October 29, 2015, Lanier Park Campus, Gainesville, Ga. For more information, visit Georgia Medical Group Management Association
Children’s Healthcare of Atlanta and Emory University announce that, William G. Woods, M.D., has stepped down as director of the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta and chief of hematology/oncology/BMT in the Department of Pediatrics at Emory University. A search has identified Douglas Graham, M.D., Ph.D., as the successor to this role. Dr. Graham joined Children’s on August 17, 2015, and is working with Dr. Woods to ensure a smooth transition.
Dr. Woods remains on faculty with the Aflac Cancer Center and Emory University. His new title is director emeritus.
Dr. Graham is a member of the Senior Leadership Council of Winship Cancer Institute of Emory University. He will play a role in helping to jointly recruit new oncology faculty with Winship.
Dr. Graham previously served as professor of pediatrics and immunology at the University of Colorado, with clinical practice at Children’s Hospital Colorado. He led the Biology and Treatment of Childhood Cancer Research emphasis area. He directly oversaw all basic science, translational and clinical oncology research for the Center for Cancer and Blood Disorders at Children’s Hospital Colorado.
Dr. Graham is a National Institutes of Health-funded investigator with an active laboratory focusing on developing novel therapeutics for pediatric cancer, recently validating MerTK as a novel cancer agent in leukemia, melanoma, non-small cell lung cancer and glioblastoma. He was the co-program leader of the Hematologic Malignancy Program at the University of Colorado, a National Cancer Institute-designated cancer center.
By David Terraso
There’s no doubt that wearable technologies, such as smartglasses and smartwatches, are cool. But can they be useful to people with serious medical challenges, such as acquired brain injury or post-traumatic stress disorder (PTSD)? Researchers at Shepherd Center are testing this idea with two applications – EyeRemember and Breathe Well – they have developed for Google Glass.
Glass is worn on the head just like regular eyeglasses. It has just one display on the right side, with a track-pad and natural language voice input for control, as well as a bone-conducting speaker for audio output.
At Shepherd Center, researchers, who received a Glass Accessibility Award, developed EyeRemember to assist people who have an acquired brain injury in compensating for memory difficulties that often accompany these injuries. Putting names to faces can be troublesome for anyone at times, but for someone with a brain injury, it can be a nearly constant struggle. Long-term memories often stay intact while new ones slip away in a moment.
“In addition to being difficult for the patient, this can substantially increase the burden on others because it means they require more help,” explained Tracey Wallace, a speech-language pathologist and researcher at Shepherd Center.
Patients with memory difficulties sometimes get help from using memory notebooks and smartphones. But Wallace, alongside clinical research scientist John Morris, Ph.D., and software engineer Scott Bradshaw, wanted to see if wearable technologies like Google Glass could assist.
They tested their idea with five clients enrolled in the brain injury day program at Shepherd Pathways, Shepherd Center’s post-acute brain injury rehabilitation facility in nearby Decatur, Ga.
“Each person has a team of therapists – an occupational therapist, physical therapist, speech therapist, recreational therapist, a counselor and case manager,” Dr. Morris explained. “That’s a lot of people to keep track of. The core question we had is, ‘Does our solution improve their recollection of names and details of their therapy team?’”
Patients normally receive a sheet of paper with the name, type of therapist and the therapist’s location in the clinic. “That’s very helpful, and the patients benefit from seeing it repeatedly,” Wallace noted. “The drawback is they have to initiate looking at it, and sometimes they don’t remember that they have it.”
So the research team developed EyeRemember to display the therapist’s photo, name and location in the clinic when the client gets within 3 feet of the therapist.
Each client used the app for two to four weeks. At the end, every participant was able to recall all of the targeted information with complete accuracy. All but one participant also showed significant increases in recall of this information even after they had stopped using the app, researchers reported.
“We weren’t sure that people with significant memory impairments could learn to use Google Glass, a very different sort of device. It turns out they can,” Wallace said.
In addition, she said, the benefit of using wearable technology is that the information can be provided without patients having to remember to pull the phone out.
Meanwhile, with support from the Rehabilitation Engineering Research Center for Wireless Technologies (Wireless RERC), the research team is also developing BreatheWell, a Google Glass app to help people use breathing therapy to reduce stress. Working with Shepherd Center’s SHARE Military Initiative, a comprehensive rehabilitation program for service men and women who have sustained mild to moderate traumatic brain injury and/or PTSD in post-9/11 conflicts, researchers aim to see if a wearable device might encourage greater use of breathing therapy than smartphones currently do.
When people endure stress, they experience the fight-or-flight response. Their heart rate increases, and breathing becomes shallow, exacerbating anxiety. Slowing their breathing, particularly when exhaling, helps calm them.
People often forget to practice breathing therapy and were saying it seemed like it would be effective, but they couldn’t remember how to do it when they were under stress. The team – including Wallace, Dr. Morris, Bradshaw and SHARE clinical psychologist Corissa Callahan, Ph.D., ABPP – created an app for Glass to allow users to program reminders to practice and if there might be other benefits to using a wearable to aid relaxation breathing.
Putting the app on a wearable was also attractive because it could remind patients to do something without them having to bury their head in a phone.
“People often like to stay aware of what’s going on in their environment,” Wallace explained. “If they’re staring at their phone, they’re not able to see what’s going on. Wearing Glass, you can be in the moment and look at the screen, but in your peripheral vision, you still are aware of people around you.”
Breathe Well is still in development, but researchers say it will work much like apps on smartphones, with a visual guide that allows users to determine the duration of each breath.
Researchers are adding key features, like the ability to set reminders to practice the technique with the app during periods of low stress, with the aim of making it easier for the user to perform relaxation breathing when it is truly needed. Plus, the app allows the user to upload their own calming pictures and music, and it allows clients to customize the device’s voice guidance system, changing from a male voice to a female voice or muting the voice guidance altogether.
“We want people to have options, because they’re more likely to use it if it’s adjustable to their comfort and needs,” Wallace said.
The research team expects to have results by the end of 2015. They will be presenting preliminary findings to date in a session at the upcoming 92nd Annual Conference of the American Congress of Rehabilitation Medicine in October.
Although Glass is being redesigned by Google, the team says the results from these studies can be applicable to other wearables, such as smartwatches, as well as devices that are still just a gleam in an inventor’s eye.
The Center for Weight Management at Gwinnett Medical Center announced a new intragastric balloon procedure. GMC now offers a new non-surgical solution, the Orbera™. It received FDA approval in August.
According to Robert Richard, MD, the center’s medical director, Orbera is ideal for patients with a body mass index (BMI) of 30 to 40 who have attempted more conservative weight reduction alternatives like diet and exercise.
According to a study conducted by the Harvard School of Public Health, U.S. obesity rates have doubled since 1980 and remain the highest rates among all high-income countries worldwide. If obesity trends in the U.S. continue at this same rate, it is estimated that by 2030, roughly half of all men and women will be obese.
The two-part program starts with the durable balloon filling space in a patient’s stomach to reinforce proper portion control. The second portion involves patient monitoring and support. At six months, the balloon is deflated and removed through a non-surgical procedure done under a mild sedative.
In comparison to surgical options, where patients participate in a number of medical consultations, support groups and other life coaching programs, Orbera is a less complex medical procedure due to the non-surgical nature.
“While there are both physical and mental obstacles in weight loss, having another option for patients provides an incredible sense of satisfaction and opportunity,” says Rebecca Gomez, licensed clinical psychologist at GMC’s Center for Weight Management.
According to Gomez, obesity is also influenced by a variety of behavioral, environmental and genetic factors that can include unhealthy diet, inactivity, lack of sleep, pregnancy, medications, medical problems and metabolism issues.
October 17-18, Hyatt Regency, Savannah, Ga. For more information, visit Medical Association of Georgia
October 17-18, 2015. For more information, visit Medical Association of Georgia
By Carolina Gongora, M.D.
About 600,000 people die of heart disease in the United States every year, corresponding to 1 in 4 deaths. Cardiovascular disease (CVD) is the No. 1 cause of death in both women and men and is highest in the South and lowest in the West. Unfortunately, half of Americans have at least one of the recognized risk factors for CVD, including dyslipidemia, hypertension or smoking. Despite this being the case across ethnicities and genders, there are differences among different groups regarding prevalence, treatment and outcomes.
According to the National Health Interview Survey in 2012, more men than women have have been diagnosed with coronary artery disease (CAD) or hypertension (HTN). Asians adults were less likely to have been diagnosed with CAD than whites. Asian adults and whites were less likely to be diagnosed with HTN than black adults. Poverty level is inversely associated to any type of heart disease, HTN or stroke.
In 2002, the Institute of Medicine (IOM) reported remarkable disparities in healthcare quality in racial and ethnic minorities. These observations helped encourage the development of new strategies to improve accessibility and quality of healthcare for these minorities. A decade later, quality of care has improved for most Americans, however significant disparities persist.
By 2013, similar proportion of whites, African Americans, Hispanics and American Indians had heart disease, around 10 percent. However, in terms of hypertension, there are significant differences. In whites, Hispanics and American Indians, the prevalence of hypertension and stroke is similar, around 20-25 percent and 2 percent, respectively. But in African Americans, the prevalence of hypertension and stroke is significantly higher, 32 percent and 3.6 percent, respectively. Of these hypertensive patients, only around 50 percent were controlled, 75 percent treated and 15 percent undiagnosed. In Hispanics, hypertension prevalence is similar to whites, but only one third is controlled compared to 50 percent in whites.
Regarding risk factors for HD, obesity rates are highest in Mexican American males and black women. Hypercholesterolemia is higher in white and Mexican American men and white women. Hospitalization for congestive heart failure and stroke is higher in women and highest in the southeastern part of the country. Life expectancy is higher for whites than blacks by approximately 5 percent.
Among modifiable risk factors, while smoking is higher in white women, other factors such as obesity and physical inactivity are much more common among African American and Hispanic women. It seems that Puerto Rican women have the highest rates of hypertension, obesity, smoking and dyslipidemia compared to the rest of Central and South America.
Racial minorities have been observed to receive less timely evidenced-based interventions (angioplasty, PCI and CABG) and to have worse outcomes after these interventions.
Another important difference worth mentioning among racial and ethnic groups is healthcare coverage. As expected, patients without adequate health insurance are more likely to experience poor clinical outcomes and have higher mortality. Minorities make a significant proportion of the low income and uninsured population and also rely more on acute hospital care than consistent preventive care with a primary care provider.
Presentation and diagnosis of ischemic heart disease (IHD) in women. Women present more frequently than men with chest pain without having obstructive CAD. In the setting of MI, women less often report chest pain and diaphoresis and more often complain of back or jaw pain, palpitations, lightheadedness or loss of appetite. This atypical presentation in women has been linked to the delay in diagnosis and delivery of life-saving treatment strategies, with poorer outcomes.
Before 75 years of age, a higher proportion of a CVD caused by coronary artery disease occur in men than women, and a higher proportion of strokes happen in women than in men.[6, 7]
When evaluating a woman for IHD, the determination of a woman’s risk status will guide the selection of appropriate diagnostic tests. In general, premenopausal women 50 or younger, with no CHD equivalent conditions such as diabetes or peripheral artery disease, are considered to be at low risk. Women in their 50s are classified as low or intermediate risk based on level of functional capacity, with lower functional capacity conferring higher risk. Women in their 60s are considered intermediate risk, and women 70 or older are considered high risk. The presence of comorbidities and multiple other risk factors may adjust the assessment of risk up to one category.
Specific risk factors related to women. Despite the decline in ischemic heart disease in both men and women, more women still die from CVD than men. Some data indicates the prevalence of CVD in women between 35 and 54 years old is increasing.
The traditional Framingham Risk Score is now known to underestimate women’s CV risk. It classifies 90 percent of women as low risk. The impact of some traditional risk factors differs between men and women. Hypertension is rising similarly in men and in women. However, premenopausal women are at higher risk of end-organ damage than men, and after menopause the prevalence of HTN is higher in women.
Women are at higher risk of left ventricular hypertrophy and symptomatic heart failure with preserved ejection fraction. Women who smoke and those with metabolic syndrome have 25 percent more risk of CV events than men.  The impact of developing diabetes in middle age is higher in women than men. Another significant difference is the lack of aspirin benefit is preventing ACS in women before 65 years old compared to same age men. And fewer women than men report performing the recommended 150 minutes of exercise each week.
Besides the traditional risk factors, there are risk factors that are unique to women, like pregnancy-related complications, depression, anxiety, hormonal factors and autoimmune diseases that are more common in women than men.
Women with PCOS have a higher prevalence of metabolic syndrome, diabetes, obesity and HTN. Women with PCOS have elevated coronary calcium score compared to matched controls.
Pregnancy is considered a stress test. When a woman fails this stress test, complications like preeclampsia, eclampsia, gestational diabetes (GD) and preterm delivery occur. These complications are associated with an increased risk of CVD. Preeclampsia triples the risk of CV events and quadruples the risk of future HTN.  GD increases the risk of developing diabetes melliyus (DM) later in life. In fact, the 2011 ACC guidelines included complications during pregnancy as risk factor for CVD.
Systemic rheumatologic diseases, systemic lupus erythematosus (SLE) and rheumatoid arthritis are more common in women and are associated with a 50 percent higher risk of CAD than non-affected women.[16, 17]
Incidence of IHD increases after menopause, likely due to the drop in estrogen and increase in testosterone. Within a year of menopause, cholesterol levels increase. The beneficial effects of hormone replacement therapy are controversial, and currently hormone replacement therapy is not recommended for CVD prevention. Chronic use of oral contraceptives (OCPs) in women who smoke increase by seven fold the risk of CV or thrombotic events and stroke. In women with history of HTN, progestin-only OCPs are recommended over combined OCPs.
Depression, mainly in younger women, and migraine, both more common in women than men, have been associated with increased risk of IHD and stroke. Moderate to severe depression doubles the risk of heart attack in the next 2 years and increases the risk of death. For this reason the American Heart Association (AHA) recommends women be screened and treated for depression. Migraines with aura are associated with ischemic stroke, CV events and death due to ischemic CVD, effects that are potentiated significantly by smoking and oral contraceptive use. Migraine without aura was not associated with increased risk of any CVD event.
Statistical data. Cardiovascular disease mortality trends in the U.S. showed a decline exclusively in men until 2000. However, since 2000 we have seen a 40 percent decline in CVD-related mortality in women. Despite this decline, women still have a high prevalence of CVD, and studies suggest that women have worse outcomes after MI and a higher incidence of heart failure compared to men.
Traditionally, research studies have excluded women, and in clinical trials women are underrepresented. This situation is changing, and recent evidence shows that there are differences in the presentation, pathophysiology, diagnosis and treatment of CAD for women versus men. Despite sharing many of the traditional CHD risk factors, women have unique risk factors and mechanisms of the disease compared to men.
Some studies have shown that close to half of women with abnormal noninvasive tests do not have flow-limiting coronary stenosis at angiography. However, these women still have a 9 percent occurrence of death or myocardial infarction and have worse prognosis than men. Women with stable ischemic heart disease, despite having less severe obstructive coronary artery disease compared to men have twice the mortality and morbidity.
Women with angina undergo exercise stress testing less frequently than men and are less likely to be referred to angiography and have coronary revascularization. Also, aspirin, ACE inhibitors, statin and heparin are used significantly less in women than in men. In addition, six months after a myocardial infarction, women are less likely to achieve target blood pressure, LDL and hemoglobin A1c.
Despite the decline in women’s heart disease since 2000, the burden of disease and risk factor prevalence remain high and the evidence still suggests that women with myocardial infarction have a worse outcome and higher incidence of congestive heart failure after MI compared to men. Marked reductions in cardiovascular mortality in women are the result of an increase in professional awareness, a greater focus on women’s cardiovascular risk and application of evidence-based treatments for established coronary heart disease.
Racial and ethnic disparities continue to persist in healthcare and treatment, and the increasing prevalence of CV risk factors makes these disparities more difficult to overcome. Treatment options, outcomes and healthcare coverage are still unequal in racial/ethnic minorities compared to whites. Efforts to apply evidence-based care and improve quality should continue in order to reduce the gap between women and men and among racial/ethnic groups.
- Mozaffarian, D., et al., Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation, 2015. 131(4): p. e29-322.
- Sorlie, P.D., et al., Prevalence of hypertension, awareness, treatment, and control in the Hispanic Community Health Study/Study of Latinos. Am J Hypertens, 2014. 27(6): p. 793-800.
- Daviglus, M.L., et al., Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. JAMA, 2012. 308(17): p. 1775-84.
- Popescu, I., M.S. Vaughan-Sarrazin, and G.E. Rosenthal, Differences in mortality and use of revascularization in black and white patients with acute MI admitted to hospitals with and without revascularization services. JAMA, 2007. 297(22): p. 2489-95.
- Foundation, K.F., Disparities in health and health care: five key questions and answers. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8396.pdf, 2012. Accessed July 10, 2015.
- Blomkalns, A.L., et al., Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative. J Am Coll Cardiol, 2005. 45(6): p. 832-7.
- Canto, J.G., et al., Symptom presentation of women with acute coronary syndromes: myth vs reality. Arch Intern Med, 2007. 167(22): p. 2405-13.
- Rosen, S.E., et al., Sex-Specific Disparities in Risk Factors for Coronary Heart Disease. Curr Atheroscler Rep, 2015. 17(8): p. 523.
- Gu, Q., et al., Gender differences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999-2004. Am J Hypertens, 2008. 21(7): p. 789-98.
- Bui, A.L., T.B. Horwich, and G.C. Fonarow, Epidemiology and risk profile of heart failure. Nat Rev Cardiol, 2011. 8(1): p. 30-41.
- Kalyani, R.R., et al., Sex differences in diabetes and risk of incident coronary artery disease in healthy young and middle-aged adults. Diabetes Care, 2014. 37(3): p. 830-8.
- Ridker, P.M., et al., A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med, 2005. 352(13): p. 1293-304.
- Christian, R.C., et al., Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome. J Clin Endocrinol Metab, 2003. 88(6): p. 2562-8.
- Bellamy, L., et al., Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ, 2007. 335(7627): p. 974.
- Kim, C., K.M. Newton, and R.H. Knopp, Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care, 2002. 25(10): p. 1862-8.
- Avina-Zubieta, J.A., et al., Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum, 2008. 59(12): p. 1690-7.
- Zeller, C.B. and S. Appenzeller, Cardiovascular disease in systemic lupus erythematosus: the role of traditional and lupus related risk factors. Curr Cardiol Rev, 2008. 4(2): p. 116-22.
- Matthews, K.A., et al., Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? J Am Coll Cardiol, 2009. 54(25): p. 2366-73.
- Wenger, N.K., Gender disparity in cardiovascular disease: bias or biology? Expert Rev Cardiovasc Ther, 2012. 10(11): p. 1401-11.
- Dallongevillle, J., et al., Gender differences in the implementation of cardiovascular prevention measures after an acute coronary event. Heart, 2010. 96(21): p. 1744-9.
Dr. Y. Julia Kao comes to Resurgens Orthopaedics after completing her fellowship training in adult reconstruction and joint replacement at the Hospital for Special Surgery in New York.
Resurgens Orthopaedics’ joint physicians are now performing outpatient total hip and knee procedures for qualified patients. They began these procedures in early 2014 at its St. Joseph’s facility and at Emory-Saint Joseph’s Hospital. Resurgens is utilizing techniques in anesthesia and rapid recovery protocols that are allowing patients to return home the same day.
Dr. Y. Julia Kao received her medical degree from the University of Chicago’s Pritzker School of Medicine and completed her residency at the University of California at San Francisco. She completed a fellowship in adult reconstruction and joint replacement at the Hospital for Special Surgery in New York. She is an active member of the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons. Dr. Kao is currently accepting patients at Resurgens Orthopaedics’ St. Joseph’s office, conveniently located between Brookhaven, Sandy Springs and Dunwoody.
Dexter has been Chief Operating Officer of Emory Saint Joseph’s since 2011. She began her career at Saint Joseph’s Hospital in 1998 as an administrative resident and progressed in responsibilities and leadership. Prior to her COO role, she served as interim director in both Human Resources and Radiology; division director in Clinical Services; vice president of Planning, Development and Allied Health; and vice president of Surgical Services and Planning.
Dexter also served as executive project manager during the Joint Operating Company process between Saint Joseph’s Hospital and Emory Healthcare.
Under her leadership Emory-Saint Joseph’s introduced new programs and physicians, development of patient-focused initiatives, continued expansion with the construction of an Orthopedic Joint and Spine Center and the completion of several successful accreditation and certification surveys.
“Heather is an inspiring leader whose vision and expertise have greatly contributed to the success of Emory Saint Joseph’s,” says Emory Healthcare President Dane Peterson. “In her new role, Heather’s extensive knowledge of both the health care landscape and Emory Saint Joseph’s is a tremendous asset as she continues to serve our patients, their families, our staff and physicians.”
Dexter holds an MBA from the University of Alabama and a Master of Science in Health Administration from the University of Alabama. Additionally, she completed a health care delivery executive education program at Harvard Business School.
October 8, 2015, Dalton Golf & Country Club, Dalton, Ga. For more information, visit Georgia Medical Group Management Association