Newsletter for the Medical Staff of McLaren

Winter2011
Newsletter for the
Medical Staff of
McLaren Regional
Medical Center
In this issue
Welcome
McLaren MRI
Pages 1 & 3
McLaren Regional Medical Center
P u l s e
Robotic
Whipple Surgery
Pages 2 & 3
Advancing
Neuroscience
Care
Page 4
TrueBeam
Technology
Page 5
Caring Hands
Program
Page 6
Changing Patients
Health Habits
Page 6
Endobronchial
Ultrasound
–For Minimally
Invasive Biopsy
Page 7
Resident Physicians
Research Awards
Page 8
Medical Staff
Announcements
Pages 9 - 11
Cardiothoracic
Surgeon Joins
MRMC
Page 12
Welcome
McLaren MRI- Flint
RI Diagnostic Center of Michigan, located at 750
M
Ballenger Rd. in Flint, has been renamed McLaren Regional
Medical Center-MRI to reflect the facility now being wholly
owned by McLaren Regional Medical Center. McLaren has
been a joint owner of MRI Diagnostic Centers for more than
20 years as part of a consortium established between the three
Flint-area hospitals. Effective January 1, 2011, the consortium
was dissolved. Each member of the consortium assumed
ownership and operations of one of the three MRI facilities that
had been associated with MRI Diagnostic Centers of Michigan.
“With the name change comes the continuity of care that
McLaren Heath Care affords,” said Brent Wheeler, Vice
President of Ancillary and Support Services at MRMC.
“The center will be fully integrated into MRMC’s I.T. and
PACS systems. McLaren patients will benefit from direct
access to state-of-the-art MR imaging, and great service
by the highly-trained staff.”
The McLaren Regional Medical Center-MRI on Ballenger
features the most advanced MRI system in the area – the
Discovery MR750 by GE. The system, equipped with a 3.0
Tesla magnet, allows for a faster, easier, more comfortable
continued on page 3
MR experience.
The Ballenger Road MRI
Diagnostic Center Benefits Include:
• Increased Magnet Strength over
standard MRI systems resulting in the
ability to scan faster or to scan with
higher detail.
• Less Stress Reduce patient anxiety by
preparing the exam outside the scan room
on the detachable Express Patient Table.
• No-Miss Imaging Tools such
as motion-correction techniques and
new non-contrast applications - deliver
reliable, reproducible results virtually
every time.
• More Pleasant Exam Keep patients
refreshed and comfortable by adjusting
the airflow and lighting in the bore with
multiple control settings.
A second MRI unit features the comfort
of an open bore design, the Signa Open
Speed .7 T, also by GE.
PULSE 1
States First Fully Robotic Whipple Surgery
Performed at McLaren Regional Medical Center
For more information,
contact Dr. Iddings at
(810) 733-8400.
T
he first fully robotic Whipple surgery
in the state of Michigan was performed
at McLaren Regional Medical Center
on November 4, 2010. The Whipple,
also called a pancreaticoduodenectomy,
is considered the most complex of
surgeries and is only performed by
surgical oncologists with extensive
cancer treatment training. This extremely
complicated procedure is used for
treatment of tumors of the head of the
pancreas. It involves the removal of the
gallbladder, bile duct, part of the stomach
and duodenum (small intestine) as well as
the head of the pancreas. The remaining
2 PULSE
bile duct, pancreatic duct and stomach are
then reconnected to simulate the body’s
natural connections.
This first-of-its kind surgery at McLaren,
and in the state, was performed by
Douglas Iddings, D.O., FACS, surgical
oncologist, assisted by McLaren O.R.
staff trained on the daVinci Robotic
Surgical System. The patient not only
had a complex malignant tumor but also
complex medical conditions including
anemia and extensive lung disease
(Chronic Obstructive Pulmonary Disease
or C.O.P.D.).
“If anyone could benefit
from minimally-invasive
surgery it is a person with
a complex medical history
and complex malignancy.
This particular approach
made the critical difference.”
~Douglas Iddings, D.O., FACS
A classic open Whipple procedure using
standard open surgical techniques generally
requires a very long abdominal incision to
expose the pancreas and other organs, resulting
in significant postoperative pain and a greater
chance of complications. The robotic Whipple
procedure takes close to the same amount of
time to perform as the open procedure but it
offers numerous potential benefits to patients.
Minimally invasive surgery utilizes very small
incisions which result in less pain, decreased
inflammatory response, less chance of infection,
less blood loss and a quicker recovery.
The experienced MRI staff provides superior MR imaging
services in a friendly, comfortable environment.
Welcome
Whipple surgery is currently the most
commonly performed operation to treat
pancreatic cancer. However, less than 0.01
percent of institutions have fellowship
trained surgical oncologists providing a
minimally invasive option to treat such
a complex condition. Dr. Iddings was
fellowship-trained at John Wayne Cancer
Institute and is now able to provide the
highest level of care to patients with the
most complex health issues.
“Overall the important aspects of the
surgery went very well,” states Dr.
Iddings. “The pancreato-jejunostomy
did not leak, there was no abdominal
infection, the pathologic surgical margins
were negative, the lymph node count was
higher than what is typically seen open
(26) and there was little to no pain for the
patient. This patient did have significant
COPD which added complexity to the
recovery but because of the minimally
invasive robotic approach, he was able to
recover quicker and easier than if he had,
had an open classic surgical approach.
Overall the lungs did well, and he is home
continuing to have a positive recovery.” n
McLaren MRI- Flint
continued from page 1
The experienced and friendly staff at MRI on Ballenger Road will
remain in place to continue to serve patients including on-site,
fellowship-trained radiologists. The facility’s operations will
be under the direction of Charlie Thrall, Director of Imaging
Services for MRMC.
McLaren is committed to providing the highest level of quality
in Imaging Services and service satisfaction. Under the
medical direction of Linda Lawrence, MD, a fellowship-trained
radiologist, McLaren Imaging Center has received accreditation
by the American College of Radiology (ACR) for all services
offered. The Center is the first facility in mid-Michigan to become
a designated Breast Imaging Center of Excellence by the ACR.
By awarding facilities the status of a Breast Imaging Center of
Excellence, the ACR recognizes breast imaging centers that have
earned accreditation in all of the College’s voluntary, breastimaging accreditation programs and modules, in addition to the
mandatory Mammography Accreditation Program. n
Physician offices utilizing MRI services will soon be receiving updated
materials reflecting the change. For more information or to schedule an
appointment, call McLaren Regional Medical Center - MRI at (810) 235-9311.
PULSE 3
Advancing Neuroscience Care
for Patients through
Shared Approach
Cerebral
Aneurysms
by: Jawad Shah, MD
Neurosurgery Chair,
Neuroscience
Leadership Team
Cerebral aneurysms are entities
which come in a variety of forms,
including saccular shapes, saccular
fusiform, and berry shapes. Cerebral
aneurysms come off of the variety of
cerebral arteries and are dilatations
that are prone to rupture. The effect
of a ruptured aneurysm is devastating
to the patient in that it can cause
major strokes, and in a significant
number of cases, instantaneous
death. Treatment of aneurysms is
challenging. It involves a variety of
different specialties including intensive
care, anesthesia, the operating room,
neurosurgeons, neurologists, and a
variety of other sub-specialists. Once
the aneurysm is ruptured, the sequelae
are so significant that acute treatment
can last up to three or four weeks
and beyond.
The full scope of aneurysm care
includes intensive care treatment,
neuroendovascular support, as well
as cerebrovascular surgery. All of
these tools have to be in place for
a fully equipped program to exist.
Through a collaborative effort, the
hospital administration, as well as
physicians, are putting together a
system that can keep the care here in
the community and at McLaren.
4 PULSE
Neuroscience Leadership Team members pictured left to right: Anessa Kertesz, Charles Guidot, M.D.;
Jawad Shah, M.D.; David Fernandez, M.D.; Devinder Bhrany, M.D.; Sunita Tummala, M.D.;
Faisal Ahmad, M.D.; Gerard Farrar, M.D.; Cheryl Ellegood, VP of Business Development and
Clinical Services at MRMC.
Team members not pictured include: Jeffrey Mitchell, M.D.; Hesham Gayar, M.D.; Syed Karim, M.D.;
Hugo Lopez-Negrete, M.D.; Devakinanda Pasupuletti, M.D.; Sue O’Brien, RN, and Debbie Main, RN.
MRMC Forms Neuroscience Leadership Team
A
team of physician specialists and administrative leaders
recently formed the Neuroscience Leadership Team to establish
a multidisciplinary program to enhance care for McLaren
Regional Medical Center (MRMC) neuro patients. Creating a
solid care plan requires a coordinated effort among all medical
disciplines affecting the neuroscience program.
It is important that a neurosurgeon collaborate with neurologists,
oncologists and orthopedic colleagues to make sure their plan
correlates with all others who are all involved in the critical care
of the patient.
The team’s objective is to create a bridge across these multiple
disciplines to elevate the care that is provided and also introduce
new treatments to provide cutting-edge care for the community. n
TrueBeam Technology
Sets a New Standard in Cancer Care
G
reat Lakes Cancer Institute (GLCI)-McLaren unveiled its
newest weapon in their arsenal of fighting cancer. The TrueBeam
STX real-time imaging and radiation treatment system is the
only system of its kind in Michigan and one of only a handful
in the country. It is the most advanced form of photon radiation
therapy currently available in the world. A fully-integrated
design, TrueBeam treats moving tumors with unprecedented
speed and accuracy. Hesham Gayar, M.D., Medical Director
of Radiation Therapy at GLCI-McLaren, summed up the key
features of the comprehensive treatment system.
Hesham Gayar, M.D. utilizes the TrueBeam system to deliver gated
RapidArc radiotherapy, which compensates for tumor motion by
synchronizing imaging with dose delivery during a continuous
rotation around the patient. This capability makes for an even
more powerful tool treating cancers of the thorax, such as lung
and liver cancer, when tumor motion is an issue.
"TrueBeam allows us to give more precise and faster radiation
than ever before,” states Dr. Gayar. “Its precision, less than
one millimeter, and better beam shaping saves more normal
tissue. Real-time imaging of the target during treatment and
better guidance is like GPS positioning of the tumor. This new
technology enables us to treat some types of cancer with fewer
visits, thereby reducing the patient’s radiation treatment course
from weeks to days. The faster, more accurate and image-guided
treatment reduces delivery errors due to organ motion (like
breathing during treatment). Our patients can expect leadingedge care with better tools to fight cancer.”
More information about the TrueBeam system
at GLCI-McLaren is available on the website:
mclarenregional.org/TrueBeam STX
To refer a patient to a radiation oncologist at GLCI-McLaren,
call (810) 342-3800 n
Direct Admission
Has Direct Phone Number
I
The Direct Admission process has been changed so
physicians can now call a RN directly with orders to admit.
n an effort to provide “One Stop
Shopping”, a dedicated telephone number
has been established for physicians to
call when attempting to place Direct
Admissions into the hospital. Instead of
being answered by Patient Registration,
the number will now ring straight to
one of the Utilization Management
registered nurses. The purpose of this
change is to provide physicians with a
registered nurse who is able to take initial
admitting orders and assist in the most
appropriate bed placement so patients
can start receiving care immediately
upon arrival to the Medical Center.
the New Number for
Direct Admissions
(810) 342-2371
In an effort to keep this line open for
physicians’ calls, it will only be used for
Direct Admissions to the Medical Center.
All other Patient Registration inquiries
(such as faxing face sheets, census list,
patient location, etc.) need to continue
to be directed to Patient Registration at
(810) 342-2423. n
PULSE 5
a Program for Patients to Recognize Outstanding Care
The Caring Hands program provides an
opportunity for patients to support McLaren Regional Medical Center and acknowledge
outstanding caregivers who made a difference in their visit or stay at the hospital.
Often grateful patients want to express what a difference compassionate care made in
their experience at McLaren. They may send a note of thanks or a plate of cookies. There
are some that would like to do more, but do not know how. As a McLaren physician,
nurse, or other staff member, you can inform your patients of our Caring Hands program
and provide them with an informational brochure.
Jonathan Mays, patient care technician on 9 South.
Caring Hands Recipients Receive:
• A card from the Foundation
• Acknowledgement in the McLaren
informing the caregiver that a
Foundation’s publications and the
donation was made in his/her honor
McLaren Regional Medical Center
through the Caring Hands program
weekly Update
• A Caring Hands recipient lapel pin
• Invitation to Caring Hands
annual recognition event
The best patient care comes from the heart, not for recognition. However, everyone likes to be acknowledged for a job well done.
Questions regarding the program can be directed to a member of the McLaren Foundation at (810) 342-4087
n
What is the Key to Patients
Changing their Health Habits?
When it comes to Type II diabetes,
switching to a lifestyle with healthier food
and more exercise can resolve many of the
harmful effects of the disease. So, why
don’t more patients make a lasting lifestyle
change? This dilemma led Radhika
Kakarala, M.D., a faculty physician with
McLaren Internal Residency Group
Practice, to explore what her most
successful patients did to make sustained
lifestyle modifications and take control
of their health. Here is one patient’s story.
If someone met Ken Roivas today, they
probably would never guess that he loved
eating hearty country-style food like
biscuits and gravy three to four times a
week. That’s because over the last decade
Ken has dramatically changed his lifestyle
to control his diabetes and improve his
overall health. Gone are the days of
eating anything he wanted regardless of
its nutritional content. Gone also are the
days of drinking alcohol and smoking.
The reward for changing his habits is a
healthier body, more energy, and a sense of
6 PULSE
Ken Roivas found the strength to take
control of his health through prayer, education,
and a good relationship with his physician.
satisfaction in reversing the effects of a
deadly disease through his own will power.
In 2000, the same year he welcomed
the birth of his son, Ken was diagnosed
with type II diabetes at the age of
57. Dr. Kakarala, his primary care
physician, discussed steps he needed
to take to manage his disease. She also
referred him to Diabetes Education.
“They taught me about healthy eating,”
said Roivas. “I needed to cut down on
eating out so often and switch to fiber
cereal, more fruit and steamed vegetables.”
Ken credits a few sources for his ability
to change his ways and not give up.
The discovery of a blocked carotid
artery in 2007 compounded his health
concerns and motivated him to take his
health even more seriously. In addition
he had sources of strength at home
and through his spiritual community.
Ken, an active member of Trinity Baptist
Church in Flushing, counsels people
with addictions. His experience working
with people who struggle to change
their lives may also have contributed
to his positive attitude and will power.
Ken noted the importance of having
the will to change and letting other
people be involved in that change.
“In just over three years, I’ve lost 53
pounds, gotten my blood pressure
under control and decreased by
blood glucose level in half. Now I
have learned to say ‘no’ to food I don’t
need. I try not to eat after 7 p.m., and
I try to get out and walk everyday.”
People frequently tell Ken he does not
look like he is 67 years old. Now that
he has gotten his diabetes and overall
health in check, he can enjoy acting
and feeling younger than his age too. n
Endoscopic Ultrasound
Used for Minimally Invasive Biopsy
M
u s t a f a A l n o u n o u , M . D . , FAC G , FAC P, a
gastroenterologist at the Digestive Disease Center
in Flint, recently perfor med a minimally invasive
technique using Endoscopic Ultrasound (EUS) that helped
to confirm and prove an advanced stage of disease,
Mustafa Alnounou, M.D.
sparing the patient from having unnecessary surgery.
In this instance, the patient had a CT scan that showed a pancreatic mass. Dr.
Alnounou performed EUS with fine needle aspiration and was able to confirm the
pancreatic mass to be malignant. During the same exam he was able to identify a
small suspicious one cm lesion in the left lobe of the liver. This was close to the gastric
wall. Hence, during the same EUS procedure he was able to perform transgastric
liver mass biopsy which confirmed this lesion to be metastatic - pancreatic cancer.
Traditional biopsy would have involved going through a significant length of the
liver tissue which is associated with an increased risk of bleeding and tumor seeding.
How EUS Works
Endoscopic Ultrasonography combines
endoscopic visualization and highfrequency ultrasound. This combination of
technology allows for precise delineation of
the individual layers of the gastrointestinal
tract. The technique allows local-regional
staging of gastrointestinal and pancreatic
malignancy, determination of the origin
of submucosal lesions, and differentiation
of other gut-wall abnormalities. It is
used for non-gastrointestinal diseases
in the following instances: lung
cancer staging, lymphadenopathy
of unknown cause and evaluation of
mediastinal masses. Therapeutic EUS
is used for celiac plexus neurolysis. n
“The technology allows
for detection of lesions
as small as 5mm, which
are easily missed using
cross section imaging,”
stated Dr. Alnounou. “It is
rewarding to help detect an
undiagnosed disease and
likely preventing patients
from having to undergo
unnecessary surgeries.”
Dr. Alnounou can be reached at the McLaren Digestive Disease Center
by calling (810) 342-5565.
Shown here is a schematic of how
EUS images the head of the pancreas.
The echo-endoscope is placed in
the proximal duodenum. From this
location, the head of the pancreas,
bile duct, pancreatic duct, and portal
venous system can be imaged. Tumors
can be visualized as dark, hypoechoic
structures within the pancreatic
parenchyma. The presence of portal
vein invasion can routinely be
determined from this view.
MASS
Endoscopic Ultrasound procedure
preformed at McLaren.
From the Blood Conservation Program: 2011 New Year’s Transfusion Resolutions
respect blood
1. Iaswill
a liquid transplant.
I will NOT give 2 units
3. when
1 will do.
will follow my hospital’s
2. Itransfusion
criteria.
will make
4. IEvery
Drop Count.
Source: Strategic Blood Management ™
PULSE 7
McLaren Internal Medicine Resident Physicians
for
Receive Top Honors Clinical Research
The Winners. Their Research.
First Place
Awarded to: Ali Eskander, M.D.
In the Category of Quality Improvement/
Evidence-Based Medicine-Oral Presentation:
For the research “Assessing Compliance with the
American Thoracic Society COPD guidelines in the
internal medicine and family medicine residency clinics”
Authors: Ali Eskander, M.D.; Dr. Azharuddin Tahera;
Edsil deOcampo
deOcampo, M
M.D.
D
Mohammed Kanaan, M.D.
Vidya Kollu, M.D.
A panel of experts judging clinical research projects at a
recent meeting bestowed more awards upon the residents of
McLaren Internal Medicine Residency program than any other
participating program. This recognition highlights the quality
of residents, faculty and the research conducted at McLaren
Regional Medical Center.
“We focus on creating a scholarly environment for our
residents and faculty,” stated Susan Smith, M.D., Program
Director for MRMC-MSU Residency Program in Internal
Medicine. “We are very proud to see our residents
recognized for their efforts. Having the right support
system in place creates an environment for residents to
conduct quality and compelling scholarly projects.”
The key faculty members involved with the scholarly activity
are Radhika Kakarala, M.D., Director of Scholarly Activity
for Internal Medicine; Siva Talluri, M.D.; and Jami Foreback,
M.D., currently serving as chair of McLaren’s Institutional
Review Board. There is also significant contribution to residents’
scholarly activity from many other faculty members.
“There is an expectation set here that all residents will
participate in scholarly activity,” stated Dr. Kakarala.
“First we set that expectation, then we empower them.”
Of 14 possible prizes handed out in six categories, McLaren
Internal Medicine residents took home three first place and
one second place awards. Seventeen internal medical residency
programs throughout the state submitted research projects
for consideration. n
8 PULSE
Ragni Bundesmann, Ph.D.; Dr. Gautham Gadiraju;
Hilana Hatoum, M.D.; Jami Foreback, M.D.
First Place
Awarded to: Vidya Kollu, M.D.
In the Category of Quality Improvement/
Evidence-Based Medicine-Scientific Poster Presentation:
For the research “Are venous ammonia levels useful in
the diagnosis and prognosis of hepatic encephalopathy
in pts. with chronic liver disease?”
Authors: Vidya Kollu, M.D.; Jyosthan Taalluri, M.D.;
Siddesh Besur, M.D.; Siva Talluri, M.D.
First Place
Awarded to: Ali, Eskander, M.D.
In the Category of Research-Scientific Poster Presentation:
For the research “Presentations and outcomes of small
cell lung cancer: African americans versus whites and
males versus females”
Authors: Ali Eskander, M.D., Saad Sirop, M.D.
Second Place
Awarded to: Mohammad Kanaan, M.D.
In the Category of Research -Oral Presentation:
For the research “Repeat peritoneal cytology
as a prognostic factor in ovarian cancer”
Authors: Mohammad Kanaan, M.D.; Saad Sirop, M.D.;
David Wiese, M.D.; Mohammad Mozayen, M.D.;
Sunil Nagpal, M.D.; Sukamal Saha, M.D.
Third Place
Awarded to: Edsil deOcampo, M.D.
In the Category of Research – Poster Presentation:
For the Research “Inappropriate Use of Stress Ulcer
Prophylaxis in Staff Medicine Patients Admitted to
the General Medical Floor”
Authors: Edsil deOcampo, M.D.; Aditya Neravetla, M.D.;
Maral Kojain, M.D.; Maria Smith, M.D.; Naveed Klair, M.D.;
Radhika Kakarala, M.D., MS
Announcements
Carlos Petrozzi, M.D., was
recognized as a Great Internist of
Michigan, at an American College
of Physicians - Michigan Chapter
meeting, for his noteworthy
contributions to health care and
internal medicine in Michigan.
The criteria for the award include:
outstanding clinical abilities and
performance, along with service to
the discipline of internal medicine, research and/or education.
Michael Kia, D.O., a board
certified general surgeon, has
been granted Center of Excellence
(COE) physician certification in
Bariatric Surgery by the Surgical
Review Cor poration. This
designation recognizes Dr. Kia for
achieving a high level of skill in bariatric surgery though volume
of surgical cases, pre- and postoperative care and as possessing
credentials to perform both laparoscopic and open bariatric
surgery in an accredited hospital. Dr. Kia joins fellow surgeon
Harris Dabideen, M.D., with McLaren Bariatric Institute,
to be among the specialized group of surgeons to receive
COE certification in bariatric surgery. For more information
about McLaren’s Bariatric program, contact (810) 342-5470.
Dr. Petrozzi has dedicated his clinical career to teaching
medical students and residents. He joined McLaren Regional
Medical Center in 1995. Upon joining MRMC he was named
to the Faculty of the College of Human Medicine, Michigan
State University, where he was promoted to full Professorship
in July 1999. He currently serves as Director of Academic
Programs and Senior Faculty with the Internal Medicine
Residency Program.
41
Troy , Mich igan
October 20-23, 2010
Diabe tic Group Vis
it s
Department of Family
MEHVI SH JAWAID
, MD and PAUL
DAKE, MD
Center, Flint, Michigan
Medicine, McLaren
Regional Medical
& Michigan State
Objectives
n To determine the
degree of effectiveness
betic patients (ICD
of Diabetes Group
CODE: 250.02) Low
Visits (DGVs) in controlling
Density Lipoprotein
blood pressures (SBP
Type 2 Dia(LDL), HgA1c, and
and DBP), compared
systolic and diastolic
to patients not enrolled
n Review the evidence
in DGVs.
supporting the clinical
control of Diabetes.
use of Diabetic Visit
Group in improving
measures of
n LOOKING AHEAD!
23.4043
20
5
0
-5
Change
in
-27.8208
LDL
McLaren Family Medicine Residency Program,
recently received recognition for her research poster at the 145th
Annual Scientific Meeting of the Michigan State Medical Society
in Troy. This is the first time a member of the McLaren Family
Medicine Residency program has participated in this Society’s
conflicts of interest
to disclose.
31-35
-015
36-40
-2.611
-13.953
36-40
Change
>40
-5.4834
in
-11.2782
13.75
10
GFR
5
0
BMI 28-30
-5
-10
10.2174
7.8
31-35
36-40
in
4
2
0
-2
-4
-6
-8
-10
-12
-14
-16
-18
-13.58
BMI
1.9556
BMI 28-30
8
31-35
36-40
-1.2594
-11.6006
6
>40
Percent
4
Change
2
in
-15.6262
Series 1
SBP
0
-2
Series 1
BMI 28-30
6.9231
31-35
-6
-5.357
-3.101
n In the study by
Wagner et al., a 2
year study with 707
showed improved
patients from 14
microalbumin testing,
primary care practices
fewer ER visits, HgA1c,
and patient satisfaction.
n In the Look AHEAD
study
showed slight improvementby Pi-Sunyer et al., a 1 year study
of 5,145 DM 2 patients
in HgA1c (7.3-6.6
group) and significant
in RCT,
in intervention group
improvements in
comp to 7.3-7.2 in
blood pressure, Lipids
control
and microalbumin
.
BMI
BMI 28-30
31-35
36-40
>40
Looking Ahead…
4
-4
2
-4.5745
-6
-5.1392
-8
in
Series 1
DBP
-12.2896
-13.00037
BMI
0
Percent
Change
-10
-14
n A potential confounder
arguing in greater
to-control diabetic
favor of the group
visit model is that
patients, presumably
the most difficultselected to take part
with more significant
in group visits.
psychosocial challenges,
were
n Another potential
issue in interpretation
of our data is the
in regular group
significant time commitment
visit participation,
which would automatically
committed to lifestyle
involved
change.
select for those patients
most
n Finally, another
important limitation
to the extrapolation
tively small number
of the findings in
of patients enrolled.
this study is the relan To analyze all the
above mentioned
factors in depth,
variables, I will focus
while working to
the next part of my
control the confounding
research on examining
pressure and GFR
and will endeavor
the effects of ethnicity
to enlarge the number
on blood
of patients in my
study.
Literature Review
of DGV
>40
-6.08
0
Percent
36-40
-4
-8
-2
>40
Series 1
-15
Percent
n Participation in
Diabetic Group Visits
helped improve measures
especially in patients
with increased BMI,
of control of Diabetes
LDL.
the most significant
Mellitus,
of which was HgA1c,
followed by
n However, as the
BMI’s increased from
28 to > 40, GFR and
did not show significant
systolic/diastolic
change, possibly
blood pressures
sure, as race was
not taken into account due to ethnic/genetic determinants
of blood presboth groups can
in this analysis. The
also be attributed
insignificant changes
to rather good control
groups.
in GFR in
of blood pressure
across both study
Limitations
15
Percent
31-35
BMI
Change
>40
20
8.0605
BMI 28-30
-5
-12
and have no other
37.0543
16.6667
BMI 28-30
n LDL: G1: As BMI
increased to >40,
LDL levels increased
Steady improvement
by 27.82% in this
occurred as BMI increased
in the cardiovascula
to >40 (51.10%, p<0.043). subgroup (p<0.045). G2:
r risk.
This leads to a decrease
n GFR: G1: As BMI
increased,
(p: 0.51). G2: No significant GFR progressively declined reaching
-8.06% in the BMI
change across the
>40 subgroup
BMI subgroups (p
= 0.68).
n SBP and DBP:
G1 and G2: No significant
change across all
paring SBP between
the BMI subgroups
G1 and G2, and p=0.062
(p =0.061 for comfor comparing DBP
between G1 and G2).
Conclusions
Series 1
10
0
n HgA1c: In G1,
HgA1c showed greatest
improvement in BMI
provement in the
>40 subgroup (p<0.035).
28-30 (23.40%) with
only 3.07% imcreased to >40 (HgA1c
G2: HgA1c showed
steady improvement
improved by 22.8%
in the control of Diabetes.
in this subgroup, p<0.039).
as BMI inThis shows an improvement
BMI
11.6084
Series 1
5
0
>40
20
-10
% Change
10
in
GFR
% Change
Mehvish Jawaid, M.D., a member of the
>40
BMI
device manufacturers
-2.174
15
Percent
in
pharmaceutical or
31-35
-13.171
BMI
30
Percent
-3.2415
-21.0062
-20
DBP
no relationships with
-22.8016
.5051
36-40
40
Series 1
36-40
31-35
BMI
Change
Disclosure: I have
BMI 28-30
22.0221
BMI 28-30
-40
SBP
4. Walsworth, D.
Group Visit/Shared
Medical Appointments
Presentation. Diabets
Spectrum 2003; 16:
104-107.
5. Weinger. K. Group
Medical Appointments
Is There a Future?
in Diabetes Care:
6. Wheelock et
al, Improve the
Health of
through Resident
Initiated Group Visits. Diabetic Patients
Feb 2009; 116-119.
Family Medicine.
0
-10
-20
-30
Change
Results
Series 1
5
-5
>40
0
-10
References
1. Davis et al, The
Potential of Group
Visit in Diabetes
Clinical Diabetes
Care.
2008; 26(2):58-62.
2. Houck S et al,
Group Visit 101.
Fam Prac Mgmt.
68.
2003: 663. Shahady. J. Edward,
Learning How to
do Group Visits
Chronic Disease-diabetes
for
as the Model.
HgA1c
36-40
10
% Change
in
LDL
% Change
extensive sharing
among patients of
tactics to achieve
therapeutic life-
10
% Change
20
Percent
Change
-10
n Diabetic Group
Visit: Involves
style change.
15
-15
Study.
PATIENTS
n Group #1 (G1)
— 33 diabetic patients
who have not participated
patients who have
participated in DGVs
in DGV; Group #2
(G2) — 18 diabetic
Physician because
by virtue of referral
of poor control of
their Diabetic measures.for group visits by their Primary Care
n These two groups
will be compared
over 12-month period
n Groups #1 and
(calendar year 2009).
#2 were grouped
by quartile, according
>40).
to Body Mass Index
(28-30, 31-35, 36-40,
INTERVENTION
Percent
Change
in
3.0717
0.1972
BMI
METHOD OF GROUPING
Mehvish Jawaid, M.D.
-.3521
31-35
% Change
n Retrospective
BMI 28-30
30
% Change
Awards
20
10
n Multidisciplina
ry team including
faculty, residents,
n Each group has
medical assistant,
5-8 patients accompanied
and nurse.
by significant others.
n There are 2 separate
groups, each of which
approximately two
meets monthly throughout
hours.
the year, each visit
n Topics discussed
lasting
– strategies for success
ogy of end-organ
regarding lifestyle
damage, etc.
changes, medications,
pathophysiolBENEFITS OF THE
DGVs
n Empowers patients
to better control their
disease through lifestyle
n Improved patient
change.
and provider satisfaction
compared to “traditional”
n Sharing of strategies
care.
between patients
for dealing with the
own diabetes.
day-to-day challenges
of managing one’s
OUR DIABETIC GROUP
REGISTRY
n Eleven separate
but interlinked tables.
n 800+ patients.
n Quarterly measures
of HgA1c, LDL, systolic
and diastolic blood
n Semi-annual measures
pressures and Body
of calculated GFR,
Mass Index.
microalbuminuria,
n Annual diabetic
and foot exams.
retinal exams.
n Diabetic Medication
Table — Every class
of medication approved
with date each was
started.
for use in Diabetes
in United States,
OFFICE CONTRIBUTIN
G DATA TO THE REGISTRY
n McLaren Family
Medicine Residency
Center.
n McLaren Internal
Medicine Residency
Group Practice.
n Expect other offices
to contribute data,
as this model of care
tions in the community.
is offered by other
healthcare organizaDESIGN
East Lansing, Michigan
25
Series 1
15
% Change
in
HgA1c
% Change
n Defined as a shared
medical appointment,
for management of
which involves having
a chronic condition
multiple patients
such as Diabetes,
seen in one visit
Asthma, etc.
FEATURES OF THE
DGVs
% Change
Change
DEFINITION OF DGVs
of Human Medicine,
GROUP 2 (G2)
25
Percent
Introduction
University College
GROUP 1 (G1)
-2
-4
-6
n Focusing on understanding
2.15
BMI 28-30
31-35
36-40
patients’ barriers
to attending the group
visits.
patients’ satisfaction
with this model of
care.
n Adding a Nutritionist
to our group visits
to enhance patients’
adhering to a healthy
understanding
diet.
n Formally measuring
>40
-5.00
-8
of the subtleties of
-7.93
-10
-12
-14
Series 1
-11.81
BMI
For further information,
contact: Mehvish Jawaid,
MD
• McLaren Regional
Medical Center, 401
Phone: (810) 342-2000
S. Ballenger Hwy.
Flint, MI., 48532
• E-Mail: mehvishj@mclaren
.org
meeting. Dr. Jawaid’s poster
entitled, “Effectiveness of Diabetic Group Visits” took first place
in the Clinical Medicine and Vignettes Category. Paul Dake,
M.D., served as a secondary author. n
PULSE 9
Welcome
to the Medical Staff
Muhammad Almansour, M.D., a family
medicine specialist, cares for patients at his
office located at 4071 Richfield Rd., Flint. Dr.
Almansour completed his Family Medicine
Residency at Genesys Regional Medical Center
in Grand Blanc. He received his medical degree
from Damascus University in Damascus, Syria.
John Bete Jr., D.O., a physical medicine and
rehabilitation specialist, has joined the medical
staff at McLaren Regional Medical Center.
He is seeing patients at Back Pain and Sports
Rehabilitation Specialists in Flint. Dr. Bete
completed his residency in Physical Medicine
and Rehabilitation at Michigan State University
in Lansing. He received his medical degree
from the University of New England College
of Osteopathic Medicine in Biddeford, Maine.
Leena Jindal, D.O., F.A.A.P., F.A.C.O.P.,
a board certified pediatrician, is caring for
patients at Hamilton Community Health
Network, G-3375 S. Saginaw St., Burton.
Dr. Jindal completed her residency through
Michigan State University in Lansing. She
received her medical degree from Oklahoma
State University Center for Health Sciences in
Tulsa, Oklahoma.
10 PULSE
Marcia Johnson, Psy.D., a neuropsychologist,
is caring for patients at the McLaren
Neurologic Rehabilitation Institute located
at G-4466 W. Bristol Rd., Flint. Dr. Johnson
completed a Fellowship in Clinical Health
Psychology through the Consortium for
Advanced Psychology Training, which is part
of the Michigan State University/Flint Area
Medical Education (MSU/FAME) program.
She completed her Residency at Vanderbilt
University in Nashville, Tennessee. Dr. Johnson
received her Doctorate of Psychology from
Georgia School of Professional Psychology
Argosy University in Atlanta, Georgia.
Armen Kirakosyan, M.D., an OB/GYN, has
joined the medical staff. He is seeing patients at
McLaren OB/GYN Associates, 1314 S. Linden
Rd., Suite B, Flint. Dr. Kirakosyan completed
his residency at Synergy Medical Education
Alliance in Saginaw, Michigan. He received
his medical degree from Crimean State Medical
University in Simferopol, Ukraine.
Jessica Jewart Kirby, D.O., an emergency
medicine specialist, has joined the medical
staff at McLaren Regional Medical Center. She
is caring for patients in McLaren’s Emergency
Department. Dr. Kirby completed her residency
at Genesys Regional Medical Center in Grand
Blanc. She received her medical degree from
Midwestern University-Arizona College of
Osteopathic Medicine in Glendale, Arizona.
Nitin Malhotra, M.D., a vascular surgeon,
is seeing patients at Michigan Vascular Center
5020 W. Bristol Rd., Flint. Dr. Malhotra
completed a Fellowship in Vascular Surgery at
Albany Medical Center in Albany, New York.
He also completed his residency at Albany
Medical Center. Dr. Malhotra received his
medical degree from Medical College of Ohio
in Toledo, Ohio.
Aniruddha Palya, M.D., a nephrologist, is
seeing patients at his office located at 2486
Nerredia Drive, Suite E, Flint. Dr. Palya
completed a Fellowship in Nephrology at Drexel
University College of Medicine in Philadelphia,
Pennsylvania. He completed his residency
at Mercy Catholic Medical Center in Darby,
Pennsylvania. Dr. Palya received his medical
degree from M.S. Ramaiah Medical College in
Bangalore, India.
Access Medicine
Internet Database
now available at
McLaren Library
Christopher Quinn, D.O., has joined McLaren
Regional Medical Center as an emergency
medicine specialist. Dr. Quinn completed his
Residency at Oakwood Southshore Medical
Center in Trenton, Michigan. He received his
medical degree from Michigan State University
College of Osteopathic Medicine in Lansing.
Matthew Sardelli, M.D., an orthopedic
surgeon, has joined the medical staff. He also
sees patients at Family Orthopedic Associates,
4466 W. Bristol Rd., Flint. Dr. Sardelli
completed a Fellowship in Sports Medicine
at Tria Orthopaedic Center in Bloomington,
Minnesota. He completed his Residency in
Orthopedic Surgery at University of Utah
Hospitals and Clinics in Salt Lake City, Utah.
He received his medical degree from Wayne
State University in Detroit.
T
he McLaren Medical Library is pleased
to announce the addition of AccessMedicine
to the collection of library resources. This is
an internet database of electronic books and
materials for use at the Medical Center and
Medical Education Building.
AccessMedicine provides self assessment tools,
multi media videos and images, information on
drugs, diagnostic tests, guidelines, patient
education materials and more.
Samer Saqqa, D.O., an orthopedic surgeon
specializing in spine procedures, is seeing
patients at Family Orthopedic Associates, 307
S. Court St., Lapeer. Dr. Saqqa completed a
Fellowship in spine surgery at Texas Back
Institute in Plano, Texas. He completed his
residency at Genesys Regional Medical Center
in Grand Blanc. Dr. Saqqa received his medical
degree from Michigan State University College
of Osteopathic Medicine in Lansing.
Ajay Srivastava, M.D., an orthopedic
surgeon, is now caring for patients at Family
Orthopedic Associates, 4466 W. Bristol Rd.,
Flint. Dr. Srivastava completed a Fellowship
in Research Adult Reconstruction at Shirley
Center for Orthopedic Research and Education
in LaJolla, California. He completed his
residency at McLaren Regional Medical Center
in Flint. Dr. Srivastava received his medical
degree from Seth G S Medical College in
Mumbai, India.
Those that use STAT!Ref may notice some
book titles, like Harrison’s online, Tintinalli’s
Emergency Medicine, Schwartz’s Principles
of Surgery and Hurst’s the Heart, are no longer
available. These titles and many more are
now available through AccessMedicine. n
To use AccessMedicine click on the
icon provided in your Novell delivered
applications (Web: LibraryAccessMedicine)
or click on the link provided on the library web
page at www.mclarenregional.org/medlib
and click on search medical information
here. If you do not have the icon in your
Novell window please call the PHNS
help desk and they will add it for you.
Some workstations may find this site is
blocked until PHNS approves the site for
everyone to use. AccessMedicine is
not available off-site.
PULSE 11
Cardiothoracic Surgeon
Joins McLaren as Director of
Cardiac Surgery Program
J
o s e ph M . A r c id i , Jr., M . D.,
cardiothoracic surgeon, has joined the
medical staff and assumed the position
of Director of Cardiothoracic Surgery at
McLaren Regional Medical Center.
Surgery. He was an associate staff member
at the Cleveland Clinic in the Department
of Thoracic and Cardiovascular Surgery
and recently completed a Fellowship in
Robotic Cardiac Surgery at East Carolina
University, the leading robotic cardiac
center in the United States.
Dr. Arcidi, who is board certified in general
surgery and cardiothoracic surgery, brings
a wealth of experience in both academic
and private practice settings. His clinical
interests include mitral valve repair,
surgical correction of atrial fibrillation,
operations for ischemic cardiomyopathy,
aortic reconstruction, and minimally
invasive and robotic cardiothoracic surgery.
Early in his career, Dr. Arcidi trained
with several of the pioneers of mitral
valve surgery, and his continued expertise
in this arena will expand the spectrum
of McLaren’s cardiovascular surgical
program.
Dr. Arcidi holds memberships in numerous
surgical societies, including The Society of
Thoracic Surgeons, the Western Thoracic
Surgical Association, the Southern Thoracic
Surgical Association, the European
Association for Cardio-Thoracic Surgery
and the International Society for Minimally
Invasive Cardiothoracic Surgery. n
Dr. Arcidi earned his medical degree
from Johns Hopkins University School of
Medicine in 1982 and completed a surgical
residency at Massachusetts General
Hospital. He completed both Research and
Clinical Fellowships at Emory University
and also holds additional Fellowships in
Thoracic Transplantation and Valvular
Joseph M. Arcidi, Jr., M.D.
Dr. Arcidi welcomes referrals
for new patients as well as
providing second opinions.
His practice location:
McLaren Regional Medical Center
401 S. Ballenger Hwy., 3-North
Flint, Michigan 48532
He can be reached at:
(810) 342-2590
P u l s e
Newsletter for the Medical Staff of McLaren Regional Medical Center
EDITORIAL DIRECTION
Jeffrey R. Mitchell, M.D., MBA, FACS
Vice President of Medical Affairs
McLaren Regional Medical Center
Donald Kooy, President and CEO,
McLaren Regional Medical Center
EDITOR
Ellen Peter
DESIGN
Linda Bedenis
McLaren Art
Department
CONTRIBUTING
AUTHORS
Sherry Stewart, Ellen Peter, PRINTING
Laurie Prochazka
McLaren Graphics
Department
PHOTOGRAPHY
MANAGING EDITOR
Laurie Prochazka,
Ted Klopf, Sherry Stewart,
Director of Marketing Communications, Ellen Peter
McLaren Health Care Corporation
We welcome comments, suggestions and ideas: ellenp@mclaren.org or call (810) 342-4478.
12 PULSE
MISSION
McLaren Health Care, through its
subsidiaries, will be Michigan’s best
value in healthcare as defined by
quality outcomes and cost.
VISION
McLaren Regional Medical Center will
be the recognized leader and preferred
provider of primary and specialty
healthcare services to the
communities of mid-Michigan.
Visit our website and view Pulse online
www.mclarenregional.org