Summer - the Association of Physician Assistants in Cardiovascular

Transcription

Cardiovision™
official journal of the apacvs
SUMMER 2013
highlights in this issue
www.apacvs.org
APACVS Joins PA Community in Speaking Against AMA HOD
Resolution
House of Delegates Report
33rd Annual APACVS Winter Educational Meeting
Cardiac Surgical Advanced Life Support: The New Paradigm?
CVT PAs on Medical Mission to Dominican Republic
Michael Nowak Organizes PA Medical Missions to Guatemala
Drug Shortages
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Mission & Content
Editor-in Chief
Doug Condit, PA-C
Contents
From the President’s
Desk........................................... 4
APACVS Joins PA Community
in Speaking Against
AMA HOD Resolution..... 5
33rd Annual APACVS
Winter Educational
Meeting.................................. 5
House of Delegates
Report . ................................... 6
Cardiac Surgical
Advanced Life Support:
The New Paradigm?......... 7
Doug Condit Named
Winner of the 2013 PA
Distinguished Service
Award Presented by
Montefiore Medical
Center Staff and Alumni
Association.......................... 9
CVT PAs on Medical
Mission to Dominican
Republic................................ 12
Michael Nowak Organizes
PA Medical Missions to
Guatemala . ....................... 13
submissions due oct. 31,
2013 for the susan lusty
excellence in publication
writing award................. 16
Drug Shortages.............. 17
membership
application........................ 19
The mission of CardioVISION™ is to provide a means of communicating
pertinent information among practitioners of the specialty and among
related professionals in the medical field and industry. CardioVISION is
a peer-reviewed quarterly journal that includes articles on practice issues,
credentialing issues, educational opportunities, and more. CardioVISION also
includes classified job ads and industry advertisements.
Advertisements
If you are interested in submitting an advertisement or job ad, please contact
Jill Tucker at j.tucker@apacvs.org for deadlines, rates and specifications.
Original Articles
If you are interesting in submitting an article for consideration of publication,
please contact Editor Doug Condit, PA-C, at dcondit3@verizon.net.
Reproducing Material
Single photocopies of single articles may be allowed for personal use as
permitted by national copyright laws. Written permission from the APACVS
is required for all other uses. Please contact the APACVS office for queries,
permission and/or payment of associated fees.
APACVS Membership
CardioVISION is a member benefit of the Association of Physician Assistants
in CardioVascular Surgery. Visit our website (www.apacvs.org) or contact the
APACVS office for more information.
APACVS Board of Directors
Officers:
President: David E. Lizotte, Jr., PA-C, MPAS, FAPACVS
Vice President: Steven M. Gottesfeld, PA-C
Secretary: Doug Long, PA-C, FAPACVS
Treasurer: David J. Bunnell, MSHS, PA-C
Past President: Jonathan Sobel, PA-C, FAPACVS
Board Members:
Member-at-Large: S. Scott Balderson, PA-C
Member-at-Large: Chuck Cuttic, PA-C, FAPACVS
Member-at-Large: James F. Gillen, PA-C, FAPACVS
Member-at-Large: Andrea McNiel, PA-C, FAPACVS
Member-at-Large: Edward A. Ranzenbach, PA-C, MPAS, FAPACVS,
DFAAPA, CAQ-CVTS
APACVS Office
Executive Director: Nancy Short, CMP
7044 S. 13th St., Oak Creek, WI 53154
Phone: 414.908.4952 x135 • Fax: 414.768.8001
www.apacvs.org
Cardiovision Cardiovision Cardiovision
3
www.apacvs.org
Summer 2013
froM the
From the President’s
Deskdesk
president’s
It is with great pride that I assume the role of president
for us to
to the
be
professional
to welcome
ofyour
the APACVS
andassociation
I extend aiswarm
marginalized
advocate
for
you.
I
am
glad
to
report
new members of the Executive Committee and Atby groups with
that the APACVS
continues
to work
Large-Members
of the
Board. We
have assembled
voices
for
you
every
day.
the most talented and dedicated group of louder
volunteers
I
and
have ever had the pleasure of working with
to formal
continue
Surveying the landscape ahead,
supporting the important work of the APACVS.
political action
I see we are well positioned as
Recently I opened my e-mail inbox
David E. Lizotte, Jr.,
This change in leadership, both planned and
orderly,
Jr.,
committees.
a profession to thrive in the
to find this unsolicited thought
PA-C,
MPAS, FAPACVS
FAPACVS
represents stability in an Association that We
has must
seen
atmosphere
of the
for the week staring up from my
significant
change
insignificant
the last year. Much of
this change stems from the Boards’ review
communicate
changes
to
healthcare
brought
screen. A well-intentioned soul
of the APACVS mission,
and itson
desire towhat
continue
our to grow and expand our ability to
by
the
Affordable
Care
Act
and
the
sent this quote, and despite my
educate our peers as well as members of the
surgical
team. already know.
teams
and patients
reality of physician shortages in all
usual inclination to not open these
We were faced with a classic life/ businessWe
decision
at the Winter
CME
meeting
are competent,
capable,
skilled,
specialties. We are well positioned
particular messages, I opened
in San Diego last January: grow or risk stagnation.
In
short
order,
we
chose
and knowledgeable clinicians who growth,
because we continue to build strong
this one. The result was that it
and in doing so began a journey to reviewpractice
every element
of the
Association and
medicine
in physician-led
relationships
with physicians
helped me realize that the issues,
develop
comprehensive
strategicasplans to ensure
the
realization
of this new
teams. Advocacy and outreach
willvision.
partners,
not competitors.
We areand mapped a future for the organization that was
countless e-mails, and phone calls
The
Board looked
boldly forward
be the vehicle to accomplish this
wellinnovative
positionedand
because
weWe
continue
surrounding the American Medical both
daring.
recognized
that this paradigm shift would require a
goal.
to
grow
a
strong
professional
Association (AMA) House of
change in our management company’s services, and as we pursued these discussions,
I have made itcompany
a priority
fordecided
our
that
continues
to long-term
keep
Delegates resolution that would
weassociation
received the
news
that our
management
had
to resign
Board toonce
continue
to work
with
as a primary
focus. Winston
Our
significantly restrict PA practice now toadvocacy
pursue other
opportunities.
Churchill
said that
“Life
can either be
accepted
changed.are
If itpositioning
is not accepted, key
it must
be changed.
If itways
cannot
associations
to find
to be changed,
nursingorcolleagues
made perfect sense to me. Despite
then
it must
be accepted.”
The resignationcollaborate
of the onlysomanagement
company that
that we can quickly
their
profession
as competitors
the language in the committee
any
us on theIBoard
ever
clearly
unchangeable
we aaccepted it
meet
the call
and speak –with
toof
physicians.
believehas
that
thisknown was
report that was supportive of PA
and
began
a
journey
to
find
new
management
that
was
enlightening,
to say the least.
clear voice when threats to the
is a mistake and contribute this
practice, the resolution proposed
After
dozens as
of ahours
of reviewing
a thousand
pages ofMy
proposals
profession
are mounted.
hope from
philosophy
motivation
behindmore than
to restrict our practice as PAs in
28
association
management
companies,
the
Board
unanimously
selected
Technical
is that you will continue to support
the recent concerning AMA
cardiothoracic surgery by limiting
Enterprises, Inc. (TEI), a management company with 24 employees and over 30 years
our association and serve as our
resolution.
our ability to perform invasive
of experience in association management, to take us to the next level as an association.
advocates to non-members whom
skills. I had achieved a clarity that
PAsiswere
unfortunately
bundled
in we are heading. None of this could have been
That
exactly
the direction
in which
you know and encourage them
was impossible as the APACVS
with nursing
thesupport
authorsand
of this
possible
withoutbythe
dedication of our interim management company,
to support
the the
onlychallenge
association
Board and I worked with a host of O’Neill Communications. The staff at O’Neill
accepted
of supporting us
policy. Because of our relationships
truly
represents
the
interest
associations and delegates to amend through our transition and we will foreverthat
be in their debt.
with the AATS, STS, NCCPA and
of cardiac, thoracic and vascular
or defeat what I believe was a badly
AAPA,
were of
rapidly
to seek to significantly increase membership by
With
the we
support
TEI, able
we will
surgical physician assistants.
worded but possibly well-intentioned
mobilize
support
communicate
both
improving
theand
value
of membership to PAs practicing in Cardiothoracic (CT)
policy. As you will read later in the
take a few
moments
to We will
objections
delegates
Surgery
and to
by AMA
opening
up new means of Please
membership
in the
Association.
journal, the concerns of the PA
expand
our educational
offerings,
moving participate
many of these
to APACVS
the web and
making more
in the
census.
discussing
the proposed
policy. We
community were heard and the
usewere
of social
media.
Our
website
will
receive
a
long
overdue
overhaul
–
all
in house by
We can then collect the data
a voice among many, yet we
portion of the resolution that caused TEI at no additional cost as part of our management fee. All of this and more will be
necessary to understand who we are
were heard.
a concern for our membership was achieved at a cost savings to the Association.
as a profession and continue to serve
An obstacle looming on the horizon
removed. This resulted in the AMA
your needs.membership has approved
Bythat
an overwhelming
majority
vote,
the
Association
was highlighted at the AAPA
not creating policy that is hostile to
the creation of an Associate Member category during this last election. This
Best Regards,
House of Delegates is the word
PA practice. This was a significant
will permit non-PA members of the surgical team to join the APACVS, thereby
supervision. By virtue of being
victory for PAs and the patients they increasing
David E.inLizotte,
Jr., PA-C,
MPAS,
our ability to promote the PA practice
the specialty
of Cardiovascular
supervised by physicians, instead of
serve. It helps to remind us about
and Thoracic Surgery.
FAPACVS
collaborating with them, we have
the importance of our relationships
President, APACVS
continued on next page
allowed ourselves to be defined in a
with the physician community.
dependent matter that makes it easy
One of the primary missions of
“Expecting the world to treat you fairly
because you are a good person is a little
like expecting the bull not to attack you
because you are a vegetarian.”
- Dennis Wholey
Cardiovision Cardiovision Ca
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Summer 2013
www.apacvs.org
APACVS Joins PA Community in Speaking Against
AMA HOD Resolution
By David J. Bunnell, MSHS, PA-C
The agenda of the 2013 American
Medical Association House of Delegates
(AMA HOD) included a resolution that
caused a great deal of concern in the PA
community. The resolution attempted to
define surgery very broadly and included
a statement that advocated for “direct
and/or personal supervision” for nonphysicians performing invasive skills.
It also sought to limit non-physician
involvement in pain management
practices as well. Even though the
committee report commented on their
support of PA practice in physician-led
teams, the implications of the resolution
was concerning for the future of PA
practice. House of Delegates decisions
are important because they indicate the
direction that this influential medical
association may take in their lobbying
efforts.
The American Academy of Physician
Assistants (AAPA) appealed to the
APACVS and other PA associations to
engage with delegates and associations
that had a vote on this issue. There was
also a great deal of grass-roots efforts to
speak against this resolution, including
a petition that quickly gathered 7,500
electronic signatures. Your association
expressed concern to the American
Association for Thoracic Surgery and the
Society of Thoracic Surgeons about how
this resolution would affect the care that
we currently provide to patients with
cardiovascular and thoracic diseases.
The AMA HOD heard testimony both
pro and con to this resolution. The debate
resulted in the complete removal of all
language pertaining to surgery in the
resolution. The reference committee
acknowledged the PA community in
their report. “Your reference committee
heard the concerns raised, including
those related to the practice of Physician
Assistants in Physician-led health care
teams…”
33rd Annual APACVS Winter Educational Meeting
January 23-26, 2014 Orlando, Florida
13 Reasons to Attend:
1. Expert keynote speakers share their
wisdom and tips
2. Earn CMEs
3. Network with your peers
4. Registration includes: Conference
Materials, Breakfasts, Breaks with
Snacks/Coffee, Lunch and Learns
5. The highly respected Endoscopic
Vein Harvesting Panel of Experts
moderated by Anthony Furnary, MD
6. The in-demand, hands-on
Thoracoscopic Surgical First
Assistance Course
7. The must-attend, hands-on Cardiac
Surgical Unit Advanced LifeSupport (CSU-ALS) Course
8. Caribe Royale hotel property consists
of 53 tropical acres designed for fun
and relaxation
9. Spacious one-bedroom suites with
generous amenities and spa services
available if desired
10. The Venetian Room, an awardwinning restaurant, is on the hotel
property, along with other eateries
and 24-hour room service
11. Shuttles to Walt Disney World
theme parks, Orlando Premium
Outlets, and Lake Buena Vista
Factory Stores
12. Exhibits area offers chances to
learn about new tools, technology
and services
13. Lunch and Learns provide
opportunities to learn about best
practices while you dine
Save the date! Check out
www.Apacvs.Org soon for details.
Make time to learn new techniques and
re-energize yourself at this spectacular
must-attend APACVS winter event!
The APACVS has put together a
roster of nationally known speakers in
cardiac, vascular, and thoracic surgery
to lecture on trends in the industry and
share their wisdom on best practices.
Caribe Royale Hotel
In addition, there will be ample handson opportunities to learn cuttingedge techniques. Don’t forget that the
exhibitors make this meeting possible, so
be sure to make some time to visit with
them and learn about their tools and
services. As always, we are interested in
hearing your feedback so we can serve
you better. Do not hesitate to share
your thoughts about this event with the
APACVS Board.
5
www.apacvs.org
Summer 2013
House of Delegates Report
by David J. Bunnell, MSHS, PA-C
The American Academy of Physician
Assistants (AAPA) held their annual
conference this year in Washington,
D.C. It was reasonably well attended
with almost 6,000 Physician Assistants
gathering to learn, network, and
reconnect with colleagues. The annual
Memorial Day weekend event also
called for the reconvening of the
House of Delegates (HOD) where
representatives from each state and
specialty meet to have the ongoing
conversation about who we are and
who we want to be. It takes the form
of resolutions, debate, and voting.
I had the privilege of serving as
your Chief Delegate with President
David Lizotte, PA-C, serving as the
Alternate Delegate. It is notable that
PA leaders who are not delegates often
visit the house proceedings to catch up
with colleagues and keep their finger
on the pulse of our profession. Past
President and Past Chief Delegate
Dana Gray, PA-C; Past President
John Byrnes, PA-C; Fellow Member
and JAAPA Editorial Board Member
Steve Wilson, PA-C; as well as Past
President and current AAPA Board of
Directors Member Michael Doll, PAC, all attended the proceedings. Steve
Wilson, PA-C, also served on the
House Nominating Committee and
had a central role in the event as the
members voted for their future leaders.
The hot topic this year was the change
in the AAPA volunteer structure. The
AAPA Board of Directors decided to
change the long-standing volunteer
committee structure from that of longserving members to that of short-term,
goal-directed committees. This idea
had come from the census of PAs that
told them that this was the manner
in which many PAs were interested
in engaging with the academy.
However, this change was upsetting
to volunteers who had served in the
previous committee structure. As a
result, there were several resolutions
introduced with the aim of restoring
the previous committee structure. The
house members overwhelmingly voted
in support of the previous committee
structure. They also voted to request
that the AAPA BOD place the new
committee structure decision on
hold until a conversation could occur
between house leaders and the AAPA
Board of Directors. The result of this
passionate debate and voting was
that the AAPA Board of Directors
agreed to put their decision on hold so
that they could meet with the HOD
leaders to discuss a mutually agreeable
solution.
Another topic of interest to specialty
associations is that of representation.
State associations have proportional
representation based on their
membership. Specialty associations
are given one seat in the house.
The Orthopedic and Dermatology
associations entered a resolution that
would increase our representation
to two votes. I had the opportunity
to speak in favor of this resolution
because I feel that the house rules
leave specialty PAs under-represented
in important votes. The testimony
against the resolution suggested that
we all live in states and are represented
by those bodies as well. There was
testimony that suggested that the
number of votes is not important.
However, delegates from the states
were not in favor of my suggestion
that they reduce their representation
to that of one vote. This is not the first
time that this sort of resolution has
been proposed. It had been defeated
in the past and unfortunately was
defeated again. I feel that proportional
representation is an equitable way
to distribute influence. However, it
is notable that arguments that make
sense for APACVS members also
make sense for that of other specialties
as well. As a result, the specialties are
closer than ever and often support
each other with shared goals.
The Association of Surgical PAs
introduced a controversial resolution in
favor of gun control. They argued that
clinicians must speak on the epidemic
of mass killings in our country because
of the devastating effects on patients,
families, and communities. There
was enthusiastic debate both for and
against this resolution. There was also
debate as to whether it was the place
of PAs to speak on these issues at all.
In the end, the resolution was referred
to a committee for further discussion
and return to the house floor in the
future for consideration. So, much as
the conversation in the country, the PA
community does not have an agreedupon solution or policy. However,
also like the country as a whole, the
conversation continues.
This is a short representation of the
meetings that occurred over three days.
I believe that this was a consequential
session of the House of Delegates. The
conversation about how the AAPA
engages with PAs, how specialty PAs
are represented in the House, and
how PAs should engage with society
will have echoes far into the future. I
consider it a great privilege to serve
as your voice in these conversations.
Thank you for allowing me to serve.
6
Summer 2013
www.apacvs.org
Cardiac Surgical Advanced
Life Support: The New
Paradigm?
By Steven M. Gottesfeld, PA-C
Post-cardiac surgery cardiogenic
shock with post-operative
arrhythmia and cardiac arrest are
associated with significant mortality
and morbidity in the immediate
post-operative setting. This is
especially acute in institutions that
do not employ cardiac surgically
trained house staff, as ICU staff may
not be adequately trained to quickly
identify potentially correctable
conditions which, uncorrected,
may lead to cardiac instability and
potentially arrest and death.
“Studies of survival after postcardiac surgery cardiac arrest are
few, but there appears to be a
considerable survival advantage
associated with early aggressive
resuscitation with emergent resternotomy and open cardiac
massage, when indicated. This
finding, which was published
by J.H. Mackey, et al., Six-Year
Prospective Audit of Chest Reopening
After Cardiac Arrest. J. H. Mackay,
S. J. Powell, J. Osgathorp, and
C. J. Rozario, revealed an overall
survival to discharge was 20/79
(25%). Favorable determinants of
outcome were: arrest on intensive
care unit (ICU), arrest within 24
hours of surgery, and reopening
within 10 minutes of arrest.
Fourteen of 29 (48%) patients
opened within 10 minutes of arrest
survived to discharge compared
to six of 50 (12%) patients where
time to reopening was more than
10 minutes (P=<0.001). Seven of
22 patients (32%) patients where
emergency bypass was utilized
survived to discharge. This study
strongly confirms the benefit of
chest reopening after cardiac arrest
in the cardiac surgical ICU. Patients
who arrest within 24 hours of
surgery and in whom reopening is
instituted within 10 minutes are
particularly likely to benefit.”
Basic cardiac life support (BLS),
advanced life support (ACLS),
and advanced trauma life support
(ATLS) courses have been
developed to enable members
of the medical/surgical team to
quickly recognize life-threatening
conditions, adopt recognizable roles,
and treat these specific disorders
in a rehearsed and ordered way.
Adoption of these courses by the
major medical/surgical institutions
has been credited with decreasing
the morbidity and mortality
associated with these disease entities.
It is widely accepted that patients
who have undergone complex
cardiac surgical procedures are
“unique” as it relates to the
hemodynamic and physiologic
changes which occur postcardiotomy. It is also becoming
increasingly obvious that the current
required training (BLS, ACLS,
etc.) does not adequately prepare
the entire post-operative surgical
team to treat these life-threatening
conditions.
Studies of survival after
post-cardiac surgery
cardiac arrest are few,
but there appears
to be a considerable
survival advantage
associated with early
aggressive resuscitation
with emergent resternotomy and open
cardiac massage, when
indicated.
This situation was quite obvious in
countries such as England, in which
nurses practice at a level inferior to
U.S. nurses, physician house staff is
7
www.apacvs.org
Summer 2013
limited, and there are few cardiac
surgical trained physician extenders
such as Physician Assistants. This
prompted Dr. Joel Dunning and
colleagues to develop an intensive
three-day Cardiac Surgery Advanced
Life Support Course (CALS) that
utilized both intensive didactic
and simulation training to review
and practice the skills necessary to
identify critically ill patients, the
proper use and ordering of arterial
blood gases, electrocardiograms,
radiography, intra-aortic balloon
pump (IABP), airway emergencies,
temporary cardiac pacing, sterile
technique, emergency sternotomies,
cardiac massage, and internal
defibrillation.
Intensive training in the recognition
and early intervention in scenarios
unique to cardiac surgery was
confirmed with the publication
of The Cardiac Surgery Advanced
Life Support Course (CALS):
Delivering Significant Improvements
in Emergency Cardiothoracic Care
(by J. Dunning, J. Nandi, S. Ariffin,
J. Jerstice, D. Danitsch, and
A. Levine).
“Twenty-four candidates participated
in the course. Critically ill patients
were simulated using intubated
mannequins, with lines and drains in
situ, and a laptop with an intensive
care unit monitor simulation
program.” Upon completion of
the three-day course the time to
successful definitive treatment was
significantly faster post-course for
the critically ill patient scenarios:
(565 secs [SD 27 secs] pre-course,
compared with 303 secs [SD 24 secs]
post-course; p < 0.0005). In addition,
the times taken to achieve a wide
range of predetermined objectives,
including airway check, assessing
breathing, circulation assessment,
treating with oxygen, appropriate
treatment of the circulation, and
requesting blood gases, chest
radiographs, and electrocardiograms,
were also significantly faster in
the post-course scenarios. Times
to successful chest reopening and
internal cardiac massage were also
significantly improved in cardiac
arrest patients: (451 secs [SD 39
secs] pre-course and 228 secs [SD
17 secs] post-course; p = 0.011.
Based on this and other information,
the CALS course was ratified
by the European Association of
Cardiothoracic Surgery and the
European Resuscitation Council
and is now being widely distributed
through the European cardiothoracic
surgical community.
Publication of these successful
results of the CALS course
developed interest across the
Atlantic. In addition, the CALS
course is now being evaluated by
the Society of Thoracic Surgeons
and is currently being offered by the
Nurses Training Institute (NTI)
for Advanced Practice Nurses
and their ICU colleagues. After
extensive review, the course has
been shortened to an eight-hour
intense training regimen which
includes didactic and simulation
training described earlier. The
APACVS Committee of Continuing
Medical Education and the Board of
Directors have reviewed this course
and feel that it presents an excellent
learning opportunity for PAs who
practice Cardiovascular, Thoracic,
and Critical Care Medicine. The
committee has become an early
advocate for this training course
and feels that it will eventually
become accepted and required to
practice in Cardiothoracic settings.
The committee was proud to offer
its first courses during the Summer
2013 Critical Care Meeting this July
and will offer it for the 2014 Winter
Meeting in Orlando.
Feedback Welcome
The APACVS CME Committee
and the Board of Directors would
like to hear your opinions on this
matter. Also, if you would like to
become involved in this training
course or you would consider
volunteering your time to serve on
the committee, please feel free to
contact s.gottesfeld@apacvs.org.
REFERENCES
1.
2.
3.
Mackay, J. H., Powell, S. J., Osgathorp, J., & Rozario, C. J. Six-year prospective audit of chest reopening after cardiac arrest.
Papworth Hospital, Cambridge CB3 8RE, UK.
European Journal of Cardio-Thoracic Surgery (impact factor: 2.55). 2002 September; 22(3): 421-5. pp. 421-5.
Dunning J., Nandi, J., Ariffin, S., Jerstice, J., Danitsch, D., & Levine, A. The Cardiac Surgery Advanced Life Support Course
(CALS): Delivering significant improvements in emergency cardiothoracic care. Ann Thorac Surg. 2006 May; 81(5): 1767-72.
8
Summer 2013
www.apacvs.org
Doug Condit Named Winner of the 2013
PA Distinguished Service Award Presented
by Montefiore Medical Center Staff and
Alumni Association
The following is based on a speech presented by Robert Sammartano, PA-C; Immediate Past President of the AASPA and
Program Director of the Montefiore Postgraduate PA Residency in Surgery. APACVS sends a heartfelt congratulations to
Doug on this achievement!
Good evening. It is a true honor
and distinct pleasure to be here
tonight. I have to admit: It was a lot
less stressful when I stood here two
years ago and shared the first PA
Distinguished Service Award with
Warren Weinstein. It is incumbent
upon me that in the few minutes
allotted, I summarize the 41-year
surgical PA career of Doug Condit.
Therefore, in keeping with tradition,
I welcome you all to the Bi-Annual
Ancient Bald PA Award night.
Doug Condit carries on the tradition
with style.
Doug arrived at Montefiore just after
the Earth had cooled and Pangea
was breaking up into continents. In
truth, Doug came here to be one of
the Fab Four of the Monte Surgical
PA World. Montefiore started the
world’s first postgraduate training
in surgery for PAs in 1971. Doug,
Clara Vanderbilt (seated somewhere
in this room), Mike Sheran, and
Gary Phelps were the experimental
subjects of Drs. Marvin Gleidman,
Richard Rosen and Scott Boley
(the only surviving member of the
Trinity). Doug and colleagues served
as surgical interns for what felt like
an eternity. After graduation they
became the first Service–Based PAs
at Montefiore: Clara in general
surgery; Mike in pediatric surgery;
Doug, who continues to this day in
Cardiothoracic Surgery; and Gary,
who moved to Isreal.
The route Doug took to get to
Monte is notable. Not surprisingly,
Doug was an Eagle Scout. His
CV states he was educated in
Colorado—Glenwood Springs
High School and Colorado State
University in Fort Collins, Colorado.
That same CV also does NOT
state his birth date. So I am not
sure if “Eagle Scout” means he was
a member of the Boy Scouts of
America or that’s just a nickname
the cavalry gave him as he trekked
East across the Great Plains in the
late 1890s.
He left CSU in 1966. For many
of us in this room, that period of
time recalls a troubled time for the
U.S. Doug, in the tradition of his
service to all, joined the U.S. Navy
and went to serve with the USMC
in Vietnam. In June of 1966, he
entered as a seaman recruit (E-1)
and was honorably discharged as a
Hospitalman First Class (E-6) four
years later in 1970.
Doug’s military career set the tone
for his PA life. His contributions to
Montefiore and the PA profession
over years are being honored tonight.
He received several citations for his
military service: National Defense
Medal, Vietnamese Service Medal
(with combat insignia and four
Doug Condit (left) pictured with Mary
Alice O’Dowd (middle), MD, President
of the Montefiore Medical Center Staff
and Alumni Association and PA Robert
Sammartano (right), who gave an
introduction.
bronze stars), Combat Action Ribbon,
Good Conduct Medal, Navy Unit
Commendation, Vietnamese Cross of
Gallantry, and Vietnam Campaign
Medal.
When Doug left the Navy, a new
allied health profession was rising
in the south; Dr. Eugene Stead at
Duke started the first undergraduate
training program for physician
assistants, which is where Clara
graduated. As with many young men
with military corpsman or medic
experience, this new profession gave
them training and an opportunity
to continue to serve in a medical/
surgical path.
9
www.apacvs.org
Summer 2013
Doug Condit (top row, center) poses with five CVT PA colleagues (all active APACVS members)
and the first and current PA Directors of the Montefiore PA Surgical Residency.
Doug went farther south to
the University of Alabama at
Birmingham PA Program and
centered on surgical practice. He
graduated in 1972 and headed
straight north to Monte.
Many of you know or have
benefited directly from Doug’s
contributions here as a surgical PA
in cardiothoracic surgery over his
40+ years at Montefiore. I have his
CV here and it has weight physically
and shows him to be a caring
PA; educator; author; committee
member; leader in local, state and
national PA issues; and a role model
for all PAs who have become surgical
PAs. Few may know how he is
responsible for shaping surgical PA
practice enjoyed here at Monte and
across the country.
The following is a shortened
list of the many organizations
that recognize his outstanding
contributions to surgical PA practice.
•
Senior Physician Assistant
in Cardiothoracic Surgery,
Montefiore Medical Center,
Bronx, New York, January 1,
1984.
•
Fifth recipient of the American
Association of Surgeon
Assistants John W. Kirklin,
MD Award for Professional
Excellence, San Francisco,
California, October 8, 1990.
•
Who's Who in Science and
Engineering, Premier Edition:
1992-1993; 1994-1995; 19961997.
•
New York State Conspicuous
Service Cross, August 30, 1996.
•
Recipient of Civilian Physician
Assistant of the Year, American
Academy of Physician Assistants
Veterans Caucus, May 26, 1997.
•
Recipient of Physician Assistant
of the Year, New York State
Society of Physician Assistants,
April 8, 2000.
•
Distinguished Fellow, American
Academy of Physician Assistants
August, 2010.
Doug Condit (left), with Clara Vanderbilt
(center) and Robert Sammartano (right) at
the banquet. All three are recipients of the
AASPA-APACVS Kirklin Award for Surgical
Excellence. Not shown is Kirklin award
winner and Montefiore alumnus John Lee,
who was too busy performing cardiac surgery
in Hawaii to participate in the festivities.
That same CV lists his authorship of
233 publications, 121 presentations
at meetings (local, state and
national), and membership on
37 various committees, boards of
directors, and editorial staffs. It also
states he served as adjunct faculty to
the Touro Manhattan and CUNY
Harlem PA programs. He is a diehard and true Yankees Fan.
Doug’s impact on the PA profession
is substantial. The honors he has
earned do not chronicle the zeal and
determination he exerted to effect
recognition for all PAs in surgery
through the years and across the
country.
In closing, your patients, physician
colleagues, co-workers, and surgical
PAs here, across the country,
and future PAs and I extend our
gratitude to you, Doug, for your
example, leadership, and continued
service. Be sure to update the CV
with tonight’s award!
10
Summer 2013
www.apacvs.org
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CVT PAs on Medical Mission
to Dominican Republic
By Doug Condit, PA-C
Sincere congratulations from
APACVS to Michael Gardocki
and Jason Lightbody! This spring,
these two APACVS members spent
a week as members of a medical
mission to Santiago, Dominican
Republic.
Dr. Robert Pascotto, who is semiretired from his cardiac surgery
practice in Fort Myers, Florida,
created the medical mission to this
hospital in 2002 and has assured
that at least two and usually three
“Heart to Heart” medical missions
occur annually. Due to his diligence,
the Jose Maria Cabral y Baez
Hospital has made some significant
strides toward building a consistent
heart program. Currently, only the
missions that he organizes perform
heart surgeries at this hospital.
This year, a multidisciplinary
team of surgeons, Gardocki,
Lightbody, critical care physicians,
anesthesiologists, and nurses from
Montefiore Medical Center spent
a week performing much needed
surgery at the hospital.
have here in the states, especially in
the face of a changing health care
system. Many patients were required
by the hospital to bring their
own medications from an outside
pharmacy and endotracheal tubes if
they were having lung surgery. Every
family we met was overwhelmingly
grateful for our help. I look forward
to going back next year and in the
years to come.” His comments about
returning are true, as this was his
third trip on a medical mission
to the Jose Maria Cabral y Baez
Hospital. It should be mentioned
that not only do volunteers donate
their time, but they also pay for
their personal transportation to the
Dominican Republic.
CVT PAs Michael Gardocki (left) and Jason
Lightbody (right) in Santiago, Dominican
Republic
CVT PA Jason Lightbody (left) with a post-op
patient in the ICU. Patients were moved out
of the monitored ICU to a regular floor bed
on POD #1 to make room for the operations
performed that day.
The team had the opportunity to
work with medical students and
residents to help them build surgical
skills and confidence to utilize these
skills in the Dominican Republic.
The local physicians, residents, and
medical students frequently took
team members over to their houses
for dinner.
When describing his first experience
on this team, Jason noted, “It was
very rewarding to be able to go
on a trip like this and give back to
so many people and families that
otherwise would never have gotten
their needed surgeries. It really
makes you appreciate all that we
Many of the medical personnel who volunteered on this mission are shown with several of their
patients.
12
Summer 2013
www.apacvs.org
Michael Nowak Organizes
PA Medical Missions to
Guatemala
By Doug Condit, PA-C
APACVS congratulates Michael
Nowak on his successful missions to
Guatemala and looks forward to
learning more about his travels.
This winter, Michael Nowak,
MPAS, PA-C, FAPACVS, a
Cardiac Surgery and Hospitalist PA
at the Mayo Clinic in Rochester,
MN, coordinated a Physician
Assistant-centered medical mission
to Guatemala with an Emergency Department PA and Physician, both
from Pennsylvania, and 11 PA students from the Seton Hill PA program.
From Jalapa, the team
visited numerous rural
villages, including some
where the villagers
had never before seen
a Caucasian person.
During their visit, they
treated approximately
1,300 individuals.
Members of the team had to literally bring all of their medical supplies
into the country with them. They brought nearly 1,000 pounds of
supplies, including medical instruments, diagnostic equipment, and
medications.
Their host family was an American family in Jalapa, a village
approximately two hours East of Guatemala City. David and Julie
Sutton and their family moved to Jalapa approximately 10 years ago.
They currently are involved in various forms of ministry. They routinely
host medical missions, as many local residents have no access to even
rudimentary health care.
From Jalapa, the team visited numerous rural villages, including some
where the villagers had never before seen a Caucasian person. During
their visit, they treated approximately 1,300 individuals.
For this trip, Michael personally raised the money necessary to purchase
medications used on the mission. To save on shipping costs, each member
of the team carried suitcases with medical supplies. Michael notes that
the trip was very inexpensive, only about $500 per person for the week
(including transportation, sleep quarters, three square meals a day, and
Setting up the mountain village clinic
Michael Nowak with a child from the
orphanage
For this trip, Michael
personally raised the
money necessary to
purchase medications
used on the mission. To
save on shipping costs,
each member of the
team carried suitcases
with medical supplies.
13
www.apacvs.org
Summer 2013
translators) and each traveler’s
airfare. He was able to also raise
some additional funds that helped
paid for some of the students’ costs.
When asked if he would do it
again, Michael commented:
“Personally, I LOVED IT, and
will be coordinating a weeklong
trip each and every year back to
the same place. My goal is to take
about 10 PAs and/or PA students.
I will be taking a team of 10 the
week of November 3 this year and
am already signing people up for
next year. The personal rewards are
incredible. Most of these people
have never received any medical
care and have never even had a
Tylenol or vitamin. Most of the
common health problems included
intestinal worm infections, fungal
skin infections, musculoskeletal
complaints, infections, and
complaints similar to what you
would see here in a primary care
office. We also brought a lot of
vitamins, toothbrushes, toothpaste,
crayons for the kids, and yes—even
some chocolate for the kids.”
Anyone interested in
participating in a PA Medical
Mission Trip to Jalapa,
Guatemala is invited to
contact Michael directly at
mnowak333@yahoo.com.
Taking a break to play some soccer with the
kids
Reviewing cardiac examination with PA
students
Rapid Strep Analysis
Decreased breath sounds, dullness to
percussion and decreased tactile fremitus
A line of approximately 100 people in the
background
“We also brought
a lot of vitamins,
toothbrushes,
toothpaste, crayons for
the kids, and yes—even
some chocolate for the
kids.”
Patient, interpreter, and medical provider
Team picture
Michael Nowak with PA student and patients
14
Summer 2013
www.apacvs.org
There is a distinction between one qualified PA and another.
It’s called a CAQ.
You’ve become a leader in your field.
You’ve honed your skills. You’ve gained
knowledge and expertise. You’ve done
everything to be an accomplished
cardiovascular and thoracic surgery PA.
The Certificate of Added Qualifications (CAQ)
in Cardiovascular and Thoracic Surgery is your
chance to prove it.
The CAQ is offered by NCCPA—the only
certifying organization for PAs in the U.S.
Already trusted by health care employers,
NCCPA helps you document your advanced
qualifications.
You already have what it takes.
Visit www.nccpa.net/cvtscaq or
call 678-417-8100, and start
earning your CAQ in CVTS today.
Then distinguish
yourself from other PAs.
submissions due
oct. 31, 2013 for
the susan lusty
excellence in
publication writing
award
The Association of Physician Assistants in Cardiovascular
Surgery (APACVS) is excited to announce the Susan
Lusty Excellence in Publication Writing Award. APACVS
is looking for PAs who wish to share their scholarly
knowledge, hands-on experience, and professional insight
with fellow APACVS members through the published
articles.
This award honors Susan Lusty, RN, the only non-PA
winner of the esteemed Kirklin Award. Susan, who was
the founding editor of Surgical Physician Assistant and who
passed away in 2003, encouraged surgical PAs to submit
their written pieces and offered a professional forum for
their publication. The APACVS is grateful to Susan for her
inspiration to PAs and her passion to share the writings of
others. To be eligible for this award, the following criteria
must be met:
1. The awardee must be a member, in good standing, of
the APACVS.
2. The awardee must be a primary or secondary author of
the manuscript.
3. The manuscript must be published in a peer-reviewed
Index Medicus journal.
4. The manuscript must be relevant to the practice of
cardiovascular and thoracic surgery or critical care.
5. The manuscript must be < 2 years old, to ensure that the
paper is clinically relevant.
6. Adjudication of the award will be accomplished by a
committee appointed by the President of the APACVS.
7. Members of the review committee, the Board of
Directors, and the CME Committee are ineligible to
receive the award.
Submissions are due October 31, 2013!
Manuscripts must be submitted electronically to the
APACVS National Office by October 31st. This award
will be given annually at the Winter Meeting in January of
2014. The manuscript will be introduced by the President at
the end of the President’s address and will be the opening
presentation at the meeting.
Questions about the submission process should be
sent to: Ed Ranzenbach, PA-C, MPAS, FAPACVS,
ranz@earthlink.net, 414-908-4952 or 877-221-5651. The
application can be downloaded by going to www.apacvs.org.
16
Summer 2013
www.apacvs.org
Drug Shortages
By Edward A. Ranzenbach, PA-C, MPAS, FAPACVS, DFAAPA, CAQ-CVTS
Member-at-Large, APACVS Board of Directors
Is it just me, or are medications commonly used in cardiac surgery no
longer available? We haven’t been able to get Papaverine, IV Furosemide,
and numerous other agents for months. Recently, our hospital pharmacy
announced that the only Calcium Chloride available was sealed in the crash
carts. Over the weekend, I wanted to lower a patient’s serum potassium using
Insulin and D50 but had to use an infusion of D10 instead. No D50? Really?
Cardinal Health, which supplies numerous generic pharmaceutical agents,
lists 65 agents currently on manufacturer backorder or short supply including
such notables as:
• Aminocaproic Acid • Gentamicin
• Ondansetron
•
Atorvastatin
•
Isoniazid
•
Bumetanide
•
Lorazepam
•
•
•
•
•
•
•
•
•
•
Atropine
•
Calcium Chloride
Cathflo Activase
Cefazolin
D25%
D50%
Dopamine
Epinephrine
Fentanyl
Furosemide
•
•
•
•
•
•
•
•
Ketorolac
Mannitol
Marcaine
Metoclopramide
Midazolam
Naloxone
Nitro-Bid
Nitroglycerine/
D5W
Norepinephrine
•
•
•
•
•
•
•
•
•
•
Pancuronium
Pantoprazole
Sodium
Papaverine Sodium
Potassium
Phosphate
Promethazine
Propofol
Sensorcaine
Sodium
Bicarbonate
Hypertonic Saline
Solu-Medrol
How can we possibly perform
complex cardiac surgery without
the basic agents we use daily to
keep our patients alive? The bigger
question is: How is it possible that
all of these common generic agents
are in such short supply? The answer
is pure economics. This became
readily apparent to me a few weeks
ago when the nightly news ran a
story about a new cancer agent that
can reduce some tumors, in some
patients, by as much as 80% and
can extend some patients’ lives for
months to years. The cost of one of
these agents was $14,000 per month.
no longer the concern of Big
Pharm. They have long ago gone
the way of generic formulary
and are manufactured by smaller
pharmaceutical companies on tight
margins. All it takes is one fly in
the ointment (literally) and these
manufacturers halt production
while they scour the process. At a
minimum, such issues can result in
shutdown of the plant and resulting
shortages. At maximum, such an
issue can result in the demise of
the manufacturer and loss of agents
for months to years while a new
manufacturer comes online.
Problems
In a six-month period in 2010, of
311 hospitals surveyed, 89% reported
drug shortages that may have caused
The agents we commonly use,
although first-line for us, are
Edward A. Ranzenbach, PA-C,
MPAS, FAPACVS, DFAAPA,
CAQ-CVTS
In aout
call
six-month
period in 2010, of 311
hospitals surveyed, 89%
reported drug shortages
that may have caused
safety issues or errors in
patient care, and 80%
experienced shortages
that caused delay or
cancellation of patient
care.
17
www.apacvs.org
Summer 2013
safety issues or errors in patient
care, and 80% experienced shortages
that caused delay or cancellation of
patient care. In some cases, hospitals
resorted to using dosages from
single-dose vials on multiple patients
to alleviate their shortage.
When it comes to manufacturers
simply not meeting the demand
for a particular drug, the Food
and Drug Administration (FDA)
actually has limited authority in this
area. The agency cannot require a
company to manufacture a particular
drug or even require that it be
notified of shortages, planned or
otherwise. Thus, it is possible for a
manufacturer to commit its resources
to drugs that have higher profit
margins rather than those that may
serve the highest patient population.
Additionally, there is the problem
of quality and how it affects the
manufacturing process. When a
drug is recalled by a manufacturer
or the FDA determines a problem
in the manufacturing process, this
often results in a shutdown of
the entire manufacturing process
while the problem is corrected
and the manufacturer undergoes
rigorous inspection by the FDA
before manufacturing may resume.
Problems such as contaminants,
biological or inorganic (such as
glass or metal in vials), in one step
of the manufacturing process can
actually affect a number of drugs
in the pipeline that depend on this
process. Kweder and Dill report that
in 2012, quality-related problems
and capacity delays continued to
account for the majority of drug
shortages, especially those involving
sterile-injectable drugs. From
2009 to 2012, six of the top 10
manufacturers of sterile-injectable
drugs received warning letters from
the FDA for serious violations in
manufacturing standards. Four of
those manufacturers closed factories
or significantly reduced production
on order to resolve these problems.
Taking Action
In October of 2011, President
Obama signed Executive Order
13588 into law that required the
government to take proactive
measures to identify and prevent the
shortage of prescription medications.
Yet, we continue to have shortages
of the basic medicines needed to
perform management of cardiac
surgery patients. I encourage you
to all go to http://www.house.gov/
representatives/find/ and find your
congress representative and senator.
Make them aware of this ongoing
crisis and encourage them to act.
Join an APACVS Committee
Help APACVS set goals and share your specific talents with the organization. To
learn more info, visit www.apacvs.org.
• Communications Committee
• Continuing Medical Education
• Corporate Relations
• Elections Committee
• Fellow Member Oversight Committee
• Finance Committee
• Membership Committee
Contact n.short@apacvs.org today!
18
Summer 2013
www.apacvs.org
APPLICATION for MEMBERSHIP in the Association of Physician Assistants in CardioVasular Surgery
Receive the many benefits of membership in the Association of Physician Assistants in CardioVascular Surgery (APACVS)
EDUCATION
PUBLICATIONS/RESOURCES
PROMOTION OF THE CVT PA
•
•
•
•
•
•
•
APACVS presents two annual educational meetings, one
focused on cardiac, vascular and thoracic surgery, one
focused on cardiothoracic critical care.
APACVS hosts several hands-on sessions including
a Certificate of Completion in Invasive Skills Course,
a Thoracoscopic Surgical First Assistant Course, a
Cardiothoracic Surgery Advanced Life Support Course,
Mechanical Assist Course, and many others planned for
the coming years.
APACVS co-sponsors the Allied Health Symposium and
Critical Care Symposium at the annual AATS meeting.
APACVS website provides a database for on-line case and
procedure logging.
APACVS is developing web-based modules that are
eligible for CME and will satisfy the new self-assessment
recertification requirements.
•
•
•
q Active
q Student APACVS maintains professional liaison relationships
with STS, AATS, AAPA, and AASPA and FACTS-Care. These
liaisons have provided critical support for cardiac, vascular
and thoracic PAs facing regional and national legislative or
regulatory battles and support our mission of education of
the cardiac, vascular and thoracic PA in all arenas.
APACVS has a delegate in the AAPA House of Delegates,
the legislative body of the AAPA. This representative has
been vital in educating the non-CVT PA as to the critical
role the CVT PA plays in contemporary medicine.
APACVS has developed positive, collaborative relationships
with other professional organizations, including the
NCCPA.
q Associate
q Resident q Retired
Name________________________________________________________________________________
Last
First
MI
Prefix
Suffix
Mailing Address__________________________________________________________________________
Company
Web URL
__________________________________________________________________________
Address
Address Line 2
__________________________________________________________________________
City
State
Zip
Primary Phone_ _________________________________ Cell Phone_______________________________
Work Phone_ ___________________________________ E-mail_ ________________________________
Publish in Directory?
q Yes
q No
Do you wish to receive e-mail updates from APACVS?
q Yes
q No
APACVS Fellow Membership provides qualified members
the opportunity to display a level of experience and
excellence in practice through the use of the FAPACVS
designation.
(One must be an Active member before applying to
become a Fellow.)
•
PROFESSIONAL LIAISON
•
Type of Membership The annual Practice & Compensation Profile provides data
on the role of the CVT PA in contemporary practice and the
compensation received.
The Association’s magazine, CardioVISION™, is published
quarterly and keeps readers informed of news and events
affecting the cardiac, vascular and thoracic PA.
•
APACVS has developed and produced a CD-rom to help
educate the medical community about what cardiac,
vascular and thoracic PAs can do.
APACVS exhibits at other CT Surgical meetings including
the STS and EACTS meetings to promote the role of the
cardiac, vascular and thoracic physician assistant to
surgeons, to hospital and practice administrators, and to
PAs in other arenas.
APACVS MEmbership year
The APACVS membership runs for one year and renews on the
anniversary.
Payment of dues must be included with application.
q $165 Active Member Annual Dues
q $100 Associate Member Annual Dues
q $75 Resident Member Annual Dues
q $25 Retired Member Annual Dues
q $0 Student Member Annual Dues
(4001.1)
(4001.2)
(4001.3)
(4001.4)
Payment Options
q Check enclosed or in mail (payable to APACVS)
q Visa q Mastercard q Discover q Am. Express
Card Number_____________________________
Expiration Date_ ___________________________
PA Program_ ___________________________________ Graduation Date__________________________
Authorizing Signature_ _______________________
Degree_ ______________________________________ Credentials_____________________________
Today’s Date______________________________
Other Professional Certification________________________________________________________________
Name on Card_____________________________
AAPA Member q Yes
q No
Member Number_______________________________________________
E-mail_ ______________________________________________
AASPA Member q Yes
q No
Member Number_______________________________________________
NCCPA Certified* q Yes
q No
Certificate Number______________________________________________
An e-mailed receipt from authorize.net will be sent to the above e-mail address
when a credit card is processed.
*All non-student applications must include an NCCPA number in order to be processed.
Check the committee(s) you’d be interested in serving
q Continuing Medical Education
q Elections
q Fellow Member Oversight
q Communications
APACVS Member specialty (Check all that apply) q Cardiac
q Facebook
q Membership
q Corporate Relations
q Website
q Thoracic q Vascular q I am a student
The personal information provided will not be used for any purposes other than
those stated upon this form unless you provide your consent. Should you have
any questions concerning your personal information please call (414) 908-4952.
APACVS endeavors at all times to treat your personal information in
accordance with all applicable laws.
Association of Physician Assistants in
CardioVascular Surgery (APACVS)
7044 S. 13th St.
Oak Creek, WI 53154
P: (414) 908-4952 F: (414) 768-8001
www.apacvs.org
CAUTION: Federal (US) law restricts this device to sale by or on the order of a physician. Refer to Instructions for Use for current
MAQUET is a registered trademark of MAQUET GmbH • Copyright MAQUET Medical Systems USA or its affiliates. •
indications, warnings, contraindications, and precautions.
THE DEBATE IS OVER:
EVH IS SAFE, EFFECTIVE AND PROVEN
Since 2009, five independent studies have reaffirmed that endoscopic vessel harvesting (EVH)
is the proven and effective therapy for the 21st century.1-5
EVH does not compromise long-term revascularization outcomes1-5
View the data
Equivalent survival and cardiac outcomes for EVH compared to open vein harvesting1-5
Post-saphenectomy wound complications show significant superiority for EVH1-3,5
Debate closed: EVH is the standard of care for coronary artery bypass graft surgery.
References: 1. Ouzounian M et al. Impact of endoscopic versus open saphenous vein harvest techniques on outcomes after coronary artery bypass grafting. Ann Thorac Surg. 2010 Feb;89(2):403-8. 2. Ad N et al. Endoscopic
versus direct vision for saphenous vein graft harvesting in coronary artery bypass surgery. J Cardiovasc Surg (Torino). 2011 Oct;52(5):739-48. 3. Dacey LJ et al. Long-term outcomes of endoscopic vein harvesting after coronary
artery bypass grafting. Circulation. 2011 Jan 18;123(2):147-53. 4. Grant SW et al. What is the impact of endoscopic vein harvesting on clinical outcomes following coronary artery bypass graft surgery? Heart. 2012 Jan;98(1):
60-4. 5. Williams JB et al. Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. JAMA. 2012 Aug 1;308(5):475-84.
VASOVIEW EVH • Uncompromising performance • Proven outcomes.
www.maquetusa.com

Summer - the Association of Physician Assistants in Cardiovascular

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