Grand Rounds January on Nashville Medical News

Grand Rounds January

Something to Smile About …

New Clinic at Meharry Provides Free Dental Care to Disadvantaged Seniors

Just before Thanksgiving, Meharry Medical College opened the Delta Dental Oral Diagnostic and Imaging Clinic to provide care for economically disadvantaged seniors. The high-tech digital diagnostic services and state-of-the-art treatment equipment were made possible by a $780,233 contribution from Delta Dental of Tennessee. Qualified seniors will receive service free of charge through a grant from Harry R. Kendall Fund for Meharry’s Adopt-A-Grandparent program. The new clinic allows faculty and students at the School of Dentistry to implement the rapidly growing usage of digital radiography, discontinuing their use of the film-based radiography system.

Vanderbilt Scientists Report Separate Gene Variants Linked to Three Types of ADHD

Researchers at Vanderbilt University Medical Center have found evidence that genetic variations affecting three different brain chemicals may contribute to the three types of attention-deficit hyperactivity disorder (ADHD). The researchers previously found a variant of the norepinephrine transporter gene was associated with the predominantly “inattentive” type of ADHD, and a variant in the dopamine transporter gene correlated with the predominantly “hyperactive and impulsive” type.

Now Randy Blakely, PhD, and colleagues report a link between a variation in the choline transporter gene and the “combined” type, characterized by both inattention and hyperactivity/impulsivity. Choline is the precursor to acetylcholine, which, along with norepinephrine and dopamine, transmits messages across the synapse, or gap between nerve cells. Transporters regulate the supply of these and other brain chemicals in the synaptic gap to ensure proper signaling. Results were published in the December issue of the Journal of Neurodevelopmental Disorders.

While further research is needed to confirm the groups’ finding, it could lead to specific treatments for each type of ADHD, said Blakely, the Allan D. Bass Professor of Pharmacology and director of the Vanderbilt Center for Molecular Neuroscience.

Skyline Uses New Technology to Map Blood Clots in the Brain

Skyline Medical Center became the first hospital in Tennessee to offer ‘GPS type of technology’ to help treat blood clots in the brain. With hemorrhagic strokes patients have just hours to get lifesaving treatment. Many lose their chance … and of the survivors, approximately half will suffer permanent disability.

Skyline Medical Center is now offering minimally invasive Stealth guided endoscopic removal of blood clots in the brain. “It’s similar to the way GPS technology works,” explained neurosurgeon Paul McCombs, MD. Pictures of the brain are loaded into a computer system before surgery. During surgery, the computer images serve as a guide. A keyhole-size surgical site is made through the surface of the brain and a catheter with the approximate circumference of a drinking straw is inserted to remove the blood causing the hemorrhagic stroke.

“This new technology allows less damage to normal healthy tissue, minimizes scarring, facilitates rehabilitation and has proven to reduce the length of hospital stay. It also lowers other risks of other complications such as pneumonia, blood clots and urinary tract infections,” according to McCombs.

HCA Names Sowell Senior VP & Chief Development Officer

HCA has named Joseph A. Sowell, III senior vice president and chief development officer. Sowell began his new job Dec. 1, 2009 and will be responsible for all activities related to mergers, acquisitions and divestitures for the hospital company, which operates 163 hospitals and 105 ambulatory surgery centers in 20 states and England.

Prior to the move to HCA, Sowell was a senior partner with Waller Lansden Dortch & Davis. His practice focus was in the areas of healthcare law, mergers and acquisitions, joint ventures, private equity financing, tax law and general corporate law. He earned both his bachelor’s degree and law degree from the University of Alabama. He also has a master of laws degree from the University of Florida.

Meharry Medical College Officer to Lead National Dental Association

Last month, Nashville dentist Dr. Walter R. Owens was installed as the 86th president of the National Dental Association (NDA), the leading voice and advocate of oral health care concerns for ethnic minorities.

Owens, a native of Nashville, practiced dentistry in Tennessee for more than 25 years before retiring from private practice in 2005. He currently serves as senior development officer for the Meharry Medical College School of Dentistry. He was joined during the installation activities by Dr. Ray Gist, the newly-elected president of the American Dental Association (ADA). Dr. Gist is the first African-American president-elect of the ADA in its 150-year history.

THA President Elected to AHA Board of Trustees

Craig A. Becker, who has served as president of the Tennessee Hospital Association since 1993, recently was elected to the American Hospital Association’s (AHA) board of trustees, effective Jan. 1, 2010. The AHA board is the policy-making body of the national hospital association. Becker has served on a variety of AHA committees, including the PAC Steering Committee and Task Force on Medicaid. He also serves as president of the State Hospital Association Executives’ Forum (SHAEF). Becker has led THA and its subsidiaries since 1993.

SCRI Solid Tumor Findings Presented at International Conference

Just before Thanksgiving, Jeffrey R. Infante, MD, Sarah Cannon Research Institute’s (SCRI) associate director of drug development, presented findings of a Phase I trial of the combination of sorafenib and capecitabine in advanced solid tumor at the International Conference on Molecular Targets and Cancer Therapeutics in Boston. Now in its 21st year, the conference was organized jointly by the European Organization for the Research and Treatment of Cancer, the US National Cancer Institute and the American Association for Cancer Research.

“Sorafenib is a small molecular inhibitor of several protein kinases, which are overactive in many of the molecular pathways that cause cells to become cancerous,” Infante explained. “The addition of a multi-targeted kinase inhibitor like sorafenib to a standard chemotherapy agent like capecitabine holds promise in a number of advanced solid tumor types.”

Infante and a team of SCRI researchers administered the combination treatment in 32 patients with advanced solid tumors. Two groups explored a 21-day schedule of the combination, while a third group was on a 14-day schedule.

Psychiatric Solutions Launches PSI Patriot Support to Assist Soldiers, Families

Psychiatric Solutions, Inc. (PSI) (NASDAQ: PSYS) recently launched PSI Patriot Support, an expanded program to provide behavioral health services to military members and their families at PSI facilities around the country.

“It’s well documented that multiple deployments to combat zones have taken a tremendous toll on the brave warriors in our military forces, as well as their families,” said Joey Jacobs, chairman, president and CEO of PSI. “We are proud that PSI Patriot Support will be able to help with a number of stress-related issues that are increasingly common. We are amazed at the strength and resiliency of our military, and all of us owe them a tremendous debt of gratitude for their service and sacrifices.”

Initially, eight facilities, none in Tennessee, have been designated as PSI Patriot Support Centers, and will work with military installation commanders, tailoring services to that particular installation’s needs. More hospitals may be added as need dictates. Patriot Support services include both inpatient and outpatient programming to treat post-traumatic stress disorder (PTSD), depression, substance abuse and general anxiety disorders that may be symptomatic of difficult combat situations, separation from families, and the stress of financial, marital or other problems.

Sontag Tapped to Lead National ACS Council

Mike Sontag, member at the law firm of Bass Berry & Sims PLC in Nashville, has been selected to chair the American Cancer Society’s new Nationwide Gift Planning Advisory Council, which commenced during the third quarter of calendar year 2009. The volunteer council will be an active source of expert planned giving and estate planning consultation, will assist in the development of promotional strategies, and will serve as a resource for the society’s marketplace introduction to potential donors.

Sontag will serve a staggered two- or three-year advisory council term and will join other executives from across the nation. Council members will provide guidance in estate planning law, tax, investment and wealth management, real estate, insurance, and personal financial planning and marketing – all to help increase the quality and quantity of planned gifts to the Society and to further its vision of a world with less cancer and more birthdays.

Soy Food Linked to Decreased Risk of Breast Cancer Recurrence, Death

Last month, researchers at Vanderbilt-Ingram Cancer Center, led by Professor of Medicine Xiao Ou Shu, MD, PhD, have found a higher intake of soy foods was associated with a lower risk of death and breast cancer recurrence among breast cancer patients in China. The study was published in the Dec. 9, 2009 issue of JAMA.

There had been a concern that soy foods could have an adverse effect on outcomes among breast cancer patients … particularly those on tamoxifen, which is designed to block estrogen. “Soy foods are rich in isoflavones, a major group of phytoestrogens that have been hypothesized to reduce the risk of breast cancer. However, the estrogen-like effect of isoflavones and the potential interaction between isoflavones and tamoxifen have led to concern about soy food consumption among breast cancer patients,” the authors wrote.

Shu and her colleagues analyzed data from the Shanghai Breast Cancer Survival Study, a large, population-based study of 5,042 female breast cancer survivors in China, which Vanderbilt University Medical Center and the Shanghai Institute of Preventive Medicine have carried out since 2001. Researchers used a food frequency questionnaire designed to measure soy foods commonly consumed in Shanghai, including tofu, soy milk, fresh soy beans and other soy products, as well as meat, fish and cruciferous vegetables. After a median follow-up of 3.9 years, there were 444 total deaths and 534 breast cancer recurrences in the study group. Soy food consumption after cancer diagnosis, measured as soy protein intake, was inversely associated with mortality and recurrence. The associations of soy protein/isoflavones intake with mortality and recurrence appear to follow a dose-response pattern until soy protein intake reaches 11 grams per day or soy isoflavones intake reaches 40 mg/day. After these points, the association appears to level off or rebound.

“We found that women in the highest soy food intake groups had the lowest mortality and recurrence rates rate compared with women in the lowest soy food intake group, regardless of tamoxifen use status,” said Shu.

Hughes Joins Southern Pediatrics in Franklin

Mark Hughes, MD, recently joined Southern Pediatrics in the Cool Springs area of Franklin. He joins two partners at this location, Gabriela Morel, MD, and Dr. Gordon Davis, MD.

Hughes is Board Certified in Pediatrics, a fellow of the American Academy of Pediatrics, and a member of the Tennessee Chapter of the American Academy of Pediatrics. This month he also becomes vice chair of the Department of Pediatrics at Baptist Hospital.

New VUMC System Lets Families Initiate Rapid Response Team

A new system at Vanderbilt gives families a powerful tool to quickly call for help if they suspect a patient’s condition is worsening or a serious new health concern is developing. The Family Initiated Rapid Response Team program is a lot like calling 911, but when a family member dials 11111 from a Vanderbilt patient’s room, a LifeFlight operator dispatches a “rapid response team” of physicians and nurses. Recently, signs went up in every non-critical care patient room, telling families that they can dial 11111 from their room to report life-threatening changes in a patient’s condition, or if they fear a situation is becoming a medical emergency.

There were initial concerns the system might be abused and non-emergency calls might tax the response team. “But we found that did not happen,” said Brent Lemonds, RN, administrative director of Emergency Services and Specialty Nursing at VUH. Lemonds headed up a pilot of the program last spring. “Rather than seeing abuse of the system, we found the vast majority of family members respect it like they do calling 911 at home.”

Gomez Named the Director of Clinical Services of Lee Medical

Mario Gomez has been named the director of Clinical Services for Williamson County-based Lee Medical, Inc. The 17-year-old vascular access service company specializes in the prevention of infection related to vascular access. Among his primary duties, Gomez will oversee the company’s clinical operations and business development across the Southeast. Gomez comes to Lee Medical with a specialization in Emergency and Critical Care Nursing. In addition to his extensive nursing knowledge, Gomez has experience as a six year combat veteran in the United States Army with a background in Special Operations.

FDA Trial in Nashville Leads to State’s First Presbyopia Surgery

Tennessee’s first breakthrough eye surgery to conquer one of the most common eye issues — presbyopia, which is age-related loss of near vision — took place last month at Wang Vision Institute and Nashville Surgery Center.

“This new and investigative surgery is called ‘Scleral Spacing Procedure’ (or SSP), and we will be performing it as part of a US FDA clinical trial research study. Wang Vision Institute is currently one of only three centers in the U.S. to lead and conduct this FDA study,” said Ming Wang, MD, PhD, who is director of the Wang Vision Institute and one of its US clinical investigators. The other two centers are in Chicago and NY. “The loss of near vision, or presbyopia, is associated with aging,” Wang explained. “Though we currently have effective technologies such as LASIK to treat the other three typical vision issues — nearsightedness, farsightedness and astigmatism — presbyopia remains the ‘last frontier to be conquered.’”

Wang said 330 patients nationwide would be recruited for the national study. He expects 30-50 surgeries to be performed in Nashville. Participants will be followed for 2 years after surgery to assess its safety, efficacy and the stability of their results.

Baptist Hospital Now Offering Online Childbirth Education Registration, Hospital Pre-Registration

Recently, Baptist Hospital began offering online registration for its various childbirth education classes to help prepare mothers, their spouse or support person and siblings for childbirth. In addition to calling 284-BABY (284-2229), parents can now register for classes online at www.BaptistHospital.com/childbirth.

Women who plan to deliver at Baptist Hospital can also save valuable time by completing a secure, online pre-registration form available at http://www.baptisthospital.com/womenshealth/registration.php, allowing patients to complete the information from home at their own convenience.

Gordian Health Solutions Releases GINA-Compliant HRA

Nashville-based personal health coaching company Gordian Health Solutions, Inc. recently released updated versions of both its online and paper-based health risk assessments (HRAs) in order to fully comply with the Genetic Information Non-Discrimination Act of 2008 (GINA). The regulations implementing the GINA legislation went into effect last month and prohibit health plans and employers from offering financial incentives to individuals participating in HRAs that request genetic information, such as family medical history.

IPeople, Passport Team Up

Franklin-based Passport Health Communications, Inc. and Dallas-based Interface People, LP have recently partnered to deliver integrated patient access management solutions to hospitals using MEDITECH Health Information Systems. The MEDITECH experts at IPeople provide programming, integration strategies and process automation to health care providers using MEDITECH’s Magic, Client Server, and Focus platforms. IPeople’s solution creates best-practice configurations for hospitals integrating Passport’s insurance eligibility verification, address verification and other patient access management services into their front end workflows.

Cogent Healthcare Selected by New Jersey Center to Provide Hospitalist Services

Brentwood-based Cogent Healthcare announced last month a new hospital medicine affiliation with Hackensack University Medical Center (HUMC), a 775-bed teaching and research hospital and the largest provider of inpatient and outpatient services in the state of New Jersey. Through the agreement, Cogent will provide comprehensive hospitalist services to HUMC’s inpatient population.

This announcement follows recently formed Cogent affiliations with Erlanger Health Systems of Chattanooga, Tenn., Shands Jacksonville Medical Center of Jacksonville, Fla. and DeKalb Medical Center of Decatur, Ga.

Cumberland Pharmaceuticals Licenses Caldolor® Internationally

Cumberland Pharmaceuticals Inc. (Nasdaq: CPIX) has entered into an exclusive agreement with DB Pharm Korea Co. Ltd., a Korean-based pharmaceutical company, for the commercialization of Caldolor® (ibuprofen) Injection in South Korea.

Under the terms of the agreement, DB Pharm Korea is responsible for seeking regulatory approval for Caldolor in South Korea, and following approval would handle ongoing regulatory reporting, product marketing, distribution and sales in the territory. Cumberland maintains responsibility for product formulation, development and manufacturing, and will provide finished product for sale. Designed to treat pain and fever in the hospital setting, Caldolor was approved by the U.S. Food and Drug Administration and launched by Cumberland in the United States in 2009.

In other Caldolor Injection news, data from a recent clinical trial was presented last month at the 44th American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting in Las Vegas. The pharmacokinetic study evaluated a single dose of Caldolor as compared to a single dose of oral ibuprofen. Results from the trial demonstrate the effects of decreasing infusion time for Caldolor from the current package insert guideline of no less than 30 minutes to an infusion time of five-to-seven minutes.

Cancer Drug Effective Against Ménétrier’s

Vanderbilt University Medical Center researchers recently reported a drug used to treat colorectal cancer also can reverse the rare stomach disorder Ménétrier’s and should be considered first-line therapy for the disease. Ménétrier’s disease causes thickening of the stomach lining, severe abdominal pain, nausea and vomiting, as well as anemia and swelling in the feet and ankles due to protein loss. Patients are at increased risk for gastric cancer. Previously, the only effective treatment was gastrectomy — surgical removal of the stomach.

The targeted cancer drug cetuximab, brand name Erbitux, relieved symptoms of severe Ménétrier’s disease in seven patients who completed a one-month course of treatment. Four of them showed near-complete remission. Erbitux is a monoclonal antibody that blocks the binding of transforming growth factor-alpha, or TGF-alpha, a signaling protein, to the epidermal growth factor (EGF) receptor.

Let’s Give Them Something to Talk About!

Awards, Honors, Recognitions

Williamson Medical Center honored internal medicine physician Richard G. Lane, MD, with the 2009 Lifetime Achievement Award. Lane was recognized for his efforts in advancing healthcare in Williamson County. In addition to leadership roles at WMC, Lane was a founding member of the Tennessee Geriatrics Society and has been a vocal healthcare advocate for the elderly, serving as delegate to the White House Conference on Aging in 1995 and receiving appointment to Gov. Phil Bredesen’s Task Force on Alzheimer’s disease in 2008.

Next month, Maury Regional Medical Center will be recognized during the annual Excellence in Tennessee program administered by the Tennessee Center for Performance Excellence (TNCPE). The Excellence Award is TNCPE’s highest honor.

Rob Pantoja, chief financial officer of The Little Clinic, was recognized by the Nashville Business Journal as the CFO of the year in the small, private company category for 2009. In addition to working with finance, Pantoja also contributes to human resources, information technology, legal, accounting, billing and managed care payer contracting.

Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt have both been named among the nation’s 45 Leapfrog Top Hospitals for 2009. The Leapfrog Group is a consortium of large companies and public employers that together provide health benefits to more than 37 million consumers spread among all 50 states. The top hospitals list is based on an annual hospital safety and quality survey, which this year took in 1,206 hospitals. VUH and VCH were the only Tennessee hospitals on the 2009 list.

League for Deaf, EAR Foundation Rechristened Hearing Bridges

The League for the Deaf and Hard of Hearing and the EAR Foundation, the only comprehensive health and human services agency in Middle Tennessee serving deaf, deaf-blind and hard of hearing children and adults, has been renamed Hearing Bridges. The process to adopt a new name began in July 2009, following the 2008 merger of the League for the Deaf and Hard of Hearing and the EAR Foundation.

“We believe that our new name, Hearing Bridges, summarizes -- in two words -- our mission to unite the deaf, hard of hearing and hearing communities through education, services and support, empowering individuals to achieve their full potential,” said Sallie Hussey, president & CEO.

The agency provides a comprehensive after-school and youth program, health and wellness programs for adults, education and outreach including sign language and speech-reading classes, no interest loans for assistive devices, scholarships, and interpreting and transcription services.

Recent Certifications & Accreditations:

Last month, Healthways, Inc. (NASDAQ: HWAY) announced the organization is among the first in the nation to receive National Committee for Quality Assurance (NCQA) Wellness and Health Promotion (WHP) accreditation. More than three-fourths of the nation’s leading employers offer wellness programs, making WHP accreditation an important comparison point when considering vendors for health and wellness programs and services. Healthways was designated as Accredited with Performance Reporting, which is granted to wellness and health promotion organizations that have submitted a specific number of results for NCQA’s standardized WHP Performance Measures.