we are developing a new class of nanoparticle delivery vehicles for this purpose. These technologies are being tested in animals and, if successful, will lead to phase 1 trials in humans.

 

3) Personalized Medicine

Carboplatin and Paclitaxel are chemotherapy drugs that are used as first-line therapy for ovarian cancer around the world. However, because of a significant incidence of platinum resistance, there are patients who fail this regimen. Few things are more disconcerting to a gynecologic oncologist then to spend six hours in the operating room removing the last remnant of ovarian cancer only to watch it return after several cycles of chemotherapy.

The choice of a chemotherapy regimen is sometimes the roll of the dice – a prediction based merely on experience and not science. Several companies are involved in choosing the right drug for the precise genetic aberration in a particular person’s particular cancer. It is time to stop approaching cancer based on the organ or origin; rather, we must choose treatment based on individual molecular structure. We are learning that the molecular structure of an ovarian cancer may have more in common with the molecular structure of certain pancreatic cancers than it does with other ovarian cancers.
Personalized medicine in oncology simply refers to treatment based on the structural idiosyncrasies of an individual’s cancer. Once this is nailed down, we should remember that the initial regimen might not be the proper treatment should the cancer return. This recommendation is based on the work of the Ovarian Cancer Institute published a few years ago. We used the microarray analyzer to compare the structure of the primary ovarian cancer with that of the recurrent cancer expecting them to be identical. To our surprise they were frequently quite disparate.

In collaboration with the College of Computer Science at Georgia Tech, we are developing computational algorithms that can accurately predict drug responsiveness of patients based on genomic/gene expression profiles. This approach uses learning algorithms, which are much more accurate than current methods employed by commercial firms such as Foundation Medicine etc.

This development is being coupled with genomic studies (DNA/RNA sequencing analyses) on ovarian cancer primary, metastatic and recurrent tumors all collected from the same cohort of patients. Further studies aim to validate these predictions in current patients by establishing primary cell lines from patient tumor samples. By submitting the patient sample to genomic profiling, we will be able to predict drug responsiveness and hopefully delete chance from the equation.
In reflecting over a 40-year career devoted to the care of women with ovarian cancer, I find myself consumed with the sheer barbarity of it all. A sharp knife opens the abdomen from the pubic symphysis to the xiphoid process to remove cancerous cells, there’s six rounds of chemotherapy, a recurrence and then more surgery and chemotherapy, etc.

I would like to envision the next generation of oncologists sending a newly diagnosed patient to an interventional radiologist to have some cells sucked through a skinny needle passed into the tumor under CAT scan guidance. These cells would be easily grown in the cell culture laboratory, then a geneticist would create the exact antidote to the nuclear protein in the cancer cell.

This material would then be injected into the patient at 10 in the morning, killing every cancer cell without harming a hair on her head and seeing to it that she is not late for her 2 p.m. tennis match. I would call this designer therapy – Giorgio Armani constructs the cancer treatment. Maybe one day we will see this idea come to fruition.

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Gwinnett Medical Welcomes their First Class of Medical Residents

Tuesday, August 25th, 2015

Gwinnett Medical Center  recently welcomed their first class of internal medicine residents as part of the system’s graduate medical education program. There are five first-year residents in the program and one second-year resident, who are all southeastern natives.

GMC’s graduate medical education program, which began in 2014, also includes a family medicine residency. That track is in its second year and now includes 10 residents. The graduate medical education program is designed to address the current shortage of physicians in the Atlanta metro community.

“During their three years at GMC, internal medicine residents will have the opportunity to train with subspecialists such as cardiologists and neurologists and general internal medicine physicians,” said Kimberly Bates, MD, GMC’s director of the internal medicine residency for the Graduate Medical Education Program. “In addition, their training will feature one-on-one training with critical care physicians and in the system’s high-volume emergency departments which care for nearly 140,000 patients yearly.”

Graduate medical education faculty are GMC physicians, and will work alongside the residents to provide exceptional patient care. A portion of the internal medicine residency includes office-based patient care at Academic Internal Medicine Partners (AIMP). This facility is located in Springfield Plaza at 665 Duluth Highway, Suite 401 and is currently accepting patients. It features 10 exam rooms. A number of rooms are equipped for procedures, including spirometry, EKGs, in-office lab testing and minor dermatological procedures, among others.

Residents and faculty physicians also offer geriatric care, general primary care and chronic disease management. At AIMP, residents may also participate in pre-surgical evaluations for patients with complex medical issues. AIMP physicians also have access to additional resources to treat patients with disabilities or have special needs, including those who are wheelchair bound.

GMC’s internal medicine residency program is affiliated with the Georgia Campus of Philadelphia College of Osteopathic Medicine and The Georgia Regents University/The University of Georgia Medical Partnership in Athens.

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GAFP August Committee Conclave and Board Meeting

Saturday, August 22nd, 2015

August 22-23, 2015, Chateau Elan, Braselton, Ga. For more information, visit Georgia Academy of Family Physicians

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August 2015 Trauma Commission Meeting

Thursday, August 20th, 2015

August 20, 2015, Macon, Ga. For more information, visit Georgia Trauma Commission

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